Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Identifying predictors for clinically inactive disease (CID) and sustained remission would allow rapid escalation of therapies for children less likely to achieve these states. This analysis assessed predictors of achievement of CID and sustained remission states over the first five years following diagnosis in children with JIA.
Methods: Children and young people enrolled in the Childhood Arthritis Prospective Study (CAPS), a UK multicentre inception cohort, before January 2011, were selected if diagnosed with oligoarticular, RF-negative or RF-positive polyarticular JIA.
Components for CID and sustained remission according to i) Wallace’s preliminary criteria and ii) cJADAS10 were collected at annual follow-ups to five years according to CAPS protocol. Sustained remission was defined as two consecutive follow-ups in CID. Individual baseline core outcome variables (active joint count, limited joint count, physician’s global, parental global, functional ability (Childhood Health Assessment Questionnaire (CHAQ)) and ESR) were tested for predictive ability for i) CID at one year and ii) ever sustained remission within five years. Associations were tested in multivariable logistic regressions including all COVs, age and symptom duration at initial presentation, gender, ILAR subtype and recruiting centre. Multiple imputation accounted for missing predictor and outcome data.
Results: Of 832 children, 70% were female and the majority had oligoarticular JIA (68%). At one year, 31% had achieved CID according to Wallace’s preliminary criteria and 44% according to the cJADAS10 (26% CID on both). Within five years, 60% had ever achieved sustained remission on Wallace’s preliminary criteria and 66% on the cJADAS10 (52% sustained remission on both).
In multivariable analyses, an increase in 0.125 points (1 unit) on the CHAQ at baseline independently predicted 4% lower odds of CID on the cJADAS10 (95% CI 0.92, 0.99). No baseline COVs predicted CID on Wallace’s preliminary criteria. An increased year of age at initial presentation to paediatric rheumatology independently predicted 12% higher odds of sustained remission on Wallace’s preliminary criteria (95% CI 1.07, 1.17). In addition, one increased unit in CHAQ at baseline independently predicted 6% lower odds of sustained remission on both outcome measures (95% CI: Wallace: 0.91, 0.99; cJADAS10: 0.90, 0.98). Compared with oligoarticular JIA, children with RF-negative polyarticular and RF-positive polyarticular JIA had at least 49% and 68% lower odds of both sustained remission states, respectively. Gender and symptom duration to initial presentation were not independently associated with either outcome.
Conclusion: There were different predictors for CID on the cJADAS10 vs. Wallace’s preliminary criteria although similar predictors for sustained remission using either definition were identified. Children with poor functional ability, polyarticular JIA and younger age at initial presentation could be targeted with more aggressive treatment strategies than currently in practice to better control their disease.
To cite this abstract in AMA style:Shoop-Worrall S, Verstappen SM, E. McDonagh J, Thomson W, Hyrich KL. Can We Predict Achievement of Clinically Inactive Disease and Sustained Remission in Children with Juvenile Idiopathic Arthritis? [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/can-we-predict-achievement-of-clinically-inactive-disease-and-sustained-remission-in-children-with-juvenile-idiopathic-arthritis/. Accessed March 30, 2020.
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