American College of Rheumatology provisional criteria for defining clinical inactive disease in select categories of juvenile idiopathic arthritis

Authors

  • Carol A. Wallace,

    Corresponding author
    1. Seattle Children's Hospital and University of Washington School of Medicine, Seattle
    • University of Washington School of Medicine, Division of Rheumatology – Pediatrics, Seattle Children's Hospital, 4800 Sand Point Way NE R-5420, Seattle, WA 98104
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  • Edward H. Giannini,

    1. Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Bin Huang,

    1. Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Lukasz Itert,

    1. Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Nicolino Ruperto,

    1. IRCCS G. Gaslini, Pediatria II Reumatologia, Paediatric Rheumatology International Trials Organisation, Genoa, Italy
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    • Dr. Ruperto has received consultant fees, speaking fees, and/or honoraria (less than $10,000 each) from Bristol-Myers Squibb and Roche.

  • Childhood Arthritis Rheumatology Research Alliance (CARRA),

  • Pediatric Rheumatology Collaborative Study Group (PRCSG),

  • Paediatric Rheumatology International Trials Organisation (PRINTO)


Abstract

Objective

To prospectively validate the preliminary criteria for clinical inactive disease (CID) in patients with select categories of juvenile idiopathic arthritis (JIA).

Methods

We used the process for development of classification and response criteria recommended by the American College of Rheumatology Quality of Care Committee. Patient-visit profiles were extracted from the phase III randomized controlled trial of infliximab in polyarticular-course JIA (i.e., patients considered to resemble those with select categories of JIA) and sent to an international group of expert physician raters. Using the physician ratings as the gold standard, the sensitivity and specificity were calculated using the preliminary criteria. Modifications to the criteria were made, and these were sent to a larger group of pediatric rheumatologists to determine quantitative, face, and content validity.

Results

Variables weighted heaviest by physicians when making their judgment were the number of joints with active arthritis, erythrocyte sedimentation rate (ESR), physician's global assessment, and duration of morning stiffness. Three modifications were made: the definition of uveitis, the definition of abnormal ESR, and the addition of morning stiffness. These changes did not alter the accuracy of the preliminary set.

Conclusion

The modified criteria, termed the “criteria for CID in select categories of JIA,” have excellent feasibility and face, content, criterion, and discriminant validity to detect CID in select categories of JIA. The small changes made to the preliminary criteria set did not alter the area under the receiver operating characteristic curve (0.954) or accuracy (91%), but have increased face and content validity.

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