Affordable Access

deepdyve-link
Publisher Website

Predicting Which Children with Juvenile Idiopathic Arthritis Will Not Attain Early Remission with Conventional Treatment: Results from the ReACCh-Out Cohort.

Authors
  • Guzman, Jaime1, 2, 3
  • Henrey, Andrew4, 5, 6
  • Loughin, Thomas4, 5, 6
  • Berard, Roberta A4, 5, 6
  • Shiff, Natalie J4, 5, 6
  • Jurencak, Roman4, 5, 6
  • Huber, Adam M4, 5, 6
  • Oen, Kiem4, 5, 6
  • Gerhold, Kerstin4, 5, 6
  • Feldman, Brian M4, 5, 6
  • Scuccimarri, Rosie4, 5, 6
  • Houghton, Kristin4, 5, 6
  • Chédeville, Gaëlle4, 5, 6
  • Morishita, Kimberly4, 5, 6
  • Lang, Bianca4, 5, 6
  • Dancey, Paul4, 5, 6
  • Rosenberg, Alan M4, 5, 6
  • Barsalou, Julie4, 5, 6
  • Bruns, Alessandra4, 5, 6
  • Watanabe Duffy, Karen4, 5, 6
  • And 3 more
  • 1 From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA. [email protected] , (Canada)
  • 2 The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada. [email protected] , (Canada)
  • 3 J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia. [email protected]
  • 4 From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA. , (Canada)
  • 5 The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada. , (Canada)
  • 6 J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia.
Type
Published Article
Journal
The Journal of rheumatology
Publication Date
Jun 01, 2019
Volume
46
Issue
6
Pages
628–635
Identifiers
DOI: 10.3899/jrheum.180456
PMID: 30647178
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

To estimate the probability of early remission with conventional treatment for each child with juvenile idiopathic arthritis (JIA). Children with a low chance of remission may be candidates for initial treatment with biologics or triple disease-modifying antirheumatic drugs (DMARD). We used data from 1074 subjects in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. The predicted outcome was clinically inactive disease for ≥ 6 months starting within 1 year of JIA diagnosis in patients who did not receive early biologic agents or triple DMARD. Models were developed in 200 random splits of 75% of the cohort and tested on the remaining 25% of subjects, calculating expected and observed frequencies of remission and c-index values. Our best Cox logistic model combining 18 clinical variables a median of 2 days after diagnosis had a c-index of 0.69 (95% CI 0.67-0.71), better than using JIA category alone (0.59, 95% CI 0.56-0.63). Children in the lowest probability decile had a 20% chance of remission and 21% attained remission; children in the highest decile had a 69% chance of remission and 73% attained remission. Compared to 5% of subjects identified by JIA category alone, the model identified 14% of subjects as low chance of remission (probability < 0.25), of whom 77% failed to attain remission. Although the model did not meet our a priori performance threshold (c-index > 0.70), it identified 3 times more subjects with low chance of remission than did JIA category alone, and it may serve as a benchmark for assessing value added by future laboratory/imaging biomarkers.

Report this publication

Statistics

Seen <100 times