(182) Tolerated Juvenile Idiopathic Arthritis Disease Activity States in The Childhood Arthritis and Rheumatology Research Alliance Registry

Publication Number: 1227

Background: The goal of treatment for juvenile idiopathic arthritis (JIA) is inactive disease (ID) or at least low disease activity (LDA). Current recommendations suggest treatment escalation until the disease activity target is reached.

Objectives: Our objective was to identify tolerated disease activity states at the time of no medication change and patient characteristics associated with tolerated ID or LDA.

Methods: Using the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry, we included all individuals enrolled with non-systemic JIA. We defined the maximally tolerated disease activity by identifying registry visits where there had been no medication change for >180 days prior to and 60 days following the visit. Individuals could contribute more than one observation. Disease activity was classified based on the clinical Juvenile Arthritis Disease Activity Score 10 (cJADAS10) for ID, cJADAS10 LDA, and the American College of Rheumatology (ACR) provisional criteria for clinical ID (ACR CID). The association of patient characteristics (age, sex, race, category of JIA, time since diagnosis, age at diagnosis, number of prior medications, and physician global, active joint count, patient global, and morning stiffness at the visit prior to index visit) and tolerated disease activity of ID/LDA were assessed by logistic regression.

Results: There were 6,235 individuals with non-systemic JIA with 16,187 observations of no medication change for >180 + 60 days. Of the observations with disease activity measures the tolerated disease activity state was cJADAS10 ID in 58%, cJADAS10 LDA in 67%, and ACR CID in 29%.Meeting cJADAS10 ID was associated with rheumatoid factor (RF) - JIA (OR 1.35 [95% CI 1.03, 1.77]), Hispanic ethnicity (OR 0.60 [0.38, 0.95]), Other race (OR 0.52 [0.29, 0.90]), prior patient global (OR 0.81 [0.78, 0.86]), and prior morning stiffness ( < 15 minutes OR 0.68 [0.48, 0.96], 16-60 minutes OR 0.52 [0.34, 0.79], >60 minutes OR 0.41 [0.20, 0.84]). cJADAS10 LDA was associated with male sex (OR 1.45 [1.08, 1.95]), Hispanic ethnicity (OR 0.55 [0.34, 0.88], enthesitis-related JIA (OR 0.57 [0.36, 0.91]), prior patient global (OR 0.79 [0.74, 0.85]), and prior morning stiffness ( < 15 minutes OR 0.63 [0.44, 0.90]). ACR CID was associated with Other race (OR 0.57 [0.33, 0.98]), RF- JIA (OR 1.41 [1.12, 1.79]), RF+ JIA (OR 1.90 [1.24, 2.90]), prior physician global (OR 0.85 [0.77, 0.94]), prior patient global (OR 0.94 [0.88, 0.99]), and prior morning stiffness ( < 15 minutes OR 0.61 [0.44, 0.85], 16-60 minutes 0.48 [0.31, 0.73]).

Conclusions: At the time of no medication change, many patients with JIA had greater than ID or LDA tolerated disease activity. There are patient characteristics that are associated with having higher than ID or LDA tolerated disease activity.