Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register Long‐Term Safety, Efficacy, and Quality of Life in Patients With Juvenile Idiopathic Arthritis Treated With Intravenous Abatacept for Up to Seven Years Health-Related Quality of Life, Physical Function, Fatigue, and Disease Activity in Children with Established Polyarticular Juvenile Idiopathic Arthritis Abatacept improves health‐related quality of life, pain, sleep quality, and daily participation in subjects with juvenile idiopathic arthritis Factors affecting the efficacy of intraarticular corticosteroid injection of knees in juvenile idiopathic arthritis. Pilot study of fitness training and exercise testing in polyarticular childhood arthritis. Methotrexate improves the health-related quality of life of children with juvenile idiopathic arthritis. Preliminary validation of clinical remission criteria using the OMERACT filter for select categories of juvenile idiopathic arthritis. Incidence and Prevalence of Juvenile Idiopathic Arthritis Among Children in a Managed Care Population, 1996–2009 A prospective study comparing infection risk and disease activity in children with juvenile idiopathic arthritis treated with and without tumor necrosis factor-alpha inhibitors Comparison of intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligoarticular juvenile idiopathic arthritis. Aquatic fitness training for children with juvenile idiopathic arthritis.
Background Treatment of  juvenile idiopathic arthritis ( JIA ) has changed dramatically since the introduction of biological agents in 1999 . Objective To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA . Methods The Arthritis and Biologics in Children register ( multicentre prospect i ve observational study ) aim ed to include all consecutive patients with JIA in the Netherl and s who had started biological agents since 1999 . Patients were divided according to year of introduction of first biological agent . Patient characteristics at introduction of the first biological agent and its effectiveness were analysed over 12 years . Results 335 patients with non-systemic JIA and 86 patients with systemic JIA started a biological agent between 1999 and 2010 . Etanercept remained the most often prescribed biological agent for non-systemic JIA ; anakinra became first choice for systemic JIA . The use of systemic glucocorticoids and synthetic disease-modifying antirheumatic drugs before biological agents decreased . During these 12 years of observation , biological agents were prescribed earlier in the disease course and to patients with lower baseline JADAS ( Juvenile Arthritis Disease Activity Score ) disease activity . All baseline disease activity parameters were lowered in patients with non-systemic JIA . In systemic JIA , prescription patterns changed towards very early introduction of biological agents ( median 0.4 years of disease duration ) in patients with a low number of joints with active arthritis and high erythrocyte sedimentation rates . These changes for both systemic and non-systemic JIA result ed in more patients with inactive disease after 3 and 15 months of treatment . Conclusions Biological agents are increasingly prescribed , earlier in the disease and in patients with JIA with lower disease activity . These changes are accompanied by better short-term disease outcomes The efficacy and safety of abatacept in patients with juvenile idiopathic arthritis ( JIA ) who experienced an inadequate response to disease‐modifying antirheumatic drugs were previously established in a phase III study that included a 4‐month open‐label lead‐in period , a 6‐month double‐blind withdrawal period , and a long‐term extension ( LTE ) phase . The aim of this study was to present the safety , efficacy , and patient‐reported outcomes  of abatacept treatment ( 10 mg/kg every 4 weeks ) during the LTE phase , for up to 7 years of followup Objective . To compare child  self-report and parent/proxy report of health-related quality of life ( HRQOL ) , disability , and fatigue in children with active polyarticular juvenile idiopathic arthritis ( JIA ) to that of children with inactive polyarticular JIA and to previous data from healthy controls . Methods . Cross-sectional survey of children with polyarticular JIA diagnosed and treated between 2000 to 2006 and their parent/proxy . The Childhood Health Assessment Question naire , Pediatric Quality of Life Inventory ( PedsQL ) Generic Core Scales , PedsQL Rheumatology Module , and PedsQL Multidimensional Fatigue Scale were administered . Disease activity data were collected from the physician clinic notes . Comparisons were performed with t tests . Correlations between patient and parent/proxy reports were measured with Pearson correlation coefficients . Results . Sixty children and /or their parents/proxies participated ( 79 % response rate ) . Disease activity status was available for 52 , and 32 met criteria for inactive disease ( 62 % ) . Participants reported lower scores on the PedsQL Generic Core Scales ( range 2.54–9.13 points lower ) and the PedsQL Rheumatology Module ( range 2.46–6.96 points lower ) than those with inactive disease . Participants also reported lower scores on the PedsQL Multidimensional Fatigue Scale than did healthy controls , regardless of disease activity status ( range 0.06–9.2 points lower ) . Conclusion . Although children in this cohort with polyarticular JIA and inactive disease reported HRQOL scores similar to those of healthy controls , children with polyarticular JIA and their parents/proxies tended to report more fatigue than controls , regardless of disease activity . Application of these measures prospect ively to larger cohorts of children with JIA is needed to assess these differences To assess health‐related quality of life ( HRQOL ) in abatacept‐treated children/adolescents with juvenile idiopathic arthritis ( JIA ) OBJECTIVE To determine in a prospect i ve analysis whether baseline demographic , clinical , and laboratory variables predict the outcome of intraarticular corticosteroid ( IAC ) injection of the knees in children with juvenile idiopathic arthritis ( JIA ) . METHODS We studied consecutive patients who met the criteria for the diagnosis of JIA and received their initial injection of triamcinolone hexacetonide in one or both knees .  Predictor variables included sex , age , age at onset of JIA , onset subtype , disease duration , drug therapy at the time of IAC injection , physician and parent global assessment of disease status , Childhood Health Assessment Question naire disability index , erythrocyte sedimentation rate ( ESR ) , C-reactive protein , involvement of other joints besides knees , amount of fluid aspirated , and dose of IAC injected . The primary outcome measure was persistence of complete clinical response at 6 months , i.e. , no evidence of synovitis clinical ly . RESULTS Ninety-four patients were available for analysis . At 6 months after the IAC injection , 65 ( 69 % ) patients showed a sustained complete clinical response , whereas 29 ( 31 % ) had had a recurrence of joint inflammation . Univariate statistical analyses showed that patients who had a sustained clinical response had a significantly higher ESR than those who did not ( p = 0.023 ) . The ESR was the only variable that remained in the best-fit model from multivariate logistic regression analysis ( OR 2.61 , p = 0.049 ) . CONCLUSION Our findings indicate that patients with JIA who have a higher ESR are more likely to benefit from IAC injection of the knees OBJECTIVE To 1 ) assess the safety and feasibility of laboratory-based exercise testing in juvenile idiopathic arthritis ( JIA ) , 2 ) test the safety and feasibility of a 3-month exercise program in JIA , 3 ) assess pain during exercise in JIA , 4 ) compare ratings of perceived effort ( RPE ) with heart rate ( HR ) achieved , and 5 ) estimate the training effect on metabolic efficiency of gait as measured by submaximal exercise testing . METHODS Nine children with JIA were enrolled in a 12-week circuit training program involving pool , stationary bicycle , treadmill , and Fitball . They underwent formal exercise testing before and after the program , underwent a full joint assessment , were administered the Childhood Health Assessment Question naire and Juvenile Arthritis Functional Status Index , and were assessed for overall quality of life and health-related quality of life . A visual analog scale was used to assess pain during testing and training , and the Borg scale was used to measure RPE . RESULTS Children with JIA were able to participate in exercise testing without any significant problems . Children with severe hip disease dropped out of the exercise program due to  pain  during the exercise sessions and worsened arthritis symptoms . Target HR was achieved and correlated with RPE in the bicycle and treadmill sessions . Submaximal exercise testing showed an improvement with a small to moderate effect size . CONCLUSION This study suggests that it is safe , feasible , and acceptable for children with arthritis , in the absence of severe hip involvement , to participate in formal exercise testing and structured fitness programs OBJECTIVES To examine the change in health-related quality of life ( HRQOL ) and its determinants in children with juvenile idiopathic arthritis ( JIA ) treated with methotrexate ( MTX ) .  METHODS Patients were extracted from the PRINTO clinical trial which aim ed to evaluate the efficacy and safety profile of MTX administered in st and ard , intermediate or higher doses ( 10 , 15 and 30 mg/m(2)/week respectively ) . Children with polyarticular-course JIA , who were less than 18 years and had a complete HRQOL assessment were included . RESULTS A total of 521 children were included . At baseline , patients with JIA showed poorer HRQOL ( p<0.01 ) than healthy children . In 207/412 ( 50 % ) and 63 ( 15 % ) children , HRQOL values were 2 st and ard deviations below the mean of healthy controls in the physical and psychosocial summary scale , respectively . After 6 months of treatment with st and ard dose MTX , there was a statistically significant improvement in all HRQOL health concepts , particularly the physical ones . Similar improvements were observed in those who did not respond to a st and ard dose of MTX and were subsequently r and omised to a higher dose . The presence of marked disability at baseline was associated with a fivefold increased risk of retaining poor physical health after 6 months of active treatment with st and ard dose MTX . Other less important determinants of retaining poor physical well-being were the baseline level of systemic inflammation , pain intensity and an antinuclear-antibody-negative status . CONCLUSIONS MTX treatment produces a significant improvement across a wide range of HRQOL components , particularly in the physical domains , in patients with JIA OBJECTIVE To begin the validation process of the preliminary criteria for inactive disease ( ID ) , clinical remission on medication ( CRM ) , and clinical remission off medication ( CR ) in children with select forms of juvenile idiopathic arthritis ( JIA ) . METHODS We used the OMERACT filter paradigm to estimate the validity of the criteria within each of the filter 's 3 components : truth , discrimination , and feasibility , in 5 categories of JIA : systemic arthritis , persistent and extended oligoarthritis , and rheumatoid factor-positive and negative polyarthritis . Data sources for determining validity estimates included a Delphi question naire survey sent to 246 pediatric rheumatologists in 34 countries , a consensus conference attended by 20 senior pediatric rheumatologists representing 9 countries , a retrospective chart review of 437 patients with JIA from 3 tertiary care clinics who had been followed between 4 and 22 years , and the literature . RESULTS Truth component : face and content validity . These aspects of validity were largely established via the Delphi question naire exercise and the consensus conference . Using an 80 % consensus level , participants felt that a set of non-redundant variables could effectively differentiate the clinical states of ID , CRM , and CR . Criterion validity could not be irrefutably established because no gold st and ard for inactive disease exists for JIA . As an alternative , published investigations of remission in JIA were used to estimate concurrent and convergent validity , as surrogates for criterion validity and as indicators of overall construct validity . Correlational analyses revealed the new criteria to have good construct validity . Discrimination component : the criteria demonstrated moderate to high levels of classification , prognosis , and responsiveness ( sensitivity to change ) using data from the chart review . Patients who were able to attain CR remained disease-free for substantially longer periods than did those who attained only ID or CRM . Responsiveness was evidence d by the ability of the criteria to allow movement of most patients between the disease states , consistent with what is known of the course of the disease . Feasibility component : Results of the Delphi and consensus conference produced a set of criteria that are easily , quickly , and inexpensively completed in the physician 's office , and present minimal or no risk to the patient . CONCLUSION The preliminary criteria demonstrated moderate to excellent validity characteristics in some , but not all components of the OMERACT filter . Prospect i ve validation studies are under way Objective . Few studies based in well-defined North American population s have examined the occurrence of juvenile idiopathic arthritis ( JIA ) , and none has been based in an ethnically diverse population . We used computerized healthcare information from the Kaiser Permanente Northern California membership to vali date JIA diagnoses and estimate the incidence and prevalence of the disease in this well-characterized population . Methods . We identified children aged ≤ 15 years with ≥ 1 relevant International Classification of Diseases , 9th edition , diagnosis code of 696.0 , 714 , or 720 in computerized clinical encounter data during 1996–2009 . In a r and om sample , we then review ed the medical records to confirm the diagnosis and diagnosis date and to identify the best-performing case-finding algorithms . Finally , we used the case-finding algorithms to estimate the incidence rate and point prevalence of JIA . Results . A diagnosis of JIA was confirmed in 69 % of individuals with at least 1 relevant code . Forty-five percent were newly diagnosed during the study period . The age- and sex-st and ardized incidence rate of JIA per 100,000 person-years was 11.9 ( 95 % CI 10.9–12.9 ) . It was 16.4 ( 95 % CI 14.6–18.1 ) in girls and 7.7 ( 95 % CI 6.5–8.9 ) in boys . The peak incidence rate occurred in children aged 11–15 years . The prevalence of JIA per 100,000 persons was 44.7 ( 95 % CI 39.1–50.2 ) on December 31 , 2009 . Conclusion . The incidence rate of JIA observed in the Kaiser Permanente population , 1996–2009 , was similar to that reported in Rochester , Minnesota , USA , but 2 to 3 times higher than Canadian estimates Tumor necrosis factor-alpha ( TNF-α ) inhibitors are effective treatment for juvenile idiopathic arthritis ( JIA ) but may increase infection rates . However , active JIA may also render patients vulnerable to infection . In this study , we prospect ively assessed infection rates in JIA patients treated with and without TNF-α inhibitors  and correlated disease activity with infection risk .  TNF-α inhibitor-naïve JIA subjects were followed up for 12 months . Subjects initiated on TNF-α inhibitors after enrollment were analyzed in the TNF group . Subjects treated without TNF-α inhibitors were analyzed in the non-TNF group . Question naires captured mild or severe infections . JIA disease activity by Childhood Health Assessment Question naire ( CHAQ ) disability index/pain score and physician joint count/global assessment was recorded . Twenty TNF and 36 non-TNF subjects were analyzed .  The total infection rate ratio for TNF versus non-TNF group subjects was 1.14 ( 95 % CI , 0.78–1.66 ; p = 0.51 ) . The average rate of infections per month was 0.29 for TNF and 0.24 for non-TNF subjects . No severe infections or hospitalizations occurred in either group . Secondary infectious outcomes were also similar between groups . Controlling for study group , an increase in CHAQ pain score correlated with an increase in several infectious outcome measures . Our results suggest no difference in infection rates between JIA subjects treated with and without TNF-α inhibitors . Additionally , JIA disease activity may have contributed to infection risk in our cohort , irrespective of immunosuppressive therapy . Future analysis of the relationship between treatment regimens , disease activity , and infection rates may help to further delineate predictors of infection risk in JIA patients OBJECTIVE To compare the efficacy and safety of intra-articular triamcinolone hexacetonide ( TH ) and triamcinolone acetonide ( TA ) in children with oligoarticular juvenile idiopathic arthritis ( JIA ) . METHODS One hundred and thirty joints of 85 patients undergoing intra-articular injections were r and omly treated with either TH or TA depending on the availability of the drug . The efficacy of both treatments was evaluated prospect ively in a blinded fashion . A good response was defined as a decrease in the articular score of > or = 60 % from baseline . Clinical , laboratory and immunological variables were noted in order to examine possible factors , other than treatment , predictive of the result . RESULTS Seventy injections were performed using TH and 60 with TA . The two groups were comparable for clinical , immunological and laboratory characteristics . The rate of response was significantly higher with TH than with TA : 81.4 % vs 53.3 % ( P = 0.001 ) at 6 months , 67.1 vs 43.3 % ( P = 0.006 ) at 12 months , and 60 vs 33.3 % ( P = 0.002 ) at 24 months . CONCLUSION At comparable doses TH appeared to be much more effective than TA for intra-articular use , in both short- and long-term follow-up . This result was not affected by disease duration or degree of local and systemic inflammation OBJECTIVE To evaluate the effects of an aquatic training programme for JIA patients . METHODS Fifty-four patients with JIA ( age range 5 to 13 yr ) participated in this study and were r and omized into an experimental ( n = 27 ) and a control ( n = 27 ) group . The children in the experimental group received a training programme consisting of a 1 h per week supervised training programme in a local pool of approximately 20 sessions . Effects were analysed on the following domains : functional ability , health-related quality of life , joint status and physical fitness . RESULTS Although all measures improved more in the experimental group than the control group , none of the differences was statistically significant . CONCLUSIONS The current research found no significant effect of an aquatic fitness training programme in children with JIA . Since there were no signs of worsening in health status , one can conclude that this was a safe exercise programme
The  Childhood Health Assessment Question naire ( C-HAQ )  was the most extensively studied instrument and had high reliability , but only moderate correlations with other indices of disease activity and poor responsiveness to change in disease status .
The physician global assessment of disease activity ( PGA ) and articular indices had the strongest association with disease activity and were the most responsive to change .
Measures of psychosocial function and quality of life were moderately associated with measures of disease activity , but were less responsive to changes in disease status .
In children with JIA , no single instrument was superior in reliability or validity or in describing the impact of JIA .
Although the C-HAQ has been extensively evaluated , the PGA and articular indices appear to have the highest responsiveness to change and , therefore , the highest potential for detecting important differences in treatment response
OBJECTIVE To review the performance characteristics of the instruments most commonly used to measure clinical outcomes in juvenile idiopathic arthritis ( JIA ) , including global assessment s , articular indices , functional/disability assessment s , and quality of life measures .
METHODS As part of an Agency for Healthcare Research and Quality comparative effectiveness review of antirheumatic drugs , we explored the characteristics of commonly used outcome measures for JIA .