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Trajectories of Physical Function in Canadian Children With Juvenile Idiopathic Arthritis
Clare Cunningham1,2, Meghan McPherson3,4, Lillian Lim5,6
1British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
Insights
Most children with juvenile idiopathic arthritis (JIA) experience functional improvements within two years, but a significant portion, about one-third, show mild persistent impairments. Early assessment of physical function is key for identifying these long-term challenges.
Area of Science:
- Pediatric Rheumatology
- Clinical Research
- Child Health Outcomes
Background:
- Juvenile idiopathic arthritis (JIA) is a chronic condition affecting children, leading to potential long-term functional limitations.
- Understanding the natural course of physical function in JIA is crucial for effective management and intervention.
Purpose of the Study:
- To describe physical function trajectories in children newly diagnosed with JIA.
- To identify specific trajectories associated with persistent functional impairments and their baseline predictors.
Main Methods:
- Latent class trajectory analysis (LCTA) was used to identify distinct patterns of physical function over time.
- Data from the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry (2017-2024) including Kids Disability Screen (KDS) scores were analyzed.
- Classification trees were employed to predict trajectories with persisting impairments.
Main Results:
- Five distinct physical function trajectories were identified in 940 children with JIA.
- The majority of patients showed improving functional scores within the first year.
- 38% of patients followed trajectories with mild persisting functional impairments, while 38% had impairments resolving within 1-2 years.
Conclusions:
- Most children with JIA experience functional recovery within 1-2 years post-diagnosis.
- A substantial minority (38%) exhibit mild persistent functional impairments, highlighting the need for ongoing monitoring.
- Baseline Kids Disability Screen scores may help predict long-term functional outcomes.
Objective:
We describe trajectories of physical function in children newly diagnosed with juvenile idiopathic arthritis (JIA) and identify trajectories with persisting functional impairments and associated baseline characteristics.
Methods:
We included patients enrolled in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry between 2017 and 2024 whose parents provided Kids Disability Screen (KDS) scores from at least two visits (from 0 = no disability to 10 = severe disability). Analyses included descriptive statistics, locally weighted scatterplot smoothing, Kaplan-Meier plots of time to KDS = 0, latent class trajectory analysis (LCTA), and classification trees to predict trajectories with persisting impairments.
Results:
We included 940 patients providing 7,351 KDS scores starting at a median 6 days after diagnosis up to 7 years. Baseline KDS scores were highest for rheumatoid factor-positive polyarthritis (mean 4.9, SD 3.1) and lowest for psoriatic arthritis (mean 2.4, SD 2.5), and mean scores improved within the first year in all JIA categories. Median time to KDS = 0 was 36 weeks (from 13 weeks for systemic arthritis to 73 weeks for undifferentiated arthritis). LCTA identified five trajectories: one with little measurable impairment (38% of patients), two with impairments resolving in one to two years (24%), and two with persisting mild impairments (38%). A baseline KDS ≥1.5 had a sensitivity of 0.79 and specificity of 0.48 to detect persisting mild impairment trajectories. There were no trajectories with persisting moderate or severe impairments.
Conclusion:
Most children with JIA in this cohort had mild to moderate functional impairments at diagnosis that resolved in one to two years, but one in three followed trajectories with mild persisting impairments.
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