219recently validated. This tool has been named the Juvenile Arthritis Multidimensional
Assessment Report (JAMAR) [ 72 ]. The JAMAR includes the following 15 mea-
sures/items: (1) assessment of physical function through the JAFS [ 50 ]; (2) rating of
the intensity of a child’s pain on a 21-numbered circle VAS [ 29 ]; (3) assessment of
HRQOL, through the PRQL [ 69 ]; (4) rating of a child’s overall well-being on a
21-numbered circle VAS [ 29 ]; (5) assessment of the presence of pain or swelling in
the following joints or joint groups: cervical spine, lumbosacral spine, shoulders,
elbows, wrists, small hand joints, hips, knees, ankles, and small foot joints; (6)
assessment of morning stiffness; (7) assessment of extra-articular symptoms (fever
and rash); (8) rating of the level of disease activity on a 21- numbered circle VAS
[ 29 ]; (9) rating of disease status at the time of the visit as remission, continued activ-
ity, or relapse; (10) rating of disease course from previous visit as much improved,
slightly improved, stable, slightly worsened, or much worsened; (11) checklist of the
medications the child is taking; (12) checklist of side effects of medications; (13)
report of diffi culties with medication administration; (14) report of disease-related
school problems; and (15) a question about satisfaction with the outcome of the ill-
ness [ 73 ]. The JAMAR is conceived for use as both proxy-report and patient self-
report, with the suggested age range of 7–18 years for use as self- report. The
questionnaire format has been found to be very user-friendly, easy to understand, and
readily responded to by parents and children. It is quick, taking less than 15 min to
complete and can be scanned by a health professional for a clinical overview in a few
seconds. Scoring of its components can be accomplished in less than 5 min.
The JAMAR has been selected for the assessment of PCROs in a multinational
study aimed to investigate the EPidemiology, Treatment and Outcome of Childhood
Arthritis throughout the world (EPOCA study) [ 52 ]. For the purposes of this study,
the JAMAR has been or is currently being translated and cross-culturally adapted
and validated in 45 national languages. One of the main objectives of the EPOCA
study is to promote regular use of quantitative clinical measures and incorporation
of PCROs in routine pediatric rheumatology practice.
Recently, composite disease activity scores for JIA entirely based on parent- or
child-reported outcome measures included in the JAMAR were developed. These
tools were named the Juvenile Arthritis Parent Assessment Index (JAPAI) and the
Juvenile Arthritis Child Assessment Index (JACAI), respectively [ 74 ]. The JAPAI
and JACAI are composed of the following items: (1) parent/child rating of overall
well-being on a 0–10 cm VAS (0 = best; 10 = worst); (2) parent/child rating of pain
intensity on a 0–10 cm VAS (0 = no pain; 10 = very severe pain); (3) assessment of
physical function; and (4) assessment of HRQOL. Scores of physical function and
HRQOL tools included in the composite scores are converted to a 0–10 score by
means of specifi c formulae. Two different versions of the JAPAI and JACAI were
devised: both the JAPAI-4 and JACAI-4 include all four items, whereas the JAPAI-3
and JACAI-3 include only the fi rst three items (HRQOL assessment is excluded).
After score adjustment, the JAPAI and JACAI scores are obtained as the simple lin-
ear sum of the scores of their components, which yields a global score of 0–40 for
the 4-item versions and of 0–30 for the 3-item versions. The instruments were found
to be feasible and to possess both face and content validity; they demonstrated good
8 PROMs for Juvenile Idiopathic Arthritis