{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T07:55:13Z","timestamp":1790063713876,"version":"4.0.1"},"reference-count":23,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2022,9,13]],"date-time":"2022-09-13T00:00:00Z","timestamp":1663027200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Arthritis Care &amp;amp; Research"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Our objective was to develop and validate a composite disease flare definition for juvenile spondyloarthritis (SpA) that would closely approximate the clinical decision made to reinitiate or not reinitiate systemic therapy after therapy de\u2010escalation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective chart reviews of children with SpA who underwent systemic therapy de\u2010escalation of biologic or conventional disease\u2010modifying antirheumatic drugs were used to develop and validate the flare outcome. Data on independent cohorts for development (1 center) and validation (4 centers) were collected from large tertiary health care systems. Core measure thresholds and candidate disease flare outcomes were assessed using sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs), and the receiver operating characteristic (ROC) area under the curve (AUC), with physician assessment of active disease plus re\u2010initiation of standard dose of systemic therapy as the reference standard.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the candidate definitions, clinically meaningful worsening in \u22653 of the following 5 core measures performed best: caregiver\/patient assessment of well\u2010being; physician assessment of disease activity; caregiver\/patient assessment of pain, physical function, and active joint count. The ROC AUC was 0.91, PPV 87.5%, NPV 98.1%, sensitivity 82.4%, and specificity 98.7%. Cronbach's \u03b1 was 0.81, signifying internal consistency, and factor analysis demonstrated that the outcome measured 1 construct. The Juvenile SpA Flare measure had face validity according to 21 surveyed pediatric rheumatologists. Juvenile SpA Flare had an ROC AUC of 0.85, a PPV of 92.3%, and an NPV of 96.8% in the validation cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>There is initial support for the validity of the Juvenile SpA Flare measure as a tool to identify disease flare in juvenile SpA patients de\u2010escalating therapy, and the measure is potentially applicable in clinical practice, observational studies, and therapeutic trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/acr.24763","type":"journal-article","created":{"date-parts":[[2021,8,7]],"date-time":"2021-08-07T06:01:37Z","timestamp":1628316097000},"page":"373-380","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Development and Validation of a Juvenile Spondyloarthritis Disease Flare Measure: Ascertaining Flare in Patients With Inactive Disease"],"prefix":"10.1002","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9724-0443","authenticated-orcid":false,"given":"Pamela F.","family":"Weiss","sequence":"first","affiliation":[{"name":"University of Pennsylvania and Children's Hospital of Philadelphia  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1305-4871","authenticated-orcid":false,"given":"Timothy G.","family":"Brandon","sequence":"additional","affiliation":[{"name":"Children's Hospital of Philadelphia  Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meghan E.","family":"Ryan","sequence":"additional","affiliation":[{"name":"University of Minnesota Masonic Children's Hospital  Minneapolis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3858-7065","authenticated-orcid":false,"given":"Erin B.","family":"Treemarcki","sequence":"additional","affiliation":[{"name":"University of Utah and Primary Children's Hospital  Salt Lake City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephanie","family":"Armendariz","sequence":"additional","affiliation":[{"name":"Scottish Rite Hospital for Children  Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracey B.","family":"Wright","sequence":"additional","affiliation":[{"name":"University of Texas Southwestern Medical Center and Scottish Rite Hospital for Children  Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chetna","family":"Godiwala","sequence":"additional","affiliation":[{"name":"Scottish Rite Hospital for Children  Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6225-3690","authenticated-orcid":false,"given":"Matthew L.","family":"Stoll","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Xiao","sequence":"additional","affiliation":[{"name":"University of Pennsylvania  Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1604-0130","authenticated-orcid":false,"given":"Daniel","family":"Lovell","sequence":"additional","affiliation":[{"name":"Cincinnati Children's Hospital Medical Center  Cincinnati Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,9,13]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"crossref","first-page":"819","DOI":"10.1136\/annrheumdis-2018-213030","article-title":"Treating juvenile idiopathic arthritis to target: recommendations of an international task force","volume":"77","author":"Ravelli A","year":"2018","journal-title":"Ann Rheum 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