Session Type: Abstract Submissions (ACR)
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.
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.
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 2nd 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.
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.
A. A. Grom,
Novartis Pharmaceutical Corporation,
J. L. Huggins,
D. J. Lovell,
T. V. Ting,
E. M. Morgan DeWitt,
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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/