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Rheumatology (Oxford). 2020 Jan 9. pii: kez615. doi: 10.1093/rheumatology/kez615. [Epub ahead of print]

Clinical and associated inflammatory biomarker features predictive of short-term outcomes in non-systemic juvenile idiopathic arthritis.

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Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada.
Department of Computer Sciences, University of Saskatchewan, Saskatoon, SK, Canada.
Département de Médecine, Université de Sherbrooke, Sherbrooke, QC, Canada.
Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada.
Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada.
Département de Médecine le, Centre Hospitalier Universitaire de Quebec, Quebec, QC, Canada.
Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St John's, NL, Canada.
Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NS, Canada.
Department of Pediatrics, University of Manitoba, Winnipeg, MB, Canada.
Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ON, Canada.
Department of Pediatrics, University of Calgary, Calgary, AB, Canada.
Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Department of Pediatrics, Hôpital Fleurimont (CHUS), Quebec, QC, Canada.
Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada.



To identify early predictors of disease activity at 18 months in JIA using clinical and biomarker profiling.


Clinical and biomarker data were collected at JIA diagnosis in a prospective longitudinal inception cohort of 82 children with non-systemic JIA, and their ability to predict an active joint count of 0, a physician global assessment of disease activity of ≤1 cm, and inactive disease by Wallace 2004 criteria 18 months later was assessed. Correlation-based feature selection and ReliefF were used to shortlist predictors and random forest models were trained to predict outcomes.


From the original 112 features, 13 effectively predicted 18-month outcomes. They included age, number of active/effused joints, wrist, ankle and/or knee involvement, ESR, ANA positivity and plasma levels of five inflammatory biomarkers (IL-10, IL-17, IL-12p70, soluble low-density lipoprotein receptor-related protein 1 and vitamin D), at enrolment. The clinical plus biomarker panel predicted active joint count = 0, physician global assessment ≤ 1, and inactive disease after 18 months with 0.79, 0.80 and 0.83 accuracy and 0.84, 0.83, 0.88 area under the curve, respectively. Using clinical features alone resulted in 0.75, 0.72 and 0.80 accuracy, and area under the curve values of 0.81, 0.78 and 0.83, respectively.


A panel of five plasma biomarkers combined with clinical features at the time of diagnosis more accurately predicted short-term disease activity in JIA than clinical characteristics alone. If validated in external cohorts, such a panel may guide more rationally conceived, biologically based, personalized treatment strategies in early JIA.


JIA; arthritis; childhood arthritis; classification; cytokines; machine learning; predictors

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