University of Oulu

Maria Backström, Maarit Tarkiainen, Beth S Gottlieb, Chiara Trincianti, Tingting Qiu, Esi Morgan, Daniel J Lovell, Francesca Bovis, Eliisa Löyttyniemi, Nicolino Ruperto, Paula Vähäsalo, Alessandro Consolaro, for the Pediatric Rheumatology International Trials Organization, the Pediatric Rheumatology Care & Outcomes Improvement Network and the Pediatric Rheumatology European Society JIA Working Party, Paediatric rheumatologists do not score the physician’s global assessment of juvenile idiopathic arthritis disease activity in the same way, Rheumatology, 2023;, kead151,

Paediatric rheumatologists do not score the physician’s global assessment of juvenile idiopathic arthritis disease activity in the same way

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Author: Backström, Maria1,2; Tarkiainen, Maarit3; Gottlieb, Beth S4;
Organizations: 1Department of Pediatrics, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland
2PEDEGO Research Unit, University of Oulu, Oulu, Finland
3Pediatric Research Center, Helsinki University Hospital and University of Helsinki, New Children’s Hospital, Helsinki, Finland
4Pediatric Rheumatology, Cohen Children’s Medical Center, Zucker School of Medicine at Hofstra/Northwell, New York, USA
5Department of Health Sciences, University of Genoa, Genoa, Italy
6Department of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, OH, USA
7Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA
8Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, OH, USA
9Department of Biostatistics, University of Turku, Turku, Finland
10Pediatria II—PRINTO, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
11Department of Paediatrics, Oulu University Hospital, Oulu, Finland
12Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.6 MB)
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Language: English
Published: Oxford University Press, 2023
Publish Date: 2023-04-25


Objectives: To assess the heterogeneity in factors affecting physician’s global assessment of disease activity (PhGA) and in PhGA scoring of multiple JIA patient’s case scenarios.

Methods: An electronic web-based questionnaire of factors potentially considered in PhGA was sent worldwide to members of PRINTO and the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN). The respondents were asked to rate from 0 to 100 the relevance of 17 factors possibly affecting PhGA scoring and to derive a PhGA score of 17 detailed JIA patient cases. The median and interquartile range was used to measure the heterogeneity in the scoring. To demonstrate the consistency among the PhGA scores of the patient cases provided by multiple physicians, we assessed the inter-rater reliability using intra-class correlation.

Results: The questionnaire was completed by 491 respondents. A large individual variation was observed in the impact of different factors on PhGA when assessing JIA. For non-systemic JIA the presence of fever had the largest variation and swollen joint count had the smallest. For sJIA, the largest variation was seen in the presence of erosions and the smallest in the presence of fever. The intra-class correlation of the group for PhGA scoring of patient cases was 0.53 (95% CI 0.38, 0.72).

Conclusions: In a sample of worldwide respondents, the scoring of the PhGA is divergent. Consensus on PhGA scoring guidelines is required to obtain a consistent assessment of patients.

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Series: Rheumatology
ISSN: 1462-0324
ISSN-E: 1460-2172
ISSN-L: 1462-0324
Volume: In press
DOI: 10.1093/rheumatology/kead151
Type of Publication: A1 Journal article – refereed
Field of Science: 3123 Gynaecology and paediatrics
Funding: This work was supported by: State funding for university-level health research, Vaasa Central Hospital, Finland to M.B.; State funding for university-level health research Oulu University Hospital, Finland to P.V.; The Finnish Cultural Foundation, Finland to P.V.; Maire Lisko foundation, Finland to M.B.; and The Finnish Medical Foundation grant number 4947 to M.B.
Copyright information: © The Author(s) 2023. 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-NonCommercial License (, which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact