Development and validation of a preliminary definition of minimal disease activity in patients with juvenile idiopathic arthritis.

OBJECTIVE To develop and validate a definition of minimal disease activity (MDA) in patients with juvenile idiopathic arthritis (JIA). METHODS The clinical charts of JIA patients followed over a 16-year period were reviewed to identify visits with high disease activity and MDA, defined on the basis of therapeutic decisions made by the attending physician. For each JIA activity measure recorded at the time of the visit, the cutoff value that best identified states of MDA was calculated by means of the area under the receiver operating characteristic curve analysis. A definition of MDA for oligoarthritis and polyarthritis was set up after testing the relative power of each variable in a multivariate analysis. Validation procedures included assessment of discriminant and construct validity. RESULTS The definition that resulted from the analyses led to establish that a state of MDA could be defined as the presence of a physician global assessment < or =2.5 cm and a swollen joint count of 0 in patients with oligoarthritis; and as the presence of a physician global assessment < or =3.4 cm, a parent global assessment < or =2.1 cm, and a swollen joint count < or =1 in patients with polyarthritis. Validation procedures demonstrated that the MDA definition had good discriminant and construct validity in the context of both observational studies and controlled trials. CONCLUSION We developed a preliminary definition of MDA in patients with JIA that represents a useful treatment target state and is proposed for inclusion as an outcome measure in future observational studies and clinical trials in patients with JIA.

[1]  S. Berney.  Comparison of Treatment Strategies in Early Rheumatoid Arthritis: A Randomized Trial , 2008 .

[2]  A. Martini,et al.  Physicians' and parents' ratings of inactive disease are frequently discordant in juvenile idiopathic arthritis. , 2007, The Journal of rheumatology.

[3]  J. O'dell.  The horseless carriage: moving forward with the hybrid ACR. , 2007, Arthritis and rheumatism.

[4]  A. Martini,et al.  Discordance between physician's and parent's global assessments in juvenile idiopathic arthritis. , 2007, Rheumatology.

[5]  A. Martini,et al.  Correlation between juvenile idiopathic arthritis activity and damage measures in early, advanced, and longstanding disease. , 2006, Arthritis and rheumatism.

[6]  A. Martini,et al.  Remission in juvenile idiopathic arthritis. , 2006, Clinical and experimental rheumatology.

[7]  Carol A Wallace,et al.  Current management of juvenile idiopathic arthritis. , 2006, Best practice & research. Clinical rheumatology.

[8]  Bin Huang,et al.  Patterns of clinical remission in select categories of juvenile idiopathic arthritis. , 2005, Arthritis and rheumatism.

[9]  R. Laxer,et al.  Medical treatment of juvenile idiopathic arthritis. , 2005, JAMA.

[10]  Philippe Ravaud,et al.  Minimal clinically important difference, low disease activity state, and patient acceptable symptom state: methodological issues. , 2005, The Journal of rheumatology.

[11]  David T Felson,et al.  Minimal disease activity for rheumatoid arthritis: a preliminary definition. , 2005, The Journal of rheumatology.

[12]  A. Martini,et al.  Development and validation of a clinical index for assessment of long-term damage in juvenile idiopathic arthritis. , 2005, Arthritis and rheumatism.

[13]  A. Prieur,et al.  A randomized, double-blind clinical trial of two doses of meloxicam compared with naproxen in children with juvenile idiopathic arthritis: short- and long-term efficacy and safety results. , 2005, Arthritis and rheumatism.

[14]  A. Martini,et al.  Relative responsiveness of condition specific and generic health status measures in juvenile idiopathic arthritis , 2005, Annals of the rheumatic diseases.

[15]  A. Martini,et al.  Evaluation of response to methotrexate by a functional index in juvenile chronic arthritis , 1995, Clinical Rheumatology.

[16]  M. Dougados.  It’s Good to Feel Better But It’s Better to Feel Good , 2004 .

[17]  E. Giannini,et al.  Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. , 2004, The Journal of rheumatology.

[18]  T. Pincus,et al.  Relative versus absolute goals of therapies for RA: ACR 20 or ACR 50 responses versus target values for "near remission" of DAS or single measures. , 2004, Clinical and experimental rheumatology.

[19]  A. McMahon,et al.  Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial , 2004, The Lancet.

[20]  R. Saurenmann,et al.  A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. , 2004, Arthritis and rheumatism.

[21]  M. Suarez‐Almazor,et al.  International League of Associations for Rheumatology classification of juvenile arthritis: second revision , 2004 .

[22]  M. Suarez‐Almazor,et al.  International League of Associations for Rheumatology: International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001 , 2004 .

[23]  A. Martini,et al.  Prognostic factors for radiographic progression, radiographic damage, and disability in juvenile idiopathic arthritis. , 2003, Arthritis and rheumatism.

[24]  T. Pincus,et al.  A proposed treatment algorithm for rheumatoid arthritis: aggressive therapy, methotrexate, and quantitative measures. , 2003, Clinical and experimental rheumatology.

[25]  P. Tugwell,et al.  MCID/Low Disease Activity State Workshop: low disease activity state in rheumatoid arthritis. , 2003, The Journal of rheumatology.

[26]  S. Cavuto,et al.  The Italian version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ). , 2001, Clinical and experimental rheumatology.

[27]  S. Cavuto,et al.  Cross-cultural adaptation and psychometric evaluation of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ) in 32 countries. Review of the general methodology. , 2001, Clinical and experimental rheumatology.

[28]  A. Martini,et al.  Responsiveness of clinical measures in children with oligoarticular juvenile chronic arthritis. , 1999, The Journal of rheumatology.

[29]  A. Martini,et al.  Responsiveness of outcome measures in juvenile chronic arthritis. Italian Pediatric Rheumatology Study Group. , 1999, Rheumatology.

[30]  D. Felson,et al.  Preliminary definition of improvement in juvenile arthritis. , 1997, Arthritis and rheumatism.

[31]  A. Martini,et al.  Correlation between conventional disease activity measures in juvenile chronic arthritis , 1997, Annals of the rheumatic diseases.

[32]  J J Anderson,et al.  American College of Rheumatology. Preliminary definition of improvement in rheumatoid arthritis. , 1995, Arthritis and rheumatism.

[33]  D. Lovell,et al.  Development of a disability measurement tool for juvenile rheumatoid arthritis. The Juvenile Arthritis Functional Assessment Report for Children and their Parents. , 1991, Arthritis and rheumatism.

[34]  A. Poznanski,et al.  Carpal length in children--a useful measurement in the diagnosis of rheumatoid arthritis and some concenital malformation syndromes. , 1978, Radiology.

[35]  O. Steinbrocker,et al.  Therapeutic criteria in rheumatoid arthritis. , 1949, Journal of the American Medical Association.