Skip to main content
Article
Predicting which children with juvenile idiopathic arthritis will not attain early remission with conventional treatment: Results from the Reacch-out cohort
Journal of Rheumatology
  • Jaime Guzman, The University of British Columbia
  • Andrew Henrey, Simon Fraser University
  • Thomas Loughin, Simon Fraser University
  • Roberta A. Berard, Schulich School of Medicine & Dentistry
  • Natalie J. Shiff, University of Florida
  • Roman Jurencak, University of Ottawa
  • Adam M. Huber, Dalhousie University
  • Kiem Oen, University of Manitoba
  • Kerstin Gerhold, University of Manitoba
  • Brian M. Feldman, University of Toronto
  • Rosie Scuccimarri, Centre Universitaire de Santé McGill
  • Kristin Houghton, The University of British Columbia
  • Gaëlle Chédeville, Centre Universitaire de Santé McGill
  • Kimberly Morishita, Centre Universitaire de Santé McGill
  • Bianca Lang, Dalhousie University
  • Paul Dancey, Memorial University of Newfoundland
  • Alan M. Rosenberg, University of Saskatchewan, College of Medicine
  • Julie Barsalou, University of Montreal
  • Alessandra Bruns, Centre Hospitalier Universitaire de Sherbrooke
  • Karen Watanabe Duffy, University of Ottawa
  • Susanne Benseler, University of Calgary
  • Ciaran M. Duffy, University of Calgary
  • Lori B. Tucker, The University of British Columbia
  • Roxana Bolaria, The University of British Columbia
  • Katherine Gross, The University of British Columbia
  • Stuart E. Turvey, The University of British Columbia
  • David Cabral, The University of British Columbia
  • Ross Petty, The University of British Columbia
  • Janet Ellsworth, University of Alberta
Document Type
Article
Publication Date
6-1-2019
URL with Digital Object Identifier
10.3899/jrheum.180456
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 0.67-0.71), 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.

Citation Information
Jaime Guzman, Andrew Henrey, Thomas Loughin, Roberta A. Berard, et al.. "Predicting which children with juvenile idiopathic arthritis will not attain early remission with conventional treatment: Results from the Reacch-out cohort" Journal of Rheumatology Vol. 46 Iss. 6 (2019) p. 628 - 635
Available at: http://works.bepress.com/roberta-berard/14/