The Effect of Morning Stiffness Duration on the Definition of Clinically Inactive Disease in Juvenile Idiopathic Arthritis

Objective To investigate the impact of morning stiffness (MS) on parent disease perception in children with juvenile idiopathic arthritis (JIA) with clinical inactive disease (CID). Methods 652 visits in which patients fulfilled 2004 or 2011 Wallace criteria for CID were examined. Parent-reported outcomes were compared among patients with no MS or with MS < or ≥ 15 minutes. Results Among 652 visits with CID by 2004 criteria, no MS was reported in 554 visits (85%), MS < 15 minutes in 53 (8%), and MS ≥ 15 minutes in 45 (7%). The frequency of altered physical function, health-related quality of life, and well-being, pain and disease activity visual analog scales was proportionally greater from patients without MS to those with longer MS. The frequency of parent subjective rating of disease state as remission was 87.7%, 58% and 27.7% among patients with no MS, MS < 15 minutes and MS ≥ 15 minutes, respectively. Conclusion Our results suggest that a change in 2011 CID criteria to require absence of MS should be considered.