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Disease activity measures in adult patients with JIA : a systematic review
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A Artrite Idiopática Juvenil (AIJ) é um termo que engloba várias doenças reumáticas crónicas de causa desconhecida e que, no seu conjunto, são as doenças reumáticas crónicas mais comuns na criança que, com frequência, se mantêm ativas na idade adulta. Contudo, não existem critérios específicos validados para medir a atividade da doença em adultos com AIJ, nem recomendações para o tratamento em idade adulta, o que pode ter um impacto negativo importante na transição de cuidados destes doentes para os serviços de adultos. Estudos prévios e revisões sistemáticas, de intervenções terapêuticas focaram-se na idade pediátrica, incluindo na seleção e medição de outcomes.
O nosso objetivo é perceber quais são as escalas mais usadas para medir a atividade da doença, em doentes adultos com AIJ, ao longo do tempo.
Realizámos uma revisão sistemática da literatura reportada de acordo com os critérios PRISMA. A pesquisa foi realizada via MEDLINE e Web of Science para estudos originais em inglês, na população com AIJ e mais de 18 anos, publicados depois dos anos 2000.
69 artigos cumpriram os critérios de inclusão. 53,6% mediram a atividade da doença com um único método, enquanto 46,4% utilizaram mais que um. 56,5% utilizaram Physician’s Global Assessement nesta medição. As escalas mais usadas foram: 43,9% American College of Rheumatology Pediatric criteria (ACR), 27,3% Juvenile Arthritis Disease Activity (JADAS), 15,2% Disease Activity Score (DAS28), 10,6% Wallace Criteria, 1,5% 11- point Numeric Pain Rating Scale (NRS-0-10) e 1,5% Six-point Composite Disease Activity Index (mJPsADA). Entre 2022-2009 a proporção foi semelhante, enquanto antes de 2009 a única escala usada foi o ACR. 65,5% utilizaram o ACR em associação com outra escala, sendo as mais comuns o PGA e o JADAS. 83,3% utilizaram o JADAS em associação com outro método, sendo neste caso, os mais comuns o PGA e ACR. A versão do JADAS mais utilizada foi JADAS71 e JADAS27 (27,8% cada). A avaliação da atividade da doença na AIJ Oligoarticular, Poliarticular e Sistémica teve uma utilização de escalas semelhante. Relativamente às restantes categorias de AIJ, o número de
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Marta Croca Morais
estudos foi limitativo para uma generalização. Um dos artigos concluiu que o JADAS27 é mais fidedigno que o DAS28 na avaliação da atividade da doença e outro artigo defendeu que o JADAS10 é um melhor parâmetro a refletir doença ativa que o DAS28 em doentes adultos com AIJ.
Assim, a evidência suporta que, apesar de o ACR ser, globalmente, o método mais utilizado, o JADAS teve um crescimento exponencial depois de 2009. A generalização da utilização do JADAS, juntamente com alguma evidência que lhe atribui melhor desempenho que outras ferramentas, torna-o o melhor candidato para ser validada na AIJ em idade adulta.
Juvenile Idiopathic Arthritis (JIA) is the most common chronic rheumatic disease in children with an unknown cause, which, frequently, continues active into adulthood. However, there is no specific criteria to measure disease activity and there is an absence of specific treatment recommendations in patients over 18 years old which can have a negative impact in the transition of these patients to adult care. Previous studies and systematic reviews focused on paediatric population, therefore, our aim is to understand which are the scales used to measure disease activity in adult patients with JIA throughout times. We conducted a systematic review in accordance with PRISMA. The electronic database search was MEDLINE and Web of Science focused on original studies in English, with JIA patients over 18 years old, published after the year of 2000. 69 articles met the inclusion criteria for review. 53,6% assessed disease activity based on a single method, while 46,4% used more than one. 56,5% utilized Physician’s Global Assessment to evaluate disease activity. The most used scales were 43,9% American College of Rheumatology Pediatric criteria (ACR), 27,3% Juvenile Arthritis Disease Activity (JADAS), 15,2% Disease Activity Score (DAS28), 10,6% Wallace Criteria, 1,5% 11-point Numeric Pain Rating Scale (NRS-0-10) and 1,5% Six-point Composite Disease Activity Index (mJPsADA). Between 2022-2009 the proportion was similar, whereas prior to 2009 the only scale utilized was ACR. 65,5% used ACR in association with another scale, being the most used PGA and JADAS. 83,3% used JADAS in association with another method, most frequently PGA and ACR. The most used version of JADAS was JADAS71 and JADAS27 (27,8% each). Oligoarticular, Polyarticular and Systemic JIA followed a similar utilization of scales to measure disease activity, the others categories of JIA did not have a significant number of studies attributed for a generalization. One of the articles concluded that JADAS27 was more accurate than DAS28 in measuring disease activity in adult population and another one that JADAS10 was a better reflector of active disease than DAS28. Therefore, evidence supports that even though ACR is globally the most used method to measure disease activity, JADAS had an exponential increase after 2009. The generalization of JADAS, and the scientific evidence that demonstrates its better performance, makes it the better candidate to validate in adult population with JIA.
Juvenile Idiopathic Arthritis (JIA) is the most common chronic rheumatic disease in children with an unknown cause, which, frequently, continues active into adulthood. However, there is no specific criteria to measure disease activity and there is an absence of specific treatment recommendations in patients over 18 years old which can have a negative impact in the transition of these patients to adult care. Previous studies and systematic reviews focused on paediatric population, therefore, our aim is to understand which are the scales used to measure disease activity in adult patients with JIA throughout times. We conducted a systematic review in accordance with PRISMA. The electronic database search was MEDLINE and Web of Science focused on original studies in English, with JIA patients over 18 years old, published after the year of 2000. 69 articles met the inclusion criteria for review. 53,6% assessed disease activity based on a single method, while 46,4% used more than one. 56,5% utilized Physician’s Global Assessment to evaluate disease activity. The most used scales were 43,9% American College of Rheumatology Pediatric criteria (ACR), 27,3% Juvenile Arthritis Disease Activity (JADAS), 15,2% Disease Activity Score (DAS28), 10,6% Wallace Criteria, 1,5% 11-point Numeric Pain Rating Scale (NRS-0-10) and 1,5% Six-point Composite Disease Activity Index (mJPsADA). Between 2022-2009 the proportion was similar, whereas prior to 2009 the only scale utilized was ACR. 65,5% used ACR in association with another scale, being the most used PGA and JADAS. 83,3% used JADAS in association with another method, most frequently PGA and ACR. The most used version of JADAS was JADAS71 and JADAS27 (27,8% each). Oligoarticular, Polyarticular and Systemic JIA followed a similar utilization of scales to measure disease activity, the others categories of JIA did not have a significant number of studies attributed for a generalization. One of the articles concluded that JADAS27 was more accurate than DAS28 in measuring disease activity in adult population and another one that JADAS10 was a better reflector of active disease than DAS28. Therefore, evidence supports that even though ACR is globally the most used method to measure disease activity, JADAS had an exponential increase after 2009. The generalization of JADAS, and the scientific evidence that demonstrates its better performance, makes it the better candidate to validate in adult population with JIA.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2023
Palavras-chave
Artrite idiopática juvenil Atividade da doença Adulto Reumatologia