Does childhood health assessment questionnaire can predict outcome of patients with juvenile idiopathic arthritis?

Aim

To assess the ability of Childhood Health Assessment Questionnaire (CHAQ) in predicting outcome of patients with juvenile idiopathic arthritis (JIA).

Method

87 pts. (f 69%, m 31%) average age 14,1 yrs. disease duration 5,2 yrs., were follow up for 3,7 (2-5) yrs. Parents/patients over 12 yrs. completed CHAQ at the beginning and at the end of study and disability index (DI) was calculated. CHAQ DI=0 was considered as normal, 0,125-0,5=mild, ≥0,6=moderate/severe disability. Fifty nine (67,8%)pts. were treated with methotrexate, 42 (52,8%)pts. with etanercept. Outcome was defined as active disease or remission (Wallace criteria) [1]. We used regression models for the assessment predictive strength of CHAQ.

Results

CHAQ DI at the baseline was 0,541, at the end of follow up 0,398 (p<0,05). Number of patients with moderate/severe disability decreased from 29 to 18 (33,3% vs. 20,7%, p<0,01). Number of patients in remission increased from 15 to 47 (17,2% vs.54,0%, p<0,001). Seventy (80,6%)pts. with normal CHAQ DI at baseline, were in remission at the end of study, while 66 (75,9%)pts. with moderate/severe CHAQ DI at the beginning had active disease at the last visit. CHAQ showed good predictive ability for the disease outcome (71,3%). Odds ratio for having active disease for patients with mild CHAQ DI was high (OR 3,33, CI=1,034-10,746, p=0,044), for patients with moderate/severe CHAQ DI was very high (OR 13,095, CI=3,821-44,882, p<0,001), compared to patients with normal CHAQ value. Patients with moderate/severe CHAQ DI had hazard ratio for the active disease 4,959 (CI=1,855-11,385, p<0,001).

Conclusion

CHAQ demonstrated good ability in predicting outcome of the disease. Due to its simplicity and accessibility it is useful in everyday clinical practice for identifying patients with poor prognosis.