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Comparison of criteria for the classification of childhood arthritis
S E Ramsey1, R K Bolaria, D A Cabral
1Division of Pediatric Rheumatology, University of British Columbia, Vancouver, Canada.
Insights
The International League of Associations for Rheumatology (ILAR) criteria classify childhood arthritis, but 11.6% of patients remained unclassified. Family history of psoriasis impacted classification, particularly in oligoarticular arthritis.
Area of Science:
- Pediatric Rheumatology
- Clinical Classification Systems
- Childhood Arthritis
Background:
- Traditional classification criteria for childhood arthritis exist.
- The International League of Associations for Rheumatology (ILAR) proposed a new classification system.
- Evaluating the applicability of the ILAR criteria in a clinical setting is crucial.
Purpose of the Study:
- To assess the utility of the ILAR criteria in an outpatient pediatric rheumatology clinic.
- To identify children classified by traditional criteria but unclassifiable by ILAR criteria.
- To determine the proportion of unclassifiable childhood arthritis cases.
Main Methods:
- Chart review of 70 consecutive pediatric patients with arthritis lasting at least 6 months.
- Patients were classified using traditional criteria (ACR, ESSG, Vancouver) and the ILAR system.
- Comparison of classification outcomes between the two systems.
Main Results:
- The ILAR system classified 88.4% of patients.
- Eight patients (11.6%) were unclassifiable by ILAR criteria, falling into an 'other arthritis' category.
- Family history of psoriasis was a key factor for exclusions in oligoarticular and enthesitis-related arthritis categories.
- All patients with definite juvenile psoriatic arthritis (JPsA) met ILAR criteria for psoriatic arthritis (PsA).
Conclusions:
- The ILAR criteria reclassified 11.6% of children with chronic arthritis, mainly in the oligoarticular group.
- The influence of a family history of psoriasis on classification requires further investigation.
- The ILAR system demonstrates applicability but highlights areas for refinement in childhood arthritis classification.
Objective:
To evaluate the applicability of the ILAR criteria for classification of childhood arthritis in an outpatient pediatric rheumatology clinic population, and to determine the proportion of children who met standard classification criteria, but failed to meet ILAR criteria for specific arthritides, and therefore became unclassifiable.
Methods:
We reviewed the charts of 70 consecutive patients who had arthritis for at least 6 months, and attended the clinic between September and November 1997. Sixty-nine patients were categorized according to one of the traditional classifications [ACR for juvenile rheumatoid arthritis (JRA), European Spondylarthropathy Study Group (ESSG) for spondyloarthropathy, Vancouver Criteria for juvenile psoriatic arthritis (JPsA)], and the ILAR classification system.
Results:
Sixty-one patients (88.4%) were classifiable by the ILAR system; 8 others failed to fulfill ILAR criteria for any specific category, and were assigned to the "other arthritis" category. Of the 29 patients with oligoarticular onset JRA, 6 were unclassified, 5 because of exclusions, and one because he fulfilled criteria for 2 categories. Presence of a family history of psoriasis accounted for most of the exclusions in the oligoarthritis and enthesitis related arthritis categories. All patients with polyarticular onset or systemic onset JRA were classified in the corresponding category in the ILAR system. One 9-year-old patient with spondyloarthropathy was reclassified as "other arthritis" because of exclusions. All 6 children with definite JPsA met ILAR criteria for PsA. Of 4 patients with probable JPsA, only 2 met ILAR criteria for PsA, a third was classified as rheumatoid factor negative polyarthritis, and the fourth was classified as "other arthritis" because of exclusions.
Conclusion:
The ILAR classification criteria applied to a group of children with chronic arthritis classified by traditional criteria results in reassignment of 11.6% of the patients, predominantly in the oligoarticular group. It will be important to determine the role of the presence of a family history of psoriasis in classifying these patients.