Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: A considerable proportion of children with polyarticular juvenile idiopathic arthritis (polyJIA) continue to experience active disease into adulthood. There is no validated disease activity measure for these adults; when children transfer to adult services they are often reclassified as having rheumatoid arthritis (RA) and assessed using the Disease Activity Score 28 (DAS28). DAS28 is validated in adults with RA to assess disease severity and in the UK a score of >5.1 defines qualification for biological drugs. However, in contrast to the Juvenile Arthritis Disease Activity Score (JADAS), the DAS28 does not include joints that are frequently affected in polyJIA. In this study, we compared the DAS28 with JADAS-10 and questioned whether DAS28 is appropriate to use in adults with polyJIA.
Methods: Tender and swollen joint counts out of 28, active joint count of all joints up to a maximum of 10, patient/parent global assessment and physician global assessment visual analogue scales were collected prospectively from paediatric, adolescent and young adult rheumatology clinics in patients aged 10 and above with polyJIA (classified by International League of Associations for Rheumatology). Erythrocyte sedimentation rate (ESR) values were taken within 30 days before or after the assessment (when unavailable, values were taken within 3 months before or after, providing the patient remained stable between the ESR test and assessment). When unavailable within these time periods, patients were excluded from analysis. DAS28 and JADAS-10 were calculated and compared using Spearman’s rank correlation coefficient. A DAS28 of >5.1 constitutes high disease activity in adults with RA while a JADAS-10 of >10.5 is considered to reflect high disease activity in children with polyJIA.
Results: Forty-nine patients were analysed (range 10-27 years, median 15 years, M:F ratio 1:3.5). Thirteen out of 49 patients were classified as high disease activity by JADAS-10, while only 1 out of 49 was defined as high disease activity by DAS28. Good correlation was seen between DAS28 and JADAS-10 (Spearman r=0.6939, p<0.0001) with no considerable difference between children (range 10-15 years, median 13 years, n=25, Spearman r=0.8269, p<0.0001) and adults (range 16-27 years, median 17 years, n=24, Spearman r=0.7345, p<0.0001).
Conclusion: Discrepancy in high disease activity thresholds between DAS28 and JADAS may have implications when determining which patients qualify for biological drugs, although the absolute values correlate well. Hence the JADAS may remain the more appropriate disease activity marker to use in adults with polyJIA.
To cite this abstract in AMA style:Wu Q, Ambrose N, Sen D, Leandro MJ, Wing C, Daly N, Webb K, Fisher C, Suffield L, Josephs F, Pilkington C, Eleftheriou D, Al-Obaidi M, Compeyrot-Lacassagne S, Wedderburn LR, Ioannou Y. The Juvenile Arthritis Disease Activity Score Remains the Disease Activity Marker of Choice for Adults with Polyarticular Juvenile Idiopathic Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/the-juvenile-arthritis-disease-activity-score-remains-the-disease-activity-marker-of-choice-for-adults-with-polyarticular-juvenile-idiopathic-arthritis/. Accessed September 22, 2019.
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