The PRINTO criteria for clinically inactive disease in juvenile dermatomyositis

Dragana Lazarevic, Angela Pistorio, Elena Palmisani, Paivi Miettunen, Angelo Ravelli, Clarissa Pilkington, Nico M. Wulffraat, Clara Malattia, Stella Maris Garay, Michael Hofer, Pierre Quartier, Pavla Dolezalova, Inmaculada Calvo Penades, Virginia P.L. Ferriani, Gerd Ganser, Ozgur Kasapcopur, Jose Antonio Melo-Gomes, Ann M. Reed, Malgorzata Wierzbowska, Lisa G. RiderAlberto Martini, Nicolino Ruperto

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Abstract

Objectives: To develop data-driven criteria for clinically inactive disease on and off therapy for juvenile dermatomyositis (JDM). Methods: The Paediatric Rheumatology International Trials Organisation (PRINTO) database contains 275 patients with active JDM evaluated prospectively up to 24 months. Thirty-eight patients off therapy at 24 months were defined as clinically inactive and included in the reference group. These were compared with a random sample of 76 patients who had active disease at study baseline. Individual measures of muscle strength/ endurance, muscle enzymes, physician's and parent's global disease activity/damage evaluations, inactive disease criteria derived from the literature and other ad hoc criteria were evaluated for sensitivity, specificity and Cohen's κ agreement. Results: The individual measures that best characterised inactive disease (sensitivity and specificity >0.8 and Cohen's κ >0.8) were manual muscle testing (MMT) ≥78, physician global assessment of muscle activity=0, physician global assessment of overall disease activity (PhyGloVAS) ≤0.2, Childhood Myositis Assessment Scale (CMAS) ≥48, Disease Activity Score ≤3 and Myositis Disease Activity Assessment Visual Analogue Scale ≤0.2. The best combination of variables to classify a patient as being in a state of inactive disease on or off therapy is at least three of four of the following criteria: creatine kinase ≤150, CMAS ≥48, MMT ≥78 and PhyGloVAS ≤0.2. After 24 months, 30/31 patients (96.8%) were inactive off therapy and 69/145 (47.6%) were inactive on therapy. Conclusion: PRINTO established data-driven criteria with clearly evidence-based cut-off values to identify JDM patients with clinically inactive disease. These criteria can be used in clinical trials, in research and in clinical practice.

Original languageEnglish (US)
Pages (from-to)686-693
Number of pages8
JournalAnnals of the rheumatic diseases
Volume72
Issue number5
DOIs
StatePublished - May 1 2013

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ASJC Scopus subject areas

  • Immunology and Allergy
  • Rheumatology
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Lazarevic, D., Pistorio, A., Palmisani, E., Miettunen, P., Ravelli, A., Pilkington, C., Wulffraat, N. M., Malattia, C., Garay, S. M., Hofer, M., Quartier, P., Dolezalova, P., Penades, I. C., Ferriani, V. P. L., Ganser, G., Kasapcopur, O., Melo-Gomes, J. A., Reed, A. M., Wierzbowska, M., ... Ruperto, N. (2013). The PRINTO criteria for clinically inactive disease in juvenile dermatomyositis. Annals of the rheumatic diseases, 72(5), 686-693. https://doi.org/10.1136/annrheumdis-2012-201483