Objective
To estimate the incidence and prevalence of juvenile idiopathic arthritis (JIA) in children ages <16 years in the province of Manitoba, Canada, and to determine changes in estimates between ...2000 and 2012.
Methods
JIA cases were ascertained from the administrative health data of Manitoba, using a validated case‐finding algorithm. Annual incidence and prevalence rates were estimated using a generalized linear model with generalized estimating equations (GEEs), adjusting for sociodemographic characteristics. Changes in estimates were tested using piecewise regression models.
Results
A total of 455 cases of JIA prevalence met the inclusion criteria. Sex‐ and age‐adjusted incidence estimates were 14.01 (95% confidence interval 95% CI 13.52, 14.53) in 2000/2001 and 9.18 (95% CI 8.56, 9.85) in 2010/2011. Prevalence estimates were 65.33 (95% CI 63.87, 66.83) in 2000/2001 and 59.61 (95% CI 58.17, 61.08) in 2010/2011. A linear piecewise model provided the best fit to the data. There was a significant decrease in prevalence over the study period (–0.18 95% CI –0.35, –0.02; P = 0.0292) but no statistically significant change in incidence (–0.46 95% CI –0.94, 0.01; P = 0.0571). Sex‐stratified models revealed a decrease for males in both prevalence (estimate –0.54 95% CI –0.84, –10.25; P = 0.0003) and incidence (estimate –1.02 95% CI –2.02, –0.04; P = 0.0439); there were no changes for females.
Conclusion
Few population‐based longitudinal epidemiologic studies of JIA have been conducted. Our findings suggested a decrease in overall JIA prevalence, and in incidence and prevalence in men. Further research to validate these findings in other cohorts and to explore factors that contribute to this change will benefit future health care planning for JIA.
Objective
To describe high‐dose biologic use when treating juvenile idiopathic arthritis (JIA).
Methods
Patients with JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance ...Registry and treated with a biologic after enrollment were eligible. We described the frequency of high‐dose biologic use and characteristics of patients receiving high‐dose biologics. We used regression modeling to compare 6‐month outcomes (using disease activity measures) between those who increased their biologic from standard to high dose (high‐dose group) to those who initiated and remained on standard dosing (no‐change group), and to those who switched biologic agents (biologic‐switch group). We also compared serious adverse events (SAEs) between groups.
Results
A total of 5,352 patients with JIA were treated with biologics following enrollment; 1,080 (20%) had ever received a high‐dose biologic. There were no significant differences in outcomes between the high‐dose group and the biologic‐switch group; both improved disease activity measures, including the clinical Juvenile Arthritis Disease Activity Score 10 (–3.53 and –3.95, respectively; P = 0.68). Although the SAE rates in the high‐dose group and the biologic‐switch group were numerically higher than the no‐change group, the event rates were similar, and neither rate was significantly higher than in the no‐change group (unadjusted incident rate ratio 2.5 95% confidence interval (95% CI) 0.7–8.5 and 1.8 95% CI 0.7–4.6, respectively).
Conclusion
Dosing escalation appears to be a reasonable choice to improve disease control, but large, prospective, randomized studies evaluating specific biologic agents are needed.
We studied an inception cohort of children with juvenile idiopathic arthritis (JIA) to (1) identify distinct disease courses based on changes over 5 years in 5 variables prioritized by patients, ...parents, and clinicians; and (2) estimate the probability of a severe disease course for each child at diagnosis.
Assessments of quality of life, pain, medication requirements, patient-reported side effects, and active joint counts were scheduled at 0, 6, 12, 18, 24, 36, 48, and 60 months. Patients who attended at least 6 assessments were included. Multivariable cluster analysis, r
, and silhouette statistics were used to identify distinct disease courses. One hundred candidate prediction models were developed in random samples of 75% of the cohort; their reliability and accuracy were tested in the 25% not used in their development.
Four distinct courses were identified in 609 subjects. They differed in prioritized variables, disability scores, and probabilities of attaining inactive disease and remission. We named them Mild (43.8% of children), Moderate (35.6%), Severe Controlled (9%), and Severe Persisting (11.5%). A logistic regression model using JIA category, active joint count, and pattern of joint involvement at enrollment best predicted a severe disease course (Controlled + Persisting, c-index = 0.87); 91% of children in the highest decile of risk actually experienced a severe disease course, compared to 5% of those in the lowest decile.
Children in this JIA cohort followed 1 of 4 disease courses and the probability of a severe disease course could be estimated with information available at diagnosis.
Infliximab and golimumab are intravenously (IV) administered tumor necrosis factor inhibitors approved to treat moderate-to-severe rheumatoid arthritis (RA) with concomitant methotrexate. Owing to ...differences in biologic construct, patients with IV-infliximab treatment failure may benefit from switching to IV-golimumab. Utilizing the ACR’s Rheumatology Informatics System for Effectiveness (RISE), a large electronic health records registry based in the USA, we assessed RA disease activity in patients switching from IV-infliximab to IV-golimumab. This retrospective, longitudinal, single-arm study included adults (≥ 18 years) with ≥ 1 RA diagnosis code between 2014 and 2018 and ≥ 1 IV-infliximab prescription within 6 months of a new IV-golimumab order (index date). Longitudinal assessments of disease activity using the Clinical Disease Activity Index (CDAI) were calculated in patients continuing IV-golimumab for 6–9- and 9–12-months post-switch. Paired
t
-tests evaluated significance of mean improvements during the follow-up periods. Most RA patients with disease activity assessments during the 6-month follow-up (
N
= 100; mean age: 65.3 years; 81% female; 74% white) demonstrated moderate-to-high disease activity (CDAI: 73% 38/52) at enrollment. On average, patients showed significant improvement in disease activity within 6–9 months of switching; mean CDAI scores improved from 21.3 to 14.1 (
p
< 0.0001) and were durable through 9–12 months of treatment. Real-world patients with moderate-to-high disease activity who switched from IV-infliximab to IV-golimumab demonstrated significant and sustained improvements post-switch as measured by the CDAI.
Key Points
•
This study used real-world data from the Rheumatology Informatics System for Effectiveness (RISE) registry to evaluate the efficacy of directly switching from intravenous (IV)-infliximab to IV-golimumab to control rheumatoid arthritis (RA) disease activity.
•
Most IV-infliximab patients had moderate-to-high disease activity at the time of the switch.
•
On average, IV-golimumab was effective in improving RA disease activity after switching from IV-infliximab as measured by the Clinical Disease Activity Index.
•
These data suggest that real-world RA patients with persistent symptoms despite treatment with IV-infliximab may realize improved disease control with a switch to IV-golimumab.
Objective
To operationalize and report on nationally endorsed rheumatoid arthritis (RA) performance measures (PMs) using health administrative data for British Columbia (BC), Canada.
Methods
All ...patients with RA in BC ages ≥18 years were identified between January 1, 1997 and December 31, 2009 using health administrative data and followed until December 2014. PMs tested include: the percentage of incident patients with ≥1 rheumatologist visit within 365 days; the percentage of prevalent patients with ≥1 rheumatologist visit per year; the percentage of prevalent patients dispensed disease‐modifying antirheumatic drug (DMARD) therapy; and time from RA diagnosis to DMARD therapy. Measures were reported on patients seen by rheumatologists, and in the total population.
Results
The cohort included 38,673 incident and 57,922 prevalent RA cases. The percentage of patients seen by a rheumatologist within 365 days increased over time (35% in 2000 to 65% in 2009), while the percentage of RA patients under the care of a rheumatologist seen yearly declined (79% in 2001 to 39% in 2014). The decline was due to decreasing visit rates with increasing follow‐up time rather than calendar effect. The percentage of RA patients dispensed a DMARD was suboptimal over follow‐up (37% in 2014) in the total population but higher (87%) in those under current rheumatologist care. The median time to DMARD in those seen by a rheumatologist improved from 49 days in 2000 to 23 days in 2009, with 34% receiving treatment within the 14‐day benchmark.
Conclusion
This study describes the operationalization and reporting of national PMs using administrative data and identifies gaps in care to further examine and address.
The purpose of this research was to perform a scoping review of published literature on the validity of administrative health data for ascertaining health conditions in the pediatric population (≤20 ...years).
A comprehensive search of OVID Medline (1946 - present), CINAHL (1937 - present) and EMBASE (1947 - present) was conducted. Characteristics of validation studies that were abstracted included the study population, health condition, topic of the validation (e.g., single diagnosis code versus case-finding algorithm), administrative and validation data sources. Inter-rater agreement was measured using Cohen's κ. Extracted data were analyzed using descriptive statistics.
A total of 37 articles met the study inclusion criteria. Cohen's κ for study inclusion/exclusion and data abstraction was 0.88 and 0.97, respectively. Most studies validated administrative data from the USA (43.2%) and Canada (24.3%), and focused on inpatient records (67.6%). Case-finding algorithms (56.7%) were more frequently validated than diagnoses codes alone (37.8%). Five conditions were validated in more than one study: diabetes mellitus, inflammatory bowel disease, asthma, rotavirus infection, and tuberculosis.
This scoping review identified a number of gaps in the validation of administrative health data for pediatric populations, including limited investigation of outpatient populations and older pediatric age groups.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
We studied children enrolled within 90 days of juvenile idiopathic arthritis diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) prospective inception cohort ...to identify longitudinal trajectories of pain severity and features that may predict pain trajectory at diagnosis. A total of 1062 participants were followed a median of 24.3 months (interquartile range = 16.0-37.1 months). Latent trajectory analysis of pain severity, measured in a 100-mm visual analogue scale, identified 5 distinct trajectories: (1) mild-decreasing pain (56.2% of the cohort); (2) moderate-decreasing pain (28.6%); (3) chronically moderate pain (7.4%); (4) minimal pain (4.0%); and (5) mild-increasing pain (3.7%). Mean disability and quality of life scores roughly paralleled the pain severity trajectories. At baseline, children with chronically moderate pain, compared to those with moderate-decreasing pain, were older (mean 10.0 vs 8.5 years, P = 0.01) and had higher active joint counts (mean 10.0 vs 7.2 joints, P = 0.06). Children with mild-increasing pain had lower joint counts than children with mild-decreasing pain (2.3 vs 5.2 joints, P < 0.001). Although most children with juvenile idiopathic arthritis in this cohort had mild or moderate initial levels of pain that decreased quickly, about 1 in 10 children had concerning pain trajectories (chronically moderate pain and mild-increasing pain). Systematic periodic assessment of pain severity in the months after diagnosis may help identify these concerning pain trajectories early and lay out appropriate pain management plans. Focused research into the factors leading to these concerning trajectories may help prevent them.
Introduction
The aim of this work is to evaluate treatment persistence and clinical outcomes after 6 months of on-label guselkumab use in patients with rheumatologist-diagnosed active psoriatic ...arthritis (PsA) enrolled in the CorEvitas PsA/Spondyloarthritis Registry.
Methods
Participants with PsA who initiated and persisted with on-label guselkumab use post-Food and Drug Administration (FDA) approval for active PsA (7/13/2020; subcutaneous 100 mg at weeks 0, 4, and every 8 weeks) at their 6-month follow-up visit (occurring through 3/31/2023) comprised the primary analysis population (On-Label Persisters). Hierarchical, multiplicity-controlled primary and secondary outcomes were mean (95% confidence interval) changes from baseline at 6 months in clinical Disease Activity Index for PsA (cDAPSA; primary), Physician Global Assessment (PGA) of arthritis and psoriasis (visual analog scale VAS 0–100), patient-reported pain (VAS 0–100), and percent body surface area with psoriasis (%BSA). Paired
t
tests determined changes that were statistically significantly different from 0 (
α
= 0.05).
Results
Among 114 patients who initiated on-label guselkumab and had eligible baseline and 6-month visits, 90 (78.9%) had persistent use. Among these On-Label Persisters at baseline, mean duration of PsA symptoms = 13.6 years; mean cDAPSA, PGA, and patient-reported pain = 22.0, 42.3, and 57.0, respectively; 94.4% had a history of psoriasis (mean BSA 7.6%); and 18.9% and 73.3%, respectively, previously received 1 or ≥ 2 biologic/targeted synthetic disease-modifying antirheumatic drugs. The mean change (improvement) in cDAPSA was − 5.4 (− 8.5, − 2.3;
p
< 0.001) at 6 months. Significant mean improvements in PGA (− 19.0 − 24.2, − 13.8), patient-reported pain (− 9.1 − 14.4, − 3.8), and %BSA (− 5.1 − 7.6, − 2.7) were also observed (all
p
< 0.001).
Conclusions
In this real-world PsA population, generally characterized by longstanding, treatment-resistant, active disease at baseline, persistent guselkumab use in nearly 80% of patients with on-label use was accompanied by significant improvements in joint and skin symptoms and patient-reported pain at 6 months. These registry data support results from randomized clinical trials demonstrating the efficacy of guselkumab in improving PsA signs and symptoms.
Trial Registration
clinicaltrials.gov: NCT02530268.
Graphic abstract
Objective
To examine work absenteeism, job disruptions, and perceived productivity loss and factors associated with each outcome in young adults living with systemic lupus erythematosus (SLE) and ...juvenile arthritis (JA).
Methods
One hundred forty‐three young adults, ages 18–30 years with SLE (54.5%) and JA (45.5%), completed an online survey of work experiences. Demographic, health (e.g., fatigue, disease activity), psychosocial (e.g., independence, social support), and work context (e.g., career satisfaction, job control, self‐disclosure) information was collected. Participants were asked about absenteeism, job disruptions, and perceived productivity loss in the last 6 months. Log Poisson regression analyses examined factors associated with work outcomes.
Results
A majority of participants (59%) were employed and reported a well‐managed health condition. Employed respondents were satisfied with their career progress and indicated moderate job control. More than 40% of participants reported absenteeism, job disruptions, and productivity loss. Greater job control and self‐disclosure, and less social support, were related to a higher likelihood of absenteeism. More disease activity was related to a greater likelihood of reporting job disruptions. Lower fatigue and higher job control were associated with a reduced likelihood of a productivity loss.
Conclusion
Young adult respondents with rheumatic disease experienced challenges with employment, including absenteeism, job disruptions, and productivity loss. While related to greater absenteeism, job control could play a role in a young person's ability to manage their health condition and sustain productive employment. Greater attention should also be paid to understanding health factors and social support in early work experiences.
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