Measuring Clinical Response and Remission in Juvenile Idiopathic Arthritis

Abstract and Introduction

Abstract

Purpose of review: The increasing availability of new medications for the treatment of juvenile idiopathic arthritis has made the accurate assessment of treatment outcomes critically important. The purpose of this review is to describe recent investigations focused on the development of new outcome measures in the domains of disease activity and joint damage, and to summarize recently published data within the area of health-related quality of life.
Recent findings: Since the development of the preliminary definition of disease improvement in 1997, the American College of Rheumatology pediatric response criteria have become the primary outcome measures in therapeutic trials in juvenile idiopathic arthritis. Additional definitions, including preliminary definitions of flare and remission have subsequently been added. Investigations have also sought to determine whether measures currently in use in adult rheumatoid arthritis might have utility in juvenile idiopathic arthritis. As the pathogenesis of juvenile idiopathic arthritis becomes better understood, biomarkers have significant potential as outcome measures. Lastly, recent reports regarding the health-related quality of life in large cohorts of children with juvenile idiopathic arthritis are important in guiding investigators towards areas most in need of improved treatment.
Summary: Significant progress has been made in the measurement of outcomes in juvenile idiopathic arthritis. Outcome measures will continue to be designed and tested to keep pace with the development of new therapies and the improved understanding of the disease pathogenesis.

Introduction

Since its description by Still in 1897,^[1] the classification, treatment, and outcome assessment of juvenile idiopathic arthritis (JIA) have presented significant challenges to both clinicians and researchers. With the development of more detailed disease classification criteria and therapies targeting specific aspects of the inflammatory pathway, the need for valid outcome measures for use in clinical trials, for monitoring patient responses to therapies, and for measuring individuals' disease activity longitudinally has become increasingly important. This review focuses on the developments in assessing outcomes in JIA since the topic was last reviewed in this journal in 1997,^[2] with a particular emphasis on advances within the areas of disease activity, joint damage, and health-related quality of life.