ACR Meeting Abstracts

ACR Meeting Abstracts

  • Home
  • Meetings Archive
    • ACR Convergence 2020
    • 2020 ACR/ARP PRSYM
    • 2019 ACR/ARP Annual Meeting
    • 2018 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP Annual Meeting
    • 2017 ACR/ARHP PRSYM
    • 2016-2009 Meetings
    • Download Abstracts
  • Keyword Index
  • Advanced Search
  • Your Favorites
    • Favorites
    • Login
    • Register
    • View and print all favorites
    • Clear all your favorites
  • Meeting Resource Center

Abstract Number: 1984

Causal Pathways to Health-Related Quality of Life in Children with Juvenile Idiopathic Arthritis: Results from the ReACCh-Out Cohort

Kiem Oen1, Jiahao Tian2, Thomas Loughin2, Roberta Berard3, Mercedes Chan4, Ciaran Duffy5, Brian Feldman6, Adam Huber7, Deborah Levy8, Dax G. Rumsey9, Natalie Shiff10, Shirley Tse11, Lori Tucker4, Karen Watanabe-Duffy5 and Jaime Guzman12, 1University of Manitoba, Toronto, ON, Canada, 2Simon Fraser University, Burnaby, BC, Canada, 3London Health Sciences Centre, London, ON, Canada, 4BC Children's Hospital, Vancouver, BC, Canada, 5Children's Hospital of Eastern Ontario, Ottawa, ON, Canada, 6The Hospital for Sick Children, Toronto, ON, Canada, 7Dalhousie University, Halifax, NS, Canada, 8Division of Rheumatology, The Hospital for Sick Children, Toronto, ON, Canada, 9University of Alberta, Edmonton, AB, Canada, 10Florida, Gainesville, FL, 11SickKids, Toronto, ON, Canada, 12University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada

Meeting: ACR Convergence 2020

Keywords: Disease Activity, Epidemiology, Juvenile idiopathic arthritis, pain, quality of life

  • Tweet
  • Email
  • Print
Save to PDF
Session Information

Date: Monday, November 9, 2020

Session Title: Pediatric Rheumatology – Clinical II: Outcomes & Care Delivery (1983–1987)

Session Type: Abstract Session

Session Time: 10:00AM-10:50AM

Background/Purpose: The relative roles of disease activity and disability as determinants of health-related quality of life (HRQoL) in children with JIA have been controversial; sometimes their statistical significance disappears when pain is added to multivariate models.  We explored whether structural equation modelling (SEM) may help clarify the causal pathways leading to decreased HRQoL in children with JIA. SEM estimates direct and indirect effects of candidate determinants along a causal pathway and uses multiple indicators to study determinants that are imperfectly quantified, such as disease activity and treatment intensity.

Methods: We used data from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort.  Based on published literature and clinical plausibility we proposed a priori models with explicit root causes (disease activity, treatment intensity) and mediators (pain, disease symptoms, function) leading to HRQoL measured with the Quality of my Life scale (QoML, 0=worst, 10=best) and the Juvenile Arthritis Quality of Life Questionnaire (JAQQ, 1=best, 7=worst), at five stages of disease: 1) diagnosis (within 28 days), 2) 3-9 months after diagnosis, 3) flare, 4) remission on medications, and 5) remission off medications.  SEM was applied to the data and a posteriori models were selected based on fit statistics, parameter estimates, and plausibility.  Here we focus on the models for QoML at diagnosis.

Results: We included 563 children with assessments of HRQoL within 28 days of diagnosis (Table 1).  The a priori model is shown in Figure 1, where the direction and magnitude of hypothesized effects are depicted by the number of + or – signs.  Figure 2 shows the a posteriori model with the best fit, where path coefficients estimated by SEM (numbers in Figure 2) quantify the observed direction and magnitude of effect.  Comparison of the two figures shows that most hypothesized effects were supported, with a few modifications: 1) Drug categories and Discomforts and concerns were eliminated due to overlap or for lack of measures; 2) The paths from disease activity first to pain, functional deficit (CHAQ DI) and disease symptoms are supported; 3) Participation restrictions is a subsequent common intermediary, as proposed; 4) A direct path from treatment to QoML is the only one supported, whereas the path through side effects is not significant; 5) Pain, participation restrictions and effects of treatment not mediated by side effects are then the immediate determinants of QoML. In results not shown, models for 3-9 months after diagnosis and flare were similar to that at diagnosis and largely supported the hypothesized relationships (path coefficients 0.1 to 1.0 in the expected direction).  Models for JAQQ provided greater specificity as to the domains of HRQoL affected. Models for remission stages were unsatisfactory.

Conclusion: Using SEM, we found support for disease activity and treatment intensity as root determinants of decreased HRQoL in children with JIA. Disease activity acts mainly via pain, functional impairments and participation restrictions.   Treatment main effects at diagnosis were not mediated by side effects.

Table 1: Baseline characteristics of 563 children with HRQoL assessments within 28 days of diagnosis in the ReACCh-Out cohort

Figure 1: Hypothesized a priori model of the causal pathways leading to HRQoL at diagnosis as measured by QoML. ESR, CRP, active joint count and physician global assessment of disease activity (PGADA) are proposed as measures of disease activity; and medication score, drug categories and mode of administration as measures of treatment intensity. Disease activity and treatment intensity have proposed effects on mediators, such as pain, other symptoms and function which in turn impact HRQoL. Personal and contextual factors were not analysed.

Figure 2: A posteriori model of best fit at diagnosis. Drug categories and Discomforts and concerns were removed due to overlap or lack of measures. Dashed lines represent postulated relationships not supported (p>0.05) and bold lines represent new paths that improve fit. Numbers signify path coefficients for the relationship between the variable at the arrow tail and the variable at the arrow head. A positive path coefficient of 0.5 means that a 1.0 standard deviation increase in the variable at the arrow tail corresponds to a 0.5 standard deviation increase in the variable at the arrow head. A negative path coefficient means an increase in the arrow tail variable corresponds to a decrease in the arrow head variable; and a path coefficient close to 0 reflects negligible impact.


Disclosure: K. Oen, None; J. Tian, None; T. Loughin, None; R. Berard, None; M. Chan, None; C. Duffy, None; B. Feldman, Pfizer, 1, AB2-Bio, 1, Optum, 1, Novartis, 1; A. Huber, None; D. Levy, None; D. Rumsey, None; N. Shiff, None; S. Tse, None; L. Tucker, None; K. Watanabe-Duffy, None; J. Guzman, None.

To cite this abstract in AMA style:

Oen K, Tian J, Loughin T, Berard R, Chan M, Duffy C, Feldman B, Huber A, Levy D, Rumsey D, Shiff N, Tse S, Tucker L, Watanabe-Duffy K, Guzman J. Causal Pathways to Health-Related Quality of Life in Children with Juvenile Idiopathic Arthritis: Results from the ReACCh-Out Cohort [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/causal-pathways-to-health-related-quality-of-life-in-children-with-juvenile-idiopathic-arthritis-results-from-the-reacch-out-cohort/. Accessed April 14, 2021.
  • Tweet
  • Email
  • Print
Save to PDF

« Back to ACR Convergence 2020

ACR Meeting Abstracts - https://acrabstracts.org/abstract/causal-pathways-to-health-related-quality-of-life-in-children-with-juvenile-idiopathic-arthritis-results-from-the-reacch-out-cohort/

Advanced Search

Your Favorites

You can save and print a list of your favorite abstracts by clicking the “Favorite” button at the bottom of any abstract. View your favorites »

ACR Convergence: Where Rheumatology Meets. All Virtual. November 5-9.

ACR Pediatric Rheumatology Symposium 2020

© COPYRIGHT 2021 AMERICAN COLLEGE OF RHEUMATOLOGY

Wiley

  • Home
  • Meetings Archive
  • Advanced Search
  • Meeting Resource Center
  • Online Journal
  • Privacy Policy
  • Permissions Policies
loading Cancel
Post was not sent - check your email addresses!
Email check failed, please try again
Sorry, your blog cannot share posts by email.
This site uses cookies: Find out more.