University of Oulu

Backström M, Tynjälä P, Aalto K, et al., Validating 10-joint juvenile arthritis disease activity score cut-offs for disease activity levels in non-systemic juvenile idiopathic arthritis, RMD Open 2019;5:e000888. doi: 10.1136/rmdopen-2018-000888

Validating 10-joint juvenile arthritis disease activity score cut-offs for disease activity levels in non-systemic juvenile idiopathic arthritis

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Author: Backström, Maria1; Tynjälä, Pirjo2,3; Aalto, Kristiina4;
Organizations: 1Pediatric Department, Vaasan keskussairaala, Vaasa, Finland
2Department of Pediatrics, South Karelia Central Hospital, Lappeenranta, Finland
3Poison Information Center, University of Helsinki Hospital, Helsinki, Finland
4Hospital for Children and Adolescents, University of Helsinki Hospital for Children and Adolescents, Helsinki, Finland
5Department of Pediatrics, Turku University Hospital, Turku, Finland
6Department of Pediatrics, Satakunta Central Hospital, Pori, Finland
7Department of Pediatrics, Kanta-Häme Central Hospital, Hämeenlinna, Finland
8Department of Paediatrics, Oulu University Hospital, Oulu, Finland
9Medical Research Center Oulu, Oulu University Hospital and PEDEGO Research Unit, University of Oulu, Oulu, Finland
10Department of Pediatrics, Päijät-Häme Central Hospital, Lahti, Finland
11Department of Pediatrics, Central Finland Hospital District, Jyvaskyla, Finland
12Department of Biostatistics, University of Turku, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.4 MB)
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Language: English
Published: BMJ, 2019
Publish Date: 2019-09-26


Objectives: To validate cut-offs of the Juvenile Arthritis Disease Activity Score 10 (JADAS10) and clinical JADAS10 (cJADAS10) and to compare them with other patient cohorts.

Methods: In a national multicentre study, cross-sectional data on recent visits of 337 non-systemic patients with juvenile idiopathic arthritis (JIA) were collected from nine paediatric outpatient units. The cut-offs were tested with receiver operating characteristic curve-based methods, and too high, too low and correct classification rates (CCRs) were calculated.

Results: Our earlier presented JADAS10 cut-offs seemed feasible based on the CCRs, but the cut-off values between low disease activity (LDA) and moderate disease activity (MDA) were adjusted. When JADAS10 cut-offs for clinically inactive disease (CID) were increased to 1.5 for patients with oligoarticular disease and 2.7 for patients with polyarticular disease, as recently suggested in a large multinational register study, altogether 11 patients classified as CID by the cut-off had one active joint. We suggest JADAS10 cut-off values for oligoarticular/polyarticular disease to be in CID: 0.0–0.5/0.0–0.7, LDA: 0.6–3.8/0.8–5.1 and MDA: >3.8/5.1. Suitable cJADAS10 cut-offs are the same as JADAS10 cut-offs in oligoarticular disease. In polyarticular disease, cJADAS10 cut-offs are 0–0.7 for CID, 0.8–5.0 for LDA and >5.0 for MDA.

Conclusion: International consensus on JADAS cut-off values is needed, and such a cut-off for CID should preferably exclude patients with active joints in the CID group.

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Series: RMD open
ISSN: 2056-5933
ISSN-E: 2056-5933
ISSN-L: 2056-5933
Volume: 5
Issue: 1
Article number: UNSP e000888
DOI: 10.1136/rmdopen-2018-000888
Type of Publication: A1 Journal article – refereed
Field of Science: 3121 General medicine, internal medicine and other clinical medicine
Funding: Päivikki and Sakari Sohlberg Foundation, Finland; the Alma and K. A. Snellman Foundation, Finland; Jussi Lalli and Eeva Mariapori-Lalli Foundation, Finland; State funding for university-level health research, Vaasa central Hospital, Finland; the Finnish Pediatric research Foundation, Finland.
Copyright information: © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: