A1: Clinical Inactive Disease in the Pediatric Rheumatology Care and Outcomes Improvement Network Cohort: Which Components of Clinical Inactive Disease Do Patients Not Achieve?
Bibliographic record
Abstract
Background/Purpose: The American College of Rheumatology (ACR) provisional criteria for Clinical Inactive Disease (CID) are an accepted outcome measure for juvenile idiopathic arthritis (JIA) patients (). The purpose of this study is to determine what components of CID are not met by Pediatric Rheumatology Care and Outcomes Improvement Network (PR–COIN) patients. The goal is to better understand the ways in which patients are not doing well. We hypothesize that many patients who do not meet CID have mild disease activity such as joint count <3, physician global assessment of disease activity score of <3, or short duration of morning stiffness, but otherwise would fulfill CID. Methods: PR‐COIN is a multi‐center quality improvement learning network comprised of 11 sites in North America whose mission is to improve outcomes for children with JIA. With IRB consent, patient data are entered into the ACR's Rheumatology Clinical Registry. The criteria for CID include the following: no joints with active arthritis, no systemic features, no active uveitis, normal ESR or CRP (if measured), physician global assessment of disease activity of 0, and duration of morning stiffness < 15 min (). Data were analyzed to determine which components of CID patients do not achieve. Only patients with complete data such that CID status could be calculated were included. Results: Data from 658 individual patients were analyzed. Sixty‐one percent of patients did not achieve clinical inactive disease at their most recent visit (404/ 658 patients). The top 3 components of clinical inactive disease that patients did not meet, from most frequent to least frequent, were physician global assessment (91%), joint count (66%), and duration of morning stiffness (28%). Of the patients with active disease, sixteen percent had elevated ESR or CRP (inflammatory markers were not measured in all patients), 11% had active uveitis, and <1% had active systemic JIA features. Sixty‐two percent of patients with active disease had a joint count <3, physician global assessment <3, and duration of morning stiffness < 30 minutes, perhaps indicating this was a subset of patients with mild disease activity. This represents 38% of the total population. Thus, 77% of PR‐COIN patients had clinical inactive disease or mild disease. Seven percent had active uveitis. Conclusion: Although only 39% of patients achieve CID at their most recent visit in the PR‐COIN cohort, and this falls short of our desired outcome, many of these patients with active disease appear to have only mild disease activity. Therefore, the ACR criteria for CID may be somewhat stringent and difficult to achieve in the clinical setting. CID being a binary “all or none” outcome measure makes it difficult to detect whether quality improvement activities are having any beneficial incremental impact on patient disease status. PR‐COIN will continue to seek ways to improve rates of CID.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".