scholarly journals Validation of prediction models of severe disease course and non-achievement of remission in juvenile idiopathic arthritis: part 1—results of the Canadian model in the Nordic cohort

2019 ◽  
Vol 21 (1) ◽  
Author(s):  
Veronika Rypdal ◽  
◽  
Jaime Guzman ◽  
Andrew Henrey ◽  
Thomas Loughin ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Prediction Model ◽  
Prediction Models ◽  
Severe Disease ◽  
Disease Onset ◽  
Fine Tuning ◽  
Disease Course ◽  
Internal Validation ◽  
Long Term Outcome

Abstract Background Models to predict disease course and long-term outcome based on clinical characteristics at disease onset may guide early treatment strategies in juvenile idiopathic arthritis (JIA). Before a prediction model can be recommended for use in clinical practice, it needs to be validated in a different cohort than the one used for building the model. The aim of the current study was to validate the predictive performance of the Canadian prediction model developed by Guzman et al. and the Nordic model derived from Rypdal et al. to predict severe disease course and non-achievement of remission in Nordic patients with JIA. Methods The Canadian and Nordic multivariable logistic regression models were evaluated in the Nordic JIA cohort for prediction of non-achievement of remission, and the data-driven outcome denoted severe disease course. A total of 440 patients in the Nordic cohort with a baseline visit and an 8-year visit were included. The Canadian prediction model was first externally validated exactly as published. Both the Nordic and Canadian models were subsequently evaluated with repeated fine-tuning of model coefficients in training sets and testing in disjoint validation sets. The predictive performances of the models were assessed with receiver operating characteristic curves and C-indices. A model with a C-index above 0.7 was considered useful for clinical prediction. Results The Canadian prediction model had excellent predictive ability and was comparable in performance to the Nordic model in predicting severe disease course in the Nordic JIA cohort. The Canadian model yielded a C-index of 0.85 (IQR 0.83–0.87) for prediction of severe disease course and a C-index of 0.66 (0.63–0.68) for prediction of non-achievement of remission when applied directly. The median C-indices after fine-tuning were 0.85 (0.80–0.89) and 0.69 (0.65–0.73), respectively. Internal validation of the Nordic model for prediction of severe disease course resulted in a median C-index of 0.90 (0.86–0.92). Conclusions External validation of the Canadian model and internal validation of the Nordic model with severe disease course as outcome confirm their predictive abilities. Our findings suggest that predicting long-term remission is more challenging than predicting severe disease course.

Predicting Which Children with Juvenile Idiopathic Arthritis Will Have a Severe Disease Course: Results from the ReACCh-Out Cohort

2016 ◽  
Vol 44 (2) ◽  
pp. 230-240 ◽  
Author(s):  
Jaime Guzman ◽  
Andrew Henrey ◽  
Thomas Loughin ◽  
Roberta A. Berard ◽  
Natalie J. Shiff ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Prediction Models ◽  
Severe Disease ◽  
Inactive Disease ◽  
Joint Involvement ◽  
Disease Course ◽  
Active Joint ◽  
Random Samples ◽  
Patient Reported ◽  
Distinct Disease

Objective.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.Methods.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, r2, 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.Results.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.Conclusion.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.

scholarly journals SAT0495 LONG TERM OUTCOME OF JUVENILE IDIOPATHIC ARTHRITIS IN ADULTHOOD; THE MONOCENTRIC EXPERIENCE OF 520 PATIENTS FOLLOWED FOR 20 YEARS IN A TRANSITION TERTIARY CLINIC OF PEDIATRIC RHEUMATOLOGY.

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1204.2-1204
Author(s):  
I. Pontikaki ◽  
S. Carbogno ◽  
F. Corona ◽  
A. Petaccia ◽  
R. Cimaz
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Educational Level ◽  
Disease Duration ◽  
Age At Onset ◽  
Disease Onset ◽  
Clinical Manifestations ◽  
Term Outcome ◽  
Long Term Outcome

Background:Juvenile Idiopathic Arthritis (JIA) is a chronic pediatric inflammatory disease that shows many differences compared to adult-onset arthritis. The different clinical manifestations, the assessment and the management of JIA is the reason that the transition from childhood to adulthood is an important multidimensional process that emphasizes a lot of aspects.Objectives:To describe the long-term outcome of JIA.Methods:Five-hundred and twenty patients affected by JIA and referred to a transition care rheumatology tertiary centre were considered between 1999 and 2019. The outcome assessment included remission, disease duration, medications, number of prosthesis implantation, pregnancies, mortality and social integration (employment status and educational level).Results:A hundred and thirty-eight (26%) males and 382 (73%) females were included; 157 (30%) patients were lost to follow up. The mean age of the patients was 27 (18-57) years, with a mean age at onset of 8 years and an average disease duration of 19 years. Subtypes of JIA at disease onset included 252 (48%) oligoarthritis, 134 (26%) polyarthritis, 64 (12%) systemic arthritis, 22 (4%) psoriatic arthritis, 43 (8%) enthesitis related arthritis and 1 (0.1%) undifferentiated arthritis. Ninty-three (18%) patients suffered of uveitis. Ninty-five implant prosthesis and 16 arthrodesis were recorded. At follow up 198 (38%) patients were on remission of which 107 (20%) off medication. Among the 322 patients still on medication, 84 (16%) were under treatment with oral steroids, 226 (43%) with sDMARDs and 249 (40%) with bDMARDs. Five deaths (1%) occurred in this cohort. Two hundred and thirty-five subjects had a higher educational level, 327 had an employment. We have data of twenty-nine pregnancies. The transition age was considered after the age of 16 years old. The key word for the management of this cohort was the multidisciplinary approach towards each patient, with the collaboration of other specialists (ophthalmologist, orthopedic, dermatologist, gastroenterologist, obstetric and psychologist).Conclusion:In the era of biologic therapy the long-term outcome of JIA underwent an outstanding improvement regarding a lot of variables. Two hundred and thirty-two patients were still followed, not only because of the continuation of the biological therapy, but also for a multidisciplinary care even during remission. JIA often persists over the adulthood, therefore the long term follow-up and care of these patients needs to be conducted by a rheumatologist expertized in JIA in collaboration with other specialists.Disclosure of Interests:None declared

SAT0456 Long-Term Outcome in Adult Patients with Juvenile Idiopathic Arthritis: Preliminary Results from a Greek Population

2013 ◽  
Vol 72 (Suppl 3) ◽  
pp. A736.1-A736
Author(s):  
D. Dimopoulou ◽  
M. Trachana ◽  
P. Sidiropoulos ◽  
P. Tsitsi ◽  
A. Moihovitou ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Adult Patients ◽  
Greek Population ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Preliminary Results

scholarly journals Predictors and long-term outcome in Greek adults with juvenile idiopathic arthritis: a 17-year continuous follow-up study

Rheumatology ◽  
2017 ◽  
Vol 56 (11) ◽  
pp. 1928-1938 ◽  
Author(s):  
Despoina Dimopoulou ◽  
Maria Trachana ◽  
Polyxeni Pratsidou-Gertsi ◽  
Prodromos Sidiropoulos ◽  
Florentia Kanakoudi-Tsakalidou ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Follow Up Study ◽  
Greek Adults

Long term outcome following knee replacement in patients with juvenile idiopathic arthritis

The Knee ◽  
2010 ◽  
Vol 17 (5) ◽  
pp. 340-344 ◽  
Author(s):  
Ajay Malviya ◽  
Helen E. Foster ◽  
Peter Avery ◽  
David J. Weir ◽  
David J. Deehan
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Knee Replacement ◽  
Term Outcome ◽  
Long Term Outcome

Objawy oczne w przebiegu chorób tarczycy

2018 ◽  
Vol 21 (1A) ◽  
Author(s):  
Paweł Wójtowiec ◽  
Anna Wójtowiec ◽  
Tomasz Tomkalski
Keyword(s):  
Severe Disease ◽  
Surgical Decompression ◽  
Clinical Activity ◽  
Graves Disease ◽  
Disease Course ◽  
Clinical Activity Score ◽  
Ocular Manifestations ◽  
Ocular Lesions ◽  
Degree Of Severity

Thyroid-related ocular manifestations are typically associated with Graves’ disease. The cause of Graves’ ophthalmopathy is not fully understood but it is believed to be autoimmune in origin. The most important risk factors are smoking and age. Patient’s gender also plays a significant role: ophthalmopathy is more prevalent in women but men experience a more severe disease course. There are two forms of the disease: inflammatory with congestion and pain in the eyeballs and fibrotic stage with impaired eye movements and no signs of inflammation. The degree of severity of ocular lesions is determined by NO SPECS classification and activity coefficient of orbitopathy (Clinical Activity Score – CAS). Previous clinical trials have not produced satysfying answers to questions about effective treatment of orbitopathy. In order to obtain the desired results it is to first necessary to achieve euthyroidism. Treatment is usually continual and long-term. Regimens in various centers vary, depending on their experiences. Currently the most commonly used are steroid therapy, radiation therapy and surgical decompression of the eye sockets. Surgical treatment is, however, used infrequently.

scholarly journals Assessment of the Subarachnoid Hemorrhage International Trialists (SAHIT) Models for Dichotomized Long-Term Functional Outcome Prediction After Aneurysmal Subarachnoid Hemorrhage in a United Kingdom Multicenter Cohort Study

Neurosurgery ◽  
2020 ◽  
Author(s):  
Isabel C Hostettler ◽  
Menelaos Pavlou ◽  
Gareth Ambler ◽  
Varinder S Alg ◽  
Stephen Bonner ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Functional Outcome ◽  
Outcome Prediction ◽  
Prediction Models ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Predictive Performance ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Fisher Grade

Abstract BACKGROUND Long-term outcome after subarachnoid hemorrhage, beyond the first few months, is difficult to predict, but has critical relevance to patients, their families, and carers. OBJECTIVE To assess the performance of the Subarachnoid Hemorrhage International Trialists (SAHIT) prediction models, which were initially designed to predict short-term (90 d) outcome, as predictors of long-term (2 yr) functional outcome after aneurysmal subarachnoid hemorrhage (aSAH). METHODS We included 1545 patients with angiographically-proven aSAH from the Genetic and Observational Subarachnoid Haemorrhage (GOSH) study recruited at 22 hospitals between 2011 and 2014. We collected data on age, WNFS grade on admission, history of hypertension, Fisher grade, aneurysm size and location, as well as treatment modality. Functional outcome was measured by the Glasgow Outcome Scale (GOS) with GOS 1 to 3 corresponding to unfavorable and 4 to 5 to favorable functional outcome, according to the SAHIT models. The SAHIT models were assessed for long-term outcome prediction by estimating measures of calibration (calibration slope) and discrimination (area under the receiver-operating characteristic curve [AUC]) in relation to poor clinical outcome. RESULTS Follow-up was standardized to 2 yr using imputation methods. All 3 SAHIT models demonstrated acceptable predictive performance for long-term functional outcome. The estimated AUC was 0.71 (95% CI: 0.65-0.76), 0.73 (95% CI: 0.68-0.77), and 0.74 (95% CI: 0.69-0.79) for the core, neuroimaging, and full models, respectively; the calibration slopes were 0.86, 0.84, and 0.89, indicating good calibration. CONCLUSION The SAHIT prediction models, incorporating simple factors available on hospital admission, show good predictive performance for long-term functional outcome after aSAH.

scholarly journals Functional outcome and muscle wasting in adults with tetanus

2019 ◽  
Vol 113 (11) ◽  
pp. 706-713
Author(s):  
Truong N Trung ◽  
Nguyen V T Duoc ◽  
Le T H Nhat ◽  
Lam M Yen ◽  
Nguyen V Hao ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Hospital Discharge ◽  
Barthel Index ◽  
Muscle Wasting ◽  
Short Form ◽  
Severe Disease ◽  
Rectus Femoris ◽  
Long Term Outcome ◽  
Sf 36

Abstract Background In many countries, in-hospital survival from tetanus is increasing, but long-term outcome is unknown. In high-income settings, critical illness is associated with muscle wasting and poor functional outcome, but there are few data from resource-limited settings. In this study we aimed to assess muscle wasting and long-term functional outcome in adults with tetanus. Methods In a prospective observational study involving 80 adults with tetanus, sequential rectus femoris ultrasound measurements were made at admission, 7 days, 14 days and hospital discharge. Functional outcome was assessed at hospital discharge using the Timed Up and Go test, Clinical Frailty Score, Barthel Index and RAND 36-item Short Form Health Survey (SF-36) and 3 and 6 months after discharge using the SF-36 and Barthel Index. Results Significant muscle wasting occurred between hospital admission and discharge (p<0.01), particularly in severe disease, where a median 23.49% (interquartile range 10.01–26.07) reduction in rectus femoris cross-sectional area occurred in those with severe (Ablett grades 3 and 4) disease. Muscle mass at discharge was related to objective and subjective measures of physical and emotional function at discharge and 3 and 6 months after discharge. In patients >70 y of age, functional recovery at 6 months was reduced compared with younger patients. Hospital-acquired infection and age were risk factors for muscle wasting. Conclusions Significant muscle wasting during hospitalization occurred in patients with tetanus, the extent of which correlates with functional outcome.

Sign in / Sign up

Export Citation Format

Share Document