ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 393

Association of Sex, Race and Ethnicity on Disease Outcomes in Juvenile Idiopathic Arthritis Patients

Vivek Joseph1, Tracy R. Andrews2, Esi Morgan3, Ronald Laxer4, cagri Toruner5, Tzielan Lee6,7, Beth S. Gottlieb8, C. April Bingham9, Sheetal S. Vora10, Jon M. Burnham11, Judyann C. Olson12, Murray H. Passo13, Michelle Batthish14, Meredith Riebschleger15 and Jennifer E. Weiss16, 1Internal Medicine, Rutgers New Jersey Medical School, Bloomfield, NJ, 2Biostatistics, David & Alice Jurist Institute, Hackensack University Medical Center, hackensack, NJ, 3Pediatric Rheumatology, Cincinnati Children's Hospital, Cincinnati, OH, 4Div of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada, 5Rheumatology, Nationwide Children's Hospital, Columbus, OH, 6Dept of Pediatric Rheumatology, Stanford Univ School of Med, Palo Alto, CA, 7Pediatric Rheumatology, Stanford University School of Medicine, Palo Alto, CA, 8Pediatric Rheumatology, The Steven and Alexandra Cohen Children's Medical Center of New York, The Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY, 9Penn State Health Children's Hospital, Hershey, PA, 10Pediatric Rheumatology, Medical College of Wisconsin, Milwaukee, WI, 11Pediatric Rheumatology, Children's Hospital Philadelphia, Philadelphia, PA, 12Ped/MACC Fund Research Ctr, Medical College of Wisconsin, Milwaukee, WI, 13Division of Rheumatology PTD, Medical University of South Carolina, Charleston, SC, 14Division of Pediatric Rheumatology, McMaster Children's Hospital, Hamilton, ON, Canada, 15Pediatric Rheumatology, University of Michigan, CS Mott Children's Hospiatl, Ann Arbor, MI, 16Hackensack Univ Med Ctr, Hackensack, NJ

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords:

Session Information

Date: Sunday, November 13, 2016

Title: Pediatric Rheumatology – Clinical and Therapeutic Aspects - Poster I: Juvenile Idiopathic Arthritis, Uveitis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: JIA patients are predominantly non-Hispanic white and studies have shown that race and ethnicity may be associated with worse disease.  This study assesses the associations of sex, race and ethnicity with disease outcomes in children with JIA in the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) Registry.  PR-COIN is a multicenter network that uses quality improvement methods to develop and evaluate specific JIA management strategies to improve outcomes in JIA.

Methods: A cross sectional analysis of children with JIA enrolled in the PR-COIN registry from 6/2010 and 7/2015 was done. Univariate statistics and tests of association were performed to compare patient characteristics associated with sex, race (White, African American (AA) and Asian) and ethnicity (Hispanic/Latino, non-Hispanic). One-way ANOVAs were used for all normally distributed continuous data, Wilcoxon Rank Sum for all non-normal continuous data, and Fischer’s exact test for all categorical data.                  

Results: Race information was available for 2436/3192 children (90% white, 6% African American (AA) and 4% Asian).   Ethnicity data was available for 2431 children (8% Hispanic/Latino.  Characteristics of JIA patients by sex (F:M 2.5:1), race, and ethnicity are reported in tables 1-3.  AA children were noted to have worse disease outcomes compared to other races (p<0.0001 for all observations). Asian children had the best overall disease outcome scores for all variables (p<0.0001). Hispanic children had a higher median JADAS score (3 vs 2.5 in non-Hispanics, p<0.001) and a lower median pain score (0.5 vs 1, p<0.001).  Males, Asians and Hispanics started DMARDs and biologics significantly sooner than other groups (p<0.0001).

Conclusion: Race and ethnicity are associated with different disease outcomes in children with JIA. Similar to other studies, AA and Hispanic patients had worse outcomes with higher disease activity scores. However, patients overall tended to have good outcomes with minimal morning stiffness, and low GA, pain and disability scores.  Understanding the etiology and clinical significance of outcome variations between sex, race and ethnicity may enable early identification of patients at risk for worse disease and help to improve the care of JIA patients.                          

Table 1: JIA Patient Characteristics  
Outcome Full Sample
Number 3192
JIA Subtype: n (%)
Systemic Arthritis 182 (5.70)
Polyarticular, RF (+) 211 (6.61)
Polyarticular, RF (-) 901 (28.83)
Oligoarticular, persistent 840 (26.32)
Oligoarticular, extended 226 (7.08)
Psoriatic Arthritis 217 (6.80)
Enthesitis Related Arthritis 334 (10.46)
Undifferentiated Arthritis 73 (2.29)
Patient Characteristics: n (%)
Male 779 (28.2)
Female 1983 (71.8)
Hispanic 246 (9.04)
Not Hispanic/Latino 2357 (86.59)
Not Documented  119 (4.37)
White 2327 (90.54)
Black 149 (5.80)
Asian 94 (3.66)
JIA Disease Outcome Measures: Median [IQR]
CHAQ Score 0 [0-0.38]
Duration of Morning Stiffness 1 [1-2]
MD-GA 1 [0-2]
PGA 1 [0-3]
JADAS 2 [0-6]
Pain Score 1 [0-4]
Joint Count 0 [0-2]
Treatment: Mean (SD)
Month to 1st Biologic 144.37 (130.36)
Month to DMARD 118.08 (121.86)
Note: IQR=interquartile range, Q1 and Q3; SD= Standard Deviation; MDGA=physician global assessment; CHAQ=Childhood Health Assessment Questionnaire; PGA=Patient GA.  Duration of Morning Stiffness: 1: No Stiffness; 2: <15 min; 3: 15-30 min; 4: 30 min-1hr; 5: 1-2 hr; 6:2-4 hr; 7:4-8 hr; 8: >8 hr

                                                 

Table 2. JIA Patient Characteristics by Race and Ethnicity

Race

White

African American

Asian

P Value*

Hispanic /Latino

Non-Hispanic

P Value*

Number (%)

2203 (90.44)

144 (5.91)

89 (3.65)

 

214 (8.31)

2217 (86.06)

 
JIA Subtypes: n (%)
Systemic Arthritis

117 (78.17)

19 (15.90)

7 (3.32)

16 (10.60)

130 (86.09)

Polyarticular, RF (-)

697 (93.56)

28 (3.76)

20 (2.15)

88 (9.21)

828 (86.61)

Polyarticular, RF (+)

148 (82.22)

21 (11.67)

11 (6.11)

Oligoarticular, persistent

598 (88.59)

50 (7.40)

27 (4.0)

Oligoarticular, extended

193 (94.15)

4 (1.95)

8 (3.90)

99 (10.83)

771 (84.35)

Psoriatic Arthritis

174 (91.37)

10 (4.8)

5 (2.4)

11 (5.67)

172 (88.66)

Enthesitis Related Arthritis

264 (91.32)

10 (3.84)

13 (2.56)

23 (7.59)

267 (88.12)

Undifferentiated Arthritis

53 (95.63)

3 (3.75)

0 (0)

4 (6.9)

49 (84.48)

JIA Disease Outcome Measures:  Median [IQR]
CHAQ Score (0-3)

0 [0-0.38]

0.25 [0-0.75]

0 [0-0.25]

<.0001

0 [0-0.50]

0 [0-0.50]

0.2041

Duration of Morning Stiffness†

1 [1-2]

1 [1-3]

1 [1-2]

<.0001

1 [1-2]

1 [1-2]

0.0004

MDGA (0-10)

1 [0-2]

1 [0-3]

1 [0-2]

<.0001

1 [0-2]

1 [0-2]

0.0122

PGA (0-10)

1 [0-3]

2 [0-5]

0 [0-2[

<.0001

1 [0-4]

1 [0-3]

<.0001

JADAS (0-64)

2 [0-6]

4 [1-8]

1.25 [0-5]

<.0001

3 [0.50-7]

2.5 [0-6]

<.0001

Pain Score (0-10)

1 [0-6]

3 [0-6]

0 [0-2]

<.0001

0.50 [0-4]

1 [0-4]

0.0001

Joint Count (0-64)

0 [0-2]

1 [0-3]

0 [0-1]

<.0001

0 [0-2]

0 [0-2]

0.0005

Treatment: Mean (SD)
Months to 1st Biologic

134.00 (149.00)

108.97 (88.56)

99.89 (76.37)

<.0001

122.55 (102.61)

147.04 (132.87)

<.0001

Months to 1st DMARD

123.90 (121.49)

93.93 (111.42)

85.76 (82.23)

<.0001

99.72 (97.00)

120.74 (124.73)

<.0001

Note: The P-Value represents the significance level from either a Wilcoxon rank sum test or a One-Way ANOVA.  All of the Disease Outcomes use the Wilcoxon Rank sum test because the data are not normally distributed; Treatments (Month to DMARD and Biologics) were normally distributed and are tested using a One-Way ANOVA. IQR=interquartile range, Q1 and Q3; SD= Standard Deviation; MDGA=physician global assessment; CHAQ=Childhood Health Assessment Questionnaire; PGA=Patient GA. 
† Duration of Morning Stiffness: 1: No Stiffness; 2: <15 min; 3: 15-30 min; 4: 30 min-1 hr; 5: 1-2hr; 6:2-4 hr; 7:4-8 hr; 8: >8 hr
Table 3. JIA Patient Characteristics by Sex

Outcome

Male

Female

P Value*

Number

214 (8.31)

2217 (86.06)

 

JIA Subtypes: n (%)
Systemic Arthritis

70 (44.30)

88 (55.70)

Polyarticular, RF (+)

30 (14.93)

171 (85.07)

Polyarticular, RF (-)

184 (23.03)

615 (76.97)

Oligoarticular, persistent

185 25.48)

541 (74.52)

Oligoarticular, extended

34 (15.81)

181 (84.19)

Psoriatic Arthritis

72 (36.00)

128 (64.00)

Enthesitis Related Arthritis

152 (49.697)

154 (50.33)

Undifferentiated Arthritis

26 (40.00)

39 (60.00)

JIA Disease Outcome Measures: Median [IQR]
CHAQ Score

0 [0-0.375]

0 [0-0.50]

<.0001

Duration of Morning Stiffness

1 [1-2]

1 [1-2]

0.9356

MD-GA

1 [0-2]

1 [0-2]

0.0031

PGA

1 [0-3]

1 [0-3]

<.0001

JADAS

2 [0-6]

2.5 [0-6]

<.0001

Pain Score

1 [0-4]

1 [0-4]

<.0001

Joint Count

0 [0-2]

0 [0-2]

0.0016

Treatment: Mean (SD)
Months to 1st Biologic

115.215 (110.62)

155.78 (136.33)

<.0001

Months to 1st DMARD

100.42 (122.01)

124.73 (126.27)

<.0001

* The P-Value represents the significance level from either a Wilcoxon rank sum test or a One-Way ANOVA.  All of the Disease Outcomes use the Wilcoxon Rank sum test because the data are not normally distributed; Treatments (Month to DMARD and Biologics) were normally distributed and are tested using a One-Way ANOVA.  IQR= Interquartile Range; SD= Standard Deviation; CHAQ=Childhood Health Assessment Questionnaire; MDGA=Physician Global assessment; PGA=Patient Global Assessment.  Duration of Morning Stiffness: 1: No Stiffness; 2: <15 min; 3: 15-30 min; 4: 30min-1 hr; 5: 1-2 hr; 6:2-4 hr; 7:4-8 hr; 8: >8 hr

 

Disclosure: V. Joseph, None; T. R. Andrews, None; E. Morgan, None; R. Laxer, Database funding from Novartis, 2; C. Toruner, None; T. Lee, None; B. S. Gottlieb, None; C. A. Bingham, None; S. S. Vora, None; J. M. Burnham, None; J. C. Olson, None; M. H. Passo, None; M. Batthish, None; M. Riebschleger, None; J. E. Weiss, None.

To cite this abstract in AMA style:

Joseph V, Andrews TR, Morgan E, Laxer R, Toruner C, Lee T, Gottlieb BS, Bingham CA, Vora SS, Burnham JM, Olson JC, Passo MH, Batthish M, Riebschleger M, Weiss JE. Association of Sex, Race and Ethnicity on Disease Outcomes in Juvenile Idiopathic Arthritis Patients [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/association-of-sex-race-and-ethnicity-on-disease-outcomes-in-juvenile-idiopathic-arthritis-patients/. Accessed .

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