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Responsiveness of clinical measures in children with oligoarticular juvenile chronic arthritis
N Ruperto1, A Ravelli, D Migliavacca
1Dipartimento di Scienze Pediatriche dell'Università, IRCCS Policlinico S. Matteo, Pavia, Italy.
Insights
Physician assessments and joint counts are most responsive for tracking disease activity in children with oligoarticular juvenile chronic arthritis (JCA). Functional ability measures like the Childhood Health Assessment Questionnaire (CHAQ) show limited sensitivity to change.
Area of Science:
- Pediatric Rheumatology
- Clinical Trial Methodology
- Outcome Measurement
Background:
- Juvenile chronic arthritis (JCA) encompasses various subtypes, with oligoarticular course affecting fewer than five joints.
- Accurate assessment of treatment response in pediatric rheumatic diseases is crucial for effective management.
- Identifying sensitive outcome measures is essential for evaluating interventions in oligoarticular JCA.
Purpose of the Study:
- To compare the responsiveness of various outcome measures in children diagnosed with oligoarticular JCA.
- To determine which assessments best detect clinical changes over a 3-month period.
Main Methods:
- A cohort of 26 children with oligoarticular JCA was assessed at baseline and after 3 months.
- Outcome measures included physician and parent global assessments, Childhood Health Assessment Questionnaire (CHAQ), articular variables, and inflammatory markers.
- Responsiveness was evaluated using standardized response median, effect size, and Guyatt's method.
Main Results:
- Physician global assessment, active joint count, global articular severity, and swollen joint count were highly responsive.
- Parental global well-being, joint pain/tenderness, and limited range of motion showed moderate responsiveness.
- Childhood Health Assessment Questionnaire (CHAQ), morning stiffness, and laboratory inflammatory markers demonstrated the lowest responsiveness.
Conclusions:
- Physician's subjective assessment of disease activity and articular variables are the most responsive measures for oligoarticular JCA.
- The Childhood Health Assessment Questionnaire (CHAQ) exhibits poor sensitivity to clinical changes in this pediatric patient group.
Objective:
To compare the relative responsiveness of outcome measures in children with oligoarticular course juvenile chronic arthritis (JCA).
Methods:
Twenty-six consecutive children with JCA and < or =4 joints involved were assessed at admission and after 3 months of followup. Outcome measures included physician and parent global assessments, functional ability as measured by the Childhood Health Assessment Questionnaire (CHAQ), articular variables, and laboratory indicators of systemic inflammation. Responsiveness was calculated with the standardized response median, the effect size, and the Guyatt method.
Results:
The physician global assessment of disease activity, the active joint count, the global articular severity score, and the number and score of swollen joints proved consistently more responsive with either responsiveness measure used. The parent global assessment of the child's well being, the scores of joints with pain/tenderness and limited range of motion, and the number of joints with limited range of motion showed intermediate responsiveness. The CHAQ, morning stiffness, and laboratory indicators of systemic inflammation were the least responsive measures.
Conclusion:
The subjective estimation of disease activity by the physician and the articular variables were the more responsive outcome measures in children with oligoarticular JCA. The assessment of functional ability as measured by the CHAQ showed a poor sensitivity to clinical change in this subset of patients with JCA.
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