OP0074 TOWARD THE DEVELOPMENT OF CONSENSUS-BASED GUIDELINES FOR SCORING THE PHYSICIAN GLOBAL ASSESSMENT OF DISEASE ACTIVITY IN JUVENILE IDIOPATHIC ARTHRITIS

Abstract

Background: The physician’s global assessment of disease activity (PhGA) is a key outcome measure in juvenile idiopathic arthritis (JIA). It rates the level of disease activity on a visual analogue scale, capturing the physician’s subjective appraisal of a patient’s disease activity, integrating the information obtained from the clinical history, physical examination, results of laboratory, and imaging studies. However, recent research shows that the PhGA is not scored homogeneously among pediatric rheumatologists [1]. Objectives: A task force was convened with the aim to develop and validate guidelines for more homogeneous scoring of the PhGA in JIA, clearly defining the disease activity domain and the relative weight of clinical history, comorbid conditions, and extra-articular manifestations. Methods: The project is based on 3 phases. In Phase I, researchers, physicians, allied health professionals, and parent/patient representatives from PRINTO and Pediatric Rheumatology Care and Outcome Improvement Network (PR-COIN) were asked to identify factors influencing the PhGA scoring by answering a web-based survey assessing the relevance of disease outcome parameters when scoring the PhGA. This evaluation was completed via electronic survey sent to 2640 PRINTO members and 172 PR-COIN members, asking to rank 17 factors in assessing PhGA for non-systemic JIA and, separately, systemic JIA. Based on the results of the first large survey, conjoint analysis surveys were completed by the 33 task force members, using the 1000minds web application (1000minds Ltd). Experts were presented with successive pairs of hypothetical patients who were the same except for levels of activity of only two criteria (11 criteria for non-systemic JIA were identified). Experts chose the patient judged to have a higher PhGA score or otherwise declare the scores equivalent. The web application provided the relative importance (weight) and ranking of the criteria. Results of Phase I surveys will inform an upcoming consensus meeting (Phase II). In Phase III, the consensus-based guidelines for scoring the PhGA will be validated by analyzing the PhGA scoring of multiple case scenarios. Results: Based on the responses of 31 task force members (94%), the results of the conjoint analysis survey on non-systemic JIA are shown here. Conclusion: When scoring the PhGA in patients with non-systemic JIA, task force members prioritized the number of joints with active arthritis, by both clinical exam and ultrasound or magnetic resonance imaging, and the degree of joint inflammation. Previous disease course, laboratory results, and morning stiffness received the lowest weights. Uveitis showed the highest weight variability. These results will be the basis for discussion in the task force’s consensus meeting in March 2024. REFERENCES: [1] Maria Backström, et al, Paediatric rheumatologists do not score the physician’s global assessment of juvenile idiopathic arthritis disease activity in the same way, Rheumatology, 62, 2023;3421–3426. Acknowledgements: The project was funded by the 2022 PRES-PRINTO grant, the University of North Norway in Tromso, and by the Systemic JIA Fundation. Disclosure of Interests: None declared. Criterion Weight Median rank Mean rank SD Rank 1st to 4th Rank 8th to 11th Joints with active arthritis 0.253 1.5 1.7 0.9 97% 0% Imaging 0.234 2 2.0 1.1 97% 0% Degree of joint inflammation 0.118 4 3.9 1.8 68% 6% Uveitis 0.079 5.5 6.0 3.2 42% 32% Activity limitations 0.075 6 5.7 2.0 39% 26% Enthesitis 0.054 6 6.3 2.0 23% 29% Tenosynovitis 0.053 6 6.4 1.8 10% 26% Psoriasis 0.045 8.5 7.8 2.7 13% 61% Patient’s disease course 0.036 9 8.4 2.3 6% 74% Laboratory markers of inflammation 0.028 9.5 8.9 1.9 3% 81% Morning stiffness 0.026 9 8.9 1.7 0% 81%