title: Development and validation of a composite disease activity score for juvenile idiopathic arthritis.
abstract: 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.
authors.affiliation: Istituto di Ricovero e Cura a Carattere Scientifico G. Gaslini, Genoa, and the Università degli Studi di Verona, Verona, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Consolaro
authors.forename: Nicolino
authors.initials: N
authors.lastname: Ruperto
authors.forename: Anna
authors.initials: A
authors.lastname: Bazso
authors.forename: Angela
authors.initials: A
authors.lastname: Pistorio
authors.forename: Silvia
authors.initials: S
authors.lastname: Magni-Manzoni
authors.forename: Giovanni
authors.initials: G
authors.lastname: Filocamo
authors.forename: Clara
authors.initials: C
authors.lastname: Malattia
authors.forename: Stefania
authors.initials: S
authors.lastname: Viola
authors.forename: Alberto
authors.initials: A
authors.lastname: Martini
authors.forename: Angelo
authors.initials: A
authors.lastname: Ravelli
mesh_terms: 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
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D013843:Thiazines; D013844:Thiazoles; D009288:Naproxen; D000077239:Meloxicam; D008727:Methotrexate