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Background: Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in childhood. Morning stiffness is a major symptom of JIA, and is usually associated with active disease. The 2004 preliminary criteria for inactive disease (ID) in JIA did not include the assessment of morning stiffness, whereas the 2011 revision of the criteria has allowed the presence of morning stiffness (MS) lasting ≤ 15 minutes. MS was included in 2011 revision based on the consideration that MS of a short duration (i.e., ≤ 15 minutes) can represent residua of previously active disease without current active disease. However, it is unclear whether the disease status of children with ID who have or do not have morning stiffness is comparable. Objectives: To compare the disease status of children with JIA who met the 2004 and 2011 revised criteria for ID in relation to the presence or absence morning stiffness. Methods: A database of 1208 Italian children included in 2 multicenter studies (1,2) who underwent a total of 3380 visits was examined to identify all visits in which the patients fulfilled the 2004 or 2011 criteria for ID. In case a patient met the ID criteria in more than 1 visit, only the first visit was retained. For each visit with ID, the duration of morning stiffness was categorized as ≤ 15 min or > 15 min. Clinical assessments included demographic features and parent-reported outcomes Results: A total of 668 visits in which patients met the criteria for ID were identified. Absence of morning stiffness was reported in 564 (84.4%) visits, whereas in 104 visits (15.5%) there was morning stiffness. Among the visits with morning stiffness, in 55 (8.2%) duration was ≤15 min, and in 49 (7.3%) duration was > 15 min. The table shows the comparison of disease duration and parent-reported outcomes between patients with absence or presence of morning stiffness. MS: morning stiffness; IQR: interquartile range, *above the mean of healthy children (2) Conclusion: Among patients who met the 2011 criteria for ID, those with morning stiffness ≤15 min had worse parent-reported outcomes than those without morning stiffness. This finding suggests that parents may not perceive their child’s disease state as true remission when lower degrees of morning stiffness are present. Notably, a sizeable proportion (7,3%) of children meeting the 2004 ID criteria had morning stiffness lasting > 15 min. The removal of the criterion “Duration of morning stiffness of ≤ 15 minutes” to “Absence of morning stiffness” in the definition for ID should be considered. References [1] Filocamo, et al. A new approach to clinical care of juvenile idiopathic arthritis: the Juvenile Arthritis Multidimensional Assessment Report. J Reumatol 2011 [2] Verazza, et al. Disease status, reasons for discontinuation and adverse events in 1038 Italian children with juvenile idiopathic arthritis treated with etanercept. PROJ 2016 Disclosure of Interests: Maria Francesca Gicchino: None declared, Gabriella Giancane: None declared, Alessandra Alongi: None declared, Silvia Rosina: None declared, Jessica Tibaldi: None declared, Marta Mazzoni: None declared, Angelo Ravelli Grant/research support from: Angelini, AbbVie, Bristol-Myers Squibb, Johnson & Johnson, Novartis, Pfizer, Reckitt Benkiser, and Roche, Consultant for: Angelini, AbbVie, Bristol-Myers Squibb, Johnson & Johnson, Novartis, Pfizer, Reckitt Benkiser, and Roche, Speakers bureau: Angelini, AbbVie, Bristol-Myers Squibb, Johnson & Johnson, Novartis, Pfizer, Reckitt Benkiser, and Roche, Alessandro Consolaro Grant/research support from: AbbVie, Pfizer

Background The choice of an appropriate definition of inactive disease (ID) is important because ID has been identified as the ideal therapeutic goal in the treat-to-target strategy in juvenile idiopathic arthritis (JIA).1 Several criteria for ID in JIA have been proposed, including Wallace 2004 and 2011 criteria and JADAS10 and clinical JADAS10 (cJADAS10) criteria. However, a recent study2 has shown that these criteria do not always identify the same group of patients. In addition, it is unknown whether and to what extent the formal definitions of ID agree with the subjective perception of disease remission by the physician and the parent.3 Objectives To investigate the concordance between current criteria for ID and subjective judgment of disease remission by physicians and parents in children with JIA. Methods We evaluated the clinical data of the last visits made in 669 children with JIA from March 2007 to December 2010 to identify all visits in which the caring physician and a parent judged subjectively and independently the child’s disease state as remission or non-remission and the parent declared whether he/she was satisfied or non-satisfied with current illness state (i.e. Parent Acceptable Symptom State, PASS).4 All visits judged subjectively by the physician and the parent as remission or judged in PASS by the parent were examined to identify those which met the Wallace 2004 and 2011 criteria and the JADAS10 and cJADAS10 criteria for ID. Visits which met both subjective and objective definitions were defined as concordant. Results Of the 246 visits in which the physician judged subjectively the disease state as remission, 34.6% and 27.6% met the 2004 and 2011 Wallace criteria, respectively, and 38.6% and 54.5% met the JADAS10 and cJADAS10 criteria for ID, respectively.(Figure 1) Of the 338 visits in which the parent judged subjectively the disease state as remission, 19.8% and 18% met the 2004 and 2011 Wallace criteria, respectively, and 34.9% and 48.8% met the JADAS10 and cJADAS10 criteria for ID, respectively.(Figure 2) In 76.4% of visits judged as remission by the physician, the parent provided the same evaluation. In 55.6% of visits judged as remission by the parent, the physician provided the same evaluation.(Figure 1-2) Of 467 visits judged in PASS by the parent, 17.6% and 14.8% met the 2004 and 2011 Wallace criteria, respectively, and 26.6% and 37.5% met the JADAS10 and cJADAS10 criteria for ID, respectively. Conclusion The JADAS10 and cJADAS10 criteria for ID were more concordant with physician’s and parent’s subjective judgment of remission and with parent’s satisfaction with current illness state than Wallace criteria. The cJADAS10, which lacks the acute phase reactant, revealed the best concordance with both physician’s and parent’s subjective assessments. Physician-parent agreement was greater for remission judged by the physician than for remission judged by the parent. References [1] Ravelli A, et al. Ann Rheum Dis. 2018;77:819-828; 2. Shoop-Whorral SJW, et al. Ann Rheum Dis. 2017;76:1381-1388; 3. Giancane G, et al. Nat Rev Rheumatol. 2017;13:460-461. 4. Filocamo G, et al. J Rheumatol. 2012;39:856-63. Disclosure of Interests Gabriella Giancane: None declared, Maria Francesca Gicchino: None declared, Alessandra Alongi: None declared, Chiara Campone: None declared, Alessandro Consolaro Grant/research support from: AbbVie, Pfizer, Angelo Ravelli Grant/research support from: Angelini, AbbVie, Bristol-Myers Squibb, Johnson & johnson, novartis, pfizer, reckitt benkiser, and roche, consultant for: angelini, abbvie, bristol-myers squibb, johnson & johnson, novartis, pfizer, reckitt benkiser, and roche, speakers bureau: angelini, abbvie, bristol-myers squibb, johnson & johnson, novartis, pfizer, reckitt benkiser, and roche