Development and validation of a composite disease activity score for juvenile idiopathic arthritis.
OBJECTIVE
To develop and validate a composite disease activity score for juvenile idiopathic arthritis (JIA), the Juvenile Arthritis Disease Activity Score (JADAS).


METHODS
The JADAS includes 4 measures: physician global assessment of disease activity, parent/patient global assessment of well-being, active joint count, and erythrocyte sedimentation rate. These variables are part of the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30), Pedi 50, and Pedi 70 criteria for improvement. Validation analyses were conducted on >4,500 patients and included assessment of construct validity, discriminant validity, and responsiveness to change. Three versions of the JADAS were tested based on 71-joint (range 0-101), 27-joint (range 0-57), or 10-joint (range 0-40) counts. Statistical performances of the JADAS were compared with those of 2 rheumatoid arthritis composite scores, the Disease Activity Score in 28 joints (DAS28) and the Clinical Disease Activity Index (CDAI).


RESULTS
The JADAS demonstrated good construct validity, yielding strong correlations with JIA activity measures not included in the score and moderate correlations with the Childhood Health Assessment Questionnaire. Correlations obtained for the 3 JADAS versions were comparable, but superior to those yielded by the DAS28 and CDAI. The area under the curve of the JADAS predicted long-term disease outcome, measured as radiographic progression over 3 years. In 2 clinical trials, the JADAS discriminated well between ACR Pedi 30, Pedi 50, and Pedi 70 response and revealed strong responsiveness to clinical change.


CONCLUSIONS
The JADAS was found to be a valid instrument for assessment of disease activity in JIA and is potentially applicable in standard clinical care, observational studies, and clinical trials.
Consolaro
Alessandro
A
Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Genoa, and the Università degli Studi di Verona, Verona, Italy.
Ruperto
Nicolino
N
Bazso
Anna
A
Pistorio
Angela
A
Magni-Manzoni
Silvia
S
Filocamo
Giovanni
G
Malattia
Clara
C
Viola
Stefania
S
Martini
Alberto
A
Ravelli
Angelo
A
D000293:Adolescent; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology*; D001799:Blood Sedimentation; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006801:Humans; D007596:Joints / Q000503:physiopathology*; D000077239:Meloxicam; D008727:Methotrexate / Q000627:therapeutic use; D009288:Naproxen / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012720:Severity of Illness Index; D013843:Thiazines / Q000627:therapeutic use; D013844:Thiazoles / Q000627:therapeutic use; D016896:Treatment Outcome
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D013843:Thiazines; D013844:Thiazoles; D009288:Naproxen; D000077239:Meloxicam; D008727:Methotrexate