Evidence map›Paper›PMID 31941530›Full record

ArticleArthritis research & therapy2020

Validation of prediction models of severe disease course and non-achievement of remission in juvenile idiopathic arthritis part 2: results of the Nordic model in the Canadian cohort.

Andrew Henrey, Veronika Rypdal, Martin Rypdal, Thomas Loughin, Ellen Nordal, Jaime Guzman, ReACCh-Out and NoSPeR Investigators

Abstract readValidation Study
PubMed Full text at PMC Publisher
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Article in Arthritis research & therapy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

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5citing papers in PubMed
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3 · Its place in the literature

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5 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Andrew HenreyDepartment of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Veronika RypdalDepartment of Pediatrics, University Hospital of North Norway, Tromsø, Norway.
Martin RypdalDepartment of Mathematics and Statistics, UiT - The Arctic University of Norway, Tromsø, Norway.
Thomas LoughinDepartment of Statistics and Actuarial Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
Ellen NordalDepartment of Pediatrics, University Hospital of North Norway, Tromsø, Norway.
Jaime GuzmanDivision of Pediatric Rheumatology, British Columbia Children's Hospital, 4500 Oak Street, Suite K4-122, Vancouver, British Columbia, V6H 3N1, Canada. jguzman@cw.bc.ca.
ReACCh-Out and NoSPeR Investigators

Funding

CIHR
6 · The paper itself

Abstract

backgroundValidated clinical prediction models to identify children with poor prognosis at the time of juvenile idiopathic arthritis (JIA) diagnosis would be very helpful for tailoring treatments, and avoiding under- or over-treatment. Our objective was to externally validate Nordic clinical prediction models in Canadian patients with JIA.

methodsWe used data from 513 subjects at the 3-year follow-up from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. The predicted outcomes were non-achievement of remission, severe disease course, and functional disability. The Nordic models were evaluated exactly as published and after fine-tuning the logistic regression coefficients using multiple data splits of the Canadian cohort. Missing data was handled with multiple imputation, and prediction ability was assessed with C-indices. C-index values > 0.7 were deemed to reflect helpful prediction.

resultsOverall, 81% of evaluable patients did not achieve remission off medications, 15% experienced a severe disease course, and 38% reported disability (CHAQ score > 0). The Nordic model for predicting non-achievement of remission had a C-index of 0.68 (95% CI 0.62-0.74), and 0.74 (0.67-0.80) after fine-tuning. For prediction of severe disease course, it had a C-index of 0.69 (0.61-0.78), and 0.79 (0.68-0.91) after fine-tuning. The fine-tuned Nordic model identified 85% of the cohort as low risk for a severe disease course (< 20% chance) and 7% as high risk (> 60% chance). The Nordic model to predict functional disability had a C-index of 0.57 (0.50-0.63), and 0.51 (0.39-0.63) after fine-tuning.

conclusionsFine-tuned Nordic models, combining active joint count, physician global assessment of disease activity, morning stiffness, and ankle involvement, predicted well non-achievement of remission and severe disease course in Canadian patients with JIA. The Nordic model for predicting disability could not predict functional disability in Canadian patients.

Indexed as

Arthritis, JuvenileLogistic ModelsModels, TheoreticalTreatment OutcomeAntirheumatic AgentsCanadaChildChild, PreschoolCohort StudiesDisability EvaluationFemaleHumansMalePrognosisRemission InductionAntirheumatic AgentsJuvenile idiopathic arthritisPrediction modelPrognosisValidation

Identifiers

PMID31941530
PMCPMC6964007

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