ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 0257

Can We Assess Disability in Juvenile Idiopathic Arthritis with Two Simple Questions? Results from the CAPRI Registry

Meghan McPherson1, Kristin Houghton2, Nikola Surjanovic3, Thomas Loughin3, Roberta Berard4, Jean-Philippe Proulx-Gauthier5, Gaelle Chedeville6, Dax Rumsey7, Heinrike Schmeling8, Nadia Luca8, Nicole Johnson8, Tommy Gerschman2, Paivi Miettunen8, Evelyn Rozenblyum9, Herman Tam10, Lilliam Lim7, Kimberly Morishita2, Rosie Scuccimarri11, Johannes Roth12, Ciaran Duffy12, Lori Tucker13, Brian Feldman14 and Jaime Guzman15, 1University of Manitoba, Winnipeg, MB, Canada, 2University of British Columbia, Vancouver, BC, Canada, 3Simon Fraser University, Burnaby, BC, Canada, 4London Health Sciences Centre, London, ON, Canada, 5Laval University, Québec City, QC, Canada, 6The Montreal Children's Hospital, Montréal, QC, Canada, 7University of Alberta, Edmonton, AB, Canada, 8University of Calgary, Calgary, AB, Canada, 9Temerty School of Medicine and Unity Health, Toronto, ON, Canada, 10Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada, 11MgGill University, Montréal, QC, Canada, 12University of Ottawa, Ottawa, ON, Canada, 13BC Children's Hospital, Vancouver, BC, Canada, 14The Hospital for Sick Children, Toronto, ON, Canada, 15University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada

Meeting: ACR Convergence 2021

Keywords: , ,

Session Information

Date: Saturday, November 6, 2021

Title: Pediatric Rheumatology – Clinical Poster I: JIA (0241–0265)

Session Type: Poster Session A

Session Time: 8:30AM-10:30AM

Background/Purpose: To assess if a combination of two questions (Functional Arthritis Screening with Two Questions – FAST index) can detect and roughly estimate the degree of disability in children with juvenile idiopathic arthritis (JIA) when compared to the 30-item Childhood Health Assessment Questionnaire Disability Index (CHAQ).

Methods: Children newly diagnosed with JIA enrolled in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry from February 2017 to December 2018 formed a development cohort, while children diagnosed from January 2019 to February 2020 formed a validation cohort. At enrolment and at 1y parents completed the CHAQ. At every clinic visit they answered two questions: 1) Is it hard for your child to run and play because of arthritis? (HARD), 2) Does your child usually need help from you or another person because of arthritis? (HELP). Responses were scored on 21-point horizontal numerical rating scales from 0 to 10 at 0.5 intervals. We explored >20 different models for combining the two questions to estimate CHAQ scores, using cross-validation to measure performance in subjects not used in model development. Model performance was assessed by concordance with measured CHAQ scores (Kappa using quadratic weights or custom weights selected a priori), mean squared prediction error (MSPE), and the proportion of estimated scores within 0.125 units of the measured CHAQ (CLOSE). The selected model will be validated in the validation cohort.

Results: The development cohort included 216 children at enrolment and 159 at 1y. Both questions correlated with the CHAQ at enrolment (Spearman correlation 0.65 for HARD and 0.64 for HELP) and their scores (0 to 10) were stable in patients deemed unchanged by their parents; mean change -0.16 (95%CI -0.5, 0.1) for HARD, -0.3 (-0.5, -0.03) for HELP. Relative to simply adding the two question scores and dividing by 8, a linear regression model including only HARD and HELP decreased the MSPE by half (Table 1). Using a Least Absolute Shrinkage and Selection Operator (LASSO) to add other patient characteristics led to further improvements. The best LASSO model combined HARD and HELP with age, JIA category, number of active joints and pain intensity to estimate CHAQ scores. We selected the FAST linear regression model for its balance of simplicity and performance. Figure 1 shows the concordance of this model with the measured CHAQ. Sensitivity to detect any disability (CHAQ >0) was 0.94 with a specificity of 0.56. FAST detected some disability in 27/61 (44%) of patients with a CHAQ of zero and often reported higher levels of disability than the CHAQ at lower CHAQ scores (Figure 2). Responsiveness (SRM, mean change from enrolment to 1y divided by the standard deviation) was 0.52 for FAST and 0.40 for CHAQ. Validation cohort analyses are underway.

Conclusion: This FAST index seems highly sensitive to detect disability in children with JIA and often detects unmeasured disability in patients with a CHAQ of zero. It had moderate concordance with levels of disability assessed by CHAQ, but greater sensitivity to change. It could be used as a quick and simple screen for disability at every clinic visit.

Figure 1: Two-way scatter plot of CHAQ scores estimated with the FAST index and measured CHAQ scores

Figure 2: Ability of FAST to detect degrees of disability according to published CHAQ cut-offs (Dempster et al 2001)

Disclosures: M. McPherson, None; K. Houghton, None; N. Surjanovic, None; T. Loughin, None; R. Berard, Sandoz, 2, SOBI, 2, Roche, 2; J. Proulx-Gauthier, None; G. Chedeville, None; D. Rumsey, None; H. Schmeling, Pfizer, 12, Sponsor of clinical trial, Roche, 12, Sponsor of clinical trial, Bristol-Myers Squibb, 5, UCB Biosciences GmbH, 12, Sponsor of clinical trial, Janssen, 12, Sponsor of clinical trial, Sanofi-Aventis, 12, Sponsor of clinical trial; N. Luca, None; N. Johnson, None; T. Gerschman, None; P. Miettunen, None; E. Rozenblyum, None; H. Tam, None; L. Lim, None; K. Morishita, None; R. Scuccimarri, None; J. Roth, None; C. Duffy, None; L. Tucker, None; B. Feldman, Pfizer, 12, DSMB member, AB2 Bio, 12, DSMB member; J. Guzman, None.

To cite this abstract in AMA style:

McPherson M, Houghton K, Surjanovic N, Loughin T, Berard R, Proulx-Gauthier J, Chedeville G, Rumsey D, Schmeling H, Luca N, Johnson N, Gerschman T, Miettunen P, Rozenblyum E, Tam H, Lim L, Morishita K, Scuccimarri R, Roth J, Duffy C, Tucker L, Feldman B, Guzman J. Can We Assess Disability in Juvenile Idiopathic Arthritis with Two Simple Questions? Results from the CAPRI Registry [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/can-we-assess-disability-in-juvenile-idiopathic-arthritis-with-two-simple-questions-results-from-the-capri-registry/. Accessed .

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