@article {Guzman230, author = {Jaime Guzman and Andrew Henrey and Thomas Loughin and Roberta A. Berard and Natalie J. Shiff and Roman Jurencak and Susanne M. Benseler and Lori B. Tucker}, editor = {Bolaria, Roxana and Gross, Katherine and Turvey, Stuart E. and Cabral, David and Houghton, Kristin and Morishita, Kimberly and Petty, Ross and Ellsworth, Janet and Johnson, Nicole and Miettunen, Paivi and Schmeling, Heinrike and Rosenberg, Alan M. and Oen, Kiem and Larch{\'e}, Maggie and Feldman, Brian M. and Levy, Deborah M. and Laxer, Ronald M. and Feldman, Debbie and Spiegel, Lynn and Schneider, Rayfel and Tse, Shirley M.L. and Silverman, Earl and Cameron, Bonnie and Yeung, Rae S.M. and Roth, Johannes and Gibbon, Michele and Duffy, Karen Watanabe and Duffy, Ciar{\'a}n M. and Chetaille, Anne-Laure and Dorval, Jean and Boire, Gilles and Bruns, Alessandra and Scuccimarri, Rosie and Campillo, Sarah and Ch{\'e}deville, Ga{\"e}lle and LeBlanc, Claire and Haddad, Elie and St. Cyr, Claire and Lang, Bianca and Ramsey, Suzanne E. and Stringer, Elizabeth and Huber, Adam M. and Dancey, Paul}, title = {Predicting Which Children with Juvenile Idiopathic Arthritis Will Have a Severe Disease Course: Results from the ReACCh-Out Cohort}, volume = {44}, number = {2}, pages = {230--240}, year = {2017}, doi = {10.3899/jrheum.160197}, publisher = {The Journal of Rheumatology}, abstract = {Objective. We studied an inception cohort of children with juvenile idiopathic arthritis (JIA) to (1) identify distinct disease courses based on changes over 5 years in 5 variables prioritized by patients, parents, and clinicians; and (2) estimate the probability of a severe disease course for each child at diagnosis.Methods. Assessments of quality of life, pain, medication requirements, patient-reported side effects, and active joint counts were scheduled at 0, 6, 12, 18, 24, 36, 48, and 60 months. Patients who attended at least 6 assessments were included. Multivariable cluster analysis, r2, and silhouette statistics were used to identify distinct disease courses. One hundred candidate prediction models were developed in random samples of 75\% of the cohort; their reliability and accuracy were tested in the 25\% not used in their development.Results. Four distinct courses were identified in 609 subjects. They differed in prioritized variables, disability scores, and probabilities of attaining inactive disease and remission. We named them Mild (43.8\% of children), Moderate (35.6\%), Severe Controlled (9\%), and Severe Persisting (11.5\%). A logistic regression model using JIA category, active joint count, and pattern of joint involvement at enrollment best predicted a severe disease course (Controlled + Persisting, c-index = 0.87); 91\% of children in the highest decile of risk actually experienced a severe disease course, compared to 5\% of those in the lowest decile.Conclusion. Children in this JIA cohort followed 1 of 4 disease courses and the probability of a severe disease course could be estimated with information available at diagnosis.}, issn = {0315-162X}, URL = {https://www.jrheum.org/content/44/2/230}, eprint = {https://www.jrheum.org/content/44/2/230.full.pdf}, journal = {The Journal of Rheumatology} }