Background/Purpose: Recent treat to target recommendations for the treatment of juvenile idiopathic arthritis (JIA) recommend frequent evaluation and treatment intensification until the disease activity target (low or inactive disease) is reached. Our objective was to identify the range of disease activity states that was accepted by patients and physicians, using a lack of medication change as a proxy for a sufficiently tolerable disease activity state that did not require JIA treatment change.

Methods: We included all subjects with non-systemic JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, a clinical registry of >70 North American sites. Tolerated disease activity was determined at the registry visit following no medication change for >180 days prior to the registry visit and 60 days after the visit. Disease activity was assessed by physician global assessment (PGA) (0-10 visual analog scale (VAS), parent/patient global assessment (PtGE) (0-10 VAS), active joint count (AJC), duration of morning stiffness, clinical Juvenile Arthritis Disease Activity Score (cJADAS), American College of Rheumatology (ACR) preliminary criteria for clinical inactive disease (preCID), and the ACR provisional criteria for clinical inactive disease (provCID). Subjects could contribute more than one observation. The association of tolerated inactive or active disease and clinical characteristics were assessed by logistic regression.

Results: There were 8,244 subjects with non-systemic JIA enrolled in the CARRA Registry. No medication change for >180+60 days occurred 16,214 times in 6,235 subjects. Among eligible participants with measurement at the time of the first eligible visit, mean age was 11.7 years, most had oligoarthritis (36%) or rheumatoid factor negative (RF-) polyarthritis (35%), were female (72%), and were white (82%). A physician global score >0 occurred at 45% of tolerated disease activity visits, >1 active joints were documented at 29% of visits (Table 1), and 10% patients reported >15 minutes of morning stiffness.

Only 33% (n=6445) of visits met preCID, 29% (n=5753) met provCID, and 25% (n=4815) met cJADAS inactive disease (ID). Black race was associated with decreased likelihood of cJADAS low disease activity (LDA), preCID, and provCID, but not cJADAS ID at the time of tolerated disease activity (Table 2). Polyarticular disease and preCID at the prior visit were associated with increased likelihood of preCID and provCID at tolerated disease activity visit. Enthesitis-related arthritis and time since diagnosis were associated with decreased likelihood of cJADAS LDA and Hispanic ethnicity and PtGE were associated with decreased likelihood of both cJADAS LDA or ID at the tolerated disease activity visit.

Conclusion: In a large North American registry, patients with JIA frequently had episodes of no medication changes for >6 months. At the time of presumed tolerated disease activity, many patients with JIA had active disease by simple and composite measures. Additional studies are needed to investigate the patient characteristics associated with disease activity and to assess the outcomes following maximally tolerated disease activity states.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/identification-of-tolerated-disease-activity-level-for-individuals-with-juvenile-idiopathic-arthritis-in-the-childhood-arthritis-and-rheumatology-research-alliance-registry/