Background/Purpose: The assessment of disease activity plays a pivotal role in the management of children with juvenile idiopathic arthritis (JIA). Most recent recommendations require that the parents’ and children’s perception is incorporated in the evaluation of disease course and of effectiveness of therapeutic interventions. A new disease activity tool, named parent Juvenile Arthritis Disease Activity Score (parJADAS), based only on parent-centered outcome measures, is currently under development. Aim of the study is to demonstrate, in 2 large multinational datasets, the discriminant and predictiveability of the parJADAS

Methods: The parJADAS (range 0-40) is the sum of 4 measures: 1) parent assessment of disease activity on a 21-numbered circle 0-10 VAS; 2) assessment of pain intensity on a 21-numbered circle 0-10 VAS; 3) proxy assessment of joint disease up to a maximum of 10 joints; 4) assessment of morning stiffness (MS) on a Likert scale, ranging from no MS (0 points) to > 2 hours of MS (10 points). Discriminat ability was assessed on a dataset of 8,656 children with JIA from 49 countries, enrolled in the study of Epidemiology, treatment and Outcome of Childhood Arthritis (Consolaro A et al. Lancet Child Adolesc Health. 2019), who had all the variables included in the parJADAS available. Discriminant ability was evaluated by comparing parJADAS median levels among patients with inactive disease (ID), low disease activity (LDA), moderate disease activity (MDA), and high disease activity (HDA) according to cJADAS10 and in patients whose parents were satisfied or not satisfied with disease status. To assess the influence of damage on the parJADAS, the levels of the score in patients with or without damage (Juvenile Arthritis Damage Index > 0) were compared in subjects in ID and with at least 2 years of disease course (n = 2,423). Predictive ability was assessed in a longitudinal dataset of subjects included in the PharmaChild Registry (Swart J, et al Arthritis Res Ther 2018). Patients (n = 98) were retained if they had 2 years of follow up and at least 4 visits with parJADAS available during the first year since enrolment. The AUC of the parJADAS in the first year of registry participation was calculated and compared in subjects with/without reduced functional ability (Juvenile Arthritis Functionality Scale, JAFS > 0) at 2 years and in subjects who achieved or did not achieve clinically ID at 2 years.

Results: The median levels of parJADAS in patients in ID, LDA, MDA, and HDA were 0, 3.0, 6.0, and 4.5, respectively (Kruskal-Wallis test, p < 0.001). Median parJADAS in patients whose parents were satisfied or not satisfied with disease course were 1.5 and 13.0, respectively (Mann-Whitney test p < 0.001). ParJADAS was not different in JIA patients in remission with or without damage measured with the JADI (Mann-Whitney test p = 0.08). Subjects JAFS > 0 at 2 years had greater parJADAS AUC in the first year (p < 0.001). Subjects in remission at 2 years had smaller parJADAS AUC in the first year (p < 0.001)

Conclusion: The parJADAS showed excellent discriminant and predictive ability in 2 large multinational cohorts. The score was not relevantly influenced by disease damage in JIA patients in remission.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/discriminant-and-predictive-ability-of-the-parent-version-of-the-juvenile-arthritis-disease-activity-score-in-two-large-multination-cohorts-of-patients-with-juvenile-idiopathic-arthritis/