title: Preliminary definition of disease flare in juvenile rheumatoid arthritis.
abstract: OBJECTIVE
  To develop preliminary criteria for defining disease flare in patients with polyarticular-course juvenile rheumatoid arthritis (JRA).
  
  
  METHODS
  Data from a randomized clinical trial of etanercept in JRA (51 patients) and the 6 core response variables (CRV) for JRA were used to derive flare definitions. The criterion standard of flare was treatment with placebo. Candidate flare definitions were assessed by receiver-operator characteristic (ROC) curve properties and other statistics for diagnostic tests.
  
  
  RESULTS
  Of the possible flare definitions tested with acceptable statistical properties, the one that seemed to be the most useful was worsening in any 2/6 CRV by > or = 40% without improvement in more than 1 of the remaining CRV by > or = 30%. Two other superior flare definitions were (1) worsening in 3/6 CRV by > or = 30% and (2) any worsening of the Childhood Health Assessment Questionnaire, worsening of erythrocyte sedimentation rate by > or = 30% and worsening of the active joint count by > or = 10%.
  
  
  CONCLUSIONS
  CRV are useful for defining flare in JRA. Worsening in any 2/6 CRV by > or = 40% without concomitant improvement of more than one of the remaining CRV by > or = 30% appears to be the most suitable preliminary flare definition. Because the proposed flare criteria were derived from a small number of patients, it is essential to perform more definitive testing of this and several alternative flare definitions in larger patient populations.
authors.affiliation: William S. Rowe Division of Rheumatology, Cincinnati Children's Hospital Medical Center, OH 45229, USA. brus9z@chmcc.org
authors.forename: Hermine I
authors.initials: HI
authors.lastname: Brunner
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Lovell
authors.forename: Barbara K
authors.initials: BK
authors.lastname: Finck
authors.forename: Edward H
authors.initials: EH
authors.lastname: Giannini
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D001799:Blood Sedimentation; D002648:Child; D000068800:Etanercept; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D018501:Antirheumatic Agents; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept