Bertamino, M

Bracciolini, G

Consolaro, A

Filocamo, G

Martini, A

Muratore, V

Palmisani, E

Ravelli, A

Ruperto, N

Suffia, C

English

PubMed

A Consolaro

G Filocamo

M Bertamino

E Palmisani

G Bracciolini

C Suffia

V Muratore

N Ruperto

A Martini

A Ravelli

Crossref

A new approach to defining inactive disease, minimal disease activity and parent- and child-acceptable symptom state in juvenile idiopathic arthritis

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Bertamino M

Filocamo G

Consolaro A

Palmisani E

Bracciolini G

Suffia C

Muratore V

Ruperto N

Martini A

Ravelli A

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Pediatric Rheumatology

POSTER PRESENTATION Open Access
A new approach to defining inactive disease,
minimal disease activity and parent- and child-
acceptable symptom state in juvenile idiopathic
arthritis
A Consolaro1,2,3,4*, G Filocamo1,2,3,4, M Bertamino1,2,3,4, E Palmisani1,2,3,4, G Bracciolini1,2,3,4, C Suffia1,2,3,4,
V Muratore1,2,3,4, N Ruperto1,2,3,4, A Martini1,2,3,4, A Ravelli1,2,3,4
From 18th Pediatric Rheumatology European Society (PReS) Congress
Bruges, Belgium. 14-18 September 2011
Background
Recent advances in treatment of juvenile idiopathic
arthritis (JIA) have markedly increased the potential for
achieving a remission or minimal disease activity (MDA)
state. So far, these states have been defined using a cate-
gorical model, which requires simultaneous fulfillment
of multiple criteria. However, a dimensional model,
based on pooling individual measures into a composite
score, has the advantage of providing one summary
number on a continuous scale.
Aim
To develop and validate the cut-point values of the
Juvenile Arthritis Disease Activity Score (JADAS)-10 for
remission, MDA and parent/child acceptable symptom
state.
Methods
480 children with JIA who underwent 1218 visits were
included. At each visit, the physician, a parent and the
child were asked to rate subjectively the disease status
as remission or active disease. Furthermore, the parent
and the child were asked to declare independently
whether they were satisfied or not satisfied with the cur-
rent illness state. All visits in which the inactive disease
(ID) criteria or MDA criteria were met were identified.
The “optimal” JADAS cut-point for each disease state
was determined through the ROC curve analysis. To
minimize misclassification, the minimum specificity of
85% was required. Validation of cut-points was carried
out by assessing their ability to discriminate between
different levels of ACR Pediatric response in a metho-
trexate trial and between different levels of damage,
assessed through the Juvenile Arthritis Disease Activity
Index (JADI).
Results
The JADAS-10 cut-points for ID, MDA, physician-,
parent- and child-rated remission, parent and child
acceptable symptom state were 2, 3.8, 2.9, 2.6, 2.0, 3.8,
5.3, and 3.1 for polyarthritis and 1, 2.5, 2.5, 2.3, 2.2,
4.5, and 3.1 for oligoarthritis. Assessment of discrimi-
native ability of cut-points is shown in Figures 1 and 2,
respectively.
* Correspondence: alessandroconsolaro@ospedale-gaslini.ge.it
1Dipartimento di Pediatria, Università degli Studi di Genova, Italy
Full list of author information is available at the end of the article
Figure 1
Consolaro et al. Pediatric Rheumatology 2011, 9(Suppl 1):P196
http://www.ped-rheum.com/content/9/S1/P196
© 2011 Consolaro et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative
Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly cited.
Conclusion
JADAS cut-points for ID were the lowest, which reflects
the greatest stringency of Wallace criteria. Cut-points
for children’s assessments were lower than for physi-
cians’ and parents’ assessments, suggesting that children
require a better disease control to consider the disease
in remission or declare themselves as satisfied. All
JADAS cut-points discriminated strongly between differ-
ent levels of therapeutic response and damage, which
indicates that they are suitable for use in clinical prac-
tice, observational studies and clinical trials.
Author details
1Dipartimento di Pediatria, Università degli Studi di Genova, Italy. 2Pediatria II,
IRCCS G.Gaslini, Genova, Italy. 3Dipartimento di Pediatria, Ospedale S.Orsola,
Bologna, Italy. 4Clinica Pediatrica, Fondazione IRCCS Policlinico S. Matteo,
Pavia, Italy.
Published: 14 September 2011
doi:10.1186/1546-0096-9-S1-P196
Cite this article as: Consolaro et al.: A new approach to defining inactive
disease, minimal disease activity and parent- and child-acceptable
symptom state in juvenile idiopathic arthritis. Pediatric Rheumatology
2011 9(Suppl 1):P196.
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Figure 2
Consolaro et al. Pediatric Rheumatology 2011, 9(Suppl 1):P196
http://www.ped-rheum.com/content/9/S1/P196
Page 2 of 2


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A new approach to defining inactive disease, minimal disease activity and parent- and child-acceptable symptom state in juvenile idiopathic arthritis

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