Predicting Which Children with Juvenile Idiopathic Arthritis Will Not Attain Early Remission with Conventional Treatment: Results from the ReACCh-Out Cohort Journal Articles uri icon

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abstract

  • Objective.To estimate the probability of early remission with conventional treatment for each child with juvenile idiopathic arthritis (JIA). Children with a low chance of remission may be candidates for initial treatment with biologics or triple disease-modifying antirheumatic drugs (DMARD).Methods.We used data from 1074 subjects in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. The predicted outcome was clinically inactive disease for ≥ 6 months starting within 1 year of JIA diagnosis in patients who did not receive early biologic agents or triple DMARD. Models were developed in 200 random splits of 75% of the cohort and tested on the remaining 25% of subjects, calculating expected and observed frequencies of remission and c-index values.Results.Our best Cox logistic model combining 18 clinical variables a median of 2 days after diagnosis had a c-index of 0.69 (95% CI 0.67–0.71), better than using JIA category alone (0.59, 95% CI 0.56–0.63). Children in the lowest probability decile had a 20% chance of remission and 21% attained remission; children in the highest decile had a 69% chance of remission and 73% attained remission. Compared to 5% of subjects identified by JIA category alone, the model identified 14% of subjects as low chance of remission (probability < 0.25), of whom 77% failed to attain remission.Conclusion.Although the model did not meet our a priori performance threshold (c-index > 0.70), it identified 3 times more subjects with low chance of remission than did JIA category alone, and it may serve as a benchmark for assessing value added by future laboratory/imaging biomarkers.

authors

  • Larche, Margaret
  • Guzman, Jaime
  • Henrey, Andrew
  • Loughin, Thomas
  • Berard, Roberta A
  • Shiff, Natalie J
  • Jurencak, Roman
  • Huber, Adam M
  • Oen, Kiem
  • Gerhold, Kerstin
  • Feldman, Brian M
  • Scuccimarri, Rosie
  • Houghton, Kristin
  • Chédeville, Gaëlle
  • Morishita, Kimberly
  • Lang, Bianca
  • Dancey, Paul
  • Rosenberg, Alan M
  • Barsalou, Julie
  • Bruns, Alessandra
  • Watanabe Duffy, Karen
  • Benseler, Susanne
  • Duffy, Ciaran M
  • Tucker, Lori B

publication date

  • June 2019