Background/Purpose: Polyarticular juvenile idiopathic arthritis (pJIA) is a subtype of JIA wherein more than four joints are affected with arthritis; it is characterized by unpredictable flares and remissions. The importance of patient input and patient-reported outcomes (PROs) is increasingly recognized both in clinical care and in research, as these can provide insight into patients’ health-related quality of life and global experience of disease beyond physician-derived measures.
The objectives of this study were 1) to explore the discordance between the Patient Global Health Assessment (PtGA) scores, the Physician Global Health Assessment (PhGA) scores, and Pain scores, measured by the visual analog scale (VAS); and 2) and to explore whether the PtGA during disease remission is associated with future disease flare.
Methods: Data from an NIH funded clinical trial (NCT00792233) evaluating flare after discontinuation of anti-tumor necrosis factor (anti-TNF) in pJIA were used. PtGA, PhGA, and Pain scores were assessed at every study visit, on a 10-mm VAS (scored 0-10). Flare was defined as any active arthritis, using the ACR definition of active joint, when the active joint count had been 0 at the preceding study visit. ‘No flare’ was defined as an active joint count of 0. Descriptive statistics are reported and comparisons were computed using student’s t-test, Wilcoxon rank-sum, and chi-square tests. Spearman’s correlation coefficients were calculated to determine correlations between all global assessment scores. Multivariable logistic regression was performed modeling flare as the outcome with the change in assessment score as an independent covariate.
Results: One hundred and twenty twp patients had records of flare status, of which 63 developed flare and 59 did not; both groups were similar (Table 1). Of the 63 patients who developed flare, 42 patients had a visit immediately prior to flare. For study subjects with a visit immediately prior to flare, the PtGA score increased from 0.4 to 1.6, and pain increased from 0.4 to 1.8. The PhGA, on the other hand, increased the most of all measures, from 0 at the prior visit to 2.0 at the time of first flare indication (Table 2). Table 3 shows that for subjects with a visit immediately prior to flare, for every unit increase in PtGA scores, there was a 9% higher odds of developing flare (p=0.76), and for Pain scores, there was a 23% higher odds of developing flare (p=0.40). For every unit increase in the PhGA score, there was a substantially lower odds of developing flare (p=0.05).
Conclusion: Our results demonstrate that the PtGA and Pain scores are increased at the visit prior to flare, while the PhGA scores are not. Further, the PtGA and Pain score have some predictive value for flare, while the PhGA does not. These findings highlight the value of patient input in medical care and decision-making, and support the development and use of more sophisticated PROs in the care of patients with JIA.
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