Remission, minimal disease activity, and acceptable symptom state in juvenile idiopathic arthritis: Defining criteria based on the juvenile arthritis disease activity score
Remission, minimal disease activity, and acceptable symptom state in juvenile idiopathic arthritis: Defining criteria based on the juvenile arthritis disease activity score
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DOI：
10.1002/art.34373
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发表时间：
2012-07-01
影响因子：
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通讯作者：
Ravelli, Angelo
中科院分区：
文献类型：
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作者：
Consolaro, Alessandro;Bracciolini, Giulia;Ravelli, Angelo
目的利用青少年关节炎疾病活动评分（JADAS）确定青少年特发性关节炎（JIA）缓解、最小疾病活动性和父母和儿童可接受症状状态的临界值。方法选取临床数据库609例JIA患儿的数据作为截断值。通过计算累积评分分布的第75百分位，并通过受试者工作特征曲线分析，根据外部标准确定最佳临界值。外部标准包括非活动性疾病和最小活动性疾病的正式定义，医生、父母和儿童对缓解的主观评价，以及父母和儿童对可接受症状状态的评价。截止点的选择基于临床和统计依据。交叉验证采用4例JIA患者样本，共1323例患者，并基于结构效度、判别效度和预测效度评估。结果在所有版本的JADAS中，将患者分类为非活动性疾病的截止得分为1分，而对低关节JIA的最小疾病活动性分类的截止得分为2分，对多关节JIA的最小疾病活动性分类的截止得分为3.8分。医生、家长和儿童对缓解的主观评分的临界值从2到2.3不等。父母可接受症状状态的临界值为3.2 - 5.4，儿童为3 - 4.5。交叉验证分析的结果强烈支持所选择的截止值。结论建立了JADAS对JIA各种疾病状态进行分类的截止值。在交叉验证分析中，它们被证明具有良好的结构效度和判别效度以及预测疾病结局的能力。
Objective To determine cutoff values for defining remission, minimal disease activity, and parent and child acceptable symptom state in juvenile idiopathic arthritis (JIA) using the Juvenile Arthritis Disease Activity Score (JADAS). Methods For the selection of cutoff values, data from a clinical database including 609 children with JIA were used. Optimal cutoff values were determined against external criteria by calculating the 75th percentile of cumulative score distribution and through receiver operating characteristic curve analysis. External criteria included formal definitions of inactive disease and minimal disease activity, subjective rating of remission by physicians, parents, and children, and rating of acceptable symptom state by parents and children. The choice of cutoffs was made based on clinical and statistical grounds. Cross-validation was performed using 4 JIA patient samples that included a total of 1,323 patients, and was based on assessment of construct, discriminant, and predictive validity. Results With all versions of the JADAS, the cutoff score for classifying a patient as having inactive disease was 1, whereas the cutoff for classification of minimal disease activity was 2 for oligoarticular JIA and 3.8 for polyarticular JIA. Cutoffs for physicians', parents', and children's subjective rating of remission ranged from 2 to 2.3. Cutoffs for acceptable symptom state ranged from 3.2 to 5.4 for parents and from 3 to 4.5 for children. Results of cross-validation analyses strongly supported the selected cutoff values. Conclusion Cutoff values for classifying various disease states in JIA using the JADAS were developed. In cross-validation analyses, they proved to have good construct and discriminant validity and ability to predict disease outcome.