Developing a disease activity tool for systemic-onset juvenile idiopathic arthritis by international consensus using the Delphi approach

Rheumatology (Oxford). 2005 Dec;44(12):1574-8. doi: 10.1093/rheumatology/kei095. Epub 2005 Sep 13.


Objectives: The systemic form of juvenile idiopathic arthritis may present with many diverse symptoms, signs and laboratory abnormalities. Our aim was to elicit and pool items useful for developing a consensus disease activity measure for systemic arthritis in children, using an international pool of respondents.

Methods: We used a Delphi survey process in two steps. First we surveyed 187 paediatric rheumatologists and allied health professionals. We elicited 2607 items that, when combined with previously elicited items from parents/patients, could be pooled into 107 independent items. We then surveyed the paediatric rheumatologists to determine the frequency and importance of the 107 items.

Results: Our response rate was 83% to both surveys. We identified 29 items as being the most important and most frequently seen indicators of active disease. The most highly rated of these items were: presence of fever, presence of rash, elevated ESR, elevated CRP, requirement for increasing medications, abnormal physician global evaluation and presence of joints with active arthritis.

Conclusions: Twenty-nine items are thought by medical practitioners to be most relevant in determining disease activity in systemic arthritis. As a next step, the measurement properties of these items will be tested to help develop a disease activity tool.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Algorithms
  • Arthritis, Juvenile / complications
  • Arthritis, Juvenile / diagnosis*
  • Child
  • Delphi Technique
  • Health Surveys
  • Humans
  • International Cooperation
  • Severity of Illness Index*