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Predicting Which Children with Juvenile Idiopathic Arthritis Will Not Attain Early Remission with Conventional Treatment: Results from the ReACCh-Out Cohort.
Guzman, Jaime; Henrey, Andrew; Loughin, Thomas; Berard, Roberta A; Shiff, Natalie J; Jurencak, Roman; Huber, Adam M; Oen, Kiem; Gerhold, Kerstin; Feldman, Brian M; Scuccimarri, Rosie; Houghton, Kristin; Chédeville, Gaëlle; Morishita, Kimberly; Lang, Bianca; Dancey, Paul; Rosenberg, Alan M; Barsalou, Julie; Bruns, Alessandra; Watanabe Duffy, Karen; Benseler, Susanne; Duffy, Ciaran M; Tucker, Lori B.
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  • Guzman J; From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Hea
  • Henrey A; The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research I
  • Loughin T; J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pedia
  • Berard RA; From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Hea
  • Shiff NJ; The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research I
  • Jurencak R; J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pedia
  • Huber AM; From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Hea
  • Oen K; The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research I
  • Gerhold K; J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pedia
  • Feldman BM; From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Hea
  • Scuccimarri R; The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research I
  • Houghton K; J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pedia
  • Chédeville G; From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Hea
  • Morishita K; The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research I
  • Lang B; J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pedia
  • Dancey P; From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Hea
  • Rosenberg AM; The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research I
  • Barsalou J; J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pedia
  • Bruns A; From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Hea
  • Watanabe Duffy K; The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research I
  • Benseler S; J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pedia
  • Duffy CM; From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Hea
  • Tucker LB; The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research I
J Rheumatol ; 46(6): 628-635, 2019 06.
Article en En | MEDLINE | ID: mdl-30647178
OBJECTIVE: To estimate the probability of early remission with conventional treatment for each child with juvenile idiopathic arthritis (JIA). Children with a low chance of remission may be candidates for initial treatment with biologics or triple disease-modifying antirheumatic drugs (DMARD). METHODS: We used data from 1074 subjects in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. The predicted outcome was clinically inactive disease for ≥ 6 months starting within 1 year of JIA diagnosis in patients who did not receive early biologic agents or triple DMARD. Models were developed in 200 random splits of 75% of the cohort and tested on the remaining 25% of subjects, calculating expected and observed frequencies of remission and c-index values. RESULTS: Our best Cox logistic model combining 18 clinical variables a median of 2 days after diagnosis had a c-index of 0.69 (95% CI 0.67-0.71), better than using JIA category alone (0.59, 95% CI 0.56-0.63). Children in the lowest probability decile had a 20% chance of remission and 21% attained remission; children in the highest decile had a 69% chance of remission and 73% attained remission. Compared to 5% of subjects identified by JIA category alone, the model identified 14% of subjects as low chance of remission (probability < 0.25), of whom 77% failed to attain remission. CONCLUSION: Although the model did not meet our a priori performance threshold (c-index > 0.70), it identified 3 times more subjects with low chance of remission than did JIA category alone, and it may serve as a benchmark for assessing value added by future laboratory/imaging biomarkers.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Artritis Juvenil / Productos Biológicos / Antirreumáticos Tipo de estudio: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: J Rheumatol Año: 2019 Tipo del documento: Article Pais de publicación: Canadá
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Artritis Juvenil / Productos Biológicos / Antirreumáticos Tipo de estudio: Diagnostic_studies / Prognostic_studies / Risk_factors_studies Límite: Adolescent / Child / Child, preschool / Female / Humans / Male Idioma: En Revista: J Rheumatol Año: 2019 Tipo del documento: Article Pais de publicación: Canadá