Association Between Patient-Reported Outcomes and Treatment Failure in Juvenile Idiopathic Arthritis.
Association Between Patient-Reported Outcomes and Treatment Failure in Juvenile Idiopathic Arthritis.
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DOI：
10.1002/acr2.11444
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发表时间：
2022-09
影响因子：
3.4
通讯作者：
Harry, Onengiya
中科院分区：
文献类型：
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作者：
Taxter, Alysha;Donaldson, Brittany C;Rigdon, Joseph;Harry, Onengiya
青少年特发性关节炎（JIA）的儿童通常在诊断前几个月就出现症状。本研究的目的是评估基线患者报告的结果（PROs）是否与JIA药物治疗的变化相关，以及JIA诊断前的症状持续时间是否与疾病活动性评分相关。这是一项回顾性队列研究，研究对象是突发诊断为JIA的患者。在常规临床护理期间收集患者报告的症状持续时间、疼痛、能量、疾病活动、睡眠、焦虑和抑郁筛查，以及提供者报告的疾病活动和关节计数。Cox比例风险评估了诊断后9个月内首次用药失败的PROs、疾病活动度评分和症状持续时间。多变量混合效应线性回归评估症状持续时间与疾病活动度评分的关系。队列中有58名儿童（66%为女性，35%为少关节JIA）。近一半的患者在9个月内首次治疗失败。未经调整的分析显示，诊断时较高的能量（风险比[HR]: 0.82； 95%可信区间[CI]: 0.69‐0.99;P = 0.04）和较长的症状持续时间（HR: 0.96; 95% CI: 0.93‐0.99;P = 0.03）对药物治疗失败具有保护作用。校正分析显示，诊断前症状持续时间对药物治疗失败有保护作用（HR: 0.95; 95% CI: 0.92‐0.99;P = 0.02）；用药失败与疼痛、精神症状或疾病活动评分之间没有关联。在30天和60天，症状持续时间较长和疾病活动性较高呈正相关，但这并没有持续下去。较高的能量水平和较长的症状持续时间对初始JIA治疗失败具有保护作用。根据患者报告的数据，通过改变治疗模式，初步治疗可以获得更成功的结果。
Children with juvenile idiopathic arthritis (JIA) frequently exhibit symptoms months before diagnosis. The aims of this study were to assess whether baseline patient‐reported outcomes (PROs) are associated with changes in JIA pharmacotherapy treatment and whether symptom duration prior to JIA diagnosis is associated with disease activity scores over time. This is a retrospective cohort study of patients with an incident diagnosis of JIA. Patient‐reported symptom duration, pain, energy, disease activity, sleep, anxiety, and depression screenings, as well as provider‐reported disease activity and joint count, were collected during routine clinical care. Cox proportional hazards evaluated PROs, disease activity scores, and symptom duration with initial medication failure within 9 months of diagnosis. Multivariate mixed effects linear regression evaluated the association of symptom duration with disease activity scores. There were 58 children (66% female, 35% oligoarticular JIA) in the cohort. Nearly half of patients failed initial therapy within 9 months. Unadjusted analysis showed that higher energy (hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.69‐0.99; P = 0.04) and longer symptom duration (HR: 0.96; 95% CI: 0.93‐0.99; P = 0.03) at diagnosis were protective against medication failure. Adjusted analysis showed that symptom duration prior to diagnosis was protective against medication failure (HR: 0.95; 95% CI: 0.92‐0.99; P = 0.02); there was no association between medication failure and pain, psychiatric symptoms, or disease activity scores. There was a positive association with longer symptom duration and higher disease activity at 30 and 60 days, but this was not sustained. Higher energy levels and longer symptom duration are protective against initial JIA treatment failures. Initial treatments informed by patient‐reported data could lead to more successful outcomes by changes in treatment paradigms.