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Abstract Number: 277

Nearly 20% of Children ARE NOT Correctly Classified According to Current ILAR Classification in a Printo Dataset of More THAN 12,000 Juvenile Idiopathic Arthritis Patients

Alessandro Consolaro1, Francesca Bovis2, Ekaterina Alekseeva3, Violeta Vladislava Panaviene3, Jordi Anton3, Susan Nielsen3, Gordana Susic3, Maria Trachana4, Troels Herlin5, Nico Wulffraat3, Pavla Dolezalova3, Yosef Uziel6, Nahid Shafaie3, Ingrida Rumba-Rozenfelde3, Valda Stanevicha3, Nicolino Ruperto7, Daniel Lovell8, Angelo Ravelli9 and Alberto Martini10, 1Pediatria II, Istituto Giannina Gaslini, Genova, Italy, 2Pediatria II, PRINTO, PRINTO - Istituto Giannina Gaslini, Genoa, Italy, 3Istituto Giannina Gaslini, Genoa, Italy, 4Aristotle University, Thessaloniki, Greece, 5Aarhus, Genoa, Italy, 6Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, Israel, 7Pediatria II,, Istituto Giannina Gaslini, Genoa, Italy, 8PRCSG, Cincinnati, OH, 9Istituto Gaslini-PRINTO, Genova, Italy, 10Istituto Giannina Gaslini, Genova, Italy

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Classification criteria and juvenile idiopathic arthritis (JIA)

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Session Information

Session Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Juvenile Idiopathic Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose Juvenile idiopathic arthritis (JIA) is an exclusion diagnosis that encompasses all forms of arthritis that begin before the age of 16 years, persist for more than 6 weeks, and are of unknown origin. In the ILAR classification, this heterogeneous group of chronic arthritides has been categorized on clinical and laboratory grounds to try to identify homogeneous, mutually exclusive categories suitable for etiopathogenic studies. However, the ILAR classification is complex and includes several inclusion and exclusion criteria. As a result, the correct placement of a patient in a specific category is not simple.

Methods Patients enrolled in the multinational study of the EPidemiology, treatment and Outcome of Childhood Arthritis (EPOCA study) and in the Pharmacovigilance in patients treated with biologics± methotrexate study (Pharmachild) were merged in a single database, after exclusion of overlapping patients. The reasons that led to a “provisional” ILAR classification (i.e. lack of fitting into an ILAR category despite ILAR category attribution by the attending physician) in the two datasets and the queries regarding classification raised to the investigators by the PRINTO staff were analyzed and grouped into major categories according to the inclusion or exclusion criterion involved.

Results A total of 12,141 patients were included in the study. The Table shows, for each JIA subtype, the most frequent drawbacks leading to a provisional classification. Most problems were related to the lack of 2 determinations of rheumatoid factor (RF) at least 3 months apart, the missing data in the indication of the presence or absence of psoriasis in the patient or in the presence or absence of a history of psoriasis in a first degree relative, the lack of assessment of HLA-B27 antigen, or the discrepancies in data results in the indication of a family history of spondyloarthropathies.

 

N

Provisional diagnosis

N (%)

Reasons for provisional diagnosis

N (%)

Rheumatoid factor

Psoriasis

Spondylitis features

HLA-B27

Systemic arthritis

1365

295 (21.6)

219 (74.2)

83 (28.1)

67 (22.7)

34 (11.5)

Oligoarthritis

4887

1127 (23.1)

837 (74.3)

353 (31.3)

314 (27.9)

144 (12.8)

Polyarthritis RF-negative

2991

379 (12.7)

273 (72)

183 (48.3)

157 (41.4)

69 (18.2)

Polyarthritis RF-positive

492

277 (56.3)

266 (96)

33 (11.9)

28 (10.1)

10 (3.6)

Psoriatic arthritis

433

101 (23.3)

63 (62.4)

22 (21.8)

23 (22.8)

7 (6.9)

Enthesitis related arthritis

1323

217 (16.4)

118 (54.4)

90 (41.5)

–

–

Total

12141

2396 (19.7)

1776 (74.1)

764 (31.9)

589 (24.6)

264 (11)

Conclusion In current clinical practice nearly 20% of JIA patient were categorized according to physician diagnosis attribution despite the lack of fulfillment of the ILAR exclusion criteria. Most frequently, this was related to the lack of assessment of RF or the inconsistency in indication of the presence of psoriasis in a first-degree relative.


Disclosure:

A. Consolaro,
None;

F. Bovis,
None;

E. Alekseeva,

Roche Pharmaceuticals,

2,

Abbott Laboratories,

2,

Pfizer Inc,

2,

Bristol-Myers Squibb,

2,

Centocor, Inc.,

2,

Novartis Pharmaceutical Corporation,

2,

Merck Sharp & Dohme,

8,

Medac,

8;

V. V. Panaviene,

abbvie,

8,

Pfizer Inc,

2;

J. Anton,
None;

S. Nielsen,
None;

G. Susic,
None;

M. Trachana,
None;

T. Herlin,
None;

N. Wulffraat,
None;

P. Dolezalova,
None;

Y. Uziel,
None;

N. Shafaie,
None;

I. Rumba-Rozenfelde,
None;

V. Stanevicha,
None;

N. Ruperto,
None;

D. Lovell,
None;

A. Ravelli,
None;

A. Martini,
None.

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