POS0334 DRIVERS OF NON-ZERO PHYSICIAN GLOBAL SCORES DURING PERIODS OF INACTIVE DISEASE IN JUVENILE IDIOPATHIC ARTHRITIS

Abstract

BackgroundThe ACR provisional criteria for defining inactive disease (ID) in Juvenile Idiopathic Arthritis (JIA) requires that the physician’s global assessment of disease activity (PhGA) is marked as 0 on the visual analog scale (VAS). However, some investigators have noticed the tendency of some clinicians to mark the PhGA>0 even on resolution of active disease. Due to the fact that the PhGA and the count of active joints are the two main physician-centered measures included in ID criteria the analysis of their discordance may be of importance to address the issue.ObjectivesTo investigate the frequency in which the physician provides a global assessment of disease activity (PhGA)>0 and an active joint account (AJC)=0 in children with juvenile idiopathic arthritis (JIA) and search for determinants of divergence between the two measures.MethodsData were extracted from a multinational cross-sectional dataset of 7265 patients who had JIA by ILAR criteria, were recruited between 2011 and 2016 and had both PhGA and AJC recorded by the caring paediatric rheumatologist at the study visit. Determinants of discordance between PhGA and AJC=0 were searched for by multivariable logistic regression and dominance analysis.ResultsThe PhGA was scored >0 in 1211 (32,4%) of 3668 patients who had an AJC of 0. In 536 patients (14,6%) the PhGA was the single most frequent reason for not meeting the ID definition in patients with AIJ=O. Independent associations with discordant assessment were identified for tender or restricted joint count>0, history of enthesis, presence of active uveitis or systemic features, enthesitis-related or systemic arthritis, increased acute phase reactants, pain visual analog scale (VAS)>0, and impaired physical or psychosocial wellbeing. In dominance analysis, tender joint count accounted for 35,43% of PhGA variance, followed by VAS>0 (17,72%), restricted joint count >0 (16, 14%) and physical health score >0 (11,42%) (Figure 1).Figure 1.Dominance analysis of relative importance of predictive factors in explaining the variance in PhGA.ConclusionWe found that many paediatric rheumatologists did not mark a score of 0 for patients who they found not to have active joints. The presence of pain in joints not meeting the definition of active joint used in JIA was the main determinant of this phenomenon.