Physicians' and parents' ratings of inactive disease are frequently discordant in juvenile idiopathic arthritis.
OBJECTIVE
To investigate discrepancies between physicians' and parents' ratings of inactive disease in children with juvenile idiopathic arthritis (JIA) and the determinants of the discrepancy.


METHODS
Study data were obtained from the clinical database generated at the study unit. Each patient visit included a standardized assessment of JIA outcome measures. One visit for each patient was selected for analysis. Three definitions of inactive disease were applied to the data: a physician-based definition (physician global assessment = 0); a parent-based definition (parent global assessment = 0); and a formal definition, based on fulfillment of newly developed criteria for inactive disease in JIA.


RESULTS
Of 1237 visits made by 537 patients that included both physician and parent global assessments, 265 fulfilled the physician-based definition and/or the parent-based definition of inactive disease. Concordance between physicians and parents in rating the disease as inactive was seen in 40% of the visits, whereas in 60% of visits the 2 assessments were discordant. Parents tended to disagree with physicians in rating the disease as inactive if the child had pain or functional impairment, whereas physicians tended to disagree with parents in the presence of active joint symptoms. Only 2/3 of the 79 visits that fulfilled the formal definition of inactive disease also met the parent-based definition of inactive disease.


CONCLUSIONS
We found frequent discordance between physicians' and parents' ratings of inactive disease in children with JIA, which suggests that the parent's rating of a child's disease activity should be considered for inclusion in the definition of clinical remission for JIA.
Consolaro
Alessandro
A
Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Genova, Italy.
Vitale
Rosa
R
Pistorio
Angela
A
Lattanzi
Bianca
B
Ruperto
Nicolino
N
Malattia
Clara
C
Filocamo
Giovanni
G
Viola
Stefania
S
Martini
Alberto
A
Ravelli
Angelo
A
D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000503:physiopathology*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D004185:Disability Evaluation; D006801:Humans; D010290:Parents; D010820:Physicians; D011788:Quality of Life; D012074:Remission Induction; D015203:Reproducibility of Results; D012720:Severity of Illness Index