Observational study: Adherence to Disease Modifying Anti Rheumatic Drugs in Tunisian patients with Juvenile Idiopathic Arthritis

Observational study: Adherence to Disease Modifying Anti Rheumatic Drugs in Tunisian patients with Juvenile Idiopathic Arthritis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Observational study: Adherence to Disease Modifying Anti Rheumatic Drugs in Tunisian patients with Juvenile Idiopathic Arthritis Aliaa Fazaa, Asma Selmi, Azza Saad, Sawssen Miladi, Hiba Boussaa, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3273058/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Non-or poor adherence to medication appears to be particularly common in chronic inflammatory rheumatic diseases, especially in juvenile idiopathic arthritis (JIA). It leads to a reduction of the therapeutic potential, aggravation and progression of the disease and therefore represents a real health and economic issue. The main objective of our study was to evaluate the compliance of Tunisian patients with JIA with disease modifying drugs and the potential factors that may influence this compliance. Methods This was a cross-sectional study including patients with JIA (ILAR criteria), currently taking csDMARDs and/or bDMARDs for at least 3 months. Socio-demographic, clinical, biological, radiological and therapeutic data were collected. Compliance was assessed using two methods: self-reported compliance by the patient and the parent and compliance measured by two self-administered questionnaires: the PARQ (Parent Adherence Report Questionnaire) and the CARQ (Child Adherence Report Questionnaire). Results Thirty patients, 16 girls and 14 boys, with a mean age of 24.8 ± 11 years [8–47] were included. A cs DMARD was prescribed in76.7% of patients and a bDMARD in 26.7%. Eighty percent of the parents and 76.7% of the patients reported taking their treatment as prescribed. Adherence according to PARQ and CARQ had a mean of 74.58 ± 36 [0-100] and 74 ± 34 [0-100] respectively. In the univariate analysis, PARQ compliance was positively correlated with ESR (p = 0.001 ; r = 0.643) and CRP (p = 0.008 ; r = 0.561) and negatively correlated with the mother's age (p = 0.005 ; r=-0.572), the difficulty of taking medication according to the parent (p < 0.0001; r=-0.698) and negative reactions to medication according to the patient (p = 0.012; r=-0.506) and the parent (p = 0.001; r= -0.651). Adherence to medication according to the CARQ was significantly related to the "indigent card" type of social coverage (p = 0.019). In the multivariate analysis, the predictive factors for non-adherence according to the PARQ were old age of the mother (p = 0.004), low ESR (p = 0.029) and negative reactions to medication (p < 0.0001). For the CARQ, the only predictive factor for non-compliance was the difficulty following treatment (p = 0.042) reported by the parent. Conclusion Our study showed good compliance in Tunisian patients with JIA. High maternal age, low disease activity, negative reactions to medication and difficulty in following treatment were predictive of non-adherence. Appropriate educational strategies could improve patient compliance and thus the prognosis of JIA patients. disease modifying anti rheumatic drugs compliance juvenile idiopathic arthritis parent Figures Figure 1 Introduction Disease-modifying therapies for chronic inflammatory rheumatism (CIR) have developed considerably over the last few decades, improving quality of life for many patients. However, non-adherence or poor adherence to therapy appears to be particularly frequent in these chronic diseases and represents a real health and economic challenge. Indeed, it leads to a reduction in therapeutic potential, aggravation and progression of the disease, as well as a significant socio-economic impact in terms of healthcare use and lost productivity [ 1 – 3 ]. Although the impact of non-adherence to treatment during the course of ICR, particularly during the course of Juvenile Idiopathic Arthritis (JIA), is significant [ 4 – 6 ], few studies in the literature have focused on it. In Tunisia, we have no studies that have evaluated therapeutic compliance in JIA. The main objective of our study was to assess, by means of self-questionnaires, compliance with conventional synthetic modifying anti rheumatic drugs (csDMARDs) and biologic disease modifying anti rheumatic drugs (bDMARDs) in Tunisian patients with JIA, as well as the factors influencing compliance. Methods Study population This was a cross-sectional study, including patients with JIA, meeting the criteria of the International League of Associations for Rheumatology (ILAR) 2001, with ongoing treatment with csDMARDs and/or bDMARDs started at least three months ago, and followed up in the rheumatology department of Mongi Slim Hospital, La Marsa. This study did not include patients who had permanently stopped their disease-modifying treatment, or those with hearing, speech or comprehension difficulties that prevented them from answering the questionnaires accurately. Interviews with patients and their parents, and a review of medical records, enabled us to collect socio-demographic data on patients, the duration of JIA progression, and clinical-biological parameters of disease activity: visual analog scale (VAS) pain, global patient assessment (GPA), duration of morning stiffness (RM), number of nocturnal awakenings (RN), number of painful (NAD) and swollen (NAT) joints, sedimentation rate (VS), c-Reactive Protein (CRP) and JADAS 10, functional impact (C-HAQ), immunological profile, existence of extra-articular manifestations, radiographic data and characteristics of current disease-modifying therapy. Measuring therapeutic compliance Therapeutic compliance was assessed using two methods: patient and parent self-reported compliance, and compliance measured by two self-administered questionnaires distributed to patients and one of their parents respectively. Patient and parent self-reported compliance was assessed by means of a direct question: "Do you take your treatment or does your child take his/her treatment regularly as prescribed by your/ his/her rheumatologist?". In the event of a negative response, the reasons were given. Parents completed the PARQ " Parent Adherence Report Questionnaire" which assesses the child's therapeutic adherence as perceived by the parents. Patients with JIA completed the Child Adherence Report Questionnaire (CARQ), which assesses the child's therapeutic adherence. We used the two validated French versions of the PARQ and CARQ [ 7 ]. Responses to PARQ and CARQ questions are mostly scored from 0 (no adherence to treatment) to 100 (total adherence to treatment). Thus, the higher the score, the greater the compliance. The PARQ comprises several questions that are repeated for each of the following 3 themes: medication, exercise and orthotics. For each of these themes, parents are questioned on 4 points: the frequency with which their children adhere to them, the difficulty of following them, the frequency of negative reactions caused by this treatment and their opinion on its usefulness. The parents' preferred treatment is also specified. Each PARQ question is scored individually. The CARQ is a version of the PARQ that has been modified for use with children. The structure and rating scales are superimposable, except for the language and syntax, which are better adapted to children [ 7 ]. The patients and their parents completed the questionnaires themselves. Those who were illiterate or had a primary school education needed our help to complete them. Statistical study Data were entered using Excel 2019 and analyzed using SPSS version 25.0. The descriptive study involved calculating simple frequencies and relative frequencies (percentages) for qualitative variables, and means, medians, quartiles (P25 and P75), standard deviations and range for quantitative variables. For the analytical study, the chi-square test was used to identify associations between qualitative variables. Spearman correlations were used to study two-way associations between quantitative variables, specifying (p) and Spearman's rho (r), which reflect the direction and strength of the association respectively. A multivariate analysis using multiple linear regression was performed to predict factors of therapeutic non-adherence. Variables with a significance level of p < 0.2 were included in the multiple linear regression model. The model was validated using the residual Durbin-Watson study. The best predictor was determined and the equation was estimated with the beta coefficient (Ɓ) and its 95% confidence interval (CI). The Kappa measure of agreement was used to generate an estimate of reliability between the two observers (parent and child). Agreement was significant when the (p) value was less than or equal to 0.05. The kappa agreement (k) was interpreted as follows: <0 (disagreement), 0-0.20 (very weak agreement), 0.21–0.40 (weak agreement), 0.41–0.60 (moderate agreement), 0.61–0.80 (strong agreement), 0.81–0.99 (excellent agreement) and 1.00 (perfect agreement). Kendall's tau-b correlation coefficient ( τ b ) (Kendall's tau-b) was used to measure the strength and direction of association between two variables. Its value ranges from − 1 (negative correlation) to 1 (positive correlation). Results socio-demographic characteristics of the study population Thirty patients with JIA were included. The sex ratio was 0.87 (14/16). The mean age of patients at the time of the study was 24.8 ± 11 years [8-47]. The mean age of the fathers was 59.6 ± 13 years [37-86]. The mean age of the mothers was 54.1± 10 years [34-75]. Twenty-five patients had social security coverage. More than half (56.7%) were covered by public health insurance. Three-quarters of patients lived in urban areas (76.7%) and 7 in rural areas. Ten patients were under 18 years of age. They all attended school (5 primary and 5 secondary). Of the 20 patients over 18, 14 were gainfully employed, 4 in secondary school and 2 at university. Parents were married in 90% of cases. Three children had at least one deceased parent. Six fathers (22.2%) and 7 mothers (25%) had a university degree. None of the fathers were illiterate, compared with 21.4% of the mothers. All children had siblings, with an average number of siblings of 3. Characteristics of JIA The clinical, biological and radiographic characteristics of JIA patients are shown in Table 1. Table 1: Clinical, biological and radiographic characteristics of JIA patients (n=30) Variables Values Type of JIA, n (%) Systemic form FR+ polyarticular form Polyarticular shape FR- Oligoarticular form Enthesitis related arthritis (ERA) Psoriatic arthritis 2 (7,7) 4 (11,5) 10 (34,6) 10 (34,6) 4 (11,5) 0 Age of onset of JIA (years± DS) Progression time of JIA (months±SD) 7.4± 4 209.2± 125 Activity parameters Average pain VAS (mm ± SD) Average EGP (mm± DS) Average number of RN (± DS) Average MR (minutes ± SD) Average NAD (± SD) Average NAT (± SD) Average VS (mm± DS) Average CRP (mg/l) ± DS JADAS10 -VS medium± DS 32.5± 27 25.6± 26 0.17± 0 5.1± 9 0.9± 1 0.1± 1 26.59± 28 12.85± 23 7.65± 11 Functional impact Average C-HAQ± DS 0.24± 1 Extra-articular manifestations , n (%) Presence of comorbidities , n (%) 5 (16.7) 0 (0) Immunological profile FR positive, n (%) AAN positive, n (%) ACPA positive, n (%) 6 (24) 3 (12) 1 (4) Radiographic data Erosive forms, n (%) Coxite, n (%) 13 (44) 11 (36.7) SD : standard deviation, n : number of patients, RF : rheumatoid factor, ACPA : anti-citrullinated peptide antibodies, ANA : antinuclear antibodies, VAS : visual analog scale, PGE : patient global assessment, NR : number of nocturnal awakenings, MR : morning stiffness, NAD : number of painful joints, NAT : number of swollen joints, VS : sedimentation rate, CRP : C Reactive Protein, C-HAQ : Child-Health assessment Questionnaire, JADAS 10 : Juvenile Arthritis Disease Activity Score Regarding therapeutic characteristics, a csDMARD was prescribed in 76.7% of patients, with a mean duration of 92.5 months [1-372]. It consisted of oral methotrexate (MTX) in 65.2% of cases, injectable MTX in 13%, sulfasalazine in 8.7% and leflunomide in 13%. CsDMARD was combined with a bDMARD in 8 patients (33.3%) for an average of 40 months [7-85]. A bDMARD was prescribed in 26.7% of patients with a mean duration of 44.5 months [7-85]. Etanercept was prescribed in half the cases, Adalimumab in 25% and Infliximab and tocilizumab in 12.5% respectively. A bDMARD was prescribed as monotherapy in 12.5% of patients. The route of administration of the biological treatment was subcutaneous in 6 cases (75%) and intravenous in 2 cases (25%). Subcutaneous injection was performed by one of the parents in 66.7% of cases. Long-term treatments associated with disease-modifying therapies included non-steroidal anti-inflammatory drugs (NSAIDs) in 7 patients (23.3%), with an average daily number of tablets of 1.14 ± 0 [1-2], and oral corticosteroids in 8 cases (26.7%), with an average daily number of tablets of 1.38 ± 1 [1-2]. Assessment of therapeutic compliance The correlation between PARQ and the direct question to the parent was significant and strongly positive (p=0.002 and r= 0.607). The correlation between the CARQ and the direct question to the child was significant and strongly positive (p=0.003 and r= 0.525). To the direct question "Do you take your treatment or does your child take his/her treatment regularly as prescribed by your/ his/her rheumatologist?", an affirmative answer was given by parents and children in 80% and 76.7% of cases, respectively. The reasons for a negative response according to the parents were fear of possible side effects (n=3), forgetfulness (n=1) and delay in payment of treatment by the health insurance fund (n=1). The reasons for a negative response according to the children were fear of possible side effects (n=5), forgetfulness (n=1) and ineffectiveness of treatment (n=1). PARQ and CARQ scores were high with a mean of 74.58 ± 36 [0-100] and 74 ± 34 [0-100] respectively and a median of 100 [52.5-100] and 100 [47.5-100] respectively. The best treatments according to parents and children were NSAIDs (26.7%), followed by MTX (20%), corticosteroids (13.3%) and Etanercept (10%). When asked "Why this treatment?", the answers were: "because it was effective on the disease" for 63.3% of parents and 20% of patients, "easy to take" for 10% of patients and "had no side effects" according to 3.3% of parents and children. The characteristics of PARQ and CARQ are summarized in Table 2. Table 2: Characteristics of PARQ and CARQ PARQ n (%) or Avg ± DS [Min-Max] CARQ n (%) or Avg ± DS [Min-Max] Responsibility for processing Medication, n (%) Mother Father Child Exercises, n (%) Mother Father Child Other: Siblings Difficulty following treatment. Medication, Avg ± SD [Min-Max] Exercises, Avg ± SD [Min-Max] Adherence to treatment Medication, Avg ± SD [Min-Max] Exercises, Avg ± SD [Min-Max] Negative reactions Medication, Avg ± SD [Min-Max] Exercises, Avg ± SD [Min-Max] Usefulness of treatments Medication, Avg ± SD [Min-Max] Exercises, Avg ± SD [Min-Max] 14 (46,7) 0 16 (53,3) 1 (3,3) 0 4 (13,3) 1 (3,3) 25,2 ± 35 [0-100] 31,4 ± 39 [0-100] 74,5 ± 36 [0-100] 72,8 ± 39 [0-100] 19,5 ± 33 [0-100] 7,4 ± 19 [0-50] 66 ± 35 [0-100] 60 ± 38 [0-100] 10 (33,3) 1 (3,3) 19 (63,3) 3 (10) 1 (3,3) 1 (3,3) 1 (3,3) 26,3 ± 33 [0-100] 37,1 ± 27 [0-70] 74 ± 34 [0-100] 61,2 ± 39 [0-100] 23,6 ± 35 [0-100] 26,2 ± 29 [0-100] 68 ± 30 [0-100] 35 ± 21 [20-50] SD : standard deviation, n : number, Avg : average, Min : minimum, Max : maximum Study of parameters influencing therapeutic compliance Univariate analysis In the univariate analysis, PARQ compliance was positively correlated with SV (p=0.001; r=0.643) and CRP (p=0.008; r=0.561) levels. On the other hand, it was negatively correlated with mother's age (p=0.005; r= -0.572), parent's difficulty in taking medication (p<0.0001; r= -0.698) and patient's (p=0.012; r=-0.506) and parent's (p=0.001; r=-0.651) negative reactions to medication. Adherence according to PARQ was also significantly associated with type of social security coverage (p=0.014) and bDMARD route of administration (p=0.022) . Indigent and half-price booklets, as well as the intravenous route, were associated with poor therapeutic compliance. Based on the CARQ, compliance was negatively correlated with patient age (p=0.036; r =-0.385), mother's age (p=0.029; r=-0.421), duration of JIA progression (p=0.035 ; r=-0.386), difficulty in taking treatment according to the parent (p=0.001; r= -0.645) and according to the patient (p=0.002; r=-0.552), and negative reactions to medication according to the parent (p=0.011; r = -0.508). Therapeutic compliance according to the CARQ was also significantly linked to "indigent booklet" social security coverage (p=0.019) . Multivariate analysis In the multivariate analysis, the predictors of non-adherence according to the PARQ were high maternal age (p=0.004), low SV (p=0.029) and negative reactions to medication (p<0.0001). For the CARQ, the only factor contributing to non-adherence was difficulty following treatment (p=0.042) reported by the parent. Table 3 summarizes the uni and multivariate analysis of factors influencing adherence to treatment according to PARQ and CARQ. Table 3: Study of factors influencing therapeutic compliance according to PARQ and CARQ in uni- and multivariate analysis. PAR Q QAR C Univariate analysis Multivariate analysis Univariate analysis Multivariate analysis p r p B p r p B Socio-demographic characteristics Patient's age 0,101 -0,343 0,036 -0,385 Type 0,359 0,078 Father's age 0,268 -0,241 0,561 -0,119 Mother's age 0,005 -0,572 0,004 -0,901 0,029 -0,421 Housing zone 0,662 0,936 Patient's schooling 0,845 0,366 Father's level of education 0,984 0,555 Mother's level of education 0,857 0,276 Parents' situation 0,385 0,652 Number of siblings 0,866 0,036 0,158 -0,265 Features of AJI Age of onset of JIA 0,668 0,092 0,981 0,005 JIA evolution time 0,088 -0,356 0,035 -0,386 Type of AJI 0,338 0,379 Radiological profile 0,269 0,845 Disease activity EVA dl 0,297 0,222 0,191 0,246 EGP 0,336 0,205 0,724 0,067 RM 0,498 0,145 0,552 0,113 RN 0,487 -0,149 0,263 -0,211 NAD 0,434 0,176 0,261 0,220 NAT 0,636 0,107 0,710 0,074 VS 0,001 0,643 0,029 0,390 0,541 0,123 CRP 0,008 0,561 0,201 0,259 JADAS 10 0,558 0,132 0,665 -0,087 Functional impact of JIA (C-HAQ) 0,618 0,153 0,406 0,216 Therapeutic features of JIA Number of Cs-DMARDs 0,269 -0,275 0,348 0,205 Type Cs-DMARDs 0,054 0,325 Duration Cs-DMARDs 0,251 -0,285 0,353 -0,203 Duration of Cs and b DMARDs association 0,846 0,082 0,475 -0,297 Type b-DMARD 0,137 0,308 Duration b-DMARD 0,769 0,124 0,165 -0,543 Stop decision b-DMARD 0,317 0,236 0,434 0,160 0,018 42,447 Number of NSAID tablets 0,541 0,316 0,582 0,255 Number of corticosteroid tablets 0,817 -0,122 0,879 -0,065 Parents' perception of treatment (PARQ ) Difficulty with medication <0,0001 -0,698 0,001 -0,645 0,042 -0,601 Difficulty with exercises 0,570 -0,295 0,791 0,124 Negative reactions to drugs 0,001 -0,651 <0,0001 -0,599 0,011 -0,508 Negative reactions to exercises 0,587 -0,283 0,230 0,522 Usefulness of medicines 0,370 0,191 0,851 0,040 Usefulness of exercises 0,014 0,949 0,215 0,671 Patient perception of treatment (CARQ ) Difficulty with medication 0,002 -0,593 0,002 -0,552 Exercise difficulty 0,721 0,167 0,824 -0,104 Negative reactions to drugs 0,012 -0,506 0,114 -0,294 Negative reactions to exercises 0,334 -0,431 0,602 -0,219 Usefulness of medicines 0,536 0,133 0,143 0,274 Usefulness of exercises 0,809 -0,113 0,336 -0,393 VAS : visual analogue scale, PGA : patient's global assessment, NR : number of nocturnal awakenings, MR : morning stiffness, NAD : number of painful joints, NAT : number of swollen joints, VS: sedimentation rate, CRP : C Reactive Protein, C-HAQ : Child-Health assessment Questionnaire, JADAS 10 : Juvenile Arthritis Disease Activity Score Study of the concordance between PARQ and CARQ results The study of agreement between the different PARQ and CARQ items showed very strong agreement between the two concerning "best treatment" (k =0.659, p<0.0001). The percentage of agreement was 72%. These scores were significantly, positively and strongly associated ( τ b =0.545, p=0.001). The lowest level of agreement between PARQ and CARQ concerned "usefulness of treatment" (k =0.194, p=0.014). The percentage of agreement was 32%. For the items "treatment responsibility", "treatment difficulty" and "treatment adherence", the agreement between the two scores was moderate (k =0.518; p=0.006, k =0.439; p<0.0001 and k =0.415; p<0.0001) respectively. These scores were significantly, positively and moderately associated ( τ b =0.449; p=0.015, τ b =0.515; p=0.004, τ b =0.638; p<0.0001 respectively). Concerning "negative reactions", agreement between the two scores was weak (k =0.286, p=0.002). Concordance between PARQ and CARQ results is shown in Figure 1. Discussion In our study, 80% of parents reported that their children were taking their treatments as prescribed by their rheumatologists. This result is consistent with the mean PARQ, which was 74.58 ± 36 [0-100]. Among patients, 76.7% declared that they were taking their treatment correctly. This result is in line with the CARQ mean of 74 ± 34 [0-100]. PARQ and CARQ scores were thus very high, in line with the results reported in the literature [ 8,9]. Various studies have investigated medication compliance in patients with JIA. The results of these studies differ according to the treatment taken and the assessment method adopted by the authors. In the literature, medication compliance in JIA has mainly been assessed by the PARQ and CARQ scores [ 8 , 10 – 13 ]. Treatment compliance percentages ranged from 72–88% for PARQ [ 8 , 10 – 13 ] and 74.8–84.45% for CARQ [ 8 , 10 – 13 ] . Variations in results between different studies using the same assessment methods and evaluating the same treatment may also be explained by the duration of each study, the length of time the disease has progressed and, above all, by the time at which patient compliance is assessed (treatment initiation period or follow-up of a treatment already underway). Other methods of assessing therapeutic adherence in JIA have also been used. A recent Spanish study used the MPR "Medication Possession Ratio" to assess the degree of therapeutic adherence during JIA, showing an adherence rate of up to 96.3% [ 14 ]. This rate is significantly higher than that found in our work. This could be explained by the therapeutic education programs set up in this country, which improve patient compliance. In two other studies conducted in Brazil, adherence to treatment was assessed using the MORISKY questionnaire for parents and children over 9 years of age. Adherence rates varied according to the study from 46.5–69.2% but were lower than those found in our work [ 15 , 16 ]. A review of the literature published in 2017 showed a maximum adherence to biological treatments of 65% during the course of JIA [ 17 ]. A recent Norwegian study assessing adherence to cs- and bDMARDs in patients with JIA, using the Morisky questionnaire 19 years after the onset of the disease, concluded that adherence was poor in around half of cases [ 18]. The PRAQ questionnaire was used in a Brazilian pilot study showing good therapeutic adherence in 78.8% of cases [ 19 ]. In our study, fear of adverse effects was the main cause of non-compliance cited by both patients and parents. Forgetfulness was noted by one child and one parent. Only one patient considered that the treatment was not effective, and only one parent considered that the delay in reimbursement of the treatment by the health insurance fund was the cause. This result is in line with the literature, where fear of adverse effects was the main cause of non-adherence reported by patients and parents [ 10 , 20 , 21 ]. In contrast, according to Juan Carlos Gonzales et al, the major factor in non-adherence was disease remission (48.4%), followed by treatment ineffectiveness in 29% of cases, and fear of side effects in only 12.9% of cases [ 14 ]. Kearsley-Fleet et al reported that treatment ineffectiveness was the main reason for discontinuation (60%) [ 22 ], while forgetfulness was the main factor in non-adherence according to De Civita et al (55%) [ 11 ]. Leslie A et al further showed that the intensity of pain reported by parents and children was a considerable barrier to non-adherence to medication [ 9 ]. In contrast, according to Brandelli et al, fear of disease-induced pain is an important factor in good medication adherence [ 10 ]. In a Canadian study published in 2019, two major factors were also reported: the absence of the parent on the day the medication is taken (41%) and patients' reluctance to injectable treatments (40%) [ 10 ]. Similarly, children's reluctance to take treatment was the main cause of non-adherence in JIA, according to the meta-analysis by Santer M et al [ 23 ]. Len et al also reported that an unstable family situation (separation, divorce...) contributes to poor medication compliance [ 10 , 24 ]. Similarly, Miotto et al showed that unfavorable socio-economic conditions were linked to non-adherence to treatment [ 19 ]. Numerous studies have been carried out to identify factors positively or negatively correlated with adherence, with variable results. In our study, no association was found between female gender and treatment adherence. This is in line with the findings of De Civita et al [ 11 ], but contrasts with those of Anne Lohse et al. and Miotto et al, where female gender was associated with poor adherence [ 8 , 19 ]. Furthermore, in our study, PARQ and CARQ were strongly correlated with the mother's young age, contrasting with the results of De Civita et al [ 11 ]. This could be explained by the fact that mothers tend to alter their cognitive functions with age, thus forgetting the treatment of their children [ 25 ] . PARQ and CARQ were unrelated to JIA type, phenotypic and radiological disease profile, functional impact, presence of coxitis or extra-articular manifestations, in line with the literature [ 8 ]. On the other hand, short disease duration was associated with CARQ, and high SV and CRP levels were significantly correlated with PARQ. This suggests that the longer the duration of rheumatism, the more difficult it will be for the child to follow his or her treatments, and the more active the disease (high SV and CRP), the more the parent would encourage the child to take his or her medication. These results are not consistent with those reported in the literature, where these parameters were not linked to medication compliance [ 8 , 12 ]. It should be noted that in our study, no statistically significant relationship was found between medication compliance as measured by PARQ and CARQ and other disease activity parameters, in line with the findings of a recent French study [ 8 , 12 ] . Taking therapeutic characteristics into account, only the route of administration of bDMARDs was related to PARQ. However, several studies in the literature have shown a strong correlation between the type of bDMARD, notably anti-TNF alpha, and treatment adherence [ 26 , 27 ]. In addition, Bugni et al demonstrated that taking 3 or more tablets per day was strongly associated with poor adherence to treatment [ 28 ] contrasting with our results. The study of agreement between the different PARQ and CARQ items showed very strong agreement between the two concerning the best treatment, with a percentage of agreement of 72%. The weakest agreement between the PARQ and CARQ concerned the usefulness of the treatment, with a percentage of agreement of 32%. This result is in line with several other studies [ 8 , 12 , 29 ]. To the best of our knowledge, this is the first study in Tunisia to assess compliance with treatment in JIA. We used validated self-questionnaires with good reproducibility and easy comprehensibility for our patients. However, our study has a number of limitations: the self-questionnaire method remains subjective and declarative and tends to overestimate the degree of therapeutic compliance. What's more, as our study is monocentric and small, the results cannot be generalized to the rest of the population Conclusion Our study showed good compliance in Tunisian patients with JIA. Factors predictive of poor compliance were high maternal age, low disease activity, negative reactions to medication and difficulty in following treatment. Identifying these factors and improving adherence through appropriate educational strategies aimed at patients, their families and all healthcare personnel would increase drug efficacy and thus improve the prognosis of patients with JIA. Abbreviations bDMARDs biologic disease modifying anti rheumatic drugs. csDMARDs conventional synthetic modifying anti rheumatic drugs ICH International Conference on Harmonization ILAR International League of Associations for Rheumatology MEA extra-articular manifestations MTX methotrexate SPSS Statistical Package for Social Science Declarations Ethics approval The informed consent form and protocol for parents and children, in line with the principles laid down by the International Conference on Harmonization (ICH), have been validated by the Ethics Committee of the Mongi Slim Hospital in La Marsa, Tunisia (registered under number 20/2023). Competing interest The authors declare that they have no conflicts of interest. Authors' contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Aliaa Fazaa, Azza Saad, Asma Selmi, Sawssen Miladi, Hiba Boussa, Yasmine Makhlouf and Ben Abelghani Kaouther. The first draft of the manuscript was written by Asma Selmi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.” Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Availability of data and materials Not applicable Consent to participate. Informed consent was obtained from all individual participants included in the study References Guzman J, Oen K, Huber AM, Watanabe Duffy K, Boire G, Shiff N, et al. The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Ann Rheum Dis. 2016; 75:1092-1098 Selvaag AM, Aulie HA, Lilleby V, Flat B, Selvaag AM. Disease progression into adulthood and predictors of long-term active disease in juvenile idiopathic arthritis. Ann Rheum Dis 2016; 75:190-195 Pelajo CF, Sgarlat CM, Lopez-Benitez JM, Oliveira SK, Rodrigues MC, Sztajnbok FR, et al. Adherence to methotrexate in juvenile idiopathic arthritis. Rheumatol Int 2012;32(2):497-500 S Ringold ,S T Angeles-Han, Timothy Beukelman, Daniel J Lovel, Carlos A Cuello, Mara L Beckeret al. American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res 2019;71(6):717-734 Gabriella Giancane and Nicolino Ruperto. Treatment of juvenile idiopathic arthritis: what's new? Curr Opin Rheumatol 2019;31(5):428-435 Klein A, Minden K., Hospach A, Foeldvari I, Weller-Heinemann F, Trauzeddel R et al. Treat-to-target study for improved outcome in polyarticular juvenile idiopathic arthritis. Ann Rheum Dis 2020; 79:969-974. Karine Toupin April. Comparison of the perceptions of children with juvenile arthritis and their parents regarding treatment compliance and its impact on quality of life. Montreal: Faculty of Graduate Studies Université de Montréal; 2004. 189p. Anne Lohse, Irène Lemelle, Pascal Pillet, Agnès Duquesne, Claire Ballot, Tu-Anh Tran et al. Therapeutic alliance is associated with treatment adherence in children with juvenile idiopathic arthritis. Revue du rhumatisme 2021 ;89:128-133 Leslie A Favier, Tracy V. Ting and Avani C. Modi. Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of-concept trial. Pediatric Rheumatology 2018 ;16(1):75 Yvonne N. Brandelli, BA (HONS), Christine T. Chambers, Perri R. Tutelman, BHSC (HONS), Jennifer N. Stinson et al. Parent Pain Cognitions and Treatment Adherence in Juvenile Idiopathic Arthritis. Journal of Pediatric Psychology 2019;44(9):1111-1119 Mirella De Civita, Patricia L. Dobkin, Debbie Ehrmann-Feldman, Igor Karp and Ciaran M. Duffy. Development and Preliminary Reproducibility and Validity of the Parent Adherence Report Questionnaire: A Measure of Adherence in Juvenile Idiopathic Arthritis. Journal of Clinical Psychology in Medical Settings 2005;12(1) Karine Toupin April, Debbie Ehrmann Feldman, Maria Victoria Zunzunegui, Ciarán M Duffy. Association between perceived treatment adherence and health-related quality of life in children with juvenile idiopathic arthritis: perspectives of both parents and children. Patient Preference and Adherence 2008;2:121-28 Karine Toupin April, Johanne Higgins and Debbie Ehrmann Feldman. Application of Rasch analysis to the parent adherence report questionnaire in juvenile idiopathic arthritis. Pediatric Rheumatology 2016; 14:45 Juan Carlos NietoGonzález-, -LauraTrivesFolguera, Alejandra -MelgarejoOrtuño, Aranzazu Ais, Belén SerranoBenavente-, María Sanjurjo. Persistence and adherence to biologic therapies in juvenile idiopathic arthritis. Nature 2021; 11:16195 Livia de Freitas Keppeke, Juliana Molina, Vanessa Bugni Miotto e Silva, Maria Teresa de Sande e Lemos Ramos Ascensão Terreri, Gerson Dierley Keppeke , Teresa Helena Schoen and Claudio Arnaldo Len . Psychological characteristics of caregivers of pediatric patients with chronic rheumatic disease in relation to treatment adherence. Pediatric Rheumatology 2018; 16:63 Liana Silveira Adriano, Marta Maria de Franca Fonteles, Maria de Fátima Menezes Azevedo, Milena Pontes Portela Beserraa, Nirla Rodrigues Romero. Medication adherence in patients with juvenile idiopathic arthritis. Revista brasileira de Reumatologia 2017;57(1):23-29 Shoop-Worrall S J W, Kearsley-Fleet L, Tomson W, Verstappen S M M& Hyrich K L. How common is remission in juvenile idiopathic arthritis: a systematic review. Semin Arthritis Rheum 2017; 47:331-337. Anita Tollisen, Berit Flat, Anne M. Selvaag, Astrid Aasland, Trude Ingebrigtsen, Joachim Sagen and Anners Lerdal. Treatment Satisfaction with and Adherence to Disease-Modifying Antirheumatic Drugs in Adult Patients with Juvenile Idiopathic Arthritis. Arthritis. Care & Research 2021;73(2):221-231 Miotto e Silva VB, Okamoto KY, Ozaki LS, Len CA, Terreri MT. Early detection of poor adherence to treatment of pediatric rheumatic diseases: Pediatric Rheumatology Adherence Questionnaire (PRAQ) - A pilot study. Rev Paul Pediatr 2019;37(2):149-155 Leslie A. Favier, Janalee Taylor, Kristin Loiselle Rich, Karla B. Jones, Sheetal S. Vora, Julia G. Harris, et al. Harris, et al. Barriers to Adherence in Juvenile Idiopathic Arthritis: A Multicenter Collaborative Experience and Preliminary Results. J Rheumatol 2018; 45(5): 690-696 Kearley-Fleet L, Vicente González L, Steinke D et al. Methotrexate persistence and adverse drug reactions in patients with juvenile idiopathic arthritis. Rheumatology 2019;58(8):1453-1458 Kearsley-Fleet L, Heaf E, Davies R, Baildam E, Beresford M.W, Foster H.E et al. BCRD and BSPAR-ETN study groups. Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study. Lancet Rheumatol 2020;2, e217-e226. Santer M, Ring N, Yardley L, Geraghty AW, Wyke S. Treatment nonadherence in pediatric long-term medical conditions: systematic review and synthesis of qualitative studies of caregivers' views. BMC Pediatr 2014; 14:63 Len C. A, Miotto e Silva V. B & Terreri M T. Importance of adherence in the outcome of juvenile idiopathic arthritis. Current Rheumatology Reports 2014;16(4):410 Anghel LA, Farcas AM, Oprean RN. Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review. Patient Prefer Adherence 2018; 12:1151-66. Favalli E G et al. Real-life 10-year retention rate of first-line anti-TNF drugs for infammatory arthritis in adult- and juvenile-onset populations: similarities and diferences. Clin. Rheumatol 2017;36(8):1747-1755 Shoop-Worrall S J W, Kearsley-Fleet L, Tomson W, Verstappen S M M & Hyrich K L. How common is remission in juvenile idiopathic arthritis: a systematic review. Semin Arthritis Rheum 2017; 47(3):331-337 Bugni VM, Luciana S Ozaki, karine Y A Okamoto, Cassia M P L Barbosa, Maria Odte E Hilario, Claudio A Len et al. Factors associated with adherence to treatment in children and adolescents with chronic rheumatic diseases. J Pediatr (Rio J)2012;88(6):483-8 Toupin April K, Ehrmann Feldman D, Platt RW, et al. Comparison between children with juvenile idiopathic arthritis (JIA) and their parents concerning perceived treatment adherence. Arthritis Rheum 2006;55(4):558-63 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3273058","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":228596304,"identity":"77d450bb-c499-4bab-93d4-9ea8e1006b66","order_by":0,"name":"Aliaa Fazaa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvUlEQVRIiWNgGAWjYBAC9gYGxgMJDDYMDBIgrg0RWngOMDAAtaRBtaQRq4WB4TApWhiYHxx4UHM+sX9288EHDAn3iNHCZnAg4djtxBl3jiUbMCQUE9Ziz8AA1MJ2O7HhRo6ZBOOPBGJsYf9wIOHfucT5IC0MCURp4TE4kNh2IHED8VqYeQoOJPYlG2+8kZZskECUFvb2jQ9/fLOTnXcj+eCDD8RoYWCGUI4NIJIYDXBgT4riUTAKRsEoGGEAAHXpPKQNBQaoAAAAAElFTkSuQmCC","orcid":"","institution":"Department of Rheumatology, Mongi Slim Hospital, 2046 La Marsa, Tunisia","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Aliaa","middleName":"","lastName":"Fazaa","suffix":""},{"id":228596305,"identity":"57e4efe3-4b6b-481e-bd99-105b853f8b40","order_by":1,"name":"Asma Selmi","email":"","orcid":"","institution":"Rheumatology practice, Nouvelle Médina, 2063 Ben Arous, Tunis, Tunisia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Asma","middleName":"","lastName":"Selmi","suffix":""},{"id":228596306,"identity":"1670086c-31b2-4352-a2aa-895fb26cb411","order_by":2,"name":"Azza Saad","email":"","orcid":"","institution":"Department of Rheumatology, Mongi Slim Hospital, 2046 La Marsa, Tunisia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Azza","middleName":"","lastName":"Saad","suffix":""},{"id":228596307,"identity":"5898a83c-0d03-4f63-951d-c2eba406eaa2","order_by":3,"name":"Sawssen Miladi","email":"","orcid":"","institution":"Department of Rheumatology, Mongi Slim Hospital, 2046 La Marsa, Tunisia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sawssen","middleName":"","lastName":"Miladi","suffix":""},{"id":228596308,"identity":"642a6f32-47f4-47c2-8317-a0b9896837ac","order_by":4,"name":"Hiba Boussaa","email":"","orcid":"","institution":"Department of Rheumatology, Mongi Slim Hospital, 2046 La Marsa, Tunisia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Hiba","middleName":"","lastName":"Boussaa","suffix":""},{"id":228596309,"identity":"ddadc158-da28-4e44-b0fc-e414ce4197a2","order_by":5,"name":"Yasmine Makhlouf","email":"","orcid":"","institution":"Department of Rheumatology, Mongi Slim Hospital, 2046 La Marsa, Tunisia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yasmine","middleName":"","lastName":"Makhlouf","suffix":""},{"id":228596310,"identity":"a1604712-0cca-4a69-95c1-f0328731fa06","order_by":6,"name":"Kaouther Ben Abelghani","email":"","orcid":"","institution":"Department of Rheumatology, Mongi Slim Hospital, 2046 La Marsa, Tunisia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Kaouther","middleName":"Ben","lastName":"Abelghani","suffix":""},{"id":228596311,"identity":"b521b318-36ec-48b6-a9ac-fa45459d71dd","order_by":7,"name":"Ahmed Laatar","email":"","orcid":"","institution":"Department of Rheumatology, Mongi Slim Hospital, 2046 La Marsa, Tunisia","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Laatar","suffix":""}],"badges":[],"createdAt":"2023-08-17 17:59:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3273058/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3273058/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":42326258,"identity":"5e3c382f-93df-406f-8c31-029d7d75b611","added_by":"auto","created_at":"2023-08-29 18:17:42","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50097,"visible":true,"origin":"","legend":"\u003cp\u003eConcordance between parent-child responses regarding treatment adherence\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3273058/v1/0becee039359b663f1fd0e50.png"},{"id":44654253,"identity":"dc4a977e-e20b-4e1f-9d17-69e1d6c52f8f","added_by":"auto","created_at":"2023-10-15 18:37:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":535878,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3273058/v1/de563b2a-b0ac-479c-92be-c8f9ba19fcb5.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Observational study: Adherence to Disease Modifying Anti Rheumatic Drugs in Tunisian patients with Juvenile Idiopathic Arthritis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDisease-modifying therapies for chronic inflammatory rheumatism (CIR) have developed considerably over the last few decades, improving quality of life for many patients. However, non-adherence or poor adherence to therapy appears to be particularly frequent in these chronic diseases and represents a real health and economic challenge. Indeed, it leads to a reduction in therapeutic potential, aggravation and progression of the disease, as well as a significant socio-economic impact in terms of healthcare use and lost productivity [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Although the impact of non-adherence to treatment during the course of ICR, particularly during the course of Juvenile Idiopathic Arthritis (JIA), is significant [\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], few studies in the literature have focused on it. In Tunisia, we have no studies that have evaluated therapeutic compliance in JIA. The main objective of our study was to assess, by means of self-questionnaires, compliance with \u003cem\u003econventional\u003c/em\u003e synthetic \u003cem\u003emodifying anti rheumatic drugs\u003c/em\u003e (csDMARDs) and biologic \u003cem\u003edisease modifying anti rheumatic drugs\u003c/em\u003e (bDMARDs) in Tunisian patients with JIA, as well as the factors influencing compliance.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy population\u003c/p\u003e \u003cp\u003eThis was a cross-sectional study, including patients with JIA, meeting the criteria of the \u003cem\u003eInternational League of Associations for Rheumatology\u003c/em\u003e (ILAR) 2001, with ongoing treatment with csDMARDs and/or bDMARDs started at least three months ago, and followed up in the rheumatology department of Mongi Slim Hospital, La Marsa.\u003c/p\u003e \u003cp\u003eThis study did not include patients who had permanently stopped their disease-modifying treatment, or those with hearing, speech or comprehension difficulties that prevented them from answering the questionnaires accurately.\u003c/p\u003e \u003cp\u003eInterviews with patients and their parents, and a review of medical records, enabled us to collect socio-demographic data on patients, the duration of JIA progression, and clinical-biological parameters of disease activity: visual analog scale (VAS) pain, global patient assessment (GPA), duration of morning stiffness (RM), number of nocturnal awakenings (RN), number of painful (NAD) and swollen (NAT) joints, sedimentation rate (VS), c-Reactive Protein (CRP) and JADAS 10, functional impact (C-HAQ), immunological profile, existence of extra-articular manifestations, radiographic data and characteristics of current disease-modifying therapy.\u003c/p\u003e \u003cp\u003eMeasuring therapeutic compliance\u003c/p\u003e \u003cp\u003eTherapeutic compliance was assessed using two methods: patient and parent self-reported compliance, and compliance measured by two self-administered questionnaires distributed to patients and one of their parents respectively.\u003c/p\u003e \u003cp\u003ePatient and parent self-reported compliance was assessed by means of a direct question: \"Do you take your treatment or does your child take his/her treatment regularly as prescribed by your/ his/her rheumatologist?\". In the event of a negative response, the reasons were given.\u003c/p\u003e \u003cp\u003eParents completed the PARQ \"\u003cem\u003eParent Adherence Report\u003c/em\u003e Questionnaire\" which assesses the child's therapeutic adherence as perceived by the parents.\u003c/p\u003e \u003cp\u003ePatients with JIA completed the \u003cem\u003eChild Adherence Report\u003c/em\u003e Questionnaire (CARQ), which assesses the child's therapeutic adherence.\u003c/p\u003e \u003cp\u003eWe used the two validated French versions of the PARQ and CARQ [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Responses to PARQ and CARQ questions are mostly scored from 0 (no adherence to treatment) to 100 (total adherence to treatment). Thus, the higher the score, the greater the compliance. The PARQ comprises several questions that are repeated for each of the following 3 themes: medication, exercise and orthotics. For each of these themes, parents are questioned on 4 points: the frequency with which their children adhere to them, the difficulty of following them, the frequency of negative reactions caused by this treatment and their opinion on its usefulness. The parents' preferred treatment is also specified. Each PARQ question is scored individually. The CARQ is a version of the PARQ that has been modified for use with children. The structure and rating scales are superimposable, except for the language and syntax, which are better adapted to children [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe patients and their parents completed the questionnaires themselves. Those who were illiterate or had a primary school education needed our help to complete them.\u003c/p\u003e \u003cp\u003eStatistical study\u003c/p\u003e \u003cp\u003eData were entered using Excel 2019 and analyzed using SPSS version 25.0.\u003c/p\u003e \u003cp\u003eThe descriptive study involved calculating simple frequencies and relative frequencies (percentages) for qualitative variables, and means, medians, quartiles (P25 and P75), standard deviations and range for quantitative variables.\u003c/p\u003e \u003cp\u003eFor the analytical study, the chi-square test was used to identify associations between qualitative variables. Spearman correlations were used to study two-way associations between quantitative variables, specifying (p) and Spearman's rho (r), which reflect the direction and strength of the association respectively.\u003c/p\u003e \u003cp\u003eA multivariate analysis using multiple linear regression was performed to predict factors of therapeutic non-adherence. Variables with a significance level of p\u0026thinsp;\u0026lt;\u0026thinsp;0.2 were included in the multiple linear regression model. The model was validated using the residual Durbin-Watson study. The best predictor was determined and the equation was estimated with the beta coefficient (Ɓ) and its 95% confidence interval (CI).\u003c/p\u003e \u003cp\u003e The Kappa measure of agreement was used to generate an estimate of reliability between the two observers (parent and child). Agreement was significant when the (p) value was less than or equal to 0.05. The kappa agreement (k) was interpreted as follows: \u0026lt;0 (disagreement), 0-0.20 (very weak agreement), 0.21\u0026ndash;0.40 (weak agreement), 0.41\u0026ndash;0.60 (moderate agreement), 0.61\u0026ndash;0.80 (strong agreement), 0.81\u0026ndash;0.99 (excellent agreement) and 1.00 (perfect agreement). Kendall's tau-b correlation coefficient (\u003cem\u003eτ\u003c/em\u003e\u003csub\u003eb\u003c/sub\u003e ) (Kendall's tau-b) was used to measure the strength and direction of association between two variables. Its value ranges from \u0026minus;\u0026thinsp;1 (negative correlation) to 1 (positive correlation).\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003esocio-demographic characteristics of the study population\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThirty patients with JIA were included. The sex ratio was 0.87 (14/16). The mean age of patients at the time of the study was 24.8 \u0026plusmn; 11 years [8-47]. The mean age of the fathers was 59.6 \u0026plusmn; 13 years [37-86]. The mean age of the mothers was 54.1\u0026plusmn; 10 years [34-75]. Twenty-five patients had social security coverage. More than half (56.7%) were covered by public health insurance. Three-quarters of patients lived in urban areas (76.7%) and 7 in rural areas. Ten patients were under 18 years of age. They all attended school (5 primary and 5 secondary). Of the 20 patients over 18, 14 were gainfully employed, 4 in secondary school and 2 at university.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParents were married in 90% of cases. Three children had at least one deceased parent. Six fathers (22.2%) and 7 mothers (25%) had a university degree. None of the fathers were illiterate, compared with 21.4% of the mothers. All children had siblings, with an average number of siblings of 3.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eCharacteristics of JIA\u003c/h2\u003e\n\u003cp\u003eThe clinical, biological and radiographic characteristics of JIA patients are shown in Table 1.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Clinical, biological and radiographic characteristics of JIA patients (n=30)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eVariables\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eValues\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eType of JIA, n (%) \u0026nbsp;\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eSystemic form \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eFR+ polyarticular form \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePolyarticular shape FR- \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eOligoarticular form \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eEnthesitis related arthritis (ERA) \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ePsoriatic arthritis \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (7,7)\u003c/p\u003e\n \u003cp\u003e4 (11,5)\u003c/p\u003e\n \u003cp\u003e10 (34,6)\u003c/p\u003e\n \u003cp\u003e10 (34,6)\u003c/p\u003e\n \u003cp\u003e4 (11,5)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eAge of onset of JIA\u003c/u\u003e (years\u0026plusmn; DS) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cu\u003eProgression time of JIA\u003c/u\u003e (months\u0026plusmn;SD) \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e7.4\u0026plusmn; 4\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e209.2\u0026plusmn; 125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eActivity parameters\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eAverage pain VAS (mm \u0026plusmn; SD) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAverage EGP (mm\u0026plusmn; DS) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAverage number of RN (\u0026plusmn; DS) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAverage MR (minutes \u0026plusmn; SD) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAverage NAD (\u0026plusmn; SD) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAverage NAT (\u0026plusmn; SD) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAverage VS (mm\u0026plusmn; DS) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAverage CRP (mg/l) \u0026plusmn; DS \u0026nbsp;\u003c/p\u003e\n \u003cp\u003eJADAS10 -VS medium\u0026plusmn; DS \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e32.5\u0026plusmn; 27\u003c/p\u003e\n \u003cp\u003e25.6\u0026plusmn; 26\u003c/p\u003e\n \u003cp\u003e0.17\u0026plusmn; 0\u003c/p\u003e\n \u003cp\u003e5.1\u0026plusmn; 9\u003c/p\u003e\n \u003cp\u003e0.9\u0026plusmn; 1\u003c/p\u003e\n \u003cp\u003e0.1\u0026plusmn; 1\u003c/p\u003e\n \u003cp\u003e26.59\u0026plusmn; 28\u003c/p\u003e\n \u003cp\u003e12.85\u0026plusmn; 23\u003c/p\u003e\n \u003cp\u003e7.65\u0026plusmn; 11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eFunctional impact\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eAverage C-HAQ\u0026plusmn; DS \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.24\u0026plusmn; 1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eExtra-articular manifestations\u003c/u\u003e, n (%) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cu\u003ePresence of comorbidities\u003c/u\u003e, n (%) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e5 (16.7)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cu\u003eImmunological profile\u003c/u\u003e\u003c/p\u003e\n \u003cp\u003eFR positive, n (%) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eAAN positive, n (%) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eACPA positive, n (%) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (24)\u003c/p\u003e\n \u003cp\u003e3 (12)\u003c/p\u003e\n \u003cp\u003e1 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003eRadiographic data\u003c/p\u003e\n \u003cp\u003eErosive forms, n (%) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eCoxite, n (%) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13 (44)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;11 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e: standard deviation, \u003cstrong\u003en\u003c/strong\u003e: number of patients, \u003cstrong\u003eRF\u003c/strong\u003e: rheumatoid factor, \u003cstrong\u003eACPA\u003c/strong\u003e: anti-citrullinated peptide antibodies, \u003cstrong\u003eANA\u003c/strong\u003e: antinuclear antibodies, \u003cstrong\u003eVAS\u003c/strong\u003e: visual analog scale, \u003cstrong\u003ePGE\u003c/strong\u003e: patient global assessment, \u003cstrong\u003eNR\u003c/strong\u003e: number of nocturnal awakenings, \u003cstrong\u003eMR\u003c/strong\u003e: morning stiffness, \u003cstrong\u003eNAD\u003c/strong\u003e: number of painful joints, \u003cstrong\u003eNAT\u003c/strong\u003e: number of swollen joints, \u003cstrong\u003eVS\u003c/strong\u003e: sedimentation rate, \u003cstrong\u003eCRP\u003c/strong\u003e: C Reactive Protein, \u003cstrong\u003eC-HAQ\u003c/strong\u003e: Child-Health assessment Questionnaire, \u003cstrong\u003eJADAS 10\u003c/strong\u003e: Juvenile Arthritis Disease Activity Score \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRegarding therapeutic characteristics, a csDMARD was prescribed in 76.7% of patients, with a mean duration of 92.5 months [1-372]. It consisted of oral methotrexate (MTX) in 65.2% of cases, injectable MTX in 13%, sulfasalazine in 8.7% and leflunomide in 13%. CsDMARD was combined with a bDMARD in 8 patients (33.3%) for an average of 40 months [7-85]. A bDMARD was prescribed in 26.7% of patients with a mean duration of 44.5 months [7-85]. Etanercept was prescribed in half the cases, Adalimumab in 25% and Infliximab and tocilizumab in 12.5% respectively. A bDMARD was prescribed as monotherapy in 12.5% of patients.\u003c/p\u003e\n\u003cp\u003eThe route of administration of the biological treatment was subcutaneous in 6 cases (75%) and intravenous in 2 cases (25%). Subcutaneous injection was performed by one of the parents in 66.7% of cases.\u003c/p\u003e\n\u003cp\u003eLong-term treatments associated with disease-modifying therapies included non-steroidal anti-inflammatory drugs (NSAIDs) in 7 patients (23.3%), with an average daily number of tablets of 1.14 \u0026plusmn; 0 [1-2], and oral corticosteroids in 8 cases (26.7%), with an average daily number of tablets of 1.38 \u0026plusmn; 1 [1-2]. \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAssessment of therapeutic compliance\u003c/h2\u003e\n\u003cp\u003eThe correlation between PARQ and the direct question to the parent was significant and strongly positive (p=0.002 and r= 0.607). The correlation between the CARQ and the direct question to the child was significant and strongly positive (p=0.003 and r= 0.525). To the direct question \u0026quot;Do you take your treatment or does your child take his/her treatment regularly as prescribed by your/ his/her rheumatologist?\u0026quot;, an affirmative answer was given by parents and children in 80% and 76.7% of cases, respectively. The reasons for a negative response according to the parents were fear of possible side effects (n=3), forgetfulness (n=1) and delay in payment of treatment by the health insurance fund (n=1). The reasons for a negative response according to the children were fear of possible side effects (n=5), forgetfulness (n=1) and ineffectiveness of treatment (n=1).\u003c/p\u003e\n\u003cp\u003ePARQ and CARQ scores were high with\u0026nbsp;a mean of 74.58 \u0026plusmn; 36 [0-100] and 74 \u0026plusmn; 34 [0-100] respectively and a median of 100\u0026nbsp;[52.5-100] and 100\u0026nbsp;[47.5-100] respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe best treatments according to parents and children were NSAIDs (26.7%), followed by MTX (20%), corticosteroids (13.3%) and Etanercept (10%). When asked \u0026quot;Why this treatment?\u0026quot;, the answers were: \u0026quot;because it was effective on the disease\u0026quot; for 63.3% of parents and 20% of patients, \u0026quot;easy to take\u0026quot; for 10% of patients and \u0026quot;had no side effects\u0026quot; according to 3.3% of parents and children.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe characteristics of PARQ and CARQ are summarized in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Characteristics of PARQ and CARQ\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ePARQ\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%) or Avg \u0026plusmn; DS [Min-Max]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eCARQ\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003en (%) or Avg \u0026plusmn; DS [Min-Max]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eResponsibility for processing\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedication, n (%) \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003cp\u003eChild\u003c/p\u003e\n \u003cp\u003eExercises, n (%)\u003c/p\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003cp\u003eChild\u003c/p\u003e\n \u003cp\u003eOther: Siblings\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDifficulty following treatment.\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedication, Avg \u0026plusmn; SD [Min-Max]\u003c/p\u003e\n \u003cp\u003eExercises, Avg \u0026plusmn; SD [Min-Max]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAdherence to treatment\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedication, Avg \u0026plusmn; SD [Min-Max]\u003c/p\u003e\n \u003cp\u003eExercises, Avg \u0026plusmn; SD [Min-Max]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNegative reactions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedication, Avg \u0026plusmn; SD [Min-Max]\u003c/p\u003e\n \u003cp\u003eExercises, Avg \u0026plusmn; SD [Min-Max]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eUsefulness of treatments\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eMedication, Avg \u0026plusmn; SD [Min-Max]\u003c/p\u003e\n \u003cp\u003eExercises, Avg \u0026plusmn; SD [Min-Max]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e14 (46,7)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e16 (53,3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1 (3,3)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e4 (13,3)\u003c/p\u003e\n \u003cp\u003e1 (3,3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e25,2 \u0026plusmn; 35 [0-100]\u003c/p\u003e\n \u003cp\u003e31,4 \u0026plusmn; 39 [0-100]\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e74,5 \u0026plusmn; 36 [0-100]\u003c/p\u003e\n \u003cp\u003e72,8 \u0026plusmn; 39 [0-100]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e19,5 \u0026plusmn; 33 [0-100]\u003c/p\u003e\n \u003cp\u003e7,4 \u0026plusmn; 19 [0-50]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e66 \u0026plusmn; 35 [0-100]\u003c/p\u003e\n \u003cp\u003e60 \u0026plusmn; 38 [0-100]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e10 (33,3)\u003c/p\u003e\n \u003cp\u003e1 (3,3)\u003c/p\u003e\n \u003cp\u003e19 (63,3)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3 (10)\u003c/p\u003e\n \u003cp\u003e1 (3,3)\u003c/p\u003e\n \u003cp\u003e1 (3,3)\u003c/p\u003e\n \u003cp\u003e1 (3,3)\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26,3 \u0026plusmn; 33 [0-100]\u003c/p\u003e\n \u003cp\u003e37,1 \u0026plusmn; 27 [0-70]\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e74 \u0026plusmn; 34 [0-100]\u003c/p\u003e\n \u003cp\u003e61,2 \u0026plusmn; 39 [0-100]\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23,6 \u0026plusmn; 35 [0-100]\u003c/p\u003e\n \u003cp\u003e26,2 \u0026plusmn; 29 [0-100]\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e68 \u0026plusmn; 30 [0-100]\u003c/p\u003e\n \u003cp\u003e35 \u0026plusmn; 21 [20-50]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;SD\u003c/strong\u003e: standard deviation, \u003cstrong\u003en\u003c/strong\u003e: number, \u003cstrong\u003eAvg\u003c/strong\u003e: average, \u003cstrong\u003eMin\u003c/strong\u003e: minimum, \u003cstrong\u003eMax\u003c/strong\u003e: maximum\u003c/p\u003e\n\u003cp\u003eStudy of parameters influencing therapeutic compliance\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eUnivariate analysis\u003c/h2\u003e\n\u003cp\u003eIn the univariate analysis, PARQ compliance was positively correlated with SV (p=0.001; r=0.643) and CRP (p=0.008; r=0.561) levels. On the other hand, it was negatively correlated with mother\u0026apos;s age (p=0.005; r= -0.572), parent\u0026apos;s difficulty in taking medication (p\u0026lt;0.0001; r= -0.698) and patient\u0026apos;s (p=0.012; r=-0.506) and parent\u0026apos;s (p=0.001; r=-0.651) negative reactions to medication. Adherence according to PARQ was also significantly associated with type of social security coverage (p=0.014) and bDMARD route of administration (p=0.022) . Indigent and half-price booklets, as well as the intravenous route, were associated with poor therapeutic compliance.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBased on the CARQ, compliance was negatively correlated with patient age (p=0.036; r =-0.385), mother\u0026apos;s age (p=0.029; r=-0.421), duration of JIA progression (p=0.035 ; r=-0.386), difficulty in taking treatment according to the parent (p=0.001; r= -0.645) and according to the patient (p=0.002; r=-0.552), and negative reactions to medication according to the parent (p=0.011; r = -0.508).\u003c/p\u003e\n\u003cp\u003eTherapeutic compliance according to the CARQ was also significantly linked to \u0026quot;indigent booklet\u0026quot; social security coverage (p=0.019) .\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eMultivariate analysis\u003c/h2\u003e\n\u003cp\u003eIn the multivariate analysis, the predictors of non-adherence according to the PARQ were high maternal age (p=0.004), low SV (p=0.029) and negative reactions to medication (p\u0026lt;0.0001). For the CARQ, the only factor contributing to non-adherence was difficulty following treatment (p=0.042) reported by the parent.\u003c/p\u003e\n\u003cp\u003eTable 3 summarizes the uni and multivariate analysis of factors influencing adherence to treatment according to PARQ and CARQ.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Study of factors influencing therapeutic compliance according to PARQ and CARQ in uni- and multivariate analysis.\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePAR\u003c/strong\u003eQ\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eQAR\u003c/strong\u003eC\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eUnivariate\u003cstrong\u003e\u003cu\u003e\u0026nbsp;analysis\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eMultivariate\u003cstrong\u003e\u003cu\u003e\u0026nbsp;analysis\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eUnivariate\u003cstrong\u003e\u003cu\u003e\u0026nbsp;analysis\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003eMultivariate\u003cstrong\u003e\u003cu\u003e\u0026nbsp;analysis\u0026nbsp;\u003c/u\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ep\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003er\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ep\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eB\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ep\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003er\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ep\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eB\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eSocio-demographic\u003cstrong\u003e\u0026nbsp;characteristics\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePatient\u0026apos;s age \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,101\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,343\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,036\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,385\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eType\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,359\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,078\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eFather\u0026apos;s age\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,268\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,241\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,561\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,119\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMother\u0026apos;s age\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,005\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,572\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,004\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,901\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,029\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,421\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eHousing zone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,662\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,936\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003ePatient\u0026apos;s schooling\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,845\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,366\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eFather\u0026apos;s level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,984\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,555\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eMother\u0026apos;s level of education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,857\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,276\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eParents\u0026apos; situation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,385\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,652\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNumber of siblings\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,866\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,036\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,158\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,265\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eFeatures of\u0026nbsp;\u003c/strong\u003eAJI\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eAge of onset of JIA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,668\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,092\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,981\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,005\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eJIA evolution time\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,088\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,356\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,035\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,386\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eType of AJI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,338\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,379\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Radiological profile \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,269\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,845\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eDisease activity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eEVA dl\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,297\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,222\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,191\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,246\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eEGP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,336\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,205\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,724\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,067\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eRM\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,498\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,145\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,552\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,113\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eRN\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,487\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,149\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,263\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,211\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNAD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,434\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,176\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,261\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,220\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNAT\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,636\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,107\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,710\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,074\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eVS \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,643\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,029\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,390\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,541\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,123\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eCRP\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,008\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,561\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,201\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,259\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eJADAS 10\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,558\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,132\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,665\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,087\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eFunctional impact of JIA (C-HAQ)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,618\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,153\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,406\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,216\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eTherapeutic features of\u0026nbsp;\u003c/strong\u003eJIA\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Number of Cs-DMARDs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,269\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,275\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,348\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,205\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eType Cs-DMARDs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,054\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,325\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eDuration Cs-DMARDs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,251\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,285\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,353\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,203\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eDuration of Cs and b DMARDs association\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,846\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,082\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,475\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,297\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eType b-DMARD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,137\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,308\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eDuration b-DMARD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,769\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,124\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,165\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,543\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eStop decision b-DMARD\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,317\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,236\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,434\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,160\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,018\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e42,447\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNumber of NSAID tablets\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,541\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,316\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,582\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,255\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNumber of corticosteroid tablets\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,817\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,122\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,879\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,065\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eParents\u0026apos; perception of treatment (PARQ\u003c/strong\u003e)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eDifficulty with medication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,0001\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,698\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,645\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,042\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,601\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eDifficulty with exercises\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,570\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,295\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,791\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,124\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNegative reactions to drugs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,001\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,651\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0,0001\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,599\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,011\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,508\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNegative reactions to exercises\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,587\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,283\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,230\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,522\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eUsefulness of medicines\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,370\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,191\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,851\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,040\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eUsefulness of exercises\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,014\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,949\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,215\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,671\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient perception of treatment (CARQ\u003c/strong\u003e)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eDifficulty with medication\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,002\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,593\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,002\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,552\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eExercise difficulty\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,721\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,167\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,824\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,104\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNegative reactions to drugs\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,012\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0,506\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,114\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,294\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eNegative reactions to exercises\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,334\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,431\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,602\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,219\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eUsefulness of medicines\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,536\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,133\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,143\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,274\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003eUsefulness of exercises\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,809\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,113\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e0,336\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e-0,393\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\"\u003e\n \u003cp\u003e \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eVAS\u003c/strong\u003e: visual analogue scale, \u003cstrong\u003ePGA\u003c/strong\u003e: patient\u0026apos;s global assessment, \u003cstrong\u003eNR\u003c/strong\u003e: number of nocturnal awakenings, \u003cstrong\u003eMR\u003c/strong\u003e: morning stiffness, \u003cstrong\u003eNAD\u003c/strong\u003e: number of painful joints, \u003cstrong\u003eNAT\u003c/strong\u003e: number of swollen joints, \u003cstrong\u003eVS:\u0026nbsp;\u003c/strong\u003esedimentation rate, \u003cstrong\u003eCRP\u003c/strong\u003e: C Reactive Protein, \u003cstrong\u003eC-HAQ\u003c/strong\u003e: Child-Health assessment Questionnaire, \u003cstrong\u003eJADAS 10\u003c/strong\u003e: Juvenile Arthritis Disease Activity Score \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eStudy of the concordance between PARQ and CARQ results\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe study of agreement between the different PARQ and CARQ items showed very strong agreement between the two concerning \u0026quot;best treatment\u0026quot; (k =0.659, p\u0026lt;0.0001). The percentage of agreement was 72%. These scores were significantly, positively and strongly associated (\u003cem\u003e\u0026tau;\u003c/em\u003e\u003csub\u003eb\u003c/sub\u003e =0.545, p=0.001). The lowest level of agreement between PARQ and CARQ concerned \u0026quot;usefulness of treatment\u0026quot; (k =0.194, p=0.014). The percentage of agreement was 32%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFor the items \u0026quot;treatment responsibility\u0026quot;, \u0026quot;treatment difficulty\u0026quot; and \u0026quot;treatment adherence\u0026quot;, the agreement between the two scores was moderate (k =0.518; p=0.006, k =0.439; p\u0026lt;0.0001 and k =0.415; p\u0026lt;0.0001) respectively. These scores were significantly, positively and moderately associated (\u003cem\u003e\u0026tau;\u003c/em\u003e\u003csub\u003eb\u003c/sub\u003e =0.449; p=0.015,\u003cem\u003e\u0026nbsp;\u0026tau;\u003c/em\u003e\u003csub\u003eb\u003c/sub\u003e =0.515; p=0.004,\u003cem\u003e\u0026nbsp;\u0026tau;\u003c/em\u003e\u003csub\u003eb\u003c/sub\u003e =0.638; p\u0026lt;0.0001 respectively).\u003c/p\u003e\n\u003cp\u003eConcerning \u0026quot;negative reactions\u0026quot;, agreement between the two scores was weak (k =0.286, p=0.002).\u003c/p\u003e\n\u003cp\u003eConcordance between PARQ and CARQ results is shown in Figure 1.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e In our study, 80% of parents reported that their children were taking their treatments as prescribed by their rheumatologists. This result is consistent with the mean PARQ, which was 74.58\u0026thinsp;\u0026plusmn;\u0026thinsp;36 [0-100]. Among patients, 76.7% declared that they were taking their treatment correctly. This result is in line with the CARQ mean of 74\u0026thinsp;\u0026plusmn;\u0026thinsp;34 [0-100]. PARQ and CARQ scores were thus very high, in line with the results reported in the literature [ 8,9].\u003c/p\u003e \u003cp\u003eVarious studies have investigated medication compliance in patients with JIA. The results of these studies differ according to the treatment taken and the assessment method adopted by the authors. In the literature, medication compliance in JIA has mainly been assessed by the PARQ and CARQ scores [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Treatment compliance percentages ranged from 72\u0026ndash;88% for PARQ [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] and 74.8\u0026ndash;84.45% for CARQ [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eVariations in results between different studies using the same assessment methods and evaluating the same treatment may also be explained by the duration of each study, the length of time the disease has progressed and, above all, by the time at which patient compliance is assessed (treatment initiation period or follow-up of a treatment already underway).\u003c/p\u003e \u003cp\u003eOther methods of assessing therapeutic adherence in JIA have also been used. A recent Spanish study used the MPR \"Medication Possession Ratio\" to assess the degree of therapeutic adherence during JIA, showing an adherence rate of up to 96.3% [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This rate is significantly higher than that found in our work. This could be explained by the therapeutic education programs set up in this country, which improve patient compliance.\u003c/p\u003e \u003cp\u003eIn two other studies conducted in Brazil, adherence to treatment was assessed using the MORISKY questionnaire for parents and children over 9 years of age. Adherence rates varied according to the study from 46.5\u0026ndash;69.2% but were lower than those found in our work [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. A review of the literature published in 2017 showed a maximum adherence to biological treatments of 65% during the course of JIA [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A recent Norwegian study assessing adherence to cs- and bDMARDs in patients with JIA, using the Morisky questionnaire 19 years after the onset of the disease, concluded that adherence was poor in around half of cases [ 18].\u003c/p\u003e \u003cp\u003eThe PRAQ questionnaire was used in a Brazilian pilot study showing good therapeutic adherence in 78.8% of cases [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, fear of adverse effects was the main cause of non-compliance cited by both patients and parents. Forgetfulness was noted by one child and one parent. Only one patient considered that the treatment was not effective, and only one parent considered that the delay in reimbursement of the treatment by the health insurance fund was the cause. This result is in line with the literature, where fear of adverse effects was the main cause of non-adherence reported by patients and parents [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In contrast, according to Juan Carlos Gonzales et al, the major factor in non-adherence was disease remission (48.4%), followed by treatment ineffectiveness in 29% of cases, and fear of side effects in only 12.9% of cases [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Kearsley-Fleet et al reported that treatment ineffectiveness was the main reason for discontinuation (60%) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], while forgetfulness was the main factor in non-adherence according to De Civita et al (55%) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Leslie A et al further showed that the intensity of pain reported by parents and children was a considerable barrier to non-adherence to medication [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In contrast, according to Brandelli et al, fear of disease-induced pain is an important factor in good medication adherence [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In a Canadian study published in 2019, two major factors were also reported: the absence of the parent on the day the medication is taken (41%) and patients' reluctance to injectable treatments (40%) [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Similarly, children's reluctance to take treatment was the main cause of non-adherence in JIA, according to the meta-analysis by Santer M et al [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Len et al also reported that an unstable family situation (separation, divorce...) contributes to poor medication compliance [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Similarly, Miotto et al showed that unfavorable socio-economic conditions were linked to non-adherence to treatment [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eNumerous studies have been carried out to identify factors positively or negatively correlated with adherence, with variable results. In our study, no association was found between female gender and treatment adherence. This is in line with the findings of De Civita et al [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], but contrasts with those of Anne Lohse et al. and Miotto et al, where female gender was associated with poor adherence [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, in our study, PARQ and CARQ were strongly correlated with the mother's young age, contrasting with the results of De Civita et al [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. This could be explained by the fact that mothers tend to alter their cognitive functions with age, thus forgetting the treatment of their children [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003ePARQ and CARQ were unrelated to JIA type, phenotypic and radiological disease profile, functional impact, presence of coxitis or extra-articular manifestations, in line with the literature [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. On the other hand, short disease duration was associated with CARQ, and high SV and CRP levels were significantly correlated with PARQ. This suggests that the longer the duration of rheumatism, the more difficult it will be for the child to follow his or her treatments, and the more active the disease (high SV and CRP), the more the parent would encourage the child to take his or her medication. These results are not consistent with those reported in the literature, where these parameters were not linked to medication compliance [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. It should be noted that in our study, no statistically significant relationship was found between medication compliance as measured by PARQ and CARQ and other disease activity parameters, in line with the findings of a recent French study [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] .\u003c/p\u003e \u003cp\u003eTaking therapeutic characteristics into account, only the route of administration of bDMARDs was related to PARQ. However, several studies in the literature have shown a strong correlation between the type of bDMARD, notably anti-TNF alpha, and treatment adherence [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In addition, Bugni et al demonstrated that taking 3 or more tablets per day was strongly associated with poor adherence to treatment [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] contrasting with our results.\u003c/p\u003e \u003cp\u003eThe study of agreement between the different PARQ and CARQ items showed very strong agreement between the two concerning the best treatment, with a percentage of agreement of 72%. The weakest agreement between the PARQ and CARQ concerned the usefulness of the treatment, with a percentage of agreement of 32%. This result is in line with several other studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e To the best of our knowledge, this is the first study in Tunisia to assess compliance with treatment in JIA. We used validated self-questionnaires with good reproducibility and easy comprehensibility for our patients. However, our study has a number of limitations: the self-questionnaire method remains subjective and declarative and tends to overestimate the degree of therapeutic compliance. What's more, as our study is monocentric and small, the results cannot be generalized to the rest of the population\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eOur study showed good compliance in Tunisian patients with JIA. Factors predictive of poor compliance were high maternal age, low disease activity, negative reactions to medication and difficulty in following treatment. Identifying these factors and improving adherence through appropriate educational strategies aimed at patients, their families and all healthcare personnel would increase drug efficacy and thus improve the prognosis of patients with JIA.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ebDMARDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ebiologic disease modifying anti rheumatic drugs.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ecsDMARDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003econventional synthetic modifying anti rheumatic drugs\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Conference on Harmonization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eILAR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational League of Associations for Rheumatology\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMEA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eextra-articular manifestations\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMTX\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003emethotrexate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Package for Social Science\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe informed consent form and protocol for parents and children, in line with the principles laid down by the International Conference on Harmonization (ICH), have been validated by the Ethics Committee of the Mongi Slim Hospital in La Marsa, Tunisia (registered under number 20/2023).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Aliaa Fazaa, Azza Saad, Asma Selmi, Sawssen Miladi, Hiba Boussa, Yasmine Makhlouf and Ben Abelghani Kaouther. The first draft of the manuscript was written by Asma Selmi, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConsent to participate.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eInformed consent was obtained from all individual participants included in the study\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGuzman J, Oen K, Huber AM, Watanabe Duffy K, Boire G, Shiff N, et al. The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Ann Rheum Dis. 2016; 75:1092-1098\u003c/li\u003e\n\u003cli\u003eSelvaag AM, Aulie HA, Lilleby V, Flat B, Selvaag AM. Disease progression into adulthood and predictors of long-term active disease in juvenile idiopathic arthritis. Ann Rheum Dis 2016; 75:190-195\u003c/li\u003e\n\u003cli\u003ePelajo CF, Sgarlat CM, Lopez-Benitez JM, Oliveira SK, Rodrigues MC, Sztajnbok FR, et al. Adherence to methotrexate in juvenile idiopathic arthritis. Rheumatol Int 2012;32(2):497-500\u003c/li\u003e\n\u003cli\u003eS Ringold\u003cem\u003e,S T Angeles-Han, Timothy Beukelman, Daniel J Lovel, Carlos A Cuello, Mara L Beckeret al. \u003c/em\u003eAmerican College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res 2019;71(6):717-734\u003c/li\u003e\n\u003cli\u003eGabriella Giancane \u003cem\u003eand Nicolino Ruperto. \u003c/em\u003eTreatment of juvenile idiopathic arthritis: what\u0026apos;s new? Curr Opin Rheumatol 2019;31(5):428-435\u003c/li\u003e\n\u003cli\u003eKlein A, Minden K., Hospach A, Foeldvari I, Weller-Heinemann F, Trauzeddel R et al. Treat-to-target study for improved outcome in polyarticular juvenile idiopathic arthritis. Ann Rheum Dis 2020; 79:969-974.\u003c/li\u003e\n\u003cli\u003eKarine Toupin April. Comparison of the perceptions of children with juvenile arthritis and their parents regarding treatment compliance and its impact on quality of life. Montreal: Faculty of Graduate Studies Universit\u0026eacute; de Montr\u0026eacute;al; 2004. 189p.\u003c/li\u003e\n\u003cli\u003eAnne Lohse,\u003csup\u003e \u003c/sup\u003eIr\u0026egrave;ne Lemelle, Pascal Pillet, Agn\u0026egrave;s Duquesne, Claire Ballot, Tu-Anh Tran\u003csup\u003e \u003c/sup\u003e et al. Therapeutic alliance is associated with treatment adherence in children with juvenile idiopathic arthritis. Revue du rhumatisme 2021 ;89:128-133\u003c/li\u003e\n\u003cli\u003eLeslie A Favier, Tracy V. Ting and Avani C. Modi. Feasibility of a musculoskeletal ultrasound intervention to improve adherence in juvenile idiopathic arthritis: a proof-of-concept trial. Pediatric Rheumatology 2018 ;16(1):75\u003c/li\u003e\n\u003cli\u003eYvonne N. Brandelli, BA (HONS), Christine T. Chambers, Perri R. Tutelman, BHSC (HONS), Jennifer N. Stinson et al. Parent Pain Cognitions and Treatment Adherence in Juvenile Idiopathic Arthritis. Journal of Pediatric Psychology 2019;44(9):1111-1119\u003c/li\u003e\n\u003cli\u003eMirella De Civita, Patricia L. Dobkin, Debbie Ehrmann-Feldman, Igor Karp and Ciaran M. Duffy. Development and Preliminary Reproducibility and Validity of the Parent Adherence Report Questionnaire: A Measure of Adherence in Juvenile Idiopathic Arthritis. Journal of Clinical Psychology in Medical Settings 2005;12(1)\u003c/li\u003e\n\u003cli\u003eKarine Toupin April, Debbie Ehrmann Feldman, Maria Victoria Zunzunegui, Ciar\u0026aacute;n M Duffy. Association between perceived treatment adherence and health-related quality of life in children with juvenile idiopathic arthritis: perspectives of both parents and children. Patient Preference and Adherence 2008;2:121-28\u003c/li\u003e\n\u003cli\u003eKarine Toupin April, Johanne Higgins and Debbie Ehrmann Feldman. Application of Rasch analysis to the parent adherence report questionnaire in juvenile idiopathic arthritis. Pediatric Rheumatology 2016; 14:45\u003c/li\u003e\n\u003cli\u003eJuan Carlos NietoGonz\u0026aacute;lez-, -LauraTrivesFolguera, Alejandra -MelgarejoOrtu\u0026ntilde;o, Aranzazu Ais, Bel\u0026eacute;n SerranoBenavente-, Mar\u0026iacute;a Sanjurjo. Persistence and adherence to biologic therapies in juvenile idiopathic arthritis. Nature 2021; 11:16195\u003c/li\u003e\n\u003cli\u003eLivia de Freitas Keppeke, Juliana Molina, Vanessa Bugni Miotto e Silva, Maria Teresa de Sande e Lemos Ramos Ascens\u0026atilde;o Terreri, Gerson Dierley Keppeke , Teresa Helena Schoen and Claudio Arnaldo Len . Psychological characteristics of caregivers of pediatric patients with chronic rheumatic disease in relation to treatment adherence. Pediatric Rheumatology 2018; 16:63\u003c/li\u003e\n\u003cli\u003eLiana Silveira Adriano, Marta Maria de Franca Fonteles, Maria de F\u0026aacute;tima Menezes Azevedo, Milena Pontes Portela Beserraa, Nirla Rodrigues Romero. Medication adherence in patients with juvenile idiopathic arthritis. Revista brasileira de Reumatologia 2017;57(1):23-29\u003c/li\u003e\n\u003cli\u003eShoop-Worrall S J W, Kearsley-Fleet L, Tomson W, Verstappen S M M\u0026amp; Hyrich K L. How common is remission in juvenile idiopathic arthritis: a systematic review. Semin Arthritis Rheum 2017; 47:331-337.\u003c/li\u003e\n\u003cli\u003eAnita Tollisen, Berit Flat, Anne M. Selvaag, Astrid Aasland, Trude Ingebrigtsen, Joachim Sagen and Anners Lerdal. Treatment Satisfaction with and Adherence to Disease-Modifying Antirheumatic Drugs in Adult Patients with Juvenile Idiopathic Arthritis. Arthritis. Care \u0026amp; Research 2021;73(2):221-231\u003c/li\u003e\n\u003cli\u003eMiotto e Silva VB, Okamoto KY, Ozaki LS, Len CA, Terreri MT. Early detection of poor adherence to treatment of pediatric rheumatic diseases: Pediatric Rheumatology Adherence Questionnaire (PRAQ) - A pilot study. Rev Paul Pediatr 2019;37(2):149-155\u003c/li\u003e\n\u003cli\u003eLeslie A. Favier, Janalee Taylor, Kristin Loiselle Rich, Karla B. Jones, Sheetal S. Vora, Julia G. Harris, et al. Harris, et al. Barriers to Adherence in Juvenile Idiopathic Arthritis: A Multicenter Collaborative Experience and Preliminary Results. J Rheumatol 2018; 45(5): 690-696\u003c/li\u003e\n\u003cli\u003eKearley-Fleet L, Vicente Gonz\u0026aacute;lez L, Steinke D et al. Methotrexate persistence and adverse drug reactions in patients with juvenile idiopathic arthritis. Rheumatology 2019;58(8):1453-1458\u003c/li\u003e\n\u003cli\u003eKearsley-Fleet L, Heaf E, Davies R, Baildam E, Beresford M.W, Foster H.E et al. BCRD and BSPAR-ETN study groups. Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study. Lancet Rheumatol 2020;2, e217-e226.\u003c/li\u003e\n\u003cli\u003eSanter M, Ring N, Yardley L, Geraghty AW, Wyke S. Treatment nonadherence in pediatric long-term medical conditions: systematic review and synthesis of qualitative studies of caregivers\u0026apos; views. BMC Pediatr 2014; 14:63\u003c/li\u003e\n\u003cli\u003eLen C. A, Miotto e Silva V. B \u0026amp; Terreri M T. Importance of adherence in the outcome of juvenile idiopathic arthritis. Current Rheumatology Reports 2014;16(4):410\u003c/li\u003e\n\u003cli\u003eAnghel LA, Farcas AM, Oprean RN. Medication adherence and persistence in patients with autoimmune rheumatic diseases: a narrative review. Patient Prefer Adherence 2018; 12:1151-66.\u003c/li\u003e\n\u003cli\u003eFavalli E G et al. Real-life 10-year retention rate of first-line anti-TNF drugs for infammatory arthritis in adult- and juvenile-onset populations: similarities and diferences. Clin. Rheumatol 2017;36(8):1747-1755\u003c/li\u003e\n\u003cli\u003eShoop-Worrall S J W, Kearsley-Fleet L, Tomson W, Verstappen S M M \u0026amp; Hyrich K L. How common is remission in juvenile idiopathic arthritis: a systematic review. Semin Arthritis Rheum 2017; 47(3):331-337\u003c/li\u003e\n\u003cli\u003eBugni VM, Luciana S Ozaki, karine Y A Okamoto, Cassia M P L Barbosa, Maria Odte E Hilario, Claudio A Len et al. Factors associated with adherence to treatment in children and adolescents with chronic rheumatic diseases. J Pediatr (Rio J)2012;88(6):483-8\u003c/li\u003e\n\u003cli\u003eToupin April K, Ehrmann Feldman D, Platt RW, et al. Comparison between children with juvenile idiopathic arthritis (JIA) and their parents concerning perceived treatment adherence. Arthritis Rheum 2006;55(4):558-63\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"disease modifying anti rheumatic drugs, compliance, juvenile idiopathic arthritis, parent","lastPublishedDoi":"10.21203/rs.3.rs-3273058/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3273058/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eNon-or poor adherence to medication appears to be particularly common in chronic inflammatory rheumatic diseases, especially in juvenile idiopathic arthritis (JIA). It leads to a reduction of the therapeutic potential, aggravation and progression of the disease and therefore represents a real health and economic issue. The main objective of our study was to evaluate the compliance of Tunisian patients with JIA with disease modifying drugs and the potential factors that may influence this compliance.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study including patients with JIA (ILAR criteria), currently taking csDMARDs and/or bDMARDs for at least 3 months. Socio-demographic, clinical, biological, radiological and therapeutic data were collected. Compliance was assessed using two methods: self-reported compliance by the patient and the parent and compliance measured by two self-administered questionnaires: the PARQ (Parent Adherence Report Questionnaire) and the CARQ (Child Adherence Report Questionnaire).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThirty patients, 16 girls and 14 boys, with a mean age of 24.8\u0026thinsp;\u0026plusmn;\u0026thinsp;11 years [8\u0026ndash;47] were included. A cs DMARD was prescribed in76.7% of patients and a bDMARD in 26.7%. Eighty percent of the parents and 76.7% of the patients reported taking their treatment as prescribed. Adherence according to PARQ and CARQ had a mean of 74.58\u0026thinsp;\u0026plusmn;\u0026thinsp;36 [0-100] and 74\u0026thinsp;\u0026plusmn;\u0026thinsp;34 [0-100] respectively. In the univariate analysis, PARQ compliance was positively correlated with ESR (p\u0026thinsp;=\u0026thinsp;0.001 ; r\u0026thinsp;=\u0026thinsp;0.643) and CRP (p\u0026thinsp;=\u0026thinsp;0.008 ; r\u0026thinsp;=\u0026thinsp;0.561) and negatively correlated with the mother's age (p\u0026thinsp;=\u0026thinsp;0.005 ; r=-0.572), the difficulty of taking medication according to the parent (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001; r=-0.698) and negative reactions to medication according to the patient (p\u0026thinsp;=\u0026thinsp;0.012; r=-0.506) and the parent (p\u0026thinsp;=\u0026thinsp;0.001; r= -0.651). Adherence to medication according to the CARQ was significantly related to the \"indigent card\" type of social coverage (p\u0026thinsp;=\u0026thinsp;0.019). In the multivariate analysis, the predictive factors for non-adherence according to the PARQ were old age of the mother (p\u0026thinsp;=\u0026thinsp;0.004), low ESR (p\u0026thinsp;=\u0026thinsp;0.029) and negative reactions to medication (p\u0026thinsp;\u0026lt;\u0026thinsp;0.0001). For the CARQ, the only predictive factor for non-compliance was the difficulty following treatment (p\u0026thinsp;=\u0026thinsp;0.042) reported by the parent.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOur study showed good compliance in Tunisian patients with JIA. High maternal age, low disease activity, negative reactions to medication and difficulty in following treatment were predictive of non-adherence. Appropriate educational strategies could improve patient compliance and thus the prognosis of JIA patients.\u003c/p\u003e","manuscriptTitle":"Observational study: Adherence to Disease Modifying Anti Rheumatic Drugs in Tunisian patients with Juvenile Idiopathic Arthritis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-08-29 18:17:37","doi":"10.21203/rs.3.rs-3273058/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"14d2be94-f219-46d1-97ba-55a95626cb2b","owner":[],"postedDate":"August 29th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-10-15T18:29:17+00:00","versionOfRecord":[],"versionCreatedAt":"2023-08-29 18:17:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3273058","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3273058","identity":"rs-3273058","version":["v1"]},"buildId":"WrCJVZZCHTDjtuVLN7oU0","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}