title: Predicting Which Children with Juvenile Idiopathic Arthritis Will Have a Severe Disease Course: Results from the ReACCh-Out Cohort.
abstract: We studied an inception cohort of children with juvenile idiopathic arthritis (JIA) to (1) identify distinct disease courses based on changes over 5 years in 5 variables prioritized by patients, parents, and clinicians; and (2) estimate the probability of a severe disease course for each child at diagnosis.
  
  
  
  Assessments of quality of life, pain, medication requirements, patient-reported side effects, and active joint counts were scheduled at 0, 6, 12, 18, 24, 36, 48, and 60 months. Patients who attended at least 6 assessments were included. Multivariable cluster analysis, r2, and silhouette statistics were used to identify distinct disease courses. One hundred candidate prediction models were developed in random samples of 75% of the cohort; their reliability and accuracy were tested in the 25% not used in their development.
  
  
  
  Four distinct courses were identified in 609 subjects. They differed in prioritized variables, disability scores, and probabilities of attaining inactive disease and remission. We named them Mild (43.8% of children), Moderate (35.6%), Severe Controlled (9%), and Severe Persisting (11.5%). A logistic regression model using JIA category, active joint count, and pattern of joint involvement at enrollment best predicted a severe disease course (Controlled + Persisting, c-index = 0.87); 91% of children in the highest decile of risk actually experienced a severe disease course, compared to 5% of those in the lowest decile.
  
  
  
  Children in this JIA cohort followed 1 of 4 disease courses and the probability of a severe disease course could be estimated with information available at diagnosis.
authors.affiliation: From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA. jguzman@cw.bc.ca.|J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia. jguzman@cw.bc.ca.
authors.forename: Jaime
authors.initials: J
authors.lastname: Guzman
authors.affiliation: From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.|J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Henrey
authors.affiliation: From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.|J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Loughin
authors.affiliation: From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.|J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia.
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Berard
authors.affiliation: From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.|J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia.
authors.forename: Natalie J
authors.initials: NJ
authors.lastname: Shiff
authors.affiliation: From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.|J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia.
authors.forename: Roman
authors.initials: R
authors.lastname: Jurencak
authors.affiliation: From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; the Alberta Children's Hospital and University of Calgary, Calgary, Alberta; London Health Sciences Centre and Western University, London; the Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; the Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.|J. Guzman, MD, MSc, British Columbia Children's Hospital and the University of British Columbia; A. Henrey, PhD, Simon Fraser University; T. Loughin, PhD, Professor, Simon Fraser University; R.A. Berard, MD, MSc, London Health Sciences Centre and Western University; N.J. Shiff, MD, MSc, Shands Children's Hospital and University of Florida; R. Jurencak, MD, Children's Hospital of Eastern Ontario and University of Ottawa; S.M. Benseler, MD, PhD, Alberta Children's Hospital and University of Calgary; L.B. Tucker, MD, British Columbia Children's Hospital and the University of British Columbia.
authors.forename: Susanne M
authors.initials: SM
authors.lastname: Benseler
authors.forename: Lori B
authors.initials: LB
authors.lastname: Tucker
mesh_terms: D000293:Adolescent; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000188:drug therapy; D002648:Child; D002675:Child, Preschool; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011788:Quality of Life; D012074:Remission Induction; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents
keywords: JUVENILE ARTHRITIS; PREDICTION; PROGNOSIS; RISK STRATIFICATION; TREATMENT