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Undervaluing the effectiveness of conventional treatments may lead to overtreatment with biologic medications in children with juvenile idiopathic arthritis (JIA). Using data from a nationwide inception cohort and strict methods to control bias, the aim of our study was to estimate the real‐world effectiveness of simple JIAtreatment strategies recommended in current guidelines. Children with JIAwho were recruited at 16 Canadian centers from 2005 to 2010 were followed for up to 5 years. For each child, all observed treatment changes over time were assessed by independent physicians using prospectively collected data and published response criteria. Success was defined as attainment of inactive disease or maintenance of this state when stepping down treatment; minimally active disease was deemed acceptable for children with polyarticular JIA. Success rates were calculated for treatments tried ≥25 times, and logistic regression analysis identified features associated with success. A total of 4,429 treatment episodes were observed in 1,352 children. Nonsteroidal antiinflammatory drug (NSAID) monotherapy was attempted 697 times, mostly as initial treatment when <5 joints were involved, with a 54.4% success rate (95% confidence interval [95% CI] 50.3–58.6). NSAIDs plus joint injections had a 64.7% success rate (95% CI59.8–69.7). Adding methotrexate to NSAIDs and/or joint injections (attempted 566 times) had a 60.5% success rate (95% CI55.7–65.3). In adjusted analyses, each additional active joint reduced chances of success for treatment with NSAIDs (odds ratio [OR] 0.90 [95% CI0.85–0.94]) and for methotrexate combinations (OR0.96 [95% CI0.94–0.99]). Each additional year after disease onset reduced chances of success for treatment with methotrexate combinations (OR0.83 [95% CI0.72–0.95]). These real‐world effectiveness estimates show that conventional nonbiologic treatment strategies that are recommended in current guidelines are effective in achieving treatment targets in many children with JIA.

To estimate the impact of enthesitis on patient‐reported outcomes in children with juvenile idiopathic arthritis (JIA), irrespective of JIAcategory. Children enrolled in the Research in Arthritis in Canadian Children Emphasizing Outcomes cohort were studied. Entheseal tenderness by physician examination in 33 defined locations, Juvenile Arthritis Quality of Life Questionnaire (JAQQ), Quality of My Life (QoML) Questionnaire, Childhood Health Assessment Questionnaire (C‐HAQ), and a pain visual analog scale were completed at enrollment, every 6 months for 2 years, and then yearly up to 5 years. Analyses consisted of descriptive statistics, linear mixed models for longitudinal data, and analysis of covariance. Among 1,371 patients followed for a median of 35.3 months (interquartile range 22.1, 49.2), 214 (16%) had enthesitis, of whom 137 (64%) were classified as having enthesitis‐related arthritis. After adjusting for JIAcategory and covariates, children with enthesitis reported higher JAQQ(mean raw score 2.71 versus 2.16, adjusted difference 0.41 points; 95% confidence interval [95% CI] 0.22, 0.59), higher C‐HAQ(0.47 versus 0.31, adjusted difference 0.14 points; 95% CI0.07, 0.22), higher pain (3.01 versus 1.68, adjusted difference 0.94 points; 95% CI0.64, 1.25), and lower QoML(7.02 versus 8.23, adjusted difference –0.80 points; 95% CI–1.09, –0.51) scores than children without enthesitis. These differences persisted up to 5 years. Children with enthesitis, regardless of JIAcategory, report worse patient‐reported outcomes than those without enthesitis. Thus, enthesitis should be assessed in all children with JIA.

Identification of the incidence of juvenile idiopathic arthritis (JIA)–associated uveitis and its risk factors is essential to optimize early detection. Data from the Research in Arthritis in Canadian Children Emphasizing Outcomes inception cohort were used to estimate the annual incidence of new‐onset uveitis following JIAdiagnosis and to identify associated risk factors. Data were reported every 6 months for 2 years, then yearly to 5 years. Incidence was determined by Kaplan‐Meier estimators with time of JIAdiagnosis as the reference point. Univariate log‐rank analysis identified risk factors and Cox regression determined independent predictors. In total, 1,183 patients who enrolled within 6 months of JIAdiagnosis met inclusion criteria, median age at diagnosis of 9.0 years (interquartile range [IQR] 3.8–12.9), median follow‐up of 35.2 months (IQR22.7–48.3). Of these patients, 87 developed uveitis after enrollment. The incidence of new‐onset uveitis was 2.8% per year (95% confidence interval [95% CI] 2.0–3.5) in the first 5 years. The annual incidence decreased during follow‐up but remained at 2.1% (95% CI0–4.5) in the fifth year, although confidence intervals overlapped. Uveitis was associated with young age (<7 years) at JIAdiagnosis (hazard ratio [HR] 8.29, P< 0.001), positive antinuclear antibody (ANA) test (HR3.20, P< 0.001), oligoarthritis (HR2.45, P= 0.002), polyarthritis rheumatoid factor negative (HR1.65, P= 0.002), and female sex (HR1.80, P= 0.02). In multivariable analysis, only young age at JIAdiagnosis and ANApositivity were independent predictors of uveitis. Vigilant uveitis screening should continue for at least 5 years after JIAdiagnosis, and priority for screening should be placed on young age (<7 years) at JIAdiagnosis and a positive ANAtest.

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. JIAcases 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. A total of 455 cases of JIAprevalence 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% CI8.56, 9.85) in 2010/2011. Prevalence estimates were 65.33 (95% CI63.87, 66.83) in 2000/2001 and 59.61 (95% CI58.17, 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. Few population‐based longitudinal epidemiologic studies of JIAhave been conducted. Our findings suggested a decrease in overall JIAprevalence, 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.

To describe changes in health‐related quality of life (HRQoL) over time in children with juvenile idiopathic arthritis (JIA), relative to other outcomes, and to identify predictors of unfavorable HRQoL trajectories. Children with JIAin the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh‐Out) cohort were included. The Juvenile Arthritis Quality of Life Questionnaire (JAQQ, a standardized instrument), health‐related Quality of My Life (HRQoML, an instrument based on personal valuations), and JIAcore variables were completed serially. Analyses included median values, Kaplan‐Meier survival curves, and latent trajectory analysis. A total of 1,249 patients enrolled at a median of 0.5 months after diagnosis were followed for a median of 34.2 months. The degree of initial HRQoL impairment and probabilities of reaching the best possible HRQoL scores varied across JIAcategories (best for oligoarthritis, worst for rheumatoid factor–positive polyarthritis). Median times to attain best possible HRQoL scores (JAQQ59.3 months, HRQoML34.5 months), lagged behind those for disease activity, pain, and disability measures. Most patients followed trajectories with minimal or mild impairment; however, 7.6% and 13.8% of patients, respectively, followed JAQQand HRQoMLtrajectories with persistent major impairment in HRQoL. JIAcategory, aboriginal ethnicity, and baseline disease activity measures distinguished between membership in trajectories with major and minimal impairments. Improvement in HRQoL is slower than for disease activity, pain, and disability. Improvement of a measure based on respondents’ preferences (HRQoML) is more rapid than that of a standardized measure (JAQQ). Higher disease activity at diagnosis heralds an unfavorable HRQoL trajectory.

ObjectiveTo determine early outcomes and early improvements in a prospective inception cohort of children with juvenile idiopathic arthritis JIA treated with current standard therapies.MethodsPatients selected were enrolled in an inception cohort of JIA, the Research in Arthritis in Canadian Children Emphasizing Outcomes Study. The juvenile rheumatoid arthritis core criteria set measures were completed at enrollment and 6 months later. Frequencies of normal values for each of the core set measures and the American College of Rheumatology ACR Pediatric 30, 50, and 70 Pedi 70 criteria response rates achieved at 6 months after enrollment were calculated for each JIAonset subtype group.ResultsAmong 354 patients in the study, the median interval between diagnosis and enrollment was 0.7 months. At 6 months after enrollment, median values of active joint counts were highest in patients with rheumatoid factor RF–positive polyarthritis 4 and RFnegative polyarthritis 2, but were 0 or 1 for other subtypes. Fifty percent or more of patients with oligoarthritis, systemic arthritis, enthesitisrelated arthritis, and undifferentiated arthritis had no active joints, and the ACR Pedi 70 criteria response rate was 48 or more in those with oligoarthritis, RFnegative polyarthritis, and systemic arthritis.ConclusionWith current management strategies in clinical practice, improvement in disease activity was noted in considerable proportions of patients in all of the JIA subtype groups, but low levels of disease activity persisted in many. We expect that these early outcomes will prove to be significant predictors of longterm outcomes.

ObjectiveTo determine early predictors of 6month outcomes in a prospective cohort of patients with juvenile idiopathic arthritis JIA.MethodsPatients selected were those enrolled in an inception cohort study of JIA, the Research in Arthritis in Canadian Children Emphasizing Outcomes Study, within 6 months after diagnosis. The juvenile rheumatoid arthritis core criteria set and quality of life measures were collected at enrollment and 6 months later. Outcomes evaluated included inactive disease, Juvenile Arthritis Quality of Life Questionnaire JAQQ scores, and Childhood Health Assessment Questionnaire CHAQ scores at 6 months.ResultsThirtythree percent of patients had inactive disease at 6 months. Onset subtype and most baseline core criteria set measures correlated with all 3 outcomes. Relative to oligoarticular JIA, the risks of inactive disease were lower for enthesitisrelated arthritis, polyarthritis rheumatoid factor RF–negative JIA, and polyarthritis RFpositive JIA, and were similar for psoriatic arthritis. In multiple regression analyses, the baseline JAQQ score was an independent predictor of all 3 outcomes. Other independent baseline predictors included polyarthritis RFnegative and systemic JIA for inactive disease; CHAQ score and polyarthritis RFpositive JIA for the 6month CHAQ score; and active joint count, pain, and time to diagnosis for the 6month JAQQ score.ConclusionClinical measures soon after diagnosis predict shortterm outcomes for patients with JIA. The JAQQ is a predictor of multiple outcomes. Time to diagnosis affects quality of life in the short term.

To examine demographic and disease-related variables that affect pain in a large cohort of patients with juvenile rheumatoid arthritis (JRA). Selection criteria were an onset of JRA ≥5 years prior to study and age ≥8 years at the time of the study. Pain was measured by a self-administered 10-cm visual analog scale. Possible explanatory variables studied included age at study, sex, race, onset subtype, active disease duration, active joint count, and physician's global assessment (PGA). In a multiple regression model, active disease duration, PGA, and age at study were independent predictors explaining 22% of the variation in pain scores. Stratified analyses showed an effect of age in the 8–15-year group, but not in older patients. Disease-related factors explain only a small proportion of the variation in pain scores. Age has an effect on pain scores only in younger patients. The role of other factors, including psychosocial factors, needs further study.