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PRINTO group proposes new, homogeneous list of JIA disorders
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Researchers working with the Pediatric Rheumatology International Trials Organization have proposed a new, homogeneous list of four disorders that fall under juvenile idiopathic arthritis, down from the current seven, according to a consensus published in the Journal of Rheumatology.
“The most recent classification proposed in 1995 by a consensus based on expert opinions of pediatric rheumatologists representing each of the leagues of the International League of Associations for Rheumatology (ILAR) consists of six different, mutually exclusive categories defined in clinical and laboratory measures: systemic arthritis, oligoarthritis (persistent or extended), polyarthritis rheumatoid factor-positive, polyarthritis [rheumatoid factor]-negative, enthesitis-related arthritis, psoriatic arthritis and a seventh category, undifferentiated arthritis, which includes those patients who do not fit any criteria or fit more than one,” Alberto Martini, MD, of the Istituto Giannina Gaslini, Italy, and colleagues wrote.
They later added, “There is growing impetus to harmonize as much as possible the criteria in use for those diseases that are observed both in children and in adults either for use in clinical trials, in research, or in the everyday clinical setting.”
To propose revisions to the current JIA ILAR classification criteria using clinical and routine laboratory measures available around the world, and to differentiate forms of chronic arthritis commonly reported in children from those representing the juvenile counterpart of diseases observed in adults, Martini and colleagues undertook a four-step process. Reporting for now on just the first two steps, the researchers completed a Delphi Web-based consensus and convened an international nominal group technique consensus conference for the new provisional Pediatric Rheumatology International Trials Organization (PRINTO) criteria.
In their first step, the researchers participated in three rounds of Delphi interactions to revise all seven of the current ILAR JIA categories. In step two, they devised 47 questions with electronic voting to develop the new proposed criteria. In the future, the researchers plan to complete two additional steps to provide data for evidence-based validation, including a large information collection of at least 1,000 patients with new-onset JIA, and an analysis and nominal group technique consensus.
The researchers proposed four disorders that fall under the historical term “juvenile idiopathic arthritis.” They are systemic JIA, rheumatoid factor–positive JIA, enthesitis/spondylitis-related JIA and early-onset antinuclear antibody–positive JIA. Other forms of JIA were grouped under “others,” and will be evaluated during prospective data collection using a list of descriptors to determine whether the clustering of some can identify homogeneous entities.
“The criteria of these four entities will be validated during the prospective data collection,” Martini and colleagues wrote. “Rather than developing new hypothetical criteria instead of the number of joints involved or the presence of psoriasis, it was decided to group all the other forms of arthritis in the group of ‘other JIA.’ Data collected prospectively on new-onset patients falling under the definition of ‘other JIA’ will be analyzed according to a set of descriptors (age at onset, asymmetric or symmetric involvement, etc.) in the hypothesis that some of these descriptors will cluster together and define, with an evidence-based approach, new homogeneous entities.” – by Jason Laday
Disclosure: Martini reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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