Background/Purpose:

As part of a longitudinal study of Juvenile Idiopathic Arthritis (JIA), providers completed clinical outcomes assessments and patients (pt) completed self-report measures at clinic visits.  In addition to measuring ACR Pediatric response based on the 6 core variables (CHAQ, active joint count, loss of motion, ESR, physician global assessment (PGA), and pt’s well-being), providers rated the pt’s global change of overall health (GRC-health) and JIA (GRC-JIA) between visits on a scale from 1 (very much worse) to 7 (very much better).  Pt’s report of pain and health-related quality of life (HRQoL) are not part of the core measures.  Study Aims: 1) To assess the relationship between JIA improvement at the ACR-Ped70 level with the provider’s GRC-health and GRC-JIA ratings; 2) To evaluate whether pain and HRQoL as assessed by the PedsQL Core and Rheumatology modules are associated with the  provider’s GRC-health and GRC-JIA ratings.

Methods:

Inclusion criteria were diagnosis of JIA, age 8-18 yrs at enrollment, and English fluency.  Study visits occurred 3-4 times/yr concomitantly with scheduled clinic visits.  Analyses considered baseline data and 2nd assessments.

Results:

Data on 113 JIA pts was available (mean age=13.1±2.7 yrs; range=8.1-18.4 yrs).  Majority (86) were female (71%); 72 had polyarthritis (63.7%), 18 oligoarthritis (16%), 11 systemic JIA (9.7%) and 12 other (10.6%).  Mean age at diagnosis was 9.0±4.4 yrs.  The GRC-health (N=95) and the GRC-JIA (N=106) were highly correlated (r = 0.73, P <.0001).  At 2^nd assessment, 10.6% (n=12) achieved an ACR-Ped70 treatment response from baseline. ACR-Ped70, 50 and 30 improvements were all moderately correlated with GRC ratings (r range: .32-.43, P<.001).  ACR-Ped70 responders significantly differed from others in their GRC-health (4.1±1.2 vs. 5.8±1.1; P<.001) and GRC-JIA ratings (4.4±1.1 vs. 6.3±0.97; P <.001). All ACR-Ped70 responders had GRC-health and GRC-JIA ratings >4.  Both GRC ratings were significantly (P<.05) correlated with ACR core measures except ESR (P<.12) (r range: .18 -.46), and with pt’s pain (r = 0.4, .45; P<.0001).  PedsQL Core and Rheumatology Module total and domain scores were significantly correlated with both GRC ratings and ACR-Ped response levels.  The final GRC-health multivariable model included ACR-Ped70, gender, ACR-Ped70 by gender interaction, JIA subtype, active joint count and pt’s pain; none of the PedsQL scores remained significant.  Age was not significant. The final GRC-JIA model includes PGA as a significant predictor, in addition to those included in the GRC-health model.

Conclusion:

Provider’s ratings of overall health and JIA change are closely related to the level of improvement as measured by the ACR-Ped Criteria. Provider’s GRC are significantly influenced by patient’s pain rating, and takes account of the active joint count over and beyond the ACR-Ped70 response level. Nonetheless, in comparison to the ACR-JIA Response Criteria the provider’s GRC can serve as a valid measure to assess patient’s change over time, but with differential gender effect.  This study also suggests that patient reported pain should be considered in the assessment of disease progression.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/acr-criteria-providers-global-rating-of-change-and-role-of-patient-self-report-in-evaluating-change-in-disease-over-time-a-patient-reported-outcomes-measurement-information-system-study/