Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register Long‐Term Safety, Efficacy, and Quality of Life in Patients With Juvenile Idiopathic Arthritis Treated With Intravenous Abatacept for Up to Seven Years Health-Related Quality of Life, Physical Function, Fatigue, and Disease Activity in Children with Established Polyarticular Juvenile Idiopathic Arthritis Abatacept improves health‐related quality of life, pain, sleep quality, and daily participation in subjects with juvenile idiopathic arthritis Factors affecting the efficacy of intraarticular corticosteroid injection of knees in juvenile idiopathic arthritis. Pilot study of fitness training and exercise testing in polyarticular childhood arthritis. Methotrexate improves the health-related quality of life of children with juvenile idiopathic arthritis. Preliminary validation of clinical remission criteria using the OMERACT filter for select categories of juvenile idiopathic arthritis. Incidence and Prevalence of Juvenile Idiopathic Arthritis Among Children in a Managed Care Population, 1996–2009 A prospective study comparing infection risk and disease activity in children with juvenile idiopathic arthritis treated with and without tumor necrosis factor-alpha inhibitors Comparison of intra-articular triamcinolone hexacetonide and triamcinolone acetonide in oligoarticular juvenile idiopathic arthritis. Aquatic fitness training for children with juvenile idiopathic arthritis. Safety of measles, mumps and rubella vaccination in juvenile idiopathic arthritis Triamcinolone acetonide and hexacetonide intra-articular treatment of symmetrical joints in juvenile idiopathic arthritis: a double-blind trial. High prevalence of temporomandibular joint arthritis at disease onset in children with juvenile idiopathic arthritis, as detected by magnetic resonance imaging but not by ultrasound. Efficacy of custom foot orthotics in improving pain and functional status in children with juvenile idiopathic arthritis: a randomized trial. Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. The iPeer2Peer Program: a pilot randomized controlled trial in adolescents with Juvenile Idiopathic Arthritis Patterns of pain over time among children with juvenile idiopathic arthritis Measuring health status in early juvenile idiopathic arthritis: determinants and responsiveness of the child health questionnaire. Long-term follow-up on effectiveness and safety of etanercept in juvenile idiopathic arthritis: the Dutch national register Subcutaneous golimumab for children with active polyarticular-course juvenile idiopathic arthritis: results of a multicentre, double-blind, randomised-withdrawal trial Is high-resolution ultrasonography suitable for the detection of temporomandibular joint involvement in children with juvenile idiopathic arthritis?
Background Treatment of  juvenile idiopathic arthritis ( JIA ) has changed dramatically since the introduction of biological agents in 1999 . Objective To evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA . Methods The Arthritis and Biologics in Children register ( multicentre prospect i ve observational study ) aim ed to include all consecutive patients with JIA in the Netherl and s who had started biological agents since 1999 . Patients were divided according to year of introduction of first biological agent . Patient characteristics at introduction of the first biological agent and its effectiveness were analysed over 12 years . Results 335 patients with non-systemic JIA and 86 patients with systemic JIA started a biological agent between 1999 and 2010 . Etanercept remained the most often prescribed biological agent for non-systemic JIA ; anakinra became first choice for systemic JIA . The use of systemic glucocorticoids and synthetic disease-modifying antirheumatic drugs before biological agents decreased . During these 12 years of observation , biological agents were prescribed earlier in the disease course and to patients with lower baseline JADAS ( Juvenile Arthritis Disease Activity Score ) disease activity . All baseline disease activity parameters were lowered in patients with non-systemic JIA . In systemic JIA , prescription patterns changed towards very early introduction of biological agents ( median 0.4 years of disease duration ) in patients with a low number of joints with active arthritis and high erythrocyte sedimentation rates . These changes for both systemic and non-systemic JIA result ed in more patients with inactive disease after 3 and 15 months of treatment . Conclusions Biological agents are increasingly prescribed , earlier in the disease and in patients with JIA with lower disease activity . These changes are accompanied by better short-term disease outcomes The efficacy and safety of abatacept in patients with juvenile idiopathic arthritis ( JIA ) who experienced an inadequate response to disease‐modifying antirheumatic drugs were previously established in a phase III study that included a 4‐month open‐label lead‐in period , a 6‐month double‐blind withdrawal period , and a long‐term extension ( LTE ) phase . The aim of this study was to present the safety , efficacy , and patient‐reported outcomes  of abatacept treatment ( 10 mg/kg every 4 weeks ) during the LTE phase , for up to 7 years of followup Objective . To compare child  self-report and parent/proxy report of health-related quality of life ( HRQOL ) , disability , and fatigue in children with active polyarticular juvenile idiopathic arthritis ( JIA ) to that of children with inactive polyarticular JIA and to previous data from healthy controls . Methods . Cross-sectional survey of children with polyarticular JIA diagnosed and treated between 2000 to 2006 and their parent/proxy . The Childhood Health Assessment Question naire , Pediatric Quality of Life Inventory ( PedsQL ) Generic Core Scales , PedsQL Rheumatology Module , and PedsQL Multidimensional Fatigue Scale were administered . Disease activity data were collected from the physician clinic notes . Comparisons were performed with t tests . Correlations between patient and parent/proxy reports were measured with Pearson correlation coefficients . Results . Sixty children and /or their parents/proxies participated ( 79 % response rate ) . Disease activity status was available for 52 , and 32 met criteria for inactive disease ( 62 % ) . Participants reported lower scores on the PedsQL Generic Core Scales ( range 2.54–9.13 points lower ) and the PedsQL Rheumatology Module ( range 2.46–6.96 points lower ) than those with inactive disease . Participants also reported lower scores on the PedsQL Multidimensional Fatigue Scale than did healthy controls , regardless of disease activity status ( range 0.06–9.2 points lower ) . Conclusion . Although children in this cohort with polyarticular JIA and inactive disease reported HRQOL scores similar to those of healthy controls , children with polyarticular JIA and their parents/proxies tended to report more fatigue than controls , regardless of disease activity . Application of these measures prospect ively to larger cohorts of children with JIA is needed to assess these differences To assess health‐related quality of life ( HRQOL ) in abatacept‐treated children/adolescents with juvenile idiopathic arthritis ( JIA ) OBJECTIVE To determine in a prospect i ve analysis whether baseline demographic , clinical , and laboratory variables predict the outcome of intraarticular corticosteroid ( IAC ) injection of the knees in children with juvenile idiopathic arthritis ( JIA ) . METHODS We studied consecutive patients who met the criteria for the diagnosis of JIA and received their initial injection of triamcinolone hexacetonide in one or both knees .  Predictor variables included sex , age , age at onset of JIA , onset subtype , disease duration , drug therapy at the time of IAC injection , physician and parent global assessment of disease status , Childhood Health Assessment Question naire disability index , erythrocyte sedimentation rate ( ESR ) , C-reactive protein , involvement of other joints besides knees , amount of fluid aspirated , and dose of IAC injected . The primary outcome measure was persistence of complete clinical response at 6 months , i.e. , no evidence of synovitis clinical ly . RESULTS Ninety-four patients were available for analysis . At 6 months after the IAC injection , 65 ( 69 % ) patients showed a sustained complete clinical response , whereas 29 ( 31 % ) had had a recurrence of joint inflammation . Univariate statistical analyses showed that patients who had a sustained clinical response had a significantly higher ESR than those who did not ( p = 0.023 ) . The ESR was the only variable that remained in the best-fit model from multivariate logistic regression analysis ( OR 2.61 , p = 0.049 ) . CONCLUSION Our findings indicate that patients with JIA who have a higher ESR are more likely to benefit from IAC injection of the knees OBJECTIVE To 1 ) assess the safety and feasibility of laboratory-based exercise testing in juvenile idiopathic arthritis ( JIA ) , 2 ) test the safety and feasibility of a 3-month exercise program in JIA , 3 ) assess pain during exercise in JIA , 4 ) compare ratings of perceived effort ( RPE ) with heart rate ( HR ) achieved , and 5 ) estimate the training effect on metabolic efficiency of gait as measured by submaximal exercise testing . METHODS Nine children with JIA were enrolled in a 12-week circuit training program involving pool , stationary bicycle , treadmill , and Fitball . They underwent formal exercise testing before and after the program , underwent a full joint assessment , were administered the Childhood Health Assessment Question naire and Juvenile Arthritis Functional Status Index , and were assessed for overall quality of life and health-related quality of life . A visual analog scale was used to assess pain during testing and training , and the Borg scale was used to measure RPE . RESULTS Children with JIA were able to participate in exercise testing without any significant problems . Children with severe hip disease dropped out of the exercise program due to  pain  during the exercise sessions and worsened arthritis symptoms . Target HR was achieved and correlated with RPE in the bicycle and treadmill sessions . Submaximal exercise testing showed an improvement with a small to moderate effect size . CONCLUSION This study suggests that it is safe , feasible , and acceptable for children with arthritis , in the absence of severe hip involvement , to participate in formal exercise testing and structured fitness programs OBJECTIVES To examine the change in health-related quality of life ( HRQOL ) and its determinants in children with juvenile idiopathic arthritis ( JIA ) treated with methotrexate ( MTX ) .  METHODS Patients were extracted from the PRINTO clinical trial which aim ed to evaluate the efficacy and safety profile of MTX administered in st and ard , intermediate or higher doses ( 10 , 15 and 30 mg/m(2)/week respectively ) . Children with polyarticular-course JIA , who were less than 18 years and had a complete HRQOL assessment were included . RESULTS A total of 521 children were included . At baseline , patients with JIA showed poorer HRQOL ( p<0.01 ) than healthy children . In 207/412 ( 50 % ) and 63 ( 15 % ) children , HRQOL values were 2 st and ard deviations below the mean of healthy controls in the physical and psychosocial summary scale , respectively . After 6 months of treatment with st and ard dose MTX , there was a statistically significant improvement in all HRQOL health concepts , particularly the physical ones . Similar improvements were observed in those who did not respond to a st and ard dose of MTX and were subsequently r and omised to a higher dose . The presence of marked disability at baseline was associated with a fivefold increased risk of retaining poor physical health after 6 months of active treatment with st and ard dose MTX . Other less important determinants of retaining poor physical well-being were the baseline level of systemic inflammation , pain intensity and an antinuclear-antibody-negative status . CONCLUSIONS MTX treatment produces a significant improvement across a wide range of HRQOL components , particularly in the physical domains , in patients with JIA OBJECTIVE To begin the validation process of the preliminary criteria for inactive disease ( ID ) , clinical remission on medication ( CRM ) , and clinical remission off medication ( CR ) in children with select forms of juvenile idiopathic arthritis ( JIA ) . METHODS We used the OMERACT filter paradigm to estimate the validity of the criteria within each of the filter 's 3 components : truth , discrimination , and feasibility , in 5 categories of JIA : systemic arthritis , persistent and extended oligoarthritis , and rheumatoid factor-positive and negative polyarthritis . Data sources for determining validity estimates included a Delphi question naire survey sent to 246 pediatric rheumatologists in 34 countries , a consensus conference attended by 20 senior pediatric rheumatologists representing 9 countries , a retrospective chart review of 437 patients with JIA from 3 tertiary care clinics who had been followed between 4 and 22 years , and the literature . RESULTS Truth component : face and content validity . These aspects of validity were largely established via the Delphi question naire exercise and the consensus conference . Using an 80 % consensus level , participants felt that a set of non-redundant variables could effectively differentiate the clinical states of ID , CRM , and CR . Criterion validity could not be irrefutably established because no gold st and ard for inactive disease exists for JIA . As an alternative , published investigations of remission in JIA were used to estimate concurrent and convergent validity , as surrogates for criterion validity and as indicators of overall construct validity . Correlational analyses revealed the new criteria to have good construct validity . Discrimination component : the criteria demonstrated moderate to high levels of classification , prognosis , and responsiveness ( sensitivity to change ) using data from the chart review . Patients who were able to attain CR remained disease-free for substantially longer periods than did those who attained only ID or CRM . Responsiveness was evidence d by the ability of the criteria to allow movement of most patients between the disease states , consistent with what is known of the course of the disease . Feasibility component : Results of the Delphi and consensus conference produced a set of criteria that are easily , quickly , and inexpensively completed in the physician 's office , and present minimal or no risk to the patient . CONCLUSION The preliminary criteria demonstrated moderate to excellent validity characteristics in some , but not all components of the OMERACT filter . Prospect i ve validation studies are under way Objective . Few studies based in well-defined North American population s have examined the occurrence of juvenile idiopathic arthritis ( JIA ) , and none has been based in an ethnically diverse population . We used computerized healthcare information from the Kaiser Permanente Northern California membership to vali date JIA diagnoses and estimate the incidence and prevalence of the disease in this well-characterized population . Methods . We identified children aged ≤ 15 years with ≥ 1 relevant International Classification of Diseases , 9th edition , diagnosis code of 696.0 , 714 , or 720 in computerized clinical encounter data during 1996–2009 . In a r and om sample , we then review ed the medical records to confirm the diagnosis and diagnosis date and to identify the best-performing case-finding algorithms . Finally , we used the case-finding algorithms to estimate the incidence rate and point prevalence of JIA . Results . A diagnosis of JIA was confirmed in 69 % of individuals with at least 1 relevant code . Forty-five percent were newly diagnosed during the study period . The age- and sex-st and ardized incidence rate of JIA per 100,000 person-years was 11.9 ( 95 % CI 10.9–12.9 ) . It was 16.4 ( 95 % CI 14.6–18.1 ) in girls and 7.7 ( 95 % CI 6.5–8.9 ) in boys . The peak incidence rate occurred in children aged 11–15 years . The prevalence of JIA per 100,000 persons was 44.7 ( 95 % CI 39.1–50.2 ) on December 31 , 2009 . Conclusion . The incidence rate of JIA observed in the Kaiser Permanente population , 1996–2009 , was similar to that reported in Rochester , Minnesota , USA , but 2 to 3 times higher than Canadian estimates Tumor necrosis factor-alpha ( TNF-α ) inhibitors are effective treatment for juvenile idiopathic arthritis ( JIA ) but may increase infection rates . However , active JIA may also render patients vulnerable to infection . In this study , we prospect ively assessed infection rates in JIA patients treated with and without TNF-α inhibitors  and correlated disease activity with infection risk .  TNF-α inhibitor-naïve JIA subjects were followed up for 12 months . Subjects initiated on TNF-α inhibitors after enrollment were analyzed in the TNF group . Subjects treated without TNF-α inhibitors were analyzed in the non-TNF group . Question naires captured mild or severe infections . JIA disease activity by Childhood Health Assessment Question naire ( CHAQ ) disability index/pain score and physician joint count/global assessment was recorded . Twenty TNF and 36 non-TNF subjects were analyzed .  The total infection rate ratio for TNF versus non-TNF group subjects was 1.14 ( 95 % CI , 0.78–1.66 ; p = 0.51 ) . The average rate of infections per month was 0.29 for TNF and 0.24 for non-TNF subjects . No severe infections or hospitalizations occurred in either group . Secondary infectious outcomes were also similar between groups . Controlling for study group , an increase in CHAQ pain score correlated with an increase in several infectious outcome measures . Our results suggest no difference in infection rates between JIA subjects treated with and without TNF-α inhibitors . Additionally , JIA disease activity may have contributed to infection risk in our cohort , irrespective of immunosuppressive therapy . Future analysis of the relationship between treatment regimens , disease activity , and infection rates may help to further delineate predictors of infection risk in JIA patients OBJECTIVE To compare the efficacy and safety of intra-articular triamcinolone hexacetonide ( TH ) and triamcinolone acetonide ( TA ) in children with oligoarticular juvenile idiopathic arthritis ( JIA ) . METHODS One hundred and thirty joints of 85 patients undergoing intra-articular injections were r and omly treated with either TH or TA depending on the availability of the drug . The efficacy of both treatments was evaluated prospect ively in a blinded fashion . A good response was defined as a decrease in the articular score of > or = 60 % from baseline . Clinical , laboratory and immunological variables were noted in order to examine possible factors , other than treatment , predictive of the result . RESULTS Seventy injections were performed using TH and 60 with TA . The two groups were comparable for clinical , immunological and laboratory characteristics . The rate of response was significantly higher with TH than with TA : 81.4 % vs 53.3 % ( P = 0.001 ) at 6 months , 67.1 vs 43.3 % ( P = 0.006 ) at 12 months , and 60 vs 33.3 % ( P = 0.002 ) at 24 months . CONCLUSION At comparable doses TH appeared to be much more effective than TA for intra-articular use , in both short- and long-term follow-up . This result was not affected by disease duration or degree of local and systemic inflammation OBJECTIVE To evaluate the effects of an aquatic training programme for JIA patients . METHODS Fifty-four patients with JIA ( age range 5 to 13 yr ) participated in this study and were r and omized into an experimental ( n = 27 ) and a control ( n = 27 ) group . The children in the experimental group received a training programme consisting of a 1 h per week supervised training programme in a local pool of approximately 20 sessions . Effects were analysed on the following domains : functional ability , health-related quality of life , joint status and physical fitness . RESULTS Although all measures improved more in the experimental group than the control group , none of the differences was statistically significant . CONCLUSIONS The current research found no significant effect of an aquatic fitness training programme in children with JIA . Since there were no signs of worsening in health status , one can conclude that this was a safe exercise programme Objective : To assess the effect of measles , mumps and rubella ( MMR ) vaccination on disease activity in children with juvenile idiopathic arthritis ( JIA ) . Methods : A retrospective observational multicentre cohort study was performed in 314 patients with JIA , born between 1989 and 1996 .  Disease activity and medication use were compared during the period of 6 months before vaccination versus 6 months after vaccination .  Disease activity was measured by joint counts , the Physician ’s global assessment scale and erythrocyte sedimentation rate . Next , we compared disease activity in patients vaccinated between 8 and 9 years of age with the activity in patients who had not been vaccinated at this time ( who received MMR between the ages of 9 and 10 years ) . Results : No increase in disease activity or medication use was seen in the 6 months after MMR vaccination ( n = 207 ) , including in patients using methotrexate ( n = 49 ) . No overt measles infections were noted . When disease activity in vaccinated patients ( n = 108 ) was compared with activity in those not yet vaccinated ( n = 86 ) , there were no significant differences . Conclusions : The MMR booster vaccination does not seem to aggravate disease activity in JIA . This indicates that the most patients with JIA can be vaccinated safely with the MMR vaccine . A prospect i ve study is recommended OBJECTIVE Pharmacokinetic studies have shown that the biological effect of triamcinolone acetonide ( TA ) is equivalent to that of triamcinolone hexacetonide ( TH ) , if used at double the dosage . In this study we compared the efficacy of intra-articular TA at a dose twice that of TH in symmetrically involved joints , in children with juvenile idiopathic arthritis ( JIA ) . METHOD Children with active arthritis and a similar degree of inflammation in two symmetrical joints were enrolled in the study . The symmetry was assessed by both clinical examination and synovial fluid analysis . The dose given was 1 mg/kg up to 40 mg of TH or 2.0 mg/kg up to 80 mg of TA . The identity of injected compound was blinded to the patient and to the physician . RESULTS Thirty-seven patients , 30 female , seven male , with JIA , entered the study . A total of 86 joints were injected . Twenty-one ( 53.8 % ) of the joints injected with TA  relapsed first compared with only six ( 15.4 % ) of the joints injected with TH . In three ( 7.7 % ) relapse occurred simultaneously . Nine ( 23 % ) were still in remission after 24-month follow-up . The percentage of joints with lasting remission was higher with TH than with TA ( 80 vs 47.5 % after 12 months and 63.6 vs 32.4 % after 24 months , respectively ; log rank test P = 0.003 ) . CONCLUSION Even when TA is given at higher doses , TH is more effective and should be considered the drug of choice for intra-articular treatment of JIA OBJECTIVE To determine the prevalence of temporom and ibular joint ( TMJ ) disease in a cohort of children with new-onset juvenile idiopathic arthritis ( JIA ) , and to compare magnetic resonance imaging ( MRI ) with ultrasound ( US ) for the detection of acute and chronic changes of TMJ arthritis . METHODS Between January 2005 and April 2007 , children with newly diagnosed JIA were prospect ively evaluated for TMJ arthritis . Prior to imaging , jaw pain and disability were assessed with question naires and physical examination . The TMJs of all patients were imaged with MRI and US within 8 weeks of diagnosis . RESULTS Of the 32 patients enrolled , 78 % were female , and the median age was 8.6 years ( range 1.5 - 17.2 years ) .  Acute TMJ arthritis was diagnosed in 75 % of the children by MRI and in none by US ; chronic arthritis was diagnosed in 69 % by MRI and in 28 % by US . Findings of both acute and chronic TMJ disease were detected by MRI in 53 % of the patients . Of those with acute TMJ arthritis , 71 % were asymptomatic , and 63 % had normal findings on jaw examination . Fifty-six percent of patients with acute disease had an improved maximal incisal opening after corticosteroid injection . Among these responders , 56 % had been asymptomatic and had normal jaw examination findings . CONCLUSION TMJ arthritis was present in the majority of patients with new-onset JIA . Findings on MRI along with responses to treatment among asymptomatic patients with normal jaw examination findings suggest that a history review and physical examination are not sufficient to screen for TMJ disease . Our results also suggest that MRI and US findings are not well correlated , and that MRI is preferable for the detection of TMJ disease in new-onset JIA OBJECTIVE . To compare the clinical efficacy of custom foot orthotics , prefabricated " off-the-shelf " shoe inserts , and supportive athletic shoes worn alone , on reducing pain and improving function for children with juvenile idiopathic arthritis ( JIA ) . METHODS Children with JIA and foot pain ( n = 40 ) were r and omized to one of 3 groups receiving : ( 1 ) custom-made semirigid foot orthotics with shock absorbing posts ( n = 15 ) , ( 2 ) off-the-shelf flat neoprene shoe inserts ( n = 12 ) , or ( 3 ) supportive athletic shoes with a medial longitudinal arch support and shock absorbing soles worn alone ( n = 13 ) . Foot pain and functional limitations were measured using the Pediatric Pain Question naire-visual analog scale ( VAS ) , Timed Walking , Foot Function Index ( FFI ) , and the Physical Functioning Subscale of the Pediatric Quality of Life Inventory ( PedsQL ) . Measures were administered by personnel blinded to group status at baseline ( before wearing the assigned intervention ) and at 3 months ' followup . RESULTS Children in the orthotics group showed significantly greater improvements in overall pain ( p = 0.009 ) , speed of ambulation ( p = 0.013 ) , activity limitations ( p = 0.002 ) , foot pain ( p = 0.019 ) , and level of disability ( p = 0.024 ) when compared with the other 2 groups . Both children and parents in the orthotics group reported clinical ly meaningful improvement in child health-related quality of life , although the group by time interaction did not show statistical significance . Except for a reduction in pain for supportive athletic shoes ( paired t test , p = 0.011 ) , neither the off-the-shelf shoe inserts nor the supportive athletic shoes worn alone showed significant effect on any of the evaluation measures . CONCLUSION In children with JIA , custom-made semirigid foot orthotics with shock-absorbing posts significantly improve pain , speed of ambulation , and self-rated activity and functional ability levels compared with prefabricated off-the-shelf shoe inserts or supportive athletic shoes worn alone OBJECTIVE To develop preliminary criteria for inactive disease and clinical remission for select categories of juvenile idiopathic arthritis ( JIA ) , and to decide what such clinical states should predict in terms of probability of disease recurrence . METHODS A Delphi serial question naire consensus-formation approach was used initially to gather criteria in use by pediatric rheumatologists ( PR ) for defining clinical remission in oligoarticular ( persistent and extended ) , rheumatoid factor ( RF ) positive and negative polyarticular , and systemic JIA . Results from sequential question naires provided an agenda for a nominal group technique ( NGT ) conference to reach consensus on unresolved questions . RESULTS One hundred and thirty PR from 34 countries responded to the question naires and 20 PR from 9 countries attended the conference . Draft criteria for inactive disease include the following : no active arthritis ; no fever , rash , serositis , splenomegaly , or generalized lymphadenopathy attributable to JIA ; no active uveitis ; normal erythrocyte sedimentation rate or C-reactive protein ; and a physician 's global assessment of disease activity rated at the best score possible for the instrument used . According to consensus vote , 6 continuous months of inactive disease on medication defines clinical remission on medication , while 12 months of inactive disease off all anti-arthritis ( and anti-uveitis ) medications defines clinical remission off medication . The finalized criteria for remission off medication ideally should predict that a patient has < /= 20 % probability of disease recurrence within the next 5 years . CONCLUSION Using consensus formation techniques , we formulated preliminary criteria for inactive disease and clinical remission on and off medication for use in select categories of JIA . Retrospective validation is in progress ; prospect i ve validation will follow . Future efforts will include other categories of JIA Background Adolescents with Juvenile Idiopathic Arthritis ( JIA ) are at risk for physical , emotional , social and role challenges that negatively impact quality of life .  Peer mentoring has been shown to improve positive health behaviours in adolescents with chronic disease while simultaneously providing social support . The objectives of this paper are to examine the feasibility and acceptability of an online peer mentoring program ( iPeer2Peer Program ) for adolescents with JIA . Methods The iPeer2Peer program was examined using a waitlist pilot r and omized control trial ( RCT ) . Participants were r and omly allocated to the intervention or wait-list control group via a secure , web-based r and omization service . Health care providers and investigators were blinded to participant group allocation . Trained peer mentors ( 16–25 years ; successfully managing their JIA ) were matched to participants ( 12–18 years ; diagnosed with JIA ) r and omized to the intervention group to provide peer support and education for effective self-management of JIA . Participant-mentor pairings connected ten times over 8 weeks using Skype video calls . Primary outcomes focused on implementation ( i.e. measures of feasibility and acceptability ) . Secondary outcomes focused on effectiveness ( i.e. measures of self-management , self-efficacy , pain , social support and quality of life ) . Results Thirty adolescents ( mean age 14.3 ± 1.7 years , 97 % female ) completed the RCT ( intervention n = 16 , control n = 14 ) . Primary outcomes : One third ( 32 % ) of adolescents approached agreed to participate , completed baseline measures and were r and omized . Half of pairings completed ten calls within 8 weeks . Average call length was twice the required amount with call lengths of 44.72 ± 15.76 min . Participants reported satisfaction with the program and all reported that they would recommend it to their peers . Participants ’ mean engagement level with the program was 8.53/10 ( range = 7–10 ) . Secondary outcomes : Participants who completed the iPeer2Peer Program demonstrated improvements in their perceived ability to manage JIA ( p < 0.04 ) , compared to controls . No adverse events were reported . Conclusion The iPeer2Peer Program is a promising intervention that improves acceptability of self-management and peer support treatments for adolescents with JIA . By using the Internet to connect mentors to adolescents with JIA it may also improve accessibility to these re sources . Findings will be used to adapt the program and refine the methodology for a full-scale RCT .Trial registration Clinical Trials.gov Identifier : NCT01986400 . Registered November 11 , 2013 Objectives Pain is a very common symptom of juvenile idiopathic arthritis ( JIA ) . Disease activity alone can not explain symptoms of pain in all children , suggesting other factors may be relevant . The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain . Methods This study used  longitudinal- data from patients ( aged 1–16 years ) with new-onset JIA .  Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospect i ve Study ( CAPS ) were used . A two-step approach was adopted . First ,  pain trajectories  were modelled using a discrete mixture model . Second , multinomial logistic regression was used to determine the association between variables and trajectories . Results Data from 851 individuals were included ( 4 years , median follow-up ) . A three-group trajectory model was identified : consistently low pain ( n=453 ) , improved pain ( n=254 ) and consistently high pain ( n=144 ) . Children with improved pain or consistently high pain differed on average at baseline from consistently low pain . Older age at onset , poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain . Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain . Conclusions This study has identified routinely collected clinical factors , which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease . Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes OBJECTIVE To assess the determinants and responsiveness of the Norwegian version of the Child Health Question naire ( CHQ ) in patients with early juvenile idiopathic arthritis ( JIA ) and to compare health status in patients and controls . METHODS A total of 116 children ( median age 8.4 yrs ) with JIA and < 2.5 years of disease duration ( median 11.0 mo ) were examined by a pediatric rheumatologist and reassessed after a median of 10.0 months . Physical and psychosocial health were assessed by means of the CHQ , which provides summary scores for physical and psychosocial health , the Childhood Health Assessment Question naire ( CHAQ ) , and the Child Behavior Checklist ( CBCL , n = 32 ) . Matched controls ( n = 116 ) , r and omly selected from the general population , completed the CHQ at baseline . RESULTS The patients with JIA had poorer physical health and slightly impaired psychosocial health compared with the controls [ 41.2 + /- 13.6 vs 55.2 + /- 7.3 ( p < 0.001 ) and 51.0 + /- 7.5 vs 54.1 + /- 5.7 ( p = 0.002 ) , respectively ] . The most important determinants of the CHQ physical summary score were the child 's pain , morning stiffness , the CHAQ disability index , erythrocyte sedimentation rate ( ESR ) , overall well-being , and physician 's global assessment of disease activity . The psychosocial summary score correlated with the CBCL level of internalizing , externalizing , and total behavior problems . The st and ardized response mean for the physical summary score was large ( 0.96 ) for those who improved , and moderate ( -0.60 ) for those who became worse . CONCLUSION The CHQ discriminated between patients with early JIA and controls . The most important determinants of the CHQ physical summary score were the child 's pain , morning stiffness , CHAQ , ESR , overall well-being , and physician 's global assessment of disease activity . The CHQ was sensitive to clinical changes in children with JIA Objective : We undertook an observational study to obtain a complete overview of the long-term effectiveness and safety of etanercept in patients with different juvenile idiopathic arthritis ( JIA ) subtypes . Methods : At baseline we collected patient and disease characteristics of all Dutch patients with JIA who started treatment with etanercept .  Disease activity was evaluated ( at start of the study , after 3 months and then yearly ) according to the JIA core set of the American College of Rheumatology paediatric definition for 30 , 50 and 70 % improvement ( ACR Pedi 30 , 50 and 70 ) . Use of etanercept and concomitant drugs was monitored . Adverse events were recorded . Results : We included 146 patients with JIA with a median follow-up of 2.5 years per patient ( range 0.3–7.3 ) . JIA subtypes represented : 27 % systemic , 8 % polyarticular rheumatoid factor positive , 38 % polyarticular rheumatoid factor negative , 19 % oligoarticular extended , 3 % enthesitis-related and 5 % psoriatica . Most patients ( 77 % ) met the criteria of the ACR Pedi 30 in the first 3 months of treatment . For the majority of patients this improvement was sustained ; 53 ( 36 % ) of all patients met the remission criteria . No other second-line agents were needed in 43 patients . Although patients with systemic JIA responded initially less to etanercept therapy than patients from other subtypes , those who did respond showed equal effectiveness in the long term . Serious adverse events rate was low ( 0.029 per patient year ) . Conclusions : Etanercept  is effective and safe in JIA , even for a large proportion of the patients with systemic JIA . The greatest improvement occurred in the first 3 months of treatment , and was sustained for a long time in most patients ( up to 75 months ) Objective This report aims to determine the safety , pharmacokinetics ( PK ) and efficacy of subcutaneous golimumab in active polyarticular-course juvenile idiopathic arthritis ( polyJIA ) . Methods In this three-part r and omised double-blinded placebo-controlled withdrawal trial , all patients received open-label  golimumab ( 30 mg/m2 of body surface area ; maximum : 50 mg/dose ) every 4 weeks together with weekly methotrexate during Part 1 ( weeks 0–16 ) . Patients with at least 30 % improvement per American College of Rheumatology Criteria for JIA ( JIA ACR30 ) in Part 1 entered the double-blinded Part 2 ( weeks 16–48 ) after 1:1 r and omisation to continue golimumab or start placebo . In Part 3 , golimumab was continued or could be restarted as in Part 1 . The primary outcome was JIA flares in Part 2 ; secondary outcomes included JIA ACR50/70/90 responses , clinical remission , PK and safety . Results Among 173 patients with polyJIA enrolled , 89.0 % ( 154/173 ) had a JIA ACR30 response and 79.2%/65.9%/36.4 % demonstrated JIA ACR50/70/90 responses  in Part 1 . At week 48 , the primary endpoint was not met as treatment groups had comparable JIA flare rates  ( golimumab vs placebo : 32/78=41 % vs 36/76=47 % ; p=0.41 ) , and rates of clinical remission were comparable ( golimumab vs placebo : 10/78=12.8 % vs 9/76=11.8 % ) . Adverse event and serious adverse event rates were similar in the treatment groups during Part 2 . Injection site reactions occurred with < 1 % of all injections . PK analysis confirmed adequate golimumab dosing for polyJIA . Conclusion Although the primary endpoint was not met , golimumab result ed in rapid , clinical ly meaningful , improvement in children with active polyJIA . Golimumab was well tolerated , and no unexpected safety events occurred . Clinical Trial Registration NCT01230827 ; Results OBJECTIVES The purpose of this study was to determine the potential of high-resolution ultrasonography for the detection of temporom and ibular joint ( TMJ ) changes in children with juvenile idiopathic arthritis ( JIA ) . METHODS We investigated prospect ively 20 children ( 17 female and 3 male ; mean age 11.06 years , st and ard deviation 3.43 years ) with TMJ disorders caused by JIA , over a period of 16 months . Using a 12 MHz array transducer , four images in each TMJ ( 160 images ) were acquired . Each image was analysed with regard to five different aspects ( condylar erosion , thickness of the condylar disc , synovial thickness , joint effusion and enlargement of the intra-articular space ) . RESULTS Diagnosis of JIA was ensured for every child and involvement of the TMJ was proven by MRI . Overall 287 changes ( 35.9 % ) were detected by using high-resolution ultrasonography . On 124 images ( 77.5 % ) condylar erosions were diagnosed ; on 55 images ( 34.4 % ) synovial thickness was abnormal ; on 48 images ( 30 % ) we could see higher thickness of the condylar disc ; on 40 images ( 25 % ) irregularities of the bony surface were detected ; and on 20 images ( 12.5 % ) we found joint effusion . CONCLUSION High-resolution ultrasonography could be a sufficient diagnostic method , especially for the detection of condylar involvement in children with JIA , even if not all parts of the TMJ are visible for ultrasonography . High-resolution ultrasonography is a valuable tool in particular situations : ( i ) when MRI examination is not available ; ( ii ) when children fear MRI examination ; ( iii ) in more advanced stages of JIA ; and ( iv ) for monitoring the progression of TMJ involvement and response of therapy
The  Childhood Health Assessment Question naire ( C-HAQ )  was the most extensively studied instrument and had high reliability , but only moderate correlations with other indices of disease activity and poor responsiveness to change in disease status .
The physician global assessment of disease activity ( PGA ) and articular indices had the strongest association with disease activity and were the most responsive to change .
Measures of psychosocial function and quality of life were moderately associated with measures of disease activity , but were less responsive to changes in disease status .
In children with JIA , no single instrument was superior in reliability or validity or in describing the impact of JIA .
Although the C-HAQ has been extensively evaluated , the PGA and articular indices appear to have the highest responsiveness to change and , therefore , the highest potential for detecting important differences in treatment response
OBJECTIVE To review the performance characteristics of the instruments most commonly used to measure clinical outcomes in juvenile idiopathic arthritis ( JIA ) , including global assessment s , articular indices , functional/disability assessment s , and quality of life measures .
METHODS As part of an Agency for Healthcare Research and Quality comparative effectiveness review of antirheumatic drugs , we explored the characteristics of commonly used outcome measures for JIA .