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Balay-Dustrude E, Christensen R, Consolaro A, Ingrid Goh Y, Gottlieb BS, Horgan B, Horonjeff J, Maxwell LJ, Munro J, Pan N, Schultz G, Swart JF, Toupin-April K, Morgan EM. Defining patient perception of overall well-being and disease activity in the OMERACT Juvenile Idiopathic Arthritis (JIA) core domain set: A report from the JIA working group. Semin Arthritis Rheum 2024; 64:152340. [PMID: 38071831 DOI: 10.1016/j.semarthrit.2023.152340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The OMERACT Juvenile Idiopathic Arthritis (JIA) Working Group (WG) aimed to reach agreement on a consensus-based definition and description of the core domain related to patient perception of overall well-being and disease activity. METHODS A committee of patient research partners, clinicians, methodologists, and researchers drafted working definitions and descriptions. The WG conducted two iterative electronic stakeholder surveys to obtain consensus on domain description, definition, and the distinction between patient perception of overall well-being and disease activity. These definitions were then presented at the OMERACT 2023 Special Interest Group (SIG) session for agreement. RESULTS Forty-five participants, from 7 countries and 4 continents, were comprised of six patients, 18 caregivers, and 21 healthcare providers. The consensus threshold (70%) was exceeded on all survey questions from both stakeholder groups (patients/caregivers, all others). Agreement was obtained on the new definition, description, and domain title, along with agreement on separate assessments of two target domains, patient perception of overall well-being as it relates to disease and patient perception of disease activity. CONCLUSION Through an iterative consensus process and achieving agreement from the OMERACT SIG session attendees, the JIA WG has created a detailed definition and description for the two target domains in the patient perception of overall well-being related to disease core domain of the JIA mandatory core domain set. The next phase of this work will be instrument selection using the OMERACT filter 2.2.
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Affiliation(s)
- Erin Balay-Dustrude
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, Washington, USA.
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Alessandro Consolaro
- Istituto Giannina Gaslini, Genova, Italy; Università degli Studi di Genova, Genova, Italy
| | - Y Ingrid Goh
- Division of Rheumatology, The Hospital for Sick Children, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Beth S Gottlieb
- Pediatric Rheumatology, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine at Hofstra Northwell, New York, USA
| | | | - Jennifer Horonjeff
- Savvy Cooperative, New York, New York, USA; Patient research partner, USA
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jane Munro
- Rheumatology Unit, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Nancy Pan
- Hospital for Special Surgery, New York, USA; Weill Medical College of Cornell University, New York, USA
| | | | - Joost F Swart
- Wilhelmina Children's Hospital/ UMC Utrecht, Utrecht, The Netherlands; Utrecht University, Utrecht, The Netherlands
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada
| | - Esi M Morgan
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, Washington, USA
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Balay-Dustrude E, Shenoi S. Current Validated Clinical and Patient Reported Disease Outcome Measures in Juvenile Idiopathic Arthritis. Open Access Rheumatol 2023; 15:189-206. [PMID: 37841510 PMCID: PMC10574249 DOI: 10.2147/oarrr.s261773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a common chronic illness in childhood and comprises seven categories based on the International League of Associations for Rheumatology (ILAR) criteria. Accurate assessment and measurement of the clinical, functional, and quality of life outcomes of patients with JIA are paramount for understanding the disease course and formulating effective treatment strategies. Interest in the development and use of outcome measurements specifically focused on rheumatologic conditions has greatly expanded over the last two decades, adding to and improving upon the established disease measures. Furthermore, many of these measures have been validated using the widely accepted Outcome Measures in Rheumatology (OMERACT) core principles of instrument validation, allowing researchers and clinicians to gain confidence in these tools. This review summarizes the current validated disease outcome measures in JIA, including clinical, imaging, patient-reported, and functional outcome measurement tools, and highlights ongoing work that continues to refine and improve upon the available tools. The clinical disease outcome measures discussed in this review include physician global assessment (PhGA), American College of Rheumatology (ACR, Wallace) criteria for clinical inactive disease and clinical remission, juvenile arthritis disease activity scores (JADAS), juvenile spondyloarthritis disease activity index (JSPaDA), juvenile arthritis damage index (JADAI), and the ACR pediatric response scores. The imaging outcome measures discussed include the Dijkstra composite scores, childhood arthritis radiographic score of the hip (CARSH), and Poznanski Score. The patient-reported disease outcome measures discussed include patient global assessment (PtGA), patient-reported outcome measurement information system for JIA (PROMIS), juvenile arthritis parent/child centered disease assessment index (JAPAI, JACAI), juvenile arthritis multidimensional assessment report (JAMAR), and the Pediatric quality of life inventory rheumatology module (PedsQL). The functional outcome tools discussed include the Childhood Health Assessment Questionnaire (CHAQ), juvenile arthritis functionality scale and index (JAFS and JASI), and Juvenile Arthritis Functional Assessment Report and Scale (JAFAS and JAFAR).
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Affiliation(s)
- Erin Balay-Dustrude
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA, USA
- Department of Pediatric Rheumatology, Seattle Children’s Hospital and Research Center, Seattle, WA, USA
| | - Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA, USA
- Department of Pediatric Rheumatology, Seattle Children’s Hospital and Research Center, Seattle, WA, USA
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Vincent HK, Sharififar S, Abdelmalik B, Lentini L, Chen C, Woolnough LU. Gait parameters, functional performance and physical activity in active and inactive Juvenile Idiopathic Arthritis. Gait Posture 2022; 98:226-232. [PMID: 36191581 DOI: 10.1016/j.gaitpost.2022.09.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/04/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children with Juvenile Idiopathic Arthritis (JIA) may adopt different movement patterns and participate in physical activity during different states of disease. RESEARCH QUESTION Which specific features of gait and physical function performance differ among children with active or inactive JIA compared to healthy children? METHODS Forty-three children participated (14.5 ± 4.2 yrs; 60 % female). 3D-motion analysis methods were coupled with force measures from an instrumented treadmill captured gait mechanical measures. The 30-second Chair Rise Test (repetitions) and stair ascent-descent tests were performed, and the 11-point Wong-Baker face scale assessed pain after each test. RESULTS Compared to healthy controls children with active and inactive JIA had worse outcomes (12-21 % slower self-selected and fast walking speeds, 28-34 % slower stair navigation times, 28 % fewer chair rise repetitions in 30 s; all p < .05). Children with active JIA had 8-13 % slower gait speeds, 4 % fewer chair rise repetitions and 14-16 % slower stair navigation times. At faster walking speed, children with active JIA had less hip joint flexion/extension excursion in the sagittal plane during the gait cycle, produced higher leg stiffness, and demonstrated greater interlimb asymmetry in GRF vertical impulse during loading than healthy children (all p < .05). The Pedi-FABS subscore of "Duration: performing athletic activity for as long as you would like without stopping" was rated lower in children with active JIA compared to controls (p < .05). CONCLUSION Gait speed, specific load-bearing functional tasks and leg stiffness features of gait may be informative 'functional biomarkers' for assessing JIA burden and tracking treatment efficacy. Additional prospective studies are needed to determine how these features change over time with pain change, and understand impact on quality of life and physical activity participation.
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Affiliation(s)
- Heather K Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida, PO Box 112730, Gainesville, FL 32607, United States.
| | - Sharareh Sharififar
- Department of Physical Medicine and Rehabilitation, University of Florida, PO Box 112730, Gainesville, FL 32607, United States.
| | - Bishoy Abdelmalik
- Department of Physical Medicine and Rehabilitation, University of Florida, PO Box 112730, Gainesville, FL 32607, United States.
| | - Logan Lentini
- Department of Pediatrics, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States.
| | - Cong Chen
- Department of Orthopaedics, University of Florida, PO Box112727, Gainesville, FL 32611, United States.
| | - Leandra U Woolnough
- Department of Pediatrics, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States
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Oen K, Toupin-April K, Feldman BM, Berard RA, Duffy CM, Tucker LB, Tian J, Rumsey DG, Guzman J. Validation of the parent global assessment as a health-related quality of life measure in juvenile idiopathic arthritis: results from ReACCh-Out. Rheumatology (Oxford) 2022; 62:SI152-SI162. [PMID: 35713497 PMCID: PMC9949712 DOI: 10.1093/rheumatology/keac350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To (i) validate the JIA parent global assessment (parent global) as a health-related quality of life (HRQoL) instrument; (ii) evaluate measurement properties of accepted HRQoL measures relative to those of the parent global; and (iii) assess causal pathways determining parent global scores. METHODS Data from the Research in Arthritis in Canadian Children emphasizing outcomes (ReACCh-Out) cohort were used. Measurement properties were assessed in 344 patients at enrolment and 6 months later. Causal pathways were tested by structural equation modelling to understand root causes and mediators leading to parent global scores. RESULTS Construct validity was supported by Spearman correlations of 0.53-0.70 for the parent global with the Juvenile Arthritis Quality of Life Questionnaire, Quality of My Life health scale (HRQoML), Pediatric Quality of Life Inventory (PedsQL)-Parent, and Child Health Questionnaire (CHQ)-Physical. Exceptions were PedsQL-Child (0.44) and CHQ-Psychosocial (0.31). Correlations were lower (0.14-0.49) with disease activity measures (physician global assessment of disease activity, active joint count, ESR). Responsiveness of the parent global to improvement according to parent ratings (0.51) was acceptable and within the range (0.32-0.71) of that of other measures. Reliability estimates and measurement errors for all measures were unsatisfactory, likely due to the prolonged time between assessments. Causal pathways for the parent global matched those previously reported for HRQoML. CONCLUSIONS Our results offer support for the parent global as a valid measure of HRQoL for JIA. If confirmed, existing studies using the parent global may be re-interpreted, enhancing our knowledge of HRQoL in children with JIA.
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Affiliation(s)
- Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg
| | - Karine Toupin-April
- School of Rehabilitation Sciences and Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute and Institut du Savoir Montfort, Ottawa
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, and Departments of Pediatrics and Medicine, and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto
| | - Roberta A Berard
- Pediatric Rheumatology, Children’s Hospital, London Health Sciences Centre, London
| | - Ciẚran M Duffy
- Children’s Hospital of Eastern Ontario and Department of Pediatrics, University of Ottawa, Ottawa
| | - Lori B Tucker
- Division of Pediatric Rheumatology, British Columbia Children’s Hospital, and Department of Pediatrics, University of British Columbia, Vancouver
| | - Jiahao Tian
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby
| | - Dax G Rumsey
- Paediatric Rheumatology, Stollery Children’s Hospital and Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Jaime Guzman
- Correspondence to: Jaime Guzman, BC Children’s Hospital, 4500 Oak Street, Room K4-122 Vancouver, BC V6H 3N1, Canada. E-mail:
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Frid P, Baraniya D, Halbig J, Rypdal V, Songstad NT, Rosèn A, Berstad JR, Flatø B, Alakwaa F, Gil EG, Cetrelli L, Chen T, Al-Hebshi NN, Nordal E, Al-Haroni M. Salivary Oral Microbiome of Children With Juvenile Idiopathic Arthritis: A Norwegian Cross-Sectional Study. Front Cell Infect Microbiol 2020; 10:602239. [PMID: 33251163 PMCID: PMC7672027 DOI: 10.3389/fcimb.2020.602239] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
Background The oral microbiota has been connected to the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. The objective of this study was to characterize the salivary oral microbiome associated with juvenile idiopathic arthritis (JIA), and correlate it with the disease activity including gingival inflammation. Methods Fifty-nine patients with JIA (mean age, 12.6 ± 2.7 years) and 34 healthy controls (HC; mean age 12.3 ± 3.0 years) were consecutively recruited in this Norwegian cross-sectional study. Information about demographics, disease activity, medication history, frequency of tooth brushing and a modified version of the gingival bleeding index (GBI) and the simplified oral hygiene index (OHI-S) was obtained. Microbiome profiling of saliva samples was performed by sequencing of the V1-V3 region of the 16S rRNA gene, coupled with a species-level taxonomy assignment algorithm; QIIME, LEfSe and R-package for Spearman correlation matrix were used for downstream analysis. Results There were no significant differences between JIA and HC in alpha- and beta-diversity. However, differential abundance analysis revealed several taxa to be associated with JIA: TM7-G1, Solobacterium and Mogibacterium at the genus level; and Leptotrichia oral taxon 417, TM7-G1 oral taxon 352 and Capnocytophaga oral taxon 864 among others, at the species level. Haemophilus species, Leptotrichia oral taxon 223, and Bacillus subtilis, were associated with healthy controls. Gemella morbillorum, Leptotrichia sp. oral taxon 498 and Alloprevotella oral taxon 914 correlated positively with the composite juvenile arthritis 10-joint disease activity score (JADAS10), while Campylobacter oral taxon 44 among others, correlated with the number of active joints. Of all microbial markers identified, only Bacillus subtilis and Campylobacter oral taxon 44 maintained false discovery rate (FDR) < 0.1. Conclusions In this exploratory study of salivary oral microbiome we found similar alpha- and beta-diversity among children with JIA and healthy. Several taxa associated with chronic inflammation were found to be associated with JIA and disease activity, which warrants further investigation.
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Affiliation(s)
- Paula Frid
- Department of ENT, Division of Oral and Maxillofacial Surgery, University Hospital North Norway, Tromsø, Norway.,Public Dental Service Competence Centre of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Divyashri Baraniya
- Oral Microbiome Laboratory, Kornberg School of Dentistry, Temple University, Philadelphia, PA, United States
| | - Josefine Halbig
- Public Dental Service Competence Centre of North Norway, Tromsø, Norway.,Department of Clinical Dentistry, UiT the Arctic University of Norway, Tromsø, Norway
| | - Veronika Rypdal
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.,Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Nils Thomas Songstad
- Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Annika Rosèn
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| | - Johanna Rykke Berstad
- Department of ENT, Division of Oral and Maxillofacial Surgery, Oslo University Hospital, Oslo, Norway
| | - Berit Flatø
- Department of Rheumatology and Infectious Diseases, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | - Fadhl Alakwaa
- Department of Computational Medicine and Bioinformatics, University Michigan, Ann Arbor, MI, United States
| | | | - Lena Cetrelli
- Center of Oral Health Services and Research (TkMidt), Trondheim, Norway
| | - Tsute Chen
- Department of Microbiology, Forsyth Institute, Cambridge, MA, United States
| | - Nezar Noor Al-Hebshi
- Oral Microbiome Laboratory, Kornberg School of Dentistry, Temple University, Philadelphia, PA, United States
| | - Ellen Nordal
- Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway.,Department of Pediatrics and Adolescence Medicine, University Hospital of North Norway, Tromsø, Norway
| | - Mohammed Al-Haroni
- Department of Clinical Dentistry, UiT the Arctic University of Norway, Tromsø, Norway
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Mistry RR, Patro P, Agarwal V, Misra DP. Enthesitis-related arthritis: current perspectives. Open Access Rheumatol 2019; 11:19-31. [PMID: 30774484 PMCID: PMC6354696 DOI: 10.2147/oarrr.s163677] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients.
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Affiliation(s)
- Rutviz Rajendra Mistry
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Pallavi Patro
- Department of Pharmacology, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, India
| | - Vikas Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Durga Prasanna Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
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Palman J, Shoop-Worrall S, Hyrich K, McDonagh JE. Update on the epidemiology, risk factors and disease outcomes of Juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol 2018; 32:206-222. [DOI: 10.1016/j.berh.2018.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/09/2018] [Accepted: 09/09/2018] [Indexed: 02/06/2023]
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Frid P, Nordal E, Bovis F, Giancane G, Larheim TA, Rygg M, Pires Marafon D, De Angelis D, Palmisani E, Murray KJ, Oliveira S, Simonini G, Corona F, Davidson J, Foster H, Steenks MH, Flato B, Zulian F, Baildam E, Saurenmann RK, Lahdenne P, Ravelli A, Martini A, Pistorio A, Ruperto N. Temporomandibular Joint Involvement in Association With Quality of Life, Disability, and High Disease Activity in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2017; 69:677-686. [PMID: 27564918 DOI: 10.1002/acr.23003] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Revised: 07/15/2016] [Accepted: 08/02/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the demographic, disease activity, disability, and health-related quality of life (HRQOL) differences between children with juvenile idiopathic arthritis (JIA) and their healthy peers, and between children with JIA with and without clinical temporomandibular joint (TMJ) involvement and its determinants. METHODS This study is based on a cross-sectional cohort of 3,343 children with JIA and 3,409 healthy peers, enrolled in the Pediatric Rheumatology International Trials Organisation HRQOL study or in the methotrexate trial. Potential determinants of TMJ involvement included demographic, disease activity, disability, and HRQOL measures selected through univariate and multivariable logistic regression. RESULTS Clinical TMJ involvement was observed in 387 of 3,343 children with JIA (11.6%). Children with TMJ involvement, compared to those without, more often had polyarticular disease course (95% versus 70%), higher Juvenile Arthritis Disease Activity Score (odds ratio [OR] 4.6), more disability, and lower HRQOL. Children with TMJ involvement experienced clearly more disability and lower HRQOL compared to their healthy peers. The multivariable analysis showed that cervical spine involvement (OR 4.6), disease duration >4.4 years (OR 2.8), and having more disability (Childhood Health Assessment Questionnaire Disability Index >0.625) (OR 1.6) were the most important determinants for TMJ involvement. CONCLUSION Clinical TMJ involvement in JIA is associated with higher disease activity, higher disability, and impaired HRQOL. Our findings indicate the need for dedicated clinical and imaging evaluation of TMJ arthritis, especially in children with cervical spine involvement, polyarticular course, and longer disease duration.
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Affiliation(s)
- Paula Frid
- University Hospital of North Norway, UiT The Arctic University of Norway, and Public Dental Competence Center of Northern Norway, Tromsø, Norway
| | - Ellen Nordal
- University Hospital of North Norway, and UiT The Arctic University of Norway, Tromsø, Norway
| | - Francesca Bovis
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
| | | | - Tore A Larheim
- UiT The Arctic University of Norway, Tromsø, and University of Oslo, Oslo, Norway
| | - Marite Rygg
- Norwegian University of Science and Technology and St. Olavs University Hospital, Trondheim, Norway
| | | | - Donato De Angelis
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
| | - Elena Palmisani
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
| | - Kevin J Murray
- Princess Margaret Hospital for Children, Perth, Australia
| | - Sheila Oliveira
- Universidade Federal do Rio de Janeiro, and Instituto de Puericultura e Pediatria Martagao Gesteira, Rio de Janeiro, Brazil
| | | | - Fabrizia Corona
- Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Helen Foster
- Newcastle University, Newcastle Hospitals NHS Foundation Trust, and Great North Children's Hospital, Newcastle Upon Tyne, UK
| | | | - Berit Flato
- Oslo University Hospital and University of Oslo, Oslo, Norway
| | | | - Eileen Baildam
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Pekka Lahdenne
- Children's Hospital and Helsinki University Central Hospital, Helsinki, Finland
| | - Angelo Ravelli
- Università di Genova, Istituto Giannina Gaslini, and PRINTO Coordinating Center, Genoa, Italy
| | - Alberto Martini
- Università di Genova, Istituto Giannina Gaslini, and PRINTO Coordinating Center, Genoa, Italy
| | | | - Nicolino Ruperto
- Istituto Giannina Gaslini and PRINTO Coordinating Center, Genoa, Italy
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Abstract
A rational management of children and adolescents with rheumatic and autoinflammatory diseases requires the regular assessment of the level of disease activity and of child health and well-being through the use of well-validated outcome measures. Ideally, such instruments should be simple and feasible and easily applicable in standard clinical practice. In recent years, a number of novel outcome measures have been developed and validated for use in pediatric patients with rheumatic and autoinflammatory illnesses. Furthermore, there has been an increased focus on the appraisal of child and parent perception of the disease impact. The new tools have markedly enlarged the spectrum of disorders and health domains that can be assessed in a standardized way. This progress will help to enhance the reliability of research studies and clinical trials. The aim of the present review is to provide an update of the recent advances in this field of research.
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Consolaro A, Giancane G, Schiappapietra B, Davì S, Calandra S, Lanni S, Ravelli A. Clinical outcome measures in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2016; 14:23. [PMID: 27089922 PMCID: PMC4836071 DOI: 10.1186/s12969-016-0085-5] [Citation(s) in RCA: 112] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 04/07/2016] [Indexed: 11/30/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA), as a chronic condition, is associated with significant disease- and treatment-related morbidity, thus impacting children's quality of life. In order to optimize JIA management, the paediatric rheumatologist has begun to regularly use measurements of disease activity developed, validated and endorsed by international paediatric rheumatology professional societies in an effort to monitor the disease course over time and assess the efficacy of therapeutic interventions in JIA patients.A literature review was performed to describe the main outcome measures currently used in JIA patients to determine disease activity status.The Juvenile Disease Activity Score (JADAS), in its different versions (classic JADAS, JADAS-CRP and cJADAS) and the validated definitions of disease activity and response to treatment represent an important tool for the assessment of clinically relevant changes in disease activity, leading more and more to a treat-to-target strategy, based on a tight and thorough control of the patient condition. Moreover, in recent years, increasing attention on the incorporation of patient-reported or parent-reported outcomes (PRCOs), when measuring the health state of patients with paediatric rheumatic diseases has emerged.We think that the care of JIA patients cannot be possible without taking into account clinical outcome measures and, in this regard, further work is required.
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Affiliation(s)
- Alessandro Consolaro
- Istituto Giannina Gaslini, Genova, Italy. .,Università degli Studi di Genova, Genova, Italy.
| | | | | | | | | | | | - Angelo Ravelli
- Istituto Giannina Gaslini, Genova, Italy ,Università degli Studi di Genova, Genova, Italy
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van Pelt PA, Drossaert CHC, Kruize AA, Huisman J, Dolhain RJEM, Wulffraat NM. Use and perceived relevance of health-related Internet sites and online contact with peers among young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2015; 54:1833-41. [DOI: 10.1093/rheumatology/kev193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Indexed: 11/13/2022] Open
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Abstract
Measurement of health outcomes in pediatric rheumatic diseases is a critical component of clinical practice and research studies. Measures should include the biological, physical, and psychosocial dimensions of health. Health outcome measures are developed systematically, often using consensus methods. Prior to implementation into practice, health outcome measures must undergo evaluation of measurement properties such as reliability, validity, and responsiveness. There are several health outcome measures available for juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, and juvenile dermatomyositis, many of which are composite measures of disease activity. In addition, tools exist for measuring physical functioning and health-related quality of life. There is increasing focus on the incorporation of patient-reported or parent-reported outcomes when measuring the health state of patients with pediatric rheumatic diseases. Further work is required to determine the optimal health outcome measures and approach for eliciting the patient's perception of their health state in pediatric rheumatology.
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Affiliation(s)
- Nadia J C Luca
- Section of Rheumatology, Department of Paediatrics, University of Calgary and Alberta Children's Hospital, 2888 Shaganappi Trail NW, Calgary, AB T3B 6A8, Canada.
| | - Brian M Feldman
- Division of Rheumatology, Department of Paediatrics, University of Toronto and The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8, Canada; Department of Medicine and Institute of Health Policy Management and Evaluation, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada.
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13
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Berntson L. Anti-inflammatory effect by exclusive enteral nutrition (EEN) in a patient with juvenile idiopathic arthritis (JIA): brief report. Clin Rheumatol 2014; 33:1173-5. [DOI: 10.1007/s10067-014-2672-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 05/08/2014] [Indexed: 12/15/2022]
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14
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Tudur Smith C, Williamson PR, Beresford MW. Methodology of clinical trials for rare diseases. Best Pract Res Clin Rheumatol 2014; 28:247-62. [DOI: 10.1016/j.berh.2014.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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15
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de Lalouvière LLH, Ioannou Y, Fitzgerald M. Neural mechanisms underlying the pain of juvenile idiopathic arthritis. Nat Rev Rheumatol 2014; 10:205-11. [DOI: 10.1038/nrrheum.2014.4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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16
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Disease activity measures in paediatric rheumatic diseases. Int J Rheumatol 2013; 2013:715352. [PMID: 24089617 PMCID: PMC3781994 DOI: 10.1155/2013/715352] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 08/02/2013] [Indexed: 12/26/2022] Open
Abstract
Disease activity refers to potentially reversible aspects of a disease. Measurement of disease activity in paediatric rheumatic diseases is a critical component of patient care and clinical research. Disease activity measures are developed systematically, often involving consensus methods. To be useful, a disease activity measure must be feasible, valid, and interpretable. There are several challenges in quantifying disease activity in paediatric rheumatology; namely, the conditions are multidimensional, the level of activity must be valuated in the context of treatment being received, there is no gold standard for disease activity, and it is often difficult to incorporate the patient's perspective of their disease activity. To date, core sets of response variables are defined for juvenile idiopathic arthritis, juvenile systemic lupus erythematosus, and juvenile dermatomyositis, as well as definitions for improvement in response to therapy. Several specific absolute disease activity measures also exist for each condition. Further work is required to determine the optimal disease activity measures in paediatric rheumatology.
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17
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McErlane F, Beresford MW, Baildam EM, Thomson W, Hyrich KL. Recent developments in disease activity indices and outcome measures for juvenile idiopathic arthritis. Rheumatology (Oxford) 2013; 52:1941-51. [PMID: 23630368 DOI: 10.1093/rheumatology/ket150] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There has been a concerted and important international effort to develop and validate disease activity and outcome instruments specific to JIA in recent years. This review aims to describe the disease assessment indices important to routine clinical care and integral to the design of outcome studies and clinical trials in JIA. In view of the increasing number of JIA clinical studies and clinical trials, together with a number of national and international paediatric biologic registers, it is important that knowledge of these new outcome measures is widespread, such that results can be placed in a meaningful context.
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Affiliation(s)
- Flora McErlane
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester Academic Health Sciences Centre, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
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