Lurati A, Pontikaki I, Teruzzi B, Desiati F, Gerloni V, Gattinara M, Cimaz R, Fantini F
Gaetano Pini Institute, Milan, Italy.
Arthritis Rheum. 2006 May;54(5):1602-7. doi: 10.1002/art.21784.
There are no validated criteria to evaluate clinical response in juvenile idiopathic arthritis (JIA). The purpose of this study was to compare 4 sets of criteria (2 from the American College of Rheumatology [ACR] and 2 from the European League Against Rheumatism [EULAR]) for clinical response evaluation in JIA patients treated with methotrexate and/or anti-tumor necrosis factor alpha drugs.
Seventy-five patients with JIA were evaluated at baseline and after 6 months of therapy with second-line drugs. Mean age at study onset was 12.8 years (range 2-32.9 years). Diagnoses were systemic JIA (n = 16), rheumatoid factor-positive JIA (n = 5), rheumatoid factor-negative JIA (n = 9), persistent oligoarticular JIA (n = 10), extended oligoarticular JIA (n = 33), and psoriatic arthritis (n = 2). Clinical response was evaluated with the ACR Pediatric 30 criteria and the ACR 20% response criteria (ACR20), and with the EULAR Disease Activity Score (DAS) and 28-joint DAS (DAS28). Patients with EULAR criteria responses of "good" or "moderate" were classified as responders. Responders and nonresponders according to the different criteria were then compared.
For patients younger than 16 years, Cohen's kappa varied between 0.51 and 0.72, with a good-to-excellent reproducibility index for all comparisons, except for the DAS28/ACR20 comparison. The best agreement was obtained by comparing the DAS and the ACR Pediatric 30. For patients older than 16 years, the reproducibility index was good or excellent in only 2 cases, i.e., comparing the DAS and the ACR Pediatric 30 and comparing the DAS and the DAS28 (as expected).
Our study shows a good agreement overall for the different criteria tested. The highest concordance was observed between the DAS and the ACR Pediatric 30, the lowest between the DAS28 and the ACR20. Our data suggest that the ACR Pediatric 30 criteria can be used also in adult patients affected by JIA, and that the original DAS can be an alternative to the ACR Pediatric 30 in both children and young adults with JIA.
目前尚无经过验证的标准来评估青少年特发性关节炎（JIA）的临床反应。本研究的目的是比较4套标准（2套来自美国风湿病学会[ACR]，2套来自欧洲抗风湿病联盟[EULAR]），用于评估接受甲氨蝶呤和/或抗肿瘤坏死因子α药物治疗的JIA患者的临床反应。
75例JIA患者在基线时以及接受二线药物治疗6个月后进行评估。研究开始时的平均年龄为12.8岁（范围2 - 32.9岁）。诊断包括全身型JIA（n = 16）、类风湿因子阳性JIA（n = 5）、类风湿因子阴性JIA（n = 9）、持续性少关节型JIA（n = 10）、扩展性少关节型JIA（n = 33）和银屑病关节炎（n = 2）。使用ACR儿科30标准和ACR 20%反应标准（ACR20），以及EULAR疾病活动评分（DAS）和28关节DAS（DAS28）评估临床反应。EULAR标准反应为“良好”或“中等”的患者被分类为反应者。然后比较根据不同标准分类的反应者和非反应者。
对于16岁以下的患者，科恩kappa系数在0.51至0.72之间，除DAS28/ACR20比较外，所有比较的重复性指数均为良好至优秀。通过比较DAS和ACR儿科30获得了最佳一致性。对于16岁以上的患者，仅在2种情况下重复性指数良好或优秀，即比较DAS和ACR儿科30以及比较DAS和DAS28（如预期）。
我们的研究表明，所测试的不同标准总体上具有良好的一致性。DAS和ACR儿科30之间的一致性最高，DAS28和ACR20之间的一致性最低。我们的数据表明，ACR儿科30标准也可用于受JIA影响的成年患者，并且原始DAS在患有JIA的儿童和年轻成年人中可作为ACR儿科30的替代标准。
