Early clinically inactive disease and long-term outcomes in juvenile idiopathic arthritis (JIA)
What was already known?
Children and young people with JIA and persistent joint pain and swelling are at risk of disability and joint damage in the long-term. The aim for all these patients is a state of ‘clinically inactive disease’, in which there is no evidence of arthritis at that point in time.
There are a number of ways of defining clinically active disease, all dependent on assessing a range of symptoms, signs and test results.
The two most common ways are:
- Wallace’s preliminary criteria
- Below a certain cut-off on the clinical Juvenile Disease Activity Score (cJADAS).
Wallace’s criteria have five components all measured by the physician. The cJADAS has fewer components but does include a patients or parent assessment of well-being. We don’t know which of the two definitions has a better outcome in terms of physical function, joint movement, quality of life, and pain.
How was the study carried out?
This study used information from children and young people who were taking part in the Childhood Arthritis Prospective Study (CAPS). CAPS follows children and young people with arthritis from their first hospital visit for up to ten years.
What was discovered?
At one year, 7% of children and young people had a clinically inactive disease according to definition A, 16% according to definition B, 21% according to either definition, and 56% did not have clinically inactive disease at all.
Compared with children that still had swollen joints and other signs of disease after one year, those that were in either definition of clinically inactive disease had better joint movement in the next five years. But, only children who were in clinically inactive disease according definition (B) had better quality of life and everyday function in this time.
Why is this important?
Children who had a clinically inactive disease according to both doctors and themselves/parents (Definition B) had the best outcome over the first five years after coming to hospital with JIA.
Definition B is easier to use because it includes fewer tests. Information from both doctors and patients/parents should be used to better treat joint and non-joint symptoms in young people with JIA.
(Shoop-Worrall SJW. et al. (2018). Long-Term Outcomes Following Achievement of Clinically Inactive Disease in Juvenile Idiopathic Arthritis: The Importance of Definition. Arthritis Rheumatol 2018; 70(9): 1519-1529. PMID:29648683| DOI:10.1002/art.40519)