FRI0550 JIA DISEASE ACTIVITY OUTCOMES ACROSS A MULTI-CENTER COHORT: ANALYSIS OF THE PEDIATRIC RHEUMATOLOGY CARE AND OUTCOMES IMPROVEMENT NETWORK (PR-COIN) REGISTRY
Authors: Emily A. Smitherman, Bin Huang, Ronald Laxer, C. April Bingham, Cagri Yildirim-Toruner, Beth Gottlieb, Jennifer E. Weiss, Tzielan Lee, Sheetal Vora, Jon (Sandy) Burnham, Julia G. Harris, Judyann C. Olson, Mileka Gilbert, Michelle Batthish, Michael Shishov, Dustin Fleck, Esi Morgan
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Clinical remission is widely accepted as the primary target outcome for juvenile idiopathic arthritis (JIA). PR-COIN is a quality improvement collaborative that serves as a sample of pediatric rheumatology centers in North America. By measuring disease activity in practice using the ACR provisional criteria for Clinical Inactive Disease (CID), variation in patient outcomes has been previously observed between centers. <h3>Objectives</h3> The objective of this study was to evaluate differences in patient-level factors that may be driving center-level variation in JIA outcomes. <h3>Methods</h3> This study used cross-sectional data provided by PR-COIN that was collected by PR-COIN centers from March 2015 to May 2016. For each patient, sociodemographic, clinical, patient-reported, disease activity, and medication variables were extracted from the most recent encounter. Patients with disease duration less than 9 months were excluded. Patients were grouped by CID status (inactive vs active disease) and then compared using descriptive statistics, chi-square for categorical variables, and independent t-tests for continuous variables. Missing data were excluded with each analysis. Analyses were performed using R software. <h3>Results</h3> There were 2751 patients eligible for analysis from 14 centers, with 33 to 394 patients per center. We identified 1249 patients with inactive disease (47%) and 1428 patients with active disease (53%). Patients with inactive disease were younger (12 vs 13 years), more likely to have persistent oligoarticular subtype (33% vs 23%), and less likely to have enthesitis related arthritis (9% vs 14%). Patients with active disease had higher patient-reported measures of global assessment of disease activity, pain, and functional disability, as well as disease activity measures per definition. More medication usage was observed in patients with active disease compared to inactive disease across multiple categories, including both non-biologic DMARDs (45% vs. 32%) and biologic DMARDs (48% vs 35%). <h3>Conclusion</h3> This study demonstrates differences in sociodemographic, clinical, and medication factors between patients with inactive and active JIA. Further analysis is needed to adjust center-level measures of JIA disease activity using the observed differences in patient case-mix. By using population data to identify predictors of inactive disease in JIA, there is potential to develop and implement targeted clinical interventions to directly impact care and improve outcomes. <h3> Disclosure of Interests:</h3> Emily A. Smitherman: None declared, Bin Huang: None declared, Ronald Laxer Consultant for: Eli Lilly Canada, Alexion, Sanofi, C. April Bingham: None declared, Cagri Yildirim-Toruner: None declared, Beth Gottlieb: None declared, Jennifer E. Weiss: None declared, Tzielan Lee: None declared, Sheetal Vora: None declared, Jon (Sandy) Burnham: None declared, Julia G. Harris: None declared, Judyann C. Olson: None declared, Mileka Gilbert: None declared, Michelle Batthish Speakers bureau: Novartis, Abbvie, Michael Shishov: None declared, Dustin Fleck: None declared, Esi Morgan: None declared