- Poster presentation
- Open Access
Is it worth allowing the presence of morning stiffness in the definition of inactive disease in juvenile idiopathic arthritis?
© Allegra et al; licensee BioMed Central Ltd. 2014
- Published: 17 September 2014
- Demographic Feature
- Disease Status
- Lower Degree
- Disease Duration
Morning stiffness is a major symptom of juvenile idiopathic arthritis (JIA) and it is usually associated with active disease. However, it is common view that children with disease quiescence may have some degrees of residual morning stiffness. The 2004 preliminary criteria for inactive disease (ID) in JIA did not include the assessment of morning stiffness, whereas the 2011 revision of the criteria has allowed the presence of morning stiffness lasting ≤ 15 minutes. However, it is still unknown whether the disease status of children with ID who have or do not have morning stiffness is comparable.
To compare the disease status of children with JIA who meet the 2011 revised criteria for ID and have or do not have a morning stiffness lasting ≤ 15 minutes.
A database at the study center including 785 patients who had undergone a total of 2957 visits, which included a parent report of the presence and duration of morning stiffness, was analyzed to identify all visits in which patients met the criteria for ID. In each visit, the duration of morning stiffness was categorized as follows: ≤15 min, 15-30 min, 30-60 min, 1-2 hr, >2 hr. Clinical assessments included demographic features, and parent-reported outcomes. In case a patient met the ID criteria in more than 1 visit, only the first visit was retained.
Patients meeting 2004 ID criteria
Patients meeting 2011 ID criteria
N = 390
MS ≤ 15 min
N = 41
MS > 15 min
N = 29
Median (IQR) disease duration
3.8 (1.8; 7.3)
2.8 (1.4; 6)
5.7 (2.6; 7.9)
Functional ability (JAFS score) >0, N (%)
Physical health (PRQL PhS) >0, N (%)
Psychosocial health (PRQL PhS) >0, N (%)
VAS well-being >0, N (%)
VAS pain >0, N (%)
Acceptable symptom state, N (%)
Among patients who met the 2011 criteria for ID, those with morning stiffness ≤15 min had worse parent-reported outcomes than those without morning stiffness. This finding suggests that parents may not perceive their child’s disease state as true remission when lower degrees of morning stiffness are present. Notably, a sizeable proportion (6.3%) of children meeting the 2004 ID criteria had morning stiffness lasting > 15 min. The change of the criterion “Duration of morning stiffness of ≤ 15 minutes” to “Absence of morning stiffness” in the definition for ID should be considered.
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.