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Predicting unfavorable long-term outcome in juvenile idiopathic arthritis: results from the Nordic cohort study
Univ Hosp North Norway, Dept Pediat, Tromso, Norway;UIT Arctic Univ Norway, Dept Clin Med, Tromso, Norway.
NTNU Norwegian Univ Sci & Technol, Dept Clin & Mol Med, Trondheim, Norway;Nord Trondelag Hosp Trust, Levanger Hosp, Dept Pediat, Levanger, Norway.
Univ Helsinki, Hosp Children & Adolescents, Helsinki, Finland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Paediatric Inflammation Research.
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2018 (English)In: Arthritis Research & Therapy, ISSN 1478-6354, E-ISSN 1478-6362, Vol. 20, article id 91Article in journal (Refereed) Published
Abstract [en]

Background: The aim was to develop prediction rules that may guide early treatment decisions based on baseline clinical predictors of long-term unfavorable outcome in juvenile idiopathic arthritis (JIA).

Methods: In the Nordic JIA cohort, we assessed baseline disease characteristics as predictors of the following outcomes 8 years after disease onset. Non-achievement of remission off medication according to the preliminary Wallace criteria, functional disability assessed by Childhood Health Assessment Questionnaire (CHAQ) and Physical Summary Score (PhS) of the Child Health Questionnaire, and articular damage assessed by the Juvenile Arthritis Damage Index-Articular (JADI-A). Multivariable models were constructed, and cross-validations were performed by repeated partitioning of the cohort into training sets for developing prediction models and validation sets to test predictive ability.

Results: The total cohort constituted 423 children. Remission status was available in 410 children: 244 (59.5%) of these did not achieve remission off medication at the final study visit. Functional disability was present in 111/340 (32.7%) children assessed by CHAQ and 40/199 (20.1%) by PhS, and joint damage was found in 29/216 (13.4%). Model performance was acceptable for making predictions of long-term outcome. In validation sets, the area under the curves (AUCs) in the receiver operating characteristic (ROC) curves were 0.78 (IQR 0.72-0.82) for non-achievement of remission off medication, 0.73 (IQR 0.67-0.76) for functional disability assessed by CHAQ, 0.74 (IQR 0.65-0.80) for functional disability assessed by PhS, and 0.73 (IQR 0.63-0.76) for joint damage using JADI-A.

Conclusion: The feasibility of making long-term predictions of JIA outcome based on early clinical assessment is demonstrated. The prediction models have acceptable precision and require only readily available baseline variables. Further testing in other cohorts is warranted.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD , 2018. Vol. 20, article id 91
Keywords [en]
Juvenile idiopathic arthritis, Disease activity, Prediction, Outcome research
National Category
Rheumatology and Autoimmunity
Identifiers
URN: urn:nbn:se:uu:diva-356395DOI: 10.1186/s13075-018-1571-6ISI: 000431297600003PubMedID: 29724248OAI: oai:DiVA.org:uu-356395DiVA, id: diva2:1235435
Available from: 2018-07-25 Created: 2018-07-25 Last updated: 2018-07-25Bibliographically approved

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