Pediatric rheumatologists report ‘wide variation’ in JIA disease activity measurement
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Key takeaways:
- There is little uniformity in the way physicians measure disease activity in patients with juvenile idiopathic arthritis.
- Evaluations should be standardized, according to the study authors.
There is “wide variation” in the way clinicians measure and report the physician’s global assessment of disease activity in patients with juvenile idiopathic arthritis, according to data published in Rheumatology.
“[Physician’s global assessment of disease activity (PhGA)] is one of the six measures in the [American College of Rheumatology (ACR)] JIA response criteria, and is important in clinical trials,” Maria Backström, MD, of the department of pediatrics at the Wellbeing Services County of Ostrobothnia, and the University of Oulu, in Finland, and colleagues wrote. “Consistent and standardized measurement of the child’s level of disease activity is pivotal for the implementation of the treat-to-target strategy.”
To investigate the uniformity, or the lack thereof, in the ways physicians assess PhGA in patients with JIA, Backström and colleagues conducted a survey of members of the Pediatric Rheumatology International Trials Organization and the Pediatric Rheumatology Care and Outcomes Improvement Network. First, participants were asked to rate the relevance of 17 factors regarding their impact on PhGA scores in patients with systemic and non-systemic JIA. The second portion of the survey included 17 patient cases, and respondents were asked to assess the PhGA for each case on a scale of 0 to 100.
There was no definition or other set of instructions provided. Participants responded using an electronic version of the survey. Before results were analyzed, surveys were grouped according to experience levels of the participants. The experience of the participants was defined as either less than 5 years, 5 to 10 years, and greater than 10 years. Responses were also grouped depending on geography.
In all, the survey was completed by 491 clinicians. The researchers reported a “large variation” regarding the impact of different factors on assessing the PhGA in patients with JIA. In cases of non-systemic JIA, the largest variation of weight was seen in fevers, while swollen joints had the lowest variation. In systemic JIA, the largest difference was in the presence of erosions, while the presence of a fever had the least variation. In all, the intra-class correlation for the PhGA scoring was 0.53 (95% CI, 0.38-0.72).
According to the researchers, the “poor-to-moderate reliability” of the measure is important because the outcome measure can impact the way in which physicians evaluate and change therapies. Potential next steps to address this issue include standardizing scoring guidelines through “consensus techniques,” in order to increase uniformity in disease evaluations and therapy investigations, the researchers wrote.
“There is a wide variation in the PhGA scoring,” Backström and colleagues wrote. “This is an important problem because the PhGA is part of the JADAS score, an important primary outcome in JIA clinical trials, and is widely used by clinicians to justify treatment changes.”
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