Background/Purpose: The ACR Pediatric Criteria (ACR Pedi) contains a core set of outcome variables, including a measure of functional ability, to evaluate improvement over time amongst children with juvenile idiopathic arthritis (JIA). This study evaluates the responsiveness between the patient-reported Childhood Health Assessment Questionnaire (CHAQ) and newer Patient-Reported Outcomes Measurement Information Systems (PROMIS) upper extremity and mobility short-form measures.

Methods: Subjects with JIA enrolled within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry which had consecutive visits with non-missing CHAQ, PROMIS upper extremity, and PROMIS mobility t-scores were included. The percent of subjects attaining ACR Pedi 30, 50, 70, 90, 100 for each respective physical function measure across visits was evaluated using descriptive statistics and Chi square. Pearson correlation evaluated association between CHAQ and PROMIS measures.

Results: There were 2811 subjects across 6031 visits with a median age 7.5 years [IQR 4.8, 13.0] and 76% were female. Oligoarticular (40%) and polyarticular rheumatoid factor negative (32%) were the most common JIA subtypes. Patients rather than parents completed questionnaires at 43% of visits. CHAQ scores of zero were present in 1935 (32%) visits, whereas maximum mobility and upper extremity scores were seen in only 214 (4%) and 522 (9%) visits, respectively. There was no change in CHAQ, mobility, or upper extremity scores across 1775 (29%), 1882 (31%), and 1501 (25%) visits, respectively. The median CHAQ, mobility, and upper extremity scores were 0.375 [IQR 0, 1], 43 [37, 56], and 40 [31, 55]. An ACR Pedi 30 was attained 32% of visits when using CHAQ, but only 12% and 20% of visits when using PROMIS measures (Table). There were statistically significant associations between CHAQ and both PROMIS measures, respectively, for each ACR Pedi percent improvement (all p< 0.01). There were moderate negative correlations between CHAQ and PROMIS upper extremity (-0.65, p< 0.01) as well as CHAQ and PROMIS mobility (-0.47, p< 0.01).

Conclusion: Although improvement was more common when utilizing the CHAQ physical function measure, most subjects did not meet criteria for ACR Pedi score of 30% improvement using any measure. PROMIS short forms appear to be more responsive to change given the properties and distributions of these measures. Additional research is needed on how to best utilize new patient-reported physical function measures within pediatric rheumatology.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/responsiveness-of-patient-reported-physical-function-measures-in-juvenile-arthritis/