RT Journal Article
SR Electronic
T1 Predicting Which Children with Juvenile Idiopathic Arthritis Will Not Attain Early Remission with Conventional Treatment: Results from the ReACCh-Out Cohort
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP 628
OP 635
DO 10.3899/jrheum.180456
VO 46
IS 6
A1 Jaime Guzman
A1 Andrew Henrey
A1 Thomas Loughin
A1 Roberta A. Berard
A1 Natalie J. Shiff
A1 Roman Jurencak
A1 Adam M. Huber
A1 Kiem Oen
A1 Kerstin Gerhold
A1 Brian M. Feldman
A1 Rosie Scuccimarri
A1 Kristin Houghton
A1 Gaëlle Chédeville
A1 Kimberly Morishita
A1 Bianca Lang
A1 Paul Dancey
A1 Alan M. Rosenberg
A1 Julie Barsalou
A1 Alessandra Bruns
A1 Karen Watanabe Duffy
A1 Susanne Benseler
A1 Ciaran M. Duffy
A1 Lori B. Tucker
YR 2019
UL http://www.jrheum.org/content/46/6/628.abstract
AB Objective. To estimate the probability of early remission with conventional treatment for each child with juvenile idiopathic arthritis (JIA). Children with a low chance of remission may be candidates for initial treatment with biologics or triple disease-modifying antirheumatic drugs (DMARD).Methods. We used data from 1074 subjects in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. The predicted outcome was clinically inactive disease for ≥ 6 months starting within 1 year of JIA diagnosis in patients who did not receive early biologic agents or triple DMARD. Models were developed in 200 random splits of 75% of the cohort and tested on the remaining 25% of subjects, calculating expected and observed frequencies of remission and c-index values.Results. Our best Cox logistic model combining 18 clinical variables a median of 2 days after diagnosis had a c-index of 0.69 (95% CI 0.67–0.71), better than using JIA category alone (0.59, 95% CI 0.56–0.63). Children in the lowest probability decile had a 20% chance of remission and 21% attained remission; children in the highest decile had a 69% chance of remission and 73% attained remission. Compared to 5% of subjects identified by JIA category alone, the model identified 14% of subjects as low chance of remission (probability < 0.25), of whom 77% failed to attain remission.Conclusion. Although the model did not meet our a priori performance threshold (c-index > 0.70), it identified 3 times more subjects with low chance of remission than did JIA category alone, and it may serve as a benchmark for assessing value added by future laboratory/imaging biomarkers.