@article {Guzman628, author = {Jaime Guzman and Andrew Henrey and Thomas Loughin and Roberta A. Berard and Natalie J. Shiff and Roman Jurencak and Adam M. Huber and Kiem Oen and Kerstin Gerhold and Brian M. Feldman and Rosie Scuccimarri and Kristin Houghton and Ga{\"e}lle Ch{\'e}deville and Kimberly Morishita and Bianca Lang and Paul Dancey and Alan M. Rosenberg and Julie Barsalou and Alessandra Bruns and Karen Watanabe Duffy and Susanne Benseler and Ciaran M. Duffy and Lori B. Tucker}, editor = {, and Bolaria, Roxana and Gross, Katherine and Turvey, Stuart E. and Cabral, David and Petty, Ross and Ellsworth, Janet and Johnson, Nicole and Miettunen, Paivi and Larch{\'e}, Maggie 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 Chetaille, Anne-Laure and Dorval, Jean and Boire, Gilles and Campillo, Sarah and LeBlanc, Claire and Haddad, Elie and Cyr, Claire St. and Ramsey, Suzanne E. and Stringer, Elizabeth}, title = {Predicting Which Children with Juvenile Idiopathic Arthritis Will Not Attain Early Remission with Conventional Treatment: Results from the ReACCh-Out Cohort}, volume = {46}, number = {6}, pages = {628--635}, year = {2019}, doi = {10.3899/jrheum.180456}, publisher = {The Journal of Rheumatology}, abstract = {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{\textendash}0.71), better than using JIA category alone (0.59, 95\% CI 0.56{\textendash}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.}, issn = {0315-162X}, URL = {https://www.jrheum.org/content/46/6/628}, eprint = {https://www.jrheum.org/content/46/6/628.full.pdf}, journal = {The Journal of Rheumatology} }