Background/Purpose: Juvenile idiopathic arthritis (JIA) is a common childhood arthritis, which is classified into 7 subtypes. Each subtype has different clinical manifestations, treatment, and disease course. The Childhood Health Assessment Questionnaire (CHAQ) is widely used for functional ability assessment. Many studies investigated the correlation between CHAQ and JIA outcomes but the correlation between CHAQ and disease activity in each JIA subtype is still obscured. Therefore, this study aims to determine the correlation between CHAQ and disease activity in each JIA subtype during active and inactive disease.

Methods:  All JIA patients in pediatric rheumatology clinic at Ramathibodi hospital between January 2011 and December 2013 were included in this study. Demographic data, disease activity variables, and CHAQ were reviewed from medical records for 6 visits in each patient. Disease activity variables included active joint count, limited joint count, erythrocyte sedimentation rate, patient’s global assessment (PtGA), and physician’s global assessment (PGA). Juvenile Arthritis Disease Activity Score-27 (JADAS-27) was also performed by physician. The correlation between CHAQ and disease activity variables in each JIA subtype during the active and inactive disease was analyzed by Spearman’s correlation.

Results:  139 JIA patients [31% enthesitis-related arthritis (ERA), 28% systemic JIA (SJIA), 17% oligoarthritis, 15% rheumatoid factor (RF) negative polyarthritis, 6% RF positive polyarthritis, and 3% undifferentiated arthritis] were enrolled into this study. Data of 812 visits were reviewed, 606 visits were in active disease while 206 visits were in inactive disease. The median of disease duration was 2.8 years. RF negative polyarthritis patients had highest CHAQ score (0.39 ± 0.66) while oligoarthritis patients had lowest score (0.20 ± 0.32). During active disease, CHAQ had moderate to strong correlation with JADAS-27, PGA, and PtGA in all JIA subtypes (p<0.05), whereas CHAQ had low correlation with disease activity variables during inactive disease. In SJIA patients, CHAQ had strong correlation with active joint count (r=0.70), whereas CHAQ in other subtypes had only moderate correlation. CHAQ also highly correlated with joint tenderness in polyarthritis (r=0.70 in RF positive group and r=0.64 in RF negative group).

Conclusion:  Polyarthritis patients had the worst functional impairment, while oligoarthritis patients had the least functional impairment. CHAQ had good correlation with disease activity during active disease, whereas CHAQ had poor correlation during inactive disease in all JIA subtypes. Therefore, CHAQ is useful to assess disease activity in JIA patients only during active disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-correlation-of-childhood-health-assessment-questionnaire-with-disease-activity-in-juvenile-idiopathic-arthritis/