University of Oulu

Maria Backström, Pirjo Tynjälä, Kristiina Aalto, Heikki Ylijoki, Anne Putto-Laurila, Minna-Maija Grönlund, Johanna Kärki, Paula Keskitalo, Sirja Sard, Heini Pohjankoski, Maiju Hietanen, Silke Witter, Helena Lehto, Eliisa Löyttyniemi, Paula Vähäsalo, Defining new clinically derived criteria for high disease activity in non-systemic juvenile idiopathic arthritis: a Finnish multicentre study, Rheumatology Advances in Practice, Volume 2, Issue 2, 2018, rky044,

Defining new clinically derived criteria for high disease activity in non-systemic juvenile idiopathic arthritis : a Finnish multicentre study

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Author: Backström, Maria1; Tynjälä, Pirjo2,3; Aalto, Kristiina4;
Organizations: 1Department of Pediatrics, Vaasa Central Hospital, Vaasa, Finland
2Department of Pediatrics, South-Karelian Central Hospital, Lappeenranta, Finland
3Poison Information Center, Helsinki University Central Hospital, Helsinki, Finland
4Paediatric Department, Children’s Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
5Department of Pediatrics, Satakunta Central Hospital, Pori, Finland
6Department of Pediatrics, Turku University Hospital, Turku, Finland
7Department of Pediatrics, Kanta-Häme Central Hospital, Hämeenlinna, Finland
8Department of Children and Adolescents, Medical Research Center Oulu, Oulu University Hospital and PEDEGO Research Unit, University of Oulu, Oulu, Finland
9Department of Pediatrics, Päijät-Häme Central Hospital, Lahti, Finland
10Department of Pediatrics, Central Finland Central Hospital, Jyväskylä, Finland
11Department of Biostatistics, University of Turku, Turku, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.3 MB)
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Language: English
Published: Oxford University Press, 2018
Publish Date: 2019-11-08


Objectives: To redefine criteria for high disease activity (HDA) in JIA, to establish HDA cut-off values for the 10-joint Juvenile Arthritis Disease Activity Score (JADAS10) and clinical JADAS10 (cJADAS10) and to describe the distribution of patients’ disease activity levels based on the JADAS cut-off values in the literature.

Methods: Data on 305 treatment-naïve JIA patients were collected from nine paediatric units treating JIA. The median parameters of the JADAS were proposed to be the clinical criteria for HDA. The cut-off values were assessed by using two receiver operating characteristics curve–based methods. The patients were divided into disease activity levels based on currently used JADAS cut-off values.

Results: We proposed new criteria for HDA. At least three of the following criteria must be satisfied in both disease courses: in oligoarthritis, two or more active joints, ESR above normal, physician global assessment (PGA) of disease activity ≥2 and parent/patient global assessment (PtGA) of well-being ≥2; in polyarthritis, six or more active joints, ESR above normal, PGA of overall disease activity ≥4 and PtGA of well-being ≥2. The HDA cut-off values for JADAS10 (cJADAS) were ≥6.7 (6.7) for oligoarticular and ≥15.3 (14.1) for polyarticular disease. The distribution of the disease activity levels based on the JADAS cut-off values in the literature varied markedly based on which cut-offs were used.

Conclusion: New clinically derived criteria for HDA in JIA and both JADAS and cJADAS cut-off values for HDA were proposed.

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Series: Rheumatology advances in practice
ISSN: 2514-1775
ISSN-E: 2514-1775
ISSN-L: 2514-1775
Volume: 2
Issue: 2
Article number: rky044
DOI: 10.1093/rap/rky044
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Copyright information: © The Author(s) 2018. Published by Oxford University Press on behalf of the British Society for Rheumatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.