{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,4]],"date-time":"2025-10-04T00:30:13Z","timestamp":1759537813382,"version":"build-2065373602"},"reference-count":16,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T00:00:00Z","timestamp":1756598400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["acrjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["ACR Open Rheumatology"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess associations of ancestry with juvenile idiopathic arthritis (JIA) categories and clinical Juvenile Arthritis Disease Activity Scores (cJADAS10) at presentation to pediatric rheumatology care in a multicultural country with universal health care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Parents reported their child's ancestry in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh\u2010Out) cohort. For each ancestry reported for \u226530 children, we compared JIA category distribution and median cJADAS10 scores among three groups: only that ancestry, with that and other ancestries, and without that ancestry. Chi\u2010square, Fisher's exact, and Kruskal\u2010Wallis tests compared the three groups and multivariable linear regression assessed factors associated with cJADAS10 scores.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 1,407 participants, 629 (44.7%) reported more than one ancestry. British ancestry was associated with higher median cJADAS10 scores (7.5) and higher frequency of enthesitis\u2010related arthritis (18.7%) and psoriatic arthritis (10.0%), French ancestry was associated with lower cJADAS10 scores (5.8) and higher oligoarthritis (51.2%), Indigenous ancestry was associated with higher cJADAS10 scores (11.0) and higher rheumatoid factor\u2013positive polyarthritis (21.9%), Black ancestry was associated with higher rheumatoid factor\u2013positive polyarthritis (16.0%), and Eastern European ancestry was associated with lower cJADAS10 scores (3.6). Associations of ancestry with cJADAS10 scores were largely explained by differences in JIA categories (total R<jats:sup>2<\/jats:sup> = 0.28, with R<jats:sup>2<\/jats:sup> = 0.25 for JIA category alone). Black ancestry was associated with longer time from symptom onset to diagnosis (27 vs 18.9 weeks).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>British and French ancestries had distinct associations with JIA categories and cJADAS10 scores, and many children had multiple ancestries, questioning the use of a single \u201cEuropean\u201d reference group. Higher cJADAS10 scores were largely explained by differences in JIA categories across ancestries.<\/jats:p><jats:p><jats:boxed-text content-type=\"graphic\" position=\"anchor\"><jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/acr270092-gra-0001-m.png\"><jats:alt-text>image<\/jats:alt-text><\/jats:graphic><\/jats:boxed-text><\/jats:p><\/jats:sec>","DOI":"10.1002\/acr2.70092","type":"journal-article","created":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T06:24:39Z","timestamp":1756707879000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["A Tale of Many Canadas: Associations of Ancestry With Juvenile Idiopathic Arthritis Categories and Disease Severity at Presentation to Care"],"prefix":"10.1002","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3237-1725","authenticated-orcid":false,"given":"Stephanie K. A.","family":"Wong","sequence":"first","affiliation":[{"name":"British Columbia Children's Hospital and the University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4314-6750","authenticated-orcid":false,"given":"Lori B.","family":"Tucker","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and the University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7174-1007","authenticated-orcid":false,"given":"Kristin","family":"Houghton","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and the University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David A.","family":"Cabral","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and the University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mercedes","family":"Chan","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and the University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly A.","family":"Morishita","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and the University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rae S. M.","family":"Yeung","sequence":"additional","affiliation":[{"name":"The Hospital for Sick Children and University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kiem","family":"Oen","sequence":"additional","affiliation":[{"name":"University of Manitoba  Winnipeg Manitoba Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ciaran M.","family":"Duffy","sequence":"additional","affiliation":[{"name":"Children's Hospital of Eastern Ontario Research Institute and University of Ottawa  Ottawa Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2780-0617","authenticated-orcid":false,"given":"Roberta A.","family":"Berard","sequence":"additional","affiliation":[{"name":"London Health Sciences Centre and Western University  London Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ga\u00eblle","family":"Ch\u00e9deville","sequence":"additional","affiliation":[{"name":"McGill University Health Centre and McGill University  Montr\u00e9al Qu\u00e9bec Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Loughin","sequence":"additional","affiliation":[{"name":"Simon Fraser University  Burnaby British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8977-2581","authenticated-orcid":false,"given":"Jaime","family":"Guzman","sequence":"additional","affiliation":[{"name":"British Columbia Children's Hospital and the University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the ReACCh\u2010Out 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