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Rosina S, Rebollo-Gimenez AI, Tarantola L, Pistorio A, Vyzhga Y, El Miedany Y, Lotfy HM, Abu-Shady H, Eissa M, Osman NS, Hassan W, Mahgoub MY, Fouad NA, Mosa DM, Adel Y, Mohamed SEM, Radwan AR, Abu-Zaid MH, Tabra SAA, Shalaby RH, Nasef SI, Khubchandani R, Khan A, Maldar NP, Ozen S, Bayindir Y, Alsuweiti M, Alzyoud R, Almaaitah H, Vilaiyuk S, Lerkvaleekul B, Alexeeva E, Dvoryakovskaya T, Kriulin I, Bracaglia C, Pardeo M, De Benedetti F, Licciardi F, Montin D, Robasto F, Minoia F, Filocamo G, Rossano M, Simonini G, Marrani E, Abu-Rumeleih S, Kostik MM, Belozerov KE, Pal P, Bathia JN, Katsicas MM, Villarreal G, Marino A, Costi S, Sztajnbok F, Silva RM, Maggio MC, El-Ghoneimy DH, El Owaidy R, Civino A, Diomeda F, Al-Mayouf SM, Al-Sofyani F, Dāvidsone Z, Patrone E, Saad-Magalhães C, Consolaro A, Ravelli A. Defining criteria for disease activity states in systemic juvenile idiopathic arthritis based on the systemic Juvenile Arthritis Disease Activity Score. Arthritis Rheumatol 2024. [PMID: 38682570 DOI: 10.1002/art.42865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/06/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MiDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis (sJIA), based on subjective disease state assessment by the treating pediatric rheumatologist. METHODS The cutoffs definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, 6 methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, Youden index, 90% specificity, maximum agreement, and ROC curve analysis. Sixty percent of the patients were assigned to the definition cohort and 40% to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. RESULTS The sJADAS10 cutoffs that separated ID from MiDA, MiDA from MoDA, and MoDA from HDA were ≤ 2.9, ≤ 10, and > 20.6. The cutoffs discriminated strongly among different levels of pain, between patients with or without morning stiffness, and between patients whose parents judged their disease status as remission or persistent activity/flare or were satisfied or not satisfied with current illness outcome. CONCLUSION The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts, and are therefore suitable for use in clinical trials and routine practice.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ana I Rebollo-Gimenez
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Letizia Tarantola
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Angela Pistorio
- Direzione Scientifica - Unità di Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Yulia Vyzhga
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Yasser El Miedany
- Canterbury Christ Church University, UK and Egyptian College of Pediatric Rheumatology, Egypt
| | - Hala M Lotfy
- Pediatric Rheumatology Department, Abu- el Reesh Hospital, Cairo University, Cairo, Egypt
| | - Hend Abu-Shady
- Pediatric Rheumatology Department, Abu- el Reesh Hospital, Cairo University, Cairo, Egypt
| | - Mervat Eissa
- Rheumatology, Kasr Elainy Cairo University, Cairo, Egypt
| | | | - Waleed Hassan
- Rheumatology, Rehabilitation and Physical Medicine, Benha University, Benha, Egypt
| | - Marwa Y Mahgoub
- Rheumatology, Rehabilitation and Physical Medicine, Benha University, Benha, Egypt
| | - Nermeen A Fouad
- Rheumatology and Rehabilitation, Fayoum University, Fayoum, Egypt
| | - Doaa M Mosa
- Rheumatology, Rehabilitation and Physical Medicine, Mansoura University, Mansoura, Egypt
| | - Yasmin Adel
- Rheumatology, Rehabilitation and Physical Medicine, Mansoura University, Mansoura, Egypt
| | | | - Ahmed R Radwan
- Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | | | - Samar A A Tabra
- Rheumatology and Rehabilitation Tanta University, Tanta, Egypt
| | - Radwa H Shalaby
- Rheumatology and Rehabilitation Tanta University, Tanta, Egypt
| | - Samah I Nasef
- Rheumatology & Rehabilitation, Faculty of Medicine Suez Canal University, Ismailia, Egypt
| | | | | | | | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Yagmur Bayindir
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Motasem Alsuweiti
- Pediatric Immunology and Rheumatology division, Queen Rania Children's Hospital, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Raed Alzyoud
- Pediatric Immunology and Rheumatology division, Queen Rania Children's Hospital, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Hiba Almaaitah
- Pediatric Immunology and Rheumatology division, Queen Rania Children's Hospital, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Soamarat Vilaiyuk
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Butsabong Lerkvaleekul
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ekaterina Alexeeva
- National Medical Research Center of Children's Health, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Tatyana Dvoryakovskaya
- National Medical Research Center of Children's Health, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Ivan Kriulin
- National Medical Research Center of Children's Health, Moscow, Russian Federation
| | - Claudia Bracaglia
- Division of Rheumatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Manuela Pardeo
- Division of Rheumatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Francesco Licciardi
- Città della Salute e della Scienza, Pediatria specialistica Universitaria, Immunoreumatologia, Torino, Italy
| | - Davide Montin
- Città della Salute e della Scienza, Pediatria specialistica Universitaria, Immunoreumatologia, Torino, Italy
| | - Francesca Robasto
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli studi di Torino, Torino, Italy
| | - Francesca Minoia
- SC Pediatria e Immunoreumatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Filocamo
- SC Pediatria e Immunoreumatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Rossano
- SC Pediatria e Immunoreumatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Simonini
- Rheumatology Unit, IRCCS Meyer Children's Hospital, Florence, Italy
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, IRCCS Meyer Children's Hospital, Florence, Italy
| | | | - Mikhail M Kostik
- Department of Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation
| | - Konstantin E Belozerov
- Department of Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation
| | - Priyankar Pal
- Pediatric Rheumatology Institute of Child Health, Kolkata, India
| | - Jigna N Bathia
- Pediatric Rheumatology Institute of Child Health, Kolkata, India
| | - María M Katsicas
- Service of Rheumatology. Hospital de Pediatría Prof Dr JP Garrahan, Buenos Aires, Argentina
| | - Giselle Villarreal
- Service of Rheumatology. Hospital de Pediatría Prof Dr JP Garrahan, Buenos Aires, Argentina
| | - Achille Marino
- Unit of Pediatric Rheumatology, ASST G.Pini-CTO, Milan, Italy
| | - Stefania Costi
- Unit of Pediatric Rheumatology, ASST G.Pini-CTO, Milan, Italy
| | - Flavio Sztajnbok
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Division of Pediatric Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo M Silva
- Division of Pediatric Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria C Maggio
- Department PROMISE "G. D'Alessandro", University of Palermo, Italy
| | - Dalia H El-Ghoneimy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Rasha El Owaidy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Adele Civino
- Pediatric Rheumatology and Immunology Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - Federico Diomeda
- Pediatric Rheumatology and Immunology Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - Sulaiman M Al-Mayouf
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fuad Al-Sofyani
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zane Dāvidsone
- Department of Pediatrics, University Children Hospital, Riga, Latvia
| | - Elisa Patrone
- Servizio di Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Alessandro Consolaro
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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