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Preliminary Criteria for Clinical Remission for Select Categories of Juvenile Idiopathic Arthritis
CAROL A. WALLACE, NICOLINO RUPERTO, and EDWARD H. GIANNINI for the Childhood Arthritis and Rheumatology Research Alliance (CARRA), The Pediatric Rheumatology International Trials Organization (PRINTO), and The Pediatric Rheumatology Collaborative Study Group (PRCSG)
ABSTRACT. Methods. A Delphi serial questionnaire consensus-formation approach was used initially to gather criteria in use by pediatric rheumatologists (PR) for defining clinical remission in oligoarticular (persistent and extended), rheumatoid factor (RF) positive and negative polyarticular, and systemic JIA. Results from sequential questionnaires provided an agenda for a nominal group technique (NGT) conference to reach consensus on unresolved questions. Results. One hundred and thirty PR from 34 countries responded to the questionnaires and 20 PR from 9 countries attended the conference. Draft criteria for inactive disease include the following: no active arthritis; no fever, rash, serositis, splenomegaly, or generalized lymphadenopathy attributable to JIA; no active uveitis; normal erythrocyte sedimentation rate or C-reactive protein; and a physician's global assessment of disease activity rated at the best score possible for the instrument used. According to consensus vote, 6 continuous months of inactive disease on medication defines clinical remission on medication, while 12 months of inactive disease off all anti-arthritis (and anti-uveitis) medications defines clinical remission off medication. The finalized criteria for remission off medication ideally should predict that a patient has ≤ 20% probability of disease recurrence within the next 5 years. Conclusion. Using consensus formation techniques, we formulated preliminary criteria for inactive disease and clinical remission on and off medication for use in select categories of JIA. Retrospective validation is in progress; prospective validation will follow. Future efforts will include other categories of JIA. (J Rheumatology 2004;31:2290-4) Key Indexing Terms:
JUVENILE IDIOPATHIC ARTHRITIS
From the Children's Hospital and Regional Medical Center, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA; the Pediatric Rheumatology InterNational Trials Organization, IRCCS G. Gaslini, Pediatria II, Genoa, Italy; and the Division of Rheumatology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA. Supported by grants from: NIAMS (1 R21 AR48355-01), American College of Rheumatology, and Pfizer. C.A. Wallace, MD, Associate Professor, Division of Immunology and Rheumatology, Children's Hospital and Regional Medical Center, Department of Pediatrics, University of Washington School of Medicine; N. Ruperto, MD, MPH, Senior Scientist, Pediatric Rheumatology InterNational Trials Organization, IRCCS G. Gaslini, Pediatria II; E.H. Giannini, MSc, DrPH, Professor, Division of Rheumatology, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine. Address reprint requests to Dr. C.A. Wallace, Department of Rheumatology, Children's Hospital and Regional Medical Center, 4800 Sandpoint Way NE, Seattle, WA, 98105, USA. E-mail: cwallace@u.washington.edu Submitted December 17, 2003; revision accepted May 11, 2004. |