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Physician's global assessment of disease activity in juvenile idiopathic arthritis: consensus-based recommendations
Veronika Rypdal1, Hermine I Brunner2, Brian M Feldman3
1Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway; Department of Clinical Medicine, UIT the Arctic University of Norway, Tromsø, Norway.
Insights
Consensus recommendations were developed to standardize physician
Area of Science:
- Pediatric Rheumatology
- Clinical Practice Guidelines
Background:
- Juvenile idiopathic arthritis (JIA) disease activity assessment lacks standardized definitions.
- Physician's Global Assessment (PhGA) scoring requires consistent methodology.
Purpose of the Study:
- To establish consensus-based recommendations for PhGA scoring in JIA.
- To standardize the definition and assessment of disease activity in JIA.
Main Methods:
- An international task force of 34 experts was convened.
- A three-phase approach involving surveys, literature review, videoconferences, and an in-person consensus conference was employed.
- Consensus was defined as ≥78% agreement among task force members.
Main Results:
- Eighteen consensus points were agreed upon for PhGA scoring in JIA.
- Recommendations cover disease activity definitions, assessment factors for systemic and nonsystemic JIA, imaging, laboratory tests, extra-articular manifestations, treatment evaluation, and scoring timing.
- All statements achieved high consensus (≥78%) with strong agreement (≥9.2).
Conclusions:
- Consensus-based recommendations for PhGA scoring in nonsystemic and systemic JIA have been developed.
- These guidelines aim to improve the reliability of disease activity scoring in JIA patients.
Objectives:
To develop consensus-based recommendations for physician's global assessment of disease activity (PhGA) scoring and to standardise definitions of disease activity.
Methods:
An international task force of 34 members was assembled, and recommendations were developed in 3 phases: (1) 2 preliminary surveys of paediatric rheumatologists and a literature review; (2) 14 videoconference meetings, informed by multicriteria decision analysis and formal anonymous voting; and (3) a 2-day in-person consensus conference using structured nominal group technique discussions and formal voting. The threshold for achieving consensus was ≥78% of voting task force members. Agreement with the final statements was rated using a numerical rating scale from 0, strongly disagree, to 10, strongly agree.
Results:
Eighteen points to consider were agreed upon. All statements achieved consensus (≥78%), with a level of agreement ≥9.2. Points included the definition of disease activity in juvenile idiopathic arthritis (JIA), factors to assess in nonsystemic JIA and systemic JIA, consideration of available imaging and laboratory tests, the role of extra-articular manifestations, the evaluation of treatment, and the timing of PhGA scoring.
Conclusions:
The task force developed consensus-based recommendations when scoring the PhGA in nonsystemic and systemic JIA. These recommendations will lead to more reliable scoring of disease activity in patients with JIA.
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