Parent and child acceptable symptom state in juvenile idiopathic arthritis

Giovanni Filocamo, Alessandro Consolaro, Benedetta Schiappapietra, Nicolino Ruperto, Angela Pistorio, Nicoletta Solari, Silvia Pederzoli, Sara Verazza, Alberto Martini, Angelo Ravelli

Research output: Contribution to journalArticlepeer-review


Objective. To explore the parent and child acceptable symptom state in juvenile arthritis (JA-PASS and JA-CASS, respectively) and estimate the JA-PASS and JA-CASS cutoff values for outcome measures. Methods. Children with juvenile idiopathic arthritis (JIA) and their parents completed a multi-dimensional questionnaire that included parent-reported and child-reported outcomes and a question about whether they considered the disease state as satisfactory. Additional assessments included demographic data, physician-reported outcomes, and acute-phase reactant levels. Stepwise logistic regression was used to assess contributors to JA-PASS and JA-CASS. Cutoff values of outcome measures that defined JA-PASS and JA-CASS were determined using both 75th percentile and receiver-operating characteristic (ROC) curve methods. Testing procedures included evaluation of discriminative and construct validity of the satisfaction question and assessment of reliability of JA-PASS and JA-PASS cutoffs. Results. Of 584 parents, 385 (65.9%) considered their child in JA-PASS. Of 343 children, 236 (68.8%) considered themselves in JA-CASS. Significant contributors to being in either JA-PASS or JA-CASS were absence of active joints, better rating of overall well-being, and better physical function or health. Cutoff values yielded by 75th percentile and ROC curve methods were similar. Parent, child, and physician global ratings yielded the lowest percentage of false-positive misclassification and the best tradeoff between sensitivity and specificity. The satisfaction question showed good discriminative and construct validity and the JA-PASS and JA-PASS cutoffs were found to be stable over time. Conclusion. The acceptable symptom state is a relevant concept for children with JIA and their parents and constitutes a valid outcome measure that is potentially applicable in routine practice and clinical trials. The Journal of Rheumatology

Original languageEnglish
Pages (from-to)856-863
Number of pages8
JournalJournal of Rheumatology
Issue number4
Publication statusPublished - Apr 2012


  • Acceptable symptom state
  • Health status
  • Juvenile idiopathic arthritis
  • Pediatric rheumatology

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy


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