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Chaplin H, Simpson C, Wilkins K, Meehan J, Ng N, Galloway J, Scott IC, Sen D, Tattersall R, Moss-Morris R, Lempp H, Norton S. Management of refractory disease and persistent symptoms in inflammatory arthritis: qualitative framework analysis of interviews with patients and healthcare professionals. Rheumatol Adv Pract 2024; 8:rkae076. [PMID: 38966397 PMCID: PMC11223812 DOI: 10.1093/rap/rkae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 05/22/2024] [Indexed: 07/06/2024] Open
Abstract
Objectives This study aims to explore patients' and clinicians' experiences in managing and living with refractory disease (RD) and persistent physical and emotional symptoms (PPES) in patients with RA or polyarticular JIA from their perspectives through interviews and/or focus groups. Methods A qualitative exploration with 25 patients and 32 multidisciplinary rheumatology healthcare professionals (HCPs) was conducted to obtain participants respective understanding and experiences of managing RD/PPES and its impact on the patient-professional relationship. A pragmatic epistemology approach with framework analysis was employed. Results Four key themes were identified from both patients and professionals in the management of RD/PPES: risk/perpetuating factors/triggers; need for a patient-centred holistic approach to care, diagnosis and treatment; discordance and impact on the patient-practitioner relationship and current problems in managing RD/PPES. These themes covered 22 subthemes, with none being patient specific and seven being HCP specific. Suggestions for potential management strategies were highlighted throughout, such as involving other specialties or a multidisciplinary team, assessing/treating patient-reported outcome measures and psychosocial factors, patient (re)education, need for adjustments/aids or adaptations, checking the diagnosis and further investigations/imaging and optimizing medications. Conclusion Management strategies need to be developed that enable appropriate treatment plans for those with RD/PPES that account for wider biopsychosocial factors beyond inflammation and reduce discordance in the patient-practitioner relationship.
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Affiliation(s)
- Hema Chaplin
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Carol Simpson
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
| | - Kate Wilkins
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
| | - Jessica Meehan
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Nora Ng
- Rheumatology Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - James Galloway
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
- Rheumatology Department, King’s College Hospital NHS Foundation Trust, London, UK
| | - Ian C Scott
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
- Haywood Academic Rheumatology Centre, Haywood Hospital, Midlands Partnership University NHS Foundation Trust, Stoke-on-Trent, UK
| | - Debajit Sen
- Rheumatology Department, University College London Hospitals NHS Foundation Trust, London, UK
- Versus Arthritis Centre for Adolescent Rheumatology, University College London, London, UK
| | - Rachel Tattersall
- Rheumatology Department, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Barbara Ansell National Network for Adolescent and Young Adult Rheumatology, UK
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Heidi Lempp
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
| | - Sam Norton
- Health Psychology Section, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- Centre for Rheumatic Diseases, Department of Inflammation Biology, King’s College London, London, UK
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Wakefield EO, Belamkar V, Sandoval A, Puhl RM, Edelheit B, Zempsky WT, Rodrigues HA, Litt MD. Does Diagnostic Certainty Matter?: Pain-Related Stigma in Adolescents with Juvenile Idiopathic Arthritis. J Pediatr Psychol 2023; 48:341-351. [PMID: 36892594 PMCID: PMC10118850 DOI: 10.1093/jpepsy/jsac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVES Childhood chronic pain conditions are common and vulnerable to stigma. Adolescents with chronic primary pain experience diagnostic uncertainty and describe pain-related stigma experiences across multiple social contexts. Juvenile idiopathic arthritis (JIA) is a childhood autoimmune, inflammatory condition with associated chronic pain, but with well-defined diagnostic criteria. The current study examined pain-related stigma experiences in adolescents with JIA. METHODS Four focus groups of 3-7 adolescents with JIA (N = 16), ages 12-17 (Mage = 15.42, SD = 1.82), and parents (N = 13) were conducted to examine experiences of, and reaction to, pain-related stigma. Patients were recruited from an outpatient pediatric rheumatology clinic. Focus group length ranged from 28 to 99 minutes long. Two coders used directed content analysis resulting in 82.17% inter-rater level of agreement. RESULTS Adolescents with JIA described pain-related stigma experiences predominantly from school teachers and peers, and less from medical providers (e.g., school nurses), and family members after a diagnosis. The primary categories that emerged were (1) Felt Stigma, (2) Internalized Stigma, (3) Anticipatory Stigma/Concealment, and (4) Contributions to Pain-Related Stigma. A common experience of pain-related stigma was the perception by others that the adolescent was too young to have arthritis. CONCLUSIONS In common with adolescents with unexplained chronic pain, our findings indicate that adolescents with JIA experience pain-related stigma in certain social contexts. Diagnostic certainty may contribute to greater support among medical providers and within families. Future research should investigate the impact of pain-related stigma across childhood pain conditions.
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Affiliation(s)
- Emily O Wakefield
- Divisions of Pain and Palliative Medicine and Pediatric Psychology, Connecticut Children’s Medical Center, Hartford, CT
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
| | - Vaishali Belamkar
- Department of Research, Connecticut Children’s Medical Center, Hartford, CT
| | - Ashley Sandoval
- Department of Psychological Science, Central Connecticut State University, New Britain, CT
| | - Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, University of Connecticut, Hartford, CT
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, CT
| | - Barbara Edelheit
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
- Division of Rheumatology, Connecticut Children’s Medical Center, Hartford, CT
| | - William T Zempsky
- Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT
- Division of Pain and Palliative Medicine, Connecticut Children’s Medical Center, Hartford, CT
| | - Hannah A Rodrigues
- Department of Psychological Science, Central Connecticut State University, New Britain, CT
| | - Mark D Litt
- Division of Behavioral Sciences and Community Health, University of Connecticut Health Center, Farmington, CT
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The Potential Influence of Advanced Glycation End Products and (s)RAGE in Rheumatic Diseases. Int J Mol Sci 2023; 24:ijms24032894. [PMID: 36769213 PMCID: PMC9918052 DOI: 10.3390/ijms24032894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Advanced glycation end products (AGEs) are a class of compounds formed by nonenzymatic interactions between reducing sugars and proteins, lipids, or nucleic acids. AGEs can alter the protein structure and activate one of their receptors, specifically the receptor for advanced glycation end products (RAGE). These phenomena impair the functions of cells, extracellular matrix, and tissues. RAGE is expressed by a variety of cells and has been linked to chronic inflammatory autoimmune disorders such as rheumatoid arthritis, systemic lupus erythematosus, and Sjögren's syndrome. The soluble (s)RAGE cleavage product is a positively charged 48-kDa cleavage product that retains the ligand binding site but loses the transmembrane and signaling domains. By acting as a decoy, this soluble receptor inhibits the pro-inflammatory processes mediated by RAGE and its ligands. In the present review, we will give an overview of the role of AGEs, sRAGE, and RAGE polymorphisms in several rheumatic diseases. AGE overproduction may play a role in the pathogenesis and is linked to accelerated atherosclerosis. Low serum sRAGE concentrations are linked to an increased cardiovascular risk profile and a poor prognosis. Some RAGE polymorphisms may be associated with increased disease susceptibility. Finally, sRAGE levels can be used to track disease progression.
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4
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Badarnee M, Tirosh I, Kreitler S. Psychological tendencies of children with juvenile idiopathic arthritis. Scand J Psychol 2022; 63:624-633. [PMID: 35689406 PMCID: PMC9796744 DOI: 10.1111/sjop.12839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 01/07/2023]
Abstract
A bulk of studies showed an association between stressful events and juvenile idiopathic arthritis (JIA) but failed to identify specific psychological tendencies that contribute to the patients' vulnerability to stress. The purpose of this paper is to identify psychological tendencies specific to JIA that would unravel characteristic sources of stress. The study is based on the cognitive orientation model of health, which enables us to identify these kinds of tendencies in terms of four belief types (beliefs about self, general beliefs, beliefs about norms, and goals) that refer to specific themes. This is a case-control-cohort study that included a sample of 36 patients (mean age = 12.44 years, SD = 2.97, 21 females) and 41 matched controls (mean age = 13.15 years, SD = 2.01, 22 females). The JIA cognitive-orientation questionnaire was administered, and relevant medical parameters were recorded. The belief types differentiated between the two groups, and the patients were characterized using six themes. Examples of the themes are being over-sensitive, striving for success, and not fulfilling duties well. The themes differentiated between the participants' groups with an accuracy of 89.1%. The likelihood of the patients being characterized by the themes is 3.24-9.35 times more than the controls. The psychological tendencies of JIA were discussed as generators of stress (e.g., being over-sensitive) and cognitive conflicts (e.g., the contradiction between striving for success versus not fulfilling duties well). Also, the suggested reflections of these tendencies in the health workers' and patients' relationships, such as egalitarian interaction, and non-formal communication style, were described.
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Affiliation(s)
- Muhammad Badarnee
- School of Psychological SciencesTel‐Aviv UniversityTel AvivIsrael,The Psycho‐Oncology Research CenterThe Chaim Sheba Medical CenterRamat GanIsrael
| | - Irit Tirosh
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,The Edmond and Lily Safra Children's HospitalThe Chaim Sheba Medical CenterRamat GanIsrael
| | - Shulamith Kreitler
- School of Psychological SciencesTel‐Aviv UniversityTel AvivIsrael,The Psycho‐Oncology Research CenterThe Chaim Sheba Medical CenterRamat GanIsrael
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Koker O, Aliyeva A, Sahin S, Adrovic A, Yildiz M, Haslak F, Gunalp A, Barut K, Kasapcopur O. An overview of the relationship between juvenile idiopathic arthritis and potential environmental risk factors: Do early childhood habits or habitat play a role in the affair? Int J Rheum Dis 2022; 25:1376-1385. [PMID: 36039559 DOI: 10.1111/1756-185x.14431] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/09/2022] [Accepted: 08/21/2022] [Indexed: 11/30/2022]
Abstract
AIM The current study was undertaken to evaluate the influence of breastfeeding on the development and outcome measures of juvenile idiopathic arthritis (JIA). The second aim was to determine the consequences of particular sociodemographic and sociocultural characteristics and nutritional behavior of early childhood on JIA. METHODS The study includes the patients diagnosed with JIA and regularly followed up at the Department of Pediatric Rheumatology in Istanbul University-Cerrahpasa. The comparison group consisted of healthy subjects and patients with juvenile systemic lupus erythematosus (jSLE). A face-to-face survey method was conducted with the parents of the participants between February 1, 2021, and September 1, 2021. RESULTS The mean age of the JIA cohort (n = 324) was 12.2 ± 4.7 years, with a female ratio of 64.8%. The breastfeeding rate differed from the control groups (253 healthy subjects and 88 patients with jSLE) but was higher with a value of 94.8%. There was no difference between the groups (P = .097, P = .064) or within the subgroups of JIA (P = .12) regarding breastfeeding duration. Cow's milk introduction time (P = .02, P = .0001), household pet-keeping (P = .001), income level (P = .0001), maternal literacy (P = 0.013) made a statistical difference vs the control groups. CONCLUSION No relationship was established between the rate or duration of breastfeeding and the development or severity of JIA. The early introduction of cow's milk was found to be higher in the patient cohorts. The income level and maternal literacy appeared to be relevant with the high disability and damage scores, and frequent relapse rates. Secondhand smoking, higher in JIA, may prompt the basis of primary preventable strategies in JIA.
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Affiliation(s)
- Oya Koker
- Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Pediatric Rheumatology, Marmara University-Pendik Training and Research Hospital, Istanbul, Turkey
| | - Ayten Aliyeva
- Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezgin Sahin
- Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Amra Adrovic
- Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Yildiz
- Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatih Haslak
- Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aybuke Gunalp
- Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Barut
- Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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6
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Popescu C. Whole exome sequencing in a juvenile idiopathic arthritis large family with SERPINA1 gene mutations. BMC Rheumatol 2022; 6:39. [PMID: 35786784 PMCID: PMC9251928 DOI: 10.1186/s41927-022-00269-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 03/29/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Although the underlying mechanisms and mediators of arthritis in juvenile idiopathic arthritis are not well understood, accumulated evidence supports the mixt role of genetic and environmental factors. Few reports of multiplex families with JIA were published until now. The aim of this study was to describe the subjects affected by juvenile idiopathic arthritis and psoriatic features (JIAPs) in a large family. METHODS Here, we characterized an extended multiplex family of 5 patients with juvenile idiopathic arthritis and psoriatic features (PsA) at the clinical and genetic level, using whole exome sequencing. RESULTS We did not confirm in our family the linkage with the genetic factors already described that might be associated with increase susceptibility to JIA. We found a carrier status of siblings who inherited a pathogenic allele of the SERPINA1 gene from their mother who herself has two heterozygous pathogenic variants in the SERPINA1 gene. CONCLUSIONS This study didn't identify genetic contributive factors but highlights potentially environmental associations concerning the siblings of a family with juvenile idiopathic arthritis and psoriatic features (JIAPs). It is difficult to establish that SERPINA1 gene mutation has an etiological role as the levels of AAT are only slightly decreased and all the children harbor heterozygous variants.
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7
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Abstract
Studying environmental risk factors for pediatric rheumatic diseases (PRD) is important because the identification of these factors may lead to strategies to prevent disease, and to new insights into pathogenesis and therapeutic targets. Compared with other chronic diseases, there are few environmental epidemiology studies in PRD. Although strong risk factors common to all PRDs have not been identified, some exposures including infection, smoke exposure, and ultraviolet radiation have been associated with several of them. High-technology studies, especially of microbiomics and metabolomics, are increasing and will likely lead to new understandings of the complex interplay between environment, genetics, and disease.
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8
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Clarke SLN, Mageean KS, Maccora I, Harrison S, Simonini G, Sharp GC, Relton CL, Ramanan AV. Moving from nature to nurture: a systematic review and meta-analysis of environmental factors associated with juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 61:514-530. [PMID: 34382060 PMCID: PMC8824412 DOI: 10.1093/rheumatology/keab627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/10/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives JIA is the most common paediatric rheumatic disease, thought to be influenced by both genetics and the environment. Identifying environmental factors associated with disease risk will improve knowledge of disease mechanism and ultimately benefit patients. This review aimed to collate and synthesize the current evidence of environmental factors associated with JIA. Methods Four databases (MEDLINE, Embase, Web of Science and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to January 2020. Study quality was rated using the Newcastle-Ottawa Scale. Pooled estimates for each environmental factor were generated using a random-effects, inverse-variance method, where possible. The remaining environmental factors were synthesized in narrative form. Results This review includes 66 environmental factors from 39 studies (11 cohort and 28 case-control studies) over 45 years. Study sample sizes ranged from 41 to 1.9 million participants. Eight environmental factors from ten studies were meta-analysed. Caesarean section delivery was associated with increased JIA risk [pooled odds ratio (OR) 1.11, 95% CI: 1.01, 1.22]. Conversely, presence (vs absence) of siblings (pooled OR 0.60, 95% CI: 0.44, 0.81) and maternal prenatal smoking (pooled OR 0.70, 95% CI: 0.58, 0.84) were associated with decreased JIA risk. Conclusion This review identifies several environmental factors associated with JIA and demonstrates the huge breadth of environmental research undertaken over five decades. We also highlight the challenges of combining data collected over this period due to limited between study comparability, evolution in healthcare and social practices, and changing environment, which warrant consideration when planning future studies.
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Affiliation(s)
- Sarah L N Clarke
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Katie S Mageean
- Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ilaria Maccora
- Rheumatology Unit, A Meyer Children Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Sean Harrison
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gabriele Simonini
- Rheumatology Unit, A Meyer Children Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Gemma C Sharp
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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9
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Dave I, Estroff B, Gergely T, Rostad CA, Ponder LA, McCracken C, Prahalad S. Impact of the Season of Birth on the Development of Juvenile Idiopathic Arthritis in the United States: A Nationwide Registry-based Study. J Rheumatol 2021; 48:1856-1862. [PMID: 34329181 DOI: 10.3899/jrheum.201238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Autoimmune disorders result from the interplay of genetic and environmental factors. Many autoimmune disorders are associated with specific seasons of birth, implicating a role for environmental determinants in their etiopathology. We investigated if there is an association between the season of birth and the development of juvenile idiopathic arthritis ( JIA). METHODS Birth data from 10,913 children with JIA enrolled at 62 Childhood Arthritis and Rheumatology Research Alliance Registry sites was compared with 109,066,226 US births from the same period using a chi‑square goodness-of-fit test. Season of birth of the JIA cohort was compared to the US population estimate using a 2-sided 1-sample test for a binomial proportion and corrected for multiple comparisons. Secondary analysis was performed for JIA categories, age of onset, and month of birth. RESULTS A greater proportion of children with JIA were born in winter (January-March) compared to the US general population (25.72% vs 24.08%; corrected P < 0.0001). This observation was also true after stratifying for age of onset (≤ or > 6 yrs). When analyzed by the month of birth, a greater proportion of children with JIA were born in January compared to the US population (9.44% vs 8.13%; corrected P < 0.0001). CONCLUSION Relative to the general population, children with JIA are more often born in the winter, and specifically in the month of January. These observations support the hypothesis that seasonal variations in exposures during the gestational and/or early postnatal periods may contribute to development of JIA.
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Affiliation(s)
- Ishaan Dave
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Brandon Estroff
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Talia Gergely
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Christina A Rostad
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Lori A Ponder
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
| | - Courtney McCracken
- SP is supported in part by a grant from The Marcus Foundation Inc., Atlanta, and also serves on a Macrophage Activation Syndrome Advisory Committee for Novartis pharmaceuticals. I. Dave, MSPH, B. Estroff, MD, T. Gergely, BS, C. McCracken, PhD, Department of Pediatrics, Emory University School of Medicine; C.A. Rostad, MD, Department of Pediatrics, Division of Infectious diseases, Emory University School of Medicine, and Center for Childhood Infections and Vaccines, Children's Healthcare of Atlanta; L.A. Ponder, BS, Department of Human Genetics, Emory University School of Medicine; S. Prahalad, MD, MSc, Department of Pediatrics, Department of Human Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA. I. Dave and B. Estroff contributed equally. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. S. Prahalad, Marcus Professor and Chief of Pediatric Rheumatology, Emory University School of Medicine, 1760 Haygood Drive NE, Atlanta, GA 30322 USA. . Accepted for publication June 7, 2021
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Finch SL, Rosenberg AM, Kusalik AJ, Maleki F, Rezaei E, Baxter-Jones A, Benseler S, Boire G, Cabral D, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Stringer E, Tse SML, Tucker LB, Turvey SE, Szafron M, Whiting S, Yeung RS, Vatanparast H. Higher concentrations of vitamin D in Canadian children with juvenile idiopathic arthritis compared to healthy controls are associated with more frequent use of vitamin D supplements and season of birth. Nutr Res 2021; 92:139-149. [PMID: 34311227 DOI: 10.1016/j.nutres.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/05/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
A number of studies have demonstrated that patients with autoimmune disease have lower levels of vitamin D prompting speculation that vitamin D might suppress inflammation and immune responses in children with juvenile idiopathic arthritis (JIA). The objective of this study was to compare vitamin D levels in children with JIA at disease onset with healthy children. We hypothesized that children and adolescents with JIA have lower vitamin D levels than healthy children and adolescents. Data from a Canadian cohort of children with new-onset JIA (n= 164, data collection 2007-2012) were compared to Canadian Health Measures Survey (CHMS) data (n=4027, data collection 2007-2011). We compared 25-hydroxy vitamin D (25(OH)D) concentrations with measures of inflammation, vitamin D supplement use, milk intake, and season of birth. Mean 25(OH)D level was significantly higher in patients with JIA (79 ± 3.1 nmol/L) than in healthy controls (68 ± 1.8 nmol/L P <.05). Patients with JIA more often used vitamin D containing supplements (50% vs. 7%; P <.05). The prevalence of 25(OH)D deficiency (<30 nmol/L) was 6% for both groups. Children with JIA with 25(OH)D deficiency or insufficiency (<50 nmol/L) had higher C-reactive protein levels. Children with JIA were more often born in the fall and winter compared to healthy children. In contrast to earlier studies, we found vitamin D levels in Canadian children with JIA were higher compared to healthy children and associated with more frequent use of vitamin D supplements. Among children with JIA, low vitamin D levels were associated with indicators of greater inflammation.
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Affiliation(s)
- Sarah L Finch
- University of Saskatchewan, Saskatoon, Canada; University of Prince Edward Island, Charlottetown, Canada
| | | | | | | | | | | | - Susanne Benseler
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - David Cabral
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | | | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre, St. John's, Canada
| | - Ciaran Duffy
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Jaime Guzman
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Kristin Houghton
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | | | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Ron M Laxer
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Kimberly Morishita
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Kiem G Oen
- University of Manitoba, Winnipeg, Canada
| | - Ross E Petty
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | - Johannes Roth
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Rayfel Schneider
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | | | | | - Shirley M L Tse
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Lori B Tucker
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Stuart E Turvey
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | | | - Rae Sm Yeung
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
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11
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Abraham K, Koletzko B, Mildenberger E, Rouw E, von Gartzen A, Ensenauer R. Per- und polyfluorierte Alkylsubstanzen (PFAS) und Stillen: Nutzen-Risiken-Abwägungen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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12
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Mailhot G, White JH. Vitamin D and Immunity in Infants and Children. Nutrients 2020; 12:E1233. [PMID: 32349265 PMCID: PMC7282029 DOI: 10.3390/nu12051233] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 04/24/2020] [Accepted: 04/25/2020] [Indexed: 02/06/2023] Open
Abstract
The last couple of decades have seen an explosion in our interest and understanding of the role of vitamin D in the regulation of immunity. At the molecular level, the hormonal form of vitamin D signals through the nuclear vitamin D receptor (VDR), a ligand-regulated transcription factor. The VDR and vitamin D metabolic enzymes are expressed throughout the innate and adaptive arms of the immune system. The advent of genome-wide approaches to gene expression profiling have led to the identification of numerous VDR-regulated genes implicated in the regulation of innate and adaptive immunity. The molecular data infer that vitamin D signaling should boost innate immunity against pathogens of bacterial or viral origin. Vitamin D signaling also suppresses inflammatory immune responses that underlie autoimmunity and regulate allergic responses. These findings have been bolstered by clinical studies linking vitamin D deficiency to increased rates of infections, autoimmunity, and allergies. Our goals here are to provide an overview of the molecular basis for immune system regulation and to survey the clinical data from pediatric populations, using randomized placebo-controlled trials and meta-analyses where possible, linking vitamin D deficiency to increased rates of infections, autoimmune conditions, and allergies, and addressing the impact of supplementation on these conditions.
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Affiliation(s)
- Geneviève Mailhot
- Department of Nutrition, University of Montreal, Montreal, QC H3T 1A8, Canada
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC H3T 1C5, Canada
| | - John H. White
- Department of Physiology, McGill University, Montreal, QC H3G 1Y6, Canada
- Department of Medicine, McGill University, Montreal, QC H4A 3J1, Canada
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13
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Horton DB, Shenoi S. Review of environmental factors and juvenile idiopathic arthritis. Open Access Rheumatol 2019; 11:253-267. [PMID: 31807094 PMCID: PMC6842741 DOI: 10.2147/oarrr.s165916] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022] Open
Abstract
Juvenile idiopathic arthritis is a common rheumatic disease that presents as chronic childhood arthritis. JIA is considered a multifactorial disease that may result from diverse genetic and environmental risk factors. A minority of the population-attributable risk of JIA is estimated to be due to familial factors. Thus, non-genetic or environmental factors likely account for a majority of the risk of developing JIA. Yet, while substantial data have linked environmental factors to the development of rheumatoid arthritis, similar evidence regarding JIA is sparse. This narrative review provides updates on recent literature about environmental factors that might influence the risk of developing JIA, including studies about potentially beneficial and harmful influences as well as factors with unclear effects.
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Affiliation(s)
- Daniel B Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA.,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Susan Shenoi
- Department of Pediatrics, Division of Pediatric Rheumatology, Seattle Children's Hospital and Research Center and University of Washington, Seattle, WA, USA
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14
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[The importance of breastfeeding for the infant]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 61:945-951. [PMID: 29943259 DOI: 10.1007/s00103-018-2773-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Breastmilk is natural nutrition for infants. In addition to nutrients, breast milk contains a variety of immunomodulatory, anti-inflammatory and antimicrobial substances that help to reduce short- and long-term morbidity risks and positively influence the child's cognitive and psychomotor development. Studies show that breastfed children are at a significantly lower risk for lower respiratory tract infections, otitis media, and gastroenteritis compared with non-breastfed children. Also, the risk for sudden infant death syndrome is significantly reduced by breastfeeding. Breastfeeding does not have an influence on the risk of allergies, neither in the overall population nor in children with a familial predisposition. However, breastfeeding promotes brain development, especially of the white matter, and is associated with improved intelligence by about 2 IQ points. Furthermore, studies show an inverse correlation between breastfeeding and the subsequent risk for obesity, and there is evidence for a risk reduction of type 2 diabetes mellitus. Breastfed infants can largely regulate their food intake. This can have a positive effect on later eating behavior and the risk for becoming overweight. In view of the positive health effects of breastfeeding, it is recommended that infants be breast-fed exclusively during the first few months of life and that complementary feeding should be started at the earliest from the beginning of the 5th month and no later than at the beginning of the 7th month. Complementary food should be offered in a suitable form and with consideration of the signals of the child. Overall, breastfeeding can make a significant contribution to promoting public health and thereby to reducing healthcare costs.
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15
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Sperling CD, Kjaer SK, Hargreave M, Jensen A. Risk of juvenile idiopathic arthritis among children conceived after fertility treatment: a nationwide registry-based cohort study. Hum Reprod 2019; 34:1139-1145. [PMID: 30927428 DOI: 10.1093/humrep/dez035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/15/2019] [Accepted: 02/25/2019] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION Is the risk of juvenile idiopathic arthritis (JIA) increased in children conceived after fertility treatment, and is an observed association caused by specific types of fertility treatment or by factors associated with the underlying infertility? SUMMARY ANSWER The risk of JIA in children conceived after fertility treatment (any and specific types of fertility treatment) was not convincingly affected when compared with children born to fertile women. WHAT IS KNOWN ALREADY It has been suggested that fertility treatment may affect the development of the immune system and thereby increase the risk of developing autoimmune diseases, including JIA. STUDY DESIGN, SIZE, DURATION This retrospective population-based cohort study included all live-born children in Denmark between 1 January 1996 and 31 December 2012 (n = 1 084 184). The study population was followed from date of birth until first diagnosis of JIA as registered in the Danish National Patient Registry, date of 16th birthday, date of emigration, date of death or end of follow-up (31 December 2014), whichever occurred first. PARTICIPANTS/MATERIALS, SETTING, METHODS The study cohort was linked to the Danish Infertility Cohort in order to identify children born to women with fertility problems (n = 174 702) and fertility treatment (n = 89 931). Cox proportional hazard regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE During a median follow-up period of 10.3 years, 2237 children were diagnosed with JIA. Children born to women with fertility problems had an increased risk of JIA (HR 1.18, 95% CI 1.05-1.32) compared with children born to fertile women. However, the risk was not increased in children conceived after any fertility treatment (HR 1.11; 95% CI 0.95-1.29), or after specific types of fertility treatment being ART (HR 1.05; 95% CI 0.83-1.33), IVF (HR 1.01; 95% CI 0.73-1.38), ICSI (HR 0.98; 95% CI 0.64-1.50) or any fertility drugs (HR 1.10; 95% CI 0.94-1.28) compared with children born to fertile women. The associations between fertility treatment and JIA were also assessed by using children born to women with fertility problems without fertility treatment in the index pregnancy as a reference group, however, the findings did not change substantially. LIMITATIONS REASONS FOR CAUTION Despite a large study population, the statistical precision in some subgroup analyses may be affected due to the low number of JIA cases. There may be some misclassification of fertility problems, as some women have undiagnosed fertility problems and are therefore not included in the Danish Infertility Cohort; potentially leading to slight attenuation of the association between fertility problems and JIA. WIDER IMPLICATIONS OF THE FINDINGS The results are based on national data and our findings can therefore be applied to other similar populations. Our results indicate that fertility treatment per se do not increase the risk of JIA but merely that the increased risk of JIA observed among children born to women with fertility problems may be due to underlying factors related to both infertility and JIA. However, as this is the first large study in this field, further studies are needed to confirm our findings. STUDY FUNDING/COMPETING INTEREST(S) The study was supported by grants from the Jascha Foundation, the Aase and Ejner Danielsens Foundation and The Danish Rheumatism Association. All authors report no conflicts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- C D Sperling
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - S K Kjaer
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
- Department of Gynecology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - M Hargreave
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - A Jensen
- Virus, Lifestyle and Genes, Danish Cancer Society Research Center, Copenhagen, Denmark
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16
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Long-term breastfeeding influences disease activity in a low-income juvenile idiopathic arthritis cohort. Clin Rheumatol 2019; 38:2227-2231. [PMID: 31062254 DOI: 10.1007/s10067-019-04582-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 10/26/2022]
Abstract
To determine the influence of breastfeeding duration in the clinical activity of low-income juvenile idiopathic arthritis (JIA). Ninety-one JIA patients followed in Fortaleza-CE, Brazil, were cross-sectionally evaluated from May 2015 to April 2016. Breastfeeding duration was obtained by interviewing mothers. Mean age was 14.6 ± 5.2 years with 10.31 ± 3.7 years of disease duration. Polyarticular category predominated, with 39 (42.8%) patients, followed by 23 (25.3%) oligoarticular and 17 (18.7%) enthesitis-related. Forty-seven (61.8%) were receiving methotrexate isolated or combined to leflunomide, which was used by 12 (15.4%); 30 (32.9%) were on biologic DMARD with 16 (53.3%) etanercept, 8 (26.7%) adalimumab, 3 (10%) tocilizumab, and 1 (3.3%) each on infliximab, abatacept, and canakinumab. Mean(SD) CHAQ and JADAS27 were 0.37 ± 0.36 and 5.03 ± 6.1, respectively and 22 (24%) had permanent joint deformities. No family declared monthly income over US$900.00 and 32 (37.2%) earned less than US$300.00. Eighty-three (91%) were ever breastfed; over two-thirds were breastfed for more than 3 months. Those breastfed for more than 6 months had less joint deformities and a tendency to lower JADAS27 and CHAQ scores using minimally adjusted general linear or logistic models, as appropriate. Parental smoking or literacy and family income did not differ regarding breastfeeding time. This is a low-income JIA cohort with the highest breastfeeding prevalence ever reported. Breastfeeding over 6 months was associated with less disease activity.Key Point• Long-term breastfeeding benefits juvenile idiopathic arthritis.
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17
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Van Nieuwenhove E, Lagou V, Van Eyck L, Dooley J, Bodenhofer U, Roca C, Vandebergh M, Goris A, Humblet-Baron S, Wouters C, Liston A. Machine learning identifies an immunological pattern associated with multiple juvenile idiopathic arthritis subtypes. Ann Rheum Dis 2019; 78:617-628. [PMID: 30862608 DOI: 10.1136/annrheumdis-2018-214354] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/21/2019] [Accepted: 02/12/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Juvenile idiopathic arthritis (JIA) is the most common class of childhood rheumatic diseases, with distinct disease subsets that may have diverging pathophysiological origins. Both adaptive and innate immune processes have been proposed as primary drivers, which may account for the observed clinical heterogeneity, but few high-depth studies have been performed. METHODS Here we profiled the adaptive immune system of 85 patients with JIA and 43 age-matched controls with indepth flow cytometry and machine learning approaches. RESULTS Immune profiling identified immunological changes in patients with JIA. This immune signature was shared across a broad spectrum of childhood inflammatory diseases. The immune signature was identified in clinically distinct subsets of JIA, but was accentuated in patients with systemic JIA and those patients with active disease. Despite the extensive overlap in the immunological spectrum exhibited by healthy children and patients with JIA, machine learning analysis of the data set proved capable of discriminating patients with JIA from healthy controls with ~90% accuracy. CONCLUSIONS These results pave the way for large-scale immune phenotyping longitudinal studies of JIA. The ability to discriminate between patients with JIA and healthy individuals provides proof of principle for the use of machine learning to identify immune signatures that are predictive to treatment response group.
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Affiliation(s)
- Erika Van Nieuwenhove
- UZ Leuven, Leuven, Belgium.,VIB Center for Brain and Disease Research, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Vasiliki Lagou
- VIB Center for Brain and Disease Research, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,Department of Neurosciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Lien Van Eyck
- UZ Leuven, Leuven, Belgium.,VIB Center for Brain and Disease Research, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - James Dooley
- VIB Center for Brain and Disease Research, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ulrich Bodenhofer
- Institute of Bioinformatics, Linz, Austria.,LIT AI Lab, Linz Institute of Technology, Johannes Kepler University, Linz, Austria.,QUOMATIC.AI, Linz, Austria
| | - Carlos Roca
- VIB Center for Brain and Disease Research, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Marijne Vandebergh
- Department of Neurosciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - An Goris
- Department of Neurosciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Stéphanie Humblet-Baron
- VIB Center for Brain and Disease Research, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Carine Wouters
- UZ Leuven, Leuven, Belgium.,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Adrian Liston
- VIB Center for Brain and Disease Research, Leuven, Belgium .,Department of Microbiology and Immunology, KU Leuven - University of Leuven, Leuven, Belgium.,The Babraham Institute, Cambridge, United Kingdom
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18
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Chiaroni-Clarke RC, Munro JE, Pezic A, Cobb JE, Akikusa JD, Allen RC, Dwyer T, Ponsonby AL, Ellis JA. Association of Increased Sun Exposure Over the Life-course with a Reduced Risk of Juvenile Idiopathic Arthritis. Photochem Photobiol 2018; 95:867-873. [PMID: 30378692 DOI: 10.1111/php.13045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 10/16/2018] [Indexed: 12/13/2022]
Abstract
Cutaneous sun exposure is an important determinant of circulating vitamin D. Both sun exposure and vitamin D have been inversely associated with risk of autoimmune disease. In juvenile idiopathic arthritis (JIA), low circulating vitamin D appears common, but disease-related behavioral changes may have influenced sun exposure. We therefore aimed to determine whether predisease sun exposure is associated with JIA. Using validated questionnaires, we retrospectively measured sun exposure for 202 Caucasian JIA case-control pairs born in Victoria Australia, matched for birth year and time of recruitment. Measures included maternal sun exposure at 12 weeks of pregnancy and child sun exposure across the life-course prediagnosis. We converted exposure to UVR dose and looked for case-control differences using logistic regression, adjusting for potential confounders. Higher cumulative prediagnosis UVR exposure was associated with reduced risk of JIA, with a clear dose-response relationship (trend P = 0.04). UVR exposure at 12 weeks of pregnancy was similarly inversely associated with JIA (trend P = 0.011). Associations were robust to sensitivity analyses for prediagnosis behavioral changes, disease duration and knowledge of the hypothesis. Our data indicate that lower UVR exposure may increase JIA risk. This may be through decreased circulating vitamin D, but prospective studies are required to confirm this.
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Affiliation(s)
- Rachel C Chiaroni-Clarke
- Genes, Environment and Complex Disease, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jane E Munro
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Arthritis and Rheumatology, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Paediatric Rheumatology Unit, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Angela Pezic
- Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Joanna E Cobb
- Genes, Environment and Complex Disease, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jonathan D Akikusa
- Arthritis and Rheumatology, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Paediatric Rheumatology Unit, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Roger C Allen
- Arthritis and Rheumatology, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Paediatric Rheumatology Unit, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Terence Dwyer
- Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Obstetrics and Gynaecology, George Institute for Global Health, University of Oxford, Oxford, UK
| | - Anne-Louise Ponsonby
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Environmental and Genetic Epidemiology Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Justine A Ellis
- Genes, Environment and Complex Disease, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia.,Faculty of Health, Centre for Social and Early Emotional Development, Deakin University, Burwood, Victoria, Australia
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19
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Juvenile Idiopathic Arthritis: A Focus on Pharmacologic Management. J Pediatr Health Care 2018; 32:515-528. [PMID: 30177013 DOI: 10.1016/j.pedhc.2018.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 02/27/2018] [Indexed: 12/29/2022]
Abstract
Juvenile idiopathic arthritis is a chronic condition that affects many pediatric patients. It is a prevalent disease and has become the most common rheumatologic disease of childhood. The condition encompasses multiple different forms of chronic arthritides classified based on the location and number of joints affected as well as the presence or lack of a number of different inflammatory markers. The exact etiology is unknown but is thought to be multifactorial with genetic, humoral, and environmental factors playing a key role. Many pharmacologic agents are available for use in the treatment of juvenile idiopathic arthritis, with management involving the use of symptom-reducing agents and disease-modifying antirheumatic drugs. Treatment is not without adverse events, with many of the agents require monitoring regimens and patient education. Without treatment, the progression and chronicity of the disease can result in significant morbidity, with the potential for devastating consequences on the child's quality of life.
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20
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Palman J, Shoop-Worrall S, Hyrich K, McDonagh JE. Update on the epidemiology, risk factors and disease outcomes of Juvenile idiopathic arthritis. Best Pract Res Clin Rheumatol 2018; 32:206-222. [DOI: 10.1016/j.berh.2018.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 08/09/2018] [Accepted: 09/09/2018] [Indexed: 02/06/2023]
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21
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Sun B, Cheng L, Xiong Y, Hu L, Luo Z, Zhou M, Li J, Xie H, He F, Yuan X, Chen X, Zhou HH, Liu Z, Chen X, Zhang W. PSORS1C1 Hypomethylation Is Associated with Allopurinol-Induced Severe Cutaneous Adverse Reactions during Disease Onset Period: A Multicenter Retrospective Case-Control Clinical Study in Han Chinese. Front Pharmacol 2018; 8:923. [PMID: 29387007 PMCID: PMC5776094 DOI: 10.3389/fphar.2017.00923] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/05/2017] [Indexed: 12/19/2022] Open
Abstract
Background: Allopurinol-induced severe cutaneous adverse reactions (SCARs), including drug rash with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS) and toxic epidermal necrosis (TEN), are life-threatening autoimmune reactions. Evidence is growing that epigenetic variation, particularly DNA methylation, is associated with autoimmune diseases. However, the potential role of aberrant DNA methylation in allopurinol-SCARs is largely unknown. Objective: To address the knowledge gap between allopurinol-SCARs and DNA methylation, we studied the DNA methylation profiles in peripheral blood cells from allopurinol-SCARs and allopurinol-tolerant subjects. Methods: A genome-scale DNA methylation profiling was conducted using the Illumina Infinium HumanMethylation450 (HM450) platform on 15 patients with allopurinol-SCARs (3 TEN, 2 SJS/TEN overlap and 10 SJS) and 20 age- and gender-matched allopurinol-tolerant controls at disease onset. Pyrosequencing was used to validate the candidate CpG (cytosine-guanine dinucleotide) sites in an independent cohort of 40 allopurinol-SCARs and 48 allopurinol-tolerants. Results: After bioinformatics analysis of methylation data obtained from HM450 BeadChip, we identified 41 differentially methylated CpG loci (P < 0.05) annotated to 26 genes showing altered DNA methylation between allopurinol-SCARs and allopurinol-tolerants. Among these genes, significant hypomethylation of PSORS1C1 (cg24926791) was further validated in a larger sample cohort, showing significant difference between DRESS and controls (P = 0.00127), ST (SJS and TEN) and controls (P = 3.75 × 10−13), and SCARs and controls (P = 5.93 × 10−15). Conclusions: Our data identified differentially methylated genes between allopurinol-SCARs and allopurinol-tolerant controls and showed that PSORS1C1 hypomethylation was associated with allopurinol-SCARs (OR = 30.22, 95%CI = 4.73–192.96) during disease onset, suggesting that aberrant DNA methylation may be a mechanism of allopurinol-SCARs. Limitations: Firstly, the data come from whole blood samples known to possess epigenetic heterogeneity, i. e., blood samples comprise a heterogeneous cell population with varying proportions of distinct cell-types with different DNA methylation patterns. Consequently, the interpretation of DNA methylation results should be performed with great caution due to the heterogeneous nature of the sample. Secondly, whether the identified disease-associated changes of epigenome precede disease onset, or result from the disease progression, needs further investigation. Comparing the methylation status before patients develop allopurinol-SCARs and after may help examine methylation levels from disease onset to disease progression.
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Affiliation(s)
- Bao Sun
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Lin Cheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Shenzhen Eyeis Visual Science Research Institute, Shenzhen, China
| | - Yan Xiong
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Lei Hu
- Department of Pharmacy, Peking University People's Hospital, Beijing, China
| | - Zhiying Luo
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Maosong Zhou
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Ji Li
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Hongfu Xie
- Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Fazhong He
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Xiaoqing Yuan
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Xiaoping Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Hong-Hao Zhou
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Zhaoqian Liu
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
| | - Xiang Chen
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China
| | - Wei Zhang
- Department of Clinical Pharmacology, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Pharmacogenetics, Institute of Clinical Pharmacology, Central South University, Changsha, China
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AZZOUZ DOUAF, SILVERMAN GREGGJ. Is Gut Microbial LPS a Potential Trigger of Juvenile Idiopathic Arthritis? J Rheumatol 2017; 44:1569-1571. [DOI: 10.3899/jrheum.170791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Sá MCD, Moreira C, Melo C, Sousa Á, Carvalho S. Lyme disease and juvenile idiopathic arthritis - A pediatric case report. REVISTA BRASILEIRA DE REUMATOLOGIA 2017; 57:620-622. [PMID: 29173699 DOI: 10.1016/j.rbre.2015.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 08/14/2015] [Indexed: 06/07/2023] Open
Affiliation(s)
- Mário Correia de Sá
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Serviço de Pediatria, Vila Nova de Gaia, Portugal.
| | - Catarina Moreira
- Unidade de Saúde Familiar Ribeirão, Vila Nova de Famalicão, Portugal
| | - Cláudia Melo
- Centro Hospitalar do Médio Ave, Serviço de Pediatria, Vila Nova de Famalicão, Portugal
| | - Álvaro Sousa
- Centro Hospitalar do Médio Ave, Serviço de Pediatria, Vila Nova de Famalicão, Portugal
| | - Sónia Carvalho
- Centro Hospitalar do Médio Ave, Serviço de Pediatria, Vila Nova de Famalicão, Portugal
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Vieira Borba V, Sharif K, Shoenfeld Y. Breastfeeding and autoimmunity: Programing health from the beginning. Am J Reprod Immunol 2017; 79. [PMID: 29083070 DOI: 10.1111/aji.12778] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 10/10/2017] [Indexed: 12/19/2022] Open
Abstract
Breast milk is not only a completely adapted nutrition source for the newborn but also an impressive array of immune-active molecules that afford protection against infections and shape mucosal immune responses. Decisive imprinting events might be modulated during the first months of life with potential health long-term effects, enhancing the importance of breastfeeding as a major influence on the immune system correct development and modifying disease susceptibility. The aim of this review was to clarify the link between breastfeeding and autoimmune diseases, inquiring the related mechanisms, based on data available in the literature. Being breastfed was associated with a lower incidence of diabetes, celiac disease, multiple sclerosis and asthma, explained by the protection against early infections, anti-inflammatory properties, antigen-specific tolerance induction, and regulation of infant's microbiome. The protective role of human milk in idiopathic juvenile arthritis, rheumatoid arthritis, and inflammatory bowel diseases remains controversial. On the other hand, the breastfeeding mother faces a health-challenging period in life. High levels of prolactin may lead either to the development of autoimmune diseases in susceptible mothers or exacerbations of current immune-mediated disorders. These features raise the question if mothers with autoimmune diseases, mainly systemic lupus erythematosus, should avoid breastfeeding.
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Affiliation(s)
- Vânia Vieira Borba
- Department 'A' of Internal Medicine, Coimbra University Hospital Centre, Coimbra, Portugal.,Faculty of Medicine, University of Coimbra, Coimbra, Portugal.,Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - Kassem Sharif
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Department 'B' of Internal Medicine, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yehuda Shoenfeld
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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25
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Chavez-Valencia RA, Chiaroni-Clarke RC, Martino DJ, Munro JE, Allen RC, Akikusa JD, Ponsonby AL, Craig JM, Saffery R, Ellis JA. The DNA methylation landscape of CD4 + T cells in oligoarticular juvenile idiopathic arthritis. J Autoimmun 2017; 86:29-38. [PMID: 28969936 DOI: 10.1016/j.jaut.2017.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/25/2017] [Accepted: 09/25/2017] [Indexed: 02/09/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is presumed to be driven by an adverse combination of genes and environment. Epigenetic processes, including DNA methylation, act as a conduit through which the environment can regulate gene activity. Altered DNA methylation has been associated with adult autoimmune rheumatic diseases such as rheumatoid arthritis, but studies are lacking for paediatric autoimmune rheumatic diseases including JIA. Here, we performed a genome-scale case-control analysis of CD4+ T cell DNA methylation from 56 oligoarticular JIA (oJIA) cases and 57 age and sex matched controls using Illumina HumanMethylation450 arrays. DNA methylation at each array probe was tested for association with oJIA using RUV (Remove Unwanted Variation) together with a moderated t-test. Further to this 'all-inclusive' analysis, we stratified by age at diagnosis (≤6yrs, >6yrs) and by sex as potential sources of heterogeneity. Following False Discovery Rate (FDR) adjustment, no probes were associated with oJIA in the all-inclusive, >6yrs-diagnosed, or sex-stratified analyses, and only one probe was associated with oJIA in the ≤6yrs-diagnosed analysis. We attempted technical validation and replication of 14 probes (punadj<0.01) at genes of known/potential relevance to disease. At VPS53, we demonstrated a regional shift towards higher methylation in oJIA (all-inclusive) compared to controls. At REEP3, where polymorphism has been previously associated with JIA, we demonstrated higher DNA methylation in male oJIA compared to male controls. This is the most comprehensive JIA case-control analysis of DNA methylation to date. While we have generated some evidence of altered methylation in oJIA, substantial differences are not apparent in CD4+ T cells. This may indicate a lesser relevance of DNA methylation levels in childhood, compared to adult, rheumatic disease.
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Affiliation(s)
- Raul A Chavez-Valencia
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Department of Paediatrics, The University of Melbourne, Vic 3010, Australia
| | - Rachel C Chiaroni-Clarke
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Department of Paediatrics, The University of Melbourne, Vic 3010, Australia
| | - David J Martino
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Department of Paediatrics, The University of Melbourne, Vic 3010, Australia; In-FLAME, the International Inflammation Network, World Universities Network (WUN), Australia
| | - Jane E Munro
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Royal Children's Hospital, Parkville, Vic 3052, Australia
| | - Roger C Allen
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Royal Children's Hospital, Parkville, Vic 3052, Australia
| | - Jonathan D Akikusa
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Royal Children's Hospital, Parkville, Vic 3052, Australia
| | - Anne-Louise Ponsonby
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Department of Paediatrics, The University of Melbourne, Vic 3010, Australia
| | - Jeffrey M Craig
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Department of Paediatrics, The University of Melbourne, Vic 3010, Australia
| | - Richard Saffery
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Department of Paediatrics, The University of Melbourne, Vic 3010, Australia
| | - Justine A Ellis
- Murdoch Children's Research Institute, Parkville, Vic 3052, Australia; Department of Paediatrics, The University of Melbourne, Vic 3010, Australia; Centre for Social and Early Emotional Development, Faculty of Health, Deakin University, Australia.
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26
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Shenoi S, Shaffer ML, Wallace CA. Environmental Risk Factors and Early-Life Exposures in Juvenile Idiopathic Arthritis: A Case-Control Study. Arthritis Care Res (Hoboken) 2017; 68:1186-94. [PMID: 26618899 DOI: 10.1002/acr.22806] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/08/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) is a heterogeneous group of disorders characterized by chronic arthritis in children with unknown etiology. Although research evaluating environmental or early-life exposures in JIA is scarce, there are data to suggest that infections, smoking exposure, and lack of breastfeeding play a role. This case-control study investigated the association of selected environmental and early-life risk factors with the development of JIA. METHODS JIA cases were identified at a major pediatric rheumatology outpatient clinic. Each case was asked to identify up to 3 healthy playmates of similar age and same sex to serve as controls. Parents/caregivers of cases and controls completed a questionnaire on selected environmental and early-life exposures. Conditional logistic regression adjusted for age and socioeconomic status was used to determine the odds ratio (OR) for developing JIA with 95% confidence intervals (95% CIs) for the playmate-matched design. RESULTS Included in the study were 225 JIA cases and 138 controls. Compared to playmate-matched controls, preterm delivery (OR 1.8 [95% CI 1.2-2.7]) was associated with JIA. There was no association between JIA and household smoking or maternal prenatal smoking, breastfeeding, hospitalization with infection in the first year of life, daycare attendance before 6 years of age, household pets, or residential area prior to the onset of JIA. CONCLUSION There was no association between the previously reported risk factors of smoking, early-life infection, or breastfeeding and development of JIA in this study. The association of preterm delivery with JIA needs to be further studied.
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Affiliation(s)
- S Shenoi
- University of Washington School of Medicine and Seattle Children's Hospital and Research Institute, Seattle
| | - M L Shaffer
- Seattle Children's Research Institute, Seattle, Washington
| | - C A Wallace
- University of Washington School of Medicine and Seattle Children's Hospital and Research Institute, Seattle
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Arvonen M, Virta LJ, Pokka T, Kröger L, Vähäsalo P. Cow's Milk Allergy in Infancy and Later Development of Juvenile Idiopathic Arthritis: A Register-Based Case-Control Study. Am J Epidemiol 2017; 186:237-244. [PMID: 28459985 DOI: 10.1093/aje/kwx060] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022] Open
Abstract
We examined the association between cow's milk allergy (CMA) and juvenile idiopathic arthritis (JIA). The material for this case-control study was collected from national registers of all children born in Finland between 2000 and 2010 and diagnosed with JIA (n = 1,298) and age-, sex-, and place-matched controls (n = 5,179). We identified 235 children with CMA; 66 of these children also had JIA. A conditional logistic regression analysis was performed to evaluate the association between CMA and JIA and to test whether exposure to antibiotics would be a covariate for this association. In boys (but not in girls), a diagnosis of CMA and the use of hypoallergenic formula in infancy were associated with the later development of JIA (odds ratio = 2.4, 95% confidence interval: 1.6, 3.6). The association was most evident in boys who were diagnosed with JIA before age 3 years or diagnosed with CMA with predominantly gastrointestinal symptoms. There was no statistically significant additive interaction between CMA and antibiotic exposure in the later development of JIA. These associations may reflect impaired maturation of intestinal immunity and integrity in boys with a risk of JIA. Predisposing factors related to JIA pathogenesis seem to display a sex-linked disparity.
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28
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Bell SW, Shenoi S, Nelson JL, Bhatti P, Mueller BA. Juvenile idiopathic arthritis in relation to perinatal and maternal characteristics: a case control study. Pediatr Rheumatol Online J 2017; 15:36. [PMID: 28494794 PMCID: PMC5425970 DOI: 10.1186/s12969-017-0167-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/01/2017] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Existing data on associations between maternal and early childhood exposures and juvenile idiopathic arthritis (JIA) risk is scant and inconsistent with previous studies showing potential role for prematurity, number of siblings and infections. We explored JIA and International League of Associations for Rheumatology (ILAR) JIA categories in relation to selected infant (birthweight, size-for-gestational-age, gestational age), and maternal (parity, delivery type, prior fetal loss) characteristics that may be markers for exposures related to two pathways (hygiene hypothesis, microchimerism) potentially associated with autoimmune disorder occurrence. METHODS A case-control analysis with 1,234 JIA cases and 5,993 birth year-matched controls was conducted. Exposure information was obtained from WA state birth certificates. Multivariable logistic regression was used to estimate adjusted odds ratios (OR) and 95% confidence intervals (CI) for associations with maternal and early life exposures for JIA and JIA categories. RESULTS Greater maternal parity was associated with a decreased OR for JIA (most marked for persistent oligoarticular JIA, OR 0.32, 95% CI 0.15; 0.71, p for trend = 0.0001). Prior fetal loss (except for oligoarticular JIA) was associated with an increased OR for JIA. Prematurity was associated with increased risk of enthesitis related arthritis (OR 1.9, 95% CI: 1.3-2.9) and rheumatoid factor positive polyarticular JIA (OR 2.2, 95% CI: 1.0-4.8). CONCLUSIONS We observed associations of selected maternal factors with JIA, some of which varied across JIA categories. The findings of decreased ORs for JIA in relation to greater maternal parity may be consistent with the hygiene and microchimerism hypotheses. Future studies with biomarkers relevant to these hypotheses will help elucidate any associations.
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Affiliation(s)
- Samantha W. Bell
- 0000000122986657grid.34477.33Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA ,0000 0001 2297 6811grid.266102.1School of Medicine, University of California, San Francisco, San Francisco, CA USA ,0000 0001 2297 6811grid.266102.1University of California, San Francisco, 513 Parnassus Ave., Room S245, San Francisco, CA 94143 USA
| | - Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA USA
| | - J. Lee Nelson
- 0000 0001 2180 1622grid.270240.3Public Health Sciences Division, Fred Hutchison Cancer Research Center, Seattle, WA USA
| | - Parveen Bhatti
- 0000000122986657grid.34477.33Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA ,0000 0001 2180 1622grid.270240.3Public Health Sciences Division, Fred Hutchison Cancer Research Center, Seattle, WA USA
| | - Beth A. Mueller
- 0000000122986657grid.34477.33Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA USA ,0000 0001 2180 1622grid.270240.3Public Health Sciences Division, Fred Hutchison Cancer Research Center, Seattle, WA USA
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29
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Brito K, Amorim A, Funes E, Iwamoto J, Borim M, Tamelini P. ATIVIDADE DE ARTRITE IDIOPÁTICA JUVENIL NO CONTEXTO DE INFECÇÃO AGUDA PELO VÍRUS EPSTEIN – BARR. REVISTA BRASILEIRA DE REUMATOLOGIA 2017. [DOI: 10.1016/j.rbr.2017.07.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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30
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Hamooda M, Fouad H, Galal N, Sewelam N, Megahed D. Anti-cyclic citrullinated peptide antibodies in children with Juvenile Idiopathic Arthritis. Electron Physician 2016; 8:2897-2903. [PMID: 27790341 PMCID: PMC5074747 DOI: 10.19082/2897] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/07/2016] [Indexed: 11/20/2022] Open
Abstract
AIM The purpose of present study was to access the prevalence of anti-cyclic citrullinated peptide (anti-CCP) antibodies in children with Juvenile Idiopathic Arthritis (JIA), and to investigate the clinical significance and diagnostic value of the anti-CCP antibodies in correlation with age, sex & activity. METHODS This case-control study was performed on 50 patients with JIA in addition to 40 sex and age-matched children as a control group. The participants were recruited from rheumatology Outpatient Clinic of Cairo University Specialized Pediatric Hospital. Patients were subjected to full history taking, clinical examination, routine laboratory investigations and x-rays on involved joints. Both patients and controls underwent assay of anti-CCP antibodies by AxSYM Anti-CCP IgG Microparticle Enzyme Immunoassay (MEIA) which is a semi-quantitative determination of the IgG class of autoantibodies specific to cyclic citrullinated peptide (CCP) in patients' serum or plasma. Data were analyzed using Mann-Whitney U test, ANOVA, and independent-samples t-test by SPSS version 15. RESULTS Anti-CCP positivity was identified amongst patients with JIA, particularly those JIA patients experiencing RF positive polyarticular disease onset. Above all, it is important that anti-CCP positivity and bone erosions, degree of joint damage, and ESR levels were significantly correlated. CONCLUSION Anti-CCP could be utilized as a valuable marker in the polyarticular form of JIA to direct early, and could be aggressive therapeutic intervention.
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Affiliation(s)
- Mohamed Hamooda
- Paediatrics Specialty Registrar, West Yorkshire and the Humber, United Kingdom
| | - Hala Fouad
- Professor of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nermeen Galal
- Assistant Professor of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nadia Sewelam
- Lecturer of Chemical and Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Dina Megahed
- Assistant Lecturer of Rheumatology and Rehabilitation, Faculty of Medicine, Cairo University, Cairo, Egypt
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31
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Thorsen SU, Pipper CB, Alberdi-Saugstrup M, Nielsen S, Cohen A, Lundqvist M, Thygesen LC, Ascherio A, Svensson J. No association between vitamin D levels around time of birth and later risk of developing oligo- and polyarticular juvenile idiopathic arthritis: a Danish case–cohort study. Scand J Rheumatol 2016; 46:104-111. [DOI: 10.1080/03009742.2016.1178325] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- SU Thorsen
- Copenhagen Diabetes Research Centre (CPH-DIRECT), Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - CB Pipper
- Department of Public Health, Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - M Alberdi-Saugstrup
- Paediatric Rheumatology Clinic, Rigshospitalet, Copenhagen, Denmark
- Department of Paediatrics, Næstved Hospital, Næstved, Denmark
| | - S Nielsen
- Paediatric Rheumatology Clinic, Rigshospitalet, Copenhagen, Denmark
| | - A Cohen
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - M Lundqvist
- Department of Congenital Disorders, Statens Serum Institute, Copenhagen, Denmark
| | - LC Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - A Ascherio
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - J Svensson
- Copenhagen Diabetes Research Centre (CPH-DIRECT), Department of Paediatrics, Herlev University Hospital, Herlev, Denmark
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32
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Suelves AM, Lamba N, Meese HK, Foster CS, González-Martín JM, Díaz-Llopis M, Christen WG. Nuclear cataract as an early predictive factor for recalcitrant juvenile idiopathic arthritis-associated uveitis. J AAPOS 2016; 20:232-238.e1. [PMID: 27164426 DOI: 10.1016/j.jaapos.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/08/2016] [Accepted: 02/25/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze factors predictive of having treatment-resistant uveitis in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. METHODS The medical records of patients diagnosed with JIA-associated uveitis treated at a single tertiary referral center from October 2005 to March 2013 were reviewed retrospectively. The main outcome measures were demographic characteristics, ocular comorbidity, clinical course, treatments, and baseline risk factors associated with poor response to first-line therapies. RESULTS A total of 96 patients (175 eyes) were included. Of these, 58 patients (108 eyes) required biologic disease-modifying antirheumatic drugs or alkylating agents for their uveitis during follow-up (recalcitrant group), and 38 patients (67 eyes) did not (nonrecalcitrant group). Eyes of the recalcitrant group tended to have a higher incidence of cataract at baseline (49%; P < 0.0001). In the nonrecalcitrant group, the most frequent complications were cataract (20.9%) and secondary glaucoma (20.9%). The mean number of flares in the recalcitrant group was significantly reduced from 3.7/eye/year prior to cataract surgery to 1.6/eye/year after (P < 0.0001). Nuclear cataract was found to be an independent predictor for a severe course of JIA-associated uveitis. Any other type of cataract, posterior synechiae, male sex, or active uveitis at baseline were not found to be independently associated with recalcitrant uveitis. CONCLUSIONS Nuclear cataract at baseline evaluation is a risk factor for poor response to first-line therapies in JIA-associated uveitis patients.
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Affiliation(s)
- Ana M Suelves
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts; Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - Neerav Lamba
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - Halea K Meese
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts
| | - C Stephen Foster
- Massachusetts Eye Research and Surgery Institution, Waltham, Massachusetts; Ocular Immunology and Uveitis Foundation, Waltham, Massachusetts; Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts.
| | | | - Manuel Díaz-Llopis
- Department of Ophthalmology, University and Polytechnic Hospital La Fe, Valencia, Spain
| | - William G Christen
- Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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33
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Scher JU. Intestinal dysbiosis and potential consequences of microbiome-altering antibiotic use in the pathogenesis of human rheumatic disease. J Rheumatol 2016; 42:355-7. [PMID: 25729039 DOI: 10.3899/jrheum.150036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Jose U Scher
- New York University School of Medicine; and Hospital for Joint Diseases, Department of Medicine, 301 E. 17th St., New York 10003, New York, USA; E-mail:
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34
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Finkel TH, Li J, Wei Z, Wang W, Zhang H, Behrens EM, Reuschel EL, Limou S, Wise C, Punaro M, Becker ML, Munro JE, Flatø B, Førre Ø, Thompson SD, Langefeld CD, Glass DN, Glessner JT, Kim CE, Frackelton E, Shivers DK, Thomas KA, Chiavacci RM, Hou C, Xu K, Snyder J, Qiu H, Mentch F, Wang K, Winkler CA, Lie BA, Ellis JA, Hakonarson H. Variants in CXCR4 associate with juvenile idiopathic arthritis susceptibility. BMC MEDICAL GENETICS 2016; 17:24. [PMID: 27005825 PMCID: PMC4804485 DOI: 10.1186/s12881-016-0285-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 03/04/2016] [Indexed: 11/29/2022]
Abstract
Background Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease among children, the etiology of which involves a strong genetic component, but much of the underlying genetic determinants still remain unknown. Our aim was to identify novel genetic variants that predispose to JIA. Methods We performed a genome-wide association study (GWAS) and replication in a total of 1166 JIA cases and 9500 unrelated controls of European ancestry. Correlation of SNP genotype and gene expression was investigated. Then we conducted targeted resequencing of a candidate locus, among a subset of 480 cases and 480 controls. SUM test was performed to evaluate the association of the identified rare functional variants. Results The CXCR4 locus on 2q22.1 was found to be significantly associated with JIA, peaking at SNP rs953387. However, this result is subjected to subpopulation stratification within the subjects of European ancestry. After adjusting for principal components, nominal significant association remained (p < 10−4). Because of its interesting known function in immune regulation, we carried out further analyses to assess its relationship with JIA. Expression of CXCR4 was correlated with CXCR4 rs953387 genotypes in lymphoblastoid cell lines (p = 0.014) and T-cells (p = 0.0054). In addition, rare non-synonymous and stop-gain sequence variants in CXCR4, putatively damaging for CXCR4 function, were significantly enriched in JIA cases (p = 0.015). Conclusion Our results suggest the association of CXCR4 variants with JIA, implicating that this gene may be involved in the pathogenesis of autoimmune disease. However, because this locus is subjected to population stratification within the subjects of European ancestry, additional replication is still necessary for this locus to be considered a true risk locus for JIA. This cell-surface chemokine receptor has already been targeted in other diseases and may serve as a tractable therapeutic target for a specific subset of pediatric arthritis patients with additional replication and functional validation of the locus. Electronic supplementary material The online version of this article (doi:10.1186/s12881-016-0285-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Terri H Finkel
- Division of Rheumatology, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA. .,Department of Pediatrics, University of Pennsylvania School of Medicine, 19104, Philadelphia, PA, USA. .,Present Address: Department of Pediatrics, Nemours Research Institute, Nemours Children's Hospital, 32827, Orlando, FL, USA.
| | - Jin Li
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Zhi Wei
- Department of Computer Science, New Jersey Institute of Technology, 07102, New Jersey, NJ, USA
| | - Wei Wang
- Department of Computer Science, New Jersey Institute of Technology, 07102, New Jersey, NJ, USA
| | - Haitao Zhang
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Edward M Behrens
- Division of Rheumatology, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA.,Department of Pediatrics, University of Pennsylvania School of Medicine, 19104, Philadelphia, PA, USA
| | - Emma L Reuschel
- Division of Rheumatology, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA.,Department of Pediatrics, University of Pennsylvania School of Medicine, 19104, Philadelphia, PA, USA
| | - Sophie Limou
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Leidos Biomedical Research Inc., Frederick National Laboratory, 21702, Frederick, MD, USA
| | - Carol Wise
- Sarah M. and Charles E. Seay Center for Musculoskeletal Research, Texas Scottish Rite Hospital for Children, 75219, Dallas, TX, USA
| | - Marilynn Punaro
- Division of Rheumatology, Texas Scottish Rite Hospital, 75219, Dallas, TX, USA
| | - Mara L Becker
- Division of Rheumatology, Children's Mercy- Kansas City, 64108, Kansas City, MO, USA
| | - Jane E Munro
- Murdoch Childrens Research Institute, 3052, Parkville, VIC, Australia.,Paediatric Rheumatology Unit, Royal Children's Hospital, 3052, Parkville, VIC, Australia
| | - Berit Flatø
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Norway
| | - Øystein Førre
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Norway
| | - Susan D Thompson
- Cincinnati Children's Hospital Medical Center, 45229, Cincinnati, OH, USA
| | - Carl D Langefeld
- Center for Public Health Genomics and Department of Biostatistical Sciences, Wake Forest School of Medicine, 27157, Winston-Salem, NC, USA
| | - David N Glass
- Cincinnati Children's Hospital Medical Center, 45229, Cincinnati, OH, USA
| | - Joseph T Glessner
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Cecilia E Kim
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Edward Frackelton
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Debra K Shivers
- Division of Rheumatology, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Kelly A Thomas
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Rosetta M Chiavacci
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Cuiping Hou
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Kexiang Xu
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - James Snyder
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Haijun Qiu
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Frank Mentch
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA
| | - Kai Wang
- The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA.,Department of Psychiatry and Behavioral Sciences, UUniversity of Southern California, 90089, Los Angeles, CA, USA
| | - Cheryl A Winkler
- Basic Research Laboratory, Center for Cancer Research, National Cancer Institute, Leidos Biomedical Research Inc., Frederick National Laboratory, 21702, Frederick, MD, USA
| | - Benedicte A Lie
- Institute of Immunology, Oslo University Hospital, 0027, Rikshospitalet, Oslo, Norway
| | - Justine A Ellis
- Murdoch Childrens Research Institute, 3052, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, 3010, Melbourne, Australia
| | - Hakon Hakonarson
- Department of Pediatrics, University of Pennsylvania School of Medicine, 19104, Philadelphia, PA, USA. .,The Center for Applied Genomics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA. .,Division of Human Genetics, The Children's Hospital of Philadelphia, 19104, Philadelphia, PA, USA.
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Lin CH, Lin CL, Shen TC, Wei CC. Epidemiology and risk of juvenile idiopathic arthritis among children with allergic diseases: a nationwide population-based study. Pediatr Rheumatol Online J 2016; 14:15. [PMID: 26965056 PMCID: PMC4787040 DOI: 10.1186/s12969-016-0074-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Accepted: 03/04/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Epidemiological research reveals that the incidence of allergic diseases and that of autoimmune diseases have been increasing in parallel, raising an interest in a potential link between the two disorders. However, the relationship between Th2-mediated allergic disease and Th1-mediated juvenile idiopathic arthritis (JIA) remains unclear. This population-based case-control study was aimed at investigating the development of childhood-onset allergic diseases and the subsequent risks of JIA. METHODS We included 329 children with JIA diagnosed between 2000 and 2008, and 1316 age- and sex-matched controls. The odds ratios of developing JIA were calculated to determine an association with preexisting allergic diseases. RESULTS The incidence rate of JIA in Taiwan between 2000 and 2008 was 1.33 cases per 100,000 children/year according to the International League of Associations for Rheumatology (ILAR) criteria. The children with a single allergic disease had an increased risk of JIA, with adjusted odds ratios of developing JIA of 1.44 for allergic conjunctivitis (95 % confidence interval [CI], 1.07-1.95), 1.50 for allergic rhinitis (1.15-1.96), and 1.44 for asthma (1.00-2.10). The adjusted odds ratios increased with the number of concurrent allergic diseases from 1.50 (95 % CI, 1.12-2.01) for those with only one allergic disease to 1.72 (1.24-2.38) for those with at least two allergic diseases. The adjusted odds ratios of those with at least two allergic diseases increased to 1.84 (95 % CI, 1.19-2.86) for boys and 2.54 (1.42-4.54) for those older than 12 years. The children who made two or more medical visits for associated allergic diseases per year had an increased risk of JIA. CONCLUSION Children with onset of allergic diseases were at increased risk of developing JIA. The increased risk was associated with the cumulative effect of concurrent allergic diseases and frequency of seeking medical care. Further study to investigate the role of Th2-mediated allergic diseases that contribute to the development of Th1-mediated JIA is warranted.
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Affiliation(s)
- Chien-Heng Lin
- Children’s Hospital of China Medical University Hospital, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan ,Department of Public Health, China Medical University, Taichung, Taiwan
| | - Te-Chun Shen
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, China Medical University Hospital, Taichung, Taiwan ,School of Medicine, China Medical University, No2, Yu-Der Road, Taichung, 40402 Taiwan
| | - Chang-Ching Wei
- Children's Hospital of China Medical University Hospital, Taichung, Taiwan. .,School of Medicine, China Medical University, No2, Yu-Der Road, Taichung, 40402, Taiwan.
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Guo R, Cao L, Kong X, Xue H, Li X, Shen L. Atopy in children with the enthesitis-related arthritis (ERA) subtype of juvenile idiopathic arthritis is associated with a worse outcome. Eur J Pediatr 2015; 174:1441-50. [PMID: 25935591 DOI: 10.1007/s00431-015-2553-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 03/21/2015] [Accepted: 04/21/2015] [Indexed: 01/17/2023]
Abstract
UNLABELLED We aimed to assess the influence of co-existing atopy on the prognosis of enthesitis-related arthritis (ERA). Patients diagnosed with ERA between March 2006 and August 2012 were enrolled in a prospective cohort study and followed for 2 years. Management of patients was evaluated using the American College of Rheumatology (ACR) pediatric (Pedi) 30/50/70 criteria and laboratory variables. A total of 151 ERA patients were enrolled at diagnosis and were divided into those with atopy (n = 62) and those without (n = 89). When compared with the non-atopic group, atopic patients had significantly more active joints at disease onset (4.72 vs. 3.75), more joints with limitation of motion (LOM) (1.45 vs. 0.87), more painful joints (3.61 vs. 2.80), and more swollen joints (1.02 vs. 0.69) (p < 0.05 for all comparisons). At 3, 6, 12, 18, and 24 months, fewer ERA patients with atopy reached the ACR Pedi 50 and 70 criteria (at 3 months, 25.8 vs. 60.7 % and 11.3 vs. 34.8 %, respectively; at 6 months, 50 vs. 77.5 % and 22.6 vs. 58.4 %, respectively; at 12 months, 53.2 vs. 70.8 % and 33.9 vs. 55.1 %, respectively; at 18 months, 62.9 vs. 86.5 % and 56.5 vs. 78.7 %, respectively; at 24 months, 66.1 vs. 89.9 % and 61.3 vs. 78.7 %, respectively; all p < 0.05). During the 2 years of follow-up, the number of flares was significantly higher in ERA patients with co-existing atopy (1.48 vs. 0.70, p < 0.05). CONCLUSION Co-existing atopy in children with ERA may exert an adverse influence on ERA, with atopic patients manifesting more active disease at diagnosis and poorer outcome. \
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Affiliation(s)
- Ruru Guo
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Rd, Shanghai, 200127, People's Republic of China.
| | - Lanfang Cao
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Rd, Shanghai, 200127, People's Republic of China.
| | - Xianming Kong
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Rd, Shanghai, 200127, People's Republic of China.
| | - Haiyan Xue
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Rd, Shanghai, 200127, People's Republic of China.
| | - Xiaoli Li
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Rd, Shanghai, 200127, People's Republic of China.
| | - Lijuan Shen
- Department of Pediatrics, Renji Hospital, School of Medicine, Shanghai Jiaotong University, 1630 Dongfang Rd, Shanghai, 200127, People's Republic of China.
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Sá MCD, Moreira C, Melo C, Sousa Á, Carvalho S. Lyme disease and juvenile idiopathic arthritis - A pediatric case report. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 57:S0482-5004(15)00126-6. [PMID: 26498846 DOI: 10.1016/j.rbr.2015.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Revised: 07/20/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022] Open
Affiliation(s)
- Mário Correia de Sá
- Serviço de Pediatria, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal.
| | - Catarina Moreira
- Unidade de Saúde Familiar Ribeirão, Vila Nova de Famalicão, Portugal
| | - Cláudia Melo
- Serviço de Pediatria, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Álvaro Sousa
- Serviço de Pediatria, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
| | - Sónia Carvalho
- Serviço de Pediatria, Centro Hospitalar do Médio Ave, Vila Nova de Famalicão, Portugal
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Miller J, Ponsonby AL, Pezic A, Kemp A, Piper SE, Akikusa JD, Allen RC, Munro JE, Ellis JA. Sibling Exposure and Risk of Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2015; 67:1951-8. [DOI: 10.1002/art.39129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/19/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Jessica Miller
- Murdoch Childrens Research Institute; Parkville Victoria Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia, and University of Melbourne; Melbourne Victoria Australia
| | - Angela Pezic
- Murdoch Childrens Research Institute; Parkville Victoria Australia
| | - Andrew Kemp
- Murdoch Childrens Research Institute; Parkville Victoria Australia
| | - Susan E. Piper
- Monash Children's Hospital; Monash Medical Centre; Clayton Victoria Australia
| | - Jonathan D. Akikusa
- Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Victoria Australia
| | - Roger C. Allen
- Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Victoria Australia
| | - Jane E. Munro
- Murdoch Childrens Research Institute and Royal Children's Hospital; Parkville Victoria Australia
| | - Justine A. Ellis
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia, and University of Melbourne; Melbourne Victoria Australia
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DNA methylation at IL32 in juvenile idiopathic arthritis. Sci Rep 2015; 5:11063. [PMID: 26057774 PMCID: PMC4603785 DOI: 10.1038/srep11063] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 05/11/2015] [Indexed: 12/15/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common autoimmune rheumatic disease of childhood. We recently showed that DNA methylation at the gene encoding the pro-inflammatory cytokine interleukin-32 (IL32) is reduced in JIA CD4+ T cells. To extend this finding, we measured IL32 methylation in CD4+ T-cells from an additional sample of JIA cases and age- and sex-matched controls, and found a reduction in methylation associated with JIA consistent with the prior data (combined case-control dataset: 25.0% vs 37.7%, p = 0.0045). Further, JIA was associated with reduced IL32 methylation in CD8+ T cells (15.2% vs 25.5%, p = 0.034), suggesting disease-associated changes to a T cell precursor. Additionally, we measured regional SNPs, along with CD4+ T cell expression of total IL32, and the γ and β isoforms. Several SNPs were associated with methylation. Two SNPs were also associated with JIA, and we found evidence of interaction such that methylation was only associated with JIA in minor allele carriers (e.g. rs10431961 pinteraction = 0.011). Methylation at one measured CpG was inversely correlated with total IL32 expression (Spearman r = −0.73, p = 0.0009), but this was not a JIA-associated CpG. Overall, our data further confirms that reduced IL32 methylation is associated with JIA, and that SNPs play an interactive role.
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Abstract
Vitamin D, upon its discovery one century ago, was classified as a vitamin. This classification still greatly affects our perception about its biological role. 1,25(OH)2D (now known as the D hormone) is a pleiotropic steroid hormone that has multiple biologic effects. It is integral to the regulation of calcium homeostasis and bone turnover as well as having anti-proliferative, pro-differentiation, anti-bacterial, immunomodulatory and anti-inflammatory properties within the body in various cells and tissues. Vitamin D (cholecalciferol) should be considered a nutritional substrate that must be ingested or synthesized in sufficient amounts for the further synthesis of the very important regulatory steroid hormone (D hormone), especially in patients with pediatric rheumatic diseases (PRD). Vitamin D insufficiency or deficiency was shown to be pandemic and associated with numerous chronic inflammatory and malignant diseases and even with increased risk of mortality. Several studies have demonstrated that a high percentage of children with pediatric rheumatic diseases (PRD-e.g., JIA, jSLE) have a vitamin D deficiency or insufficiency which might correlate with disease outcome and flares. Glucocorticoids used to treat disease may have a regulatory effect on vitamin D metabolism which can additionally aggravate bone turnover in PRD. An effort to define the optimal serum 25(OH)D concentrations for healthy children and adults was launched in 2010 but as of now there are no guidelines about supplementation in PRD. In this review we have tried to summarize the strong evidence now suggesting that as the knowledge of the optimal approach to diagnosis and treatment PRD has evolved, there is also an emerging need for vitamin D supplementation as an adjunct to regular disease treatment. So in accordance with new vitamin D recommendations, we recommend that a child with rheumatic disease, especially if treated with steroids, needs at least 2-3 time higher doses of vitamin D than the dose recommended for age (approximately 2000 UI/day). Vitamin D supplementation has become an appealing and important adjunct treatment option in PRD.
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Affiliation(s)
- Jelena Vojinovic
- Clinic of Pediatrics, Clinical Center, Faculty of Medicine, University of Nis, Bul dr Zorana Djindjica 48, 18000, Nis, Serbia.
| | - Rolando Cimaz
- Dipartimento di Neuroscienze, Area del Farmaco e Salute del Bambino (NEUROFARBA), Viale Pieraccini, 24, 50139, Firenze, Italy.
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de Sousa Studart SA, Leite ACRM, Marinho ALLF, Pinto ACMD, Rabelo Júnior CN, de Melo Nunes R, Rocha HAL, Rocha FAC. Vitamin D levels in juvenile idiopathic arthritis from an equatorial region. Rheumatol Int 2015; 35:1717-23. [PMID: 25991398 DOI: 10.1007/s00296-015-3287-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 05/11/2015] [Indexed: 11/28/2022]
Abstract
We aimed to describe the serum levels of 25-hydroxyvitamin D (25OHD) in juvenile idiopathic arthritis (JIA) patients living in a low-latitude (3°43'S) region. Fifty JIA patients, 31 (62 %) female, seen between May 2012 and April 2013 in the northeast of Brazil had clinical data and serum collected for determination of 25OHD and parathyroid hormone (PTH) using a chemiluminescent ELISA; 20 age- and sex-matched controls were used for comparison. Mean age was 13.4 ± 4 years. Twenty-five (50 %), 15 (30 %), 4 (8 %), 4 (8 %), and 2 (4 %) patients were of the polyarticular, oligoarticular, systemic, enthesitis-related, and undifferentiated categories, respectively. Mean 25OHD was 31.6 ± 10 and 30.4 ± 5.7 ng/mL in patients and controls (P > 0.05), respectively; PTH was normal in JIA and controls; 25OHD was similar regardless of JIA category, disease activity, or severity measured by JADAS-27, CHAQ, or presence of joint deformities. Twenty-six (52 %), 20 (40 %), and 4 (8 %) patients were considered to have optimal, sufficient, and deficient 25OHD levels, respectively, whereas 11 (52 %) and 10 (48 %) controls had optimal and sufficient 25OHD. Ethnicity, body mass index, seasonal variation, and use of steroids did not influence 25OHD levels. This is the first study on 25OHD levels in JIA patients living in a low-latitude region, showing the lowest prevalence of vitamin D deficiency ever reported. Serum 25OHD was similar in JIA and controls and did not vary regardless of JIA category or severity.
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Affiliation(s)
| | | | | | | | - Carlos Nobre Rabelo Júnior
- Rheumatology Service, Pediatric Rheumatology Division, Hospital Geral de Fortaleza, Fortaleza, CE, Brazil
| | - Rodolfo de Melo Nunes
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil
| | | | - Francisco Airton Castro Rocha
- Department of Internal Medicine, Faculty of Medicine, Universidade Federal do Ceará, Fortaleza, CE, Brazil. .,, Rua Coronel Nunes de Melo, 1315, Rodolfo Teofilo, Fortaleza, CE, CEP: 60.430-270, Brazil.
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Ellis JA, Scurrah KJ, Li YR, Ponsonby AL, Chavez RA, Pezic A, Dwyer T, Akikusa JD, Allen RC, Becker ML, Thompson SD, Lie BA, Flatø B, Førre O, Punaro M, Wise C, Finkel TH, Hakonarson H, Munro JE. Epistasis amongst PTPN2 and genes of the vitamin D pathway contributes to risk of juvenile idiopathic arthritis. J Steroid Biochem Mol Biol 2015; 145:113-20. [PMID: 25460303 DOI: 10.1016/j.jsbmb.2014.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 09/22/2014] [Accepted: 10/12/2014] [Indexed: 11/22/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a leading cause of childhood-onset disability. Although epistasis (gene-gene interaction) is frequently cited as an important component of heritability in complex diseases such as JIA, there is little compelling evidence that demonstrates such interaction. PTPN2, a vitamin D responsive gene, is a confirmed susceptibility gene in JIA, and PTPN2 has been suggested to interact with vitamin D pathway genes in type 1 diabetes. We therefore, tested for evidence of epistasis amongst PTPN2 and the vitamin D pathway genes GC, VDR, CYP24A1, CYP2R1, and DHCR7 in two independent JIA case-control samples (discovery and replication). In the discovery sample (318 cases, 556 controls), we identified evidence in support of epistasis across six gene-gene combinations (e.g., GC rs1155563 and PTPN2 rs2542151, ORint=0.45, p=0.00085). Replication was obtained for three of these combinations. That is, for GC and PTPN2, CYP2R1 and VDR, and VDR and PTPN2, similar epistasis was observed using the same SNPs or correlated proxies in an independent JIA case-control sample (1008 cases, 9287 controls). Using SNP data imputed across a 4 MB region spanning each gene, we obtained highly significant evidence for epistasis amongst all 6 gene-gene combinations identified in the discovery sample (p-values ranging from 5.6×10(-9) to 7.5×10(-7)). This is the first report of epistasis in JIA risk. Epistasis amongst PTPN2 and vitamin D pathway genes was both demonstrated and replicated.
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Affiliation(s)
- Justine A Ellis
- Genes, Environment and Complex Disease, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia.
| | - Katrina J Scurrah
- Department of Physiology, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Yun R Li
- Medical Scientist Training Program, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA; Center for Applied Genomics and Department of Pediatrics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia,PA 19104, USA
| | - Anne-Louise Ponsonby
- Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia; Environmental and Genetic Epidemiology Research, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia
| | - Raul A Chavez
- Genes, Environment and Complex Disease, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia
| | - Angela Pezic
- Environmental and Genetic Epidemiology Research, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia
| | - Terence Dwyer
- Environmental and Genetic Epidemiology Research, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia
| | - Jonathan D Akikusa
- Paediatric Rheumatology Unit, Royal Children's Hospital, Parkville, Victoria 3052, Australia; Arthritis and Rheumatology Research, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia
| | - Roger C Allen
- Paediatric Rheumatology Unit, Royal Children's Hospital, Parkville, Victoria 3052, Australia; Arthritis and Rheumatology Research, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia
| | - Mara L Becker
- Divisions of Rheumatology and Clinical Pharmacology and Therapeutic Innovation, Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA
| | - Susan D Thompson
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
| | - Benedicte A Lie
- Department of Immunology, Oslo University Hospital and University of Oslo, Rikshospitalet, 0027 Oslo, Norway
| | - Berit Flatø
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway
| | - Oystein Førre
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, 0027 Oslo, Norway
| | - Marilynn Punaro
- Pediatric Rheumatology, Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA
| | - Carol Wise
- Sarah M. and Charles E. Seay Center for Musculoskeletal Research, Texas Scottish Rite Hospital for Children, Dallas, TX 75219, USA
| | - Terri H Finkel
- Department of Pediatrics, Nemours Children's Hospital, Orlando, FL 32827, USA; Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Hakon Hakonarson
- Center for Applied Genomics and Department of Pediatrics, Abramson Research Center, The Children's Hospital of Philadelphia, Philadelphia,PA 19104, USA; Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Jane E Munro
- Paediatric Rheumatology Unit, Royal Children's Hospital, Parkville, Victoria 3052, Australia; Arthritis and Rheumatology Research, Murdoch Childrens Research Institute, Parkville, Victoria 3052, Australia
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Kalinina Ayuso V, Makhotkina N, van Tent-Hoeve M, de Groot-Mijnes JD, Wulffraat NM, Rothova A, de Boer JH. Pathogenesis of juvenile idiopathic arthritis associated uveitis: the known and unknown. Surv Ophthalmol 2014; 59:517-31. [DOI: 10.1016/j.survophthal.2014.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 12/17/2022]
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Singh S, Rai G, Aggarwal A. Association of microRNA-146a and its target gene IRAK1 polymorphism with enthesitis related arthritis category of juvenile idiopathic arthritis. Rheumatol Int 2014; 34:1395-400. [DOI: 10.1007/s00296-014-3001-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 03/25/2014] [Indexed: 11/28/2022]
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Abstract
Autoimmune disease manifests in numerous forms, but as a disease group is relatively common in the population. It is complex in aetiology, with genetic and environmental determinants. The involvement of gene variants in autoimmune disease is well established, and evidence for significant involvement of the environment in various disease forms is growing. These factors may act independently, or they may interact, with the effect of one factor influenced by the presence of another. Identifying combinations of genetic and environmental factors that interact in autoimmune disease has the capacity to more fully explain disease risk profile, and to uncover underlying molecular mechanisms contributing to disease pathogenesis. In turn, such knowledge is likely to contribute significantly to the development of personalised medicine, and targeted preventative approaches. In this review, we consider the current evidence for gene-environment (G-E) interaction in autoimmune disease. Large-scale G-E interaction research efforts, while well-justified, face significant practical and methodological challenges. However, it is clear from the evidence that has already been generated that knowledge on how genes and environment interact at a biological level will be crucial in fully understanding the processes that manifest as autoimmunity.
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Alcântara ACDC, Leite CAC, Leite ACRM, Sidrim JJC, Silva FS, Rocha FAC. A longterm prospective real-life experience with leflunomide in juvenile idiopathic arthritis. J Rheumatol 2013; 41:338-44. [PMID: 24334641 DOI: 10.3899/jrheum.130294] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe a clinical practice with leflunomide (LEF) in juvenile idiopathic arthritis (JIA). METHODS Patients with JIA seen between May 2008 and May 2012 and considered nonresponsive to methotrexate (MTX) were given LEF and prospectively followed. Primary outcome was a 28-joint Disease Activity Score (DAS28) of low disease activity (< 3.2) in less than 6 months. Childhood Health Assessment Questionnaire (CHAQ) scores and safety data were recorded. RESULTS Forty-three patients (33 female) were included with 25 (58.1%) polyarticular, 10 oligoarticular (7 extended; 3 persistent), 6 systemic, and 2 enthesitis-related. Ten (23.2%) were rheumatoid factor-positive and 7 (16.3%) had antinuclear antibodies. Prior drugs other than MTX: 11 (25.5%) chloroquine diphosphate + MTX and 2 (4.6%) sulfasalazine + MTX; mean prednisone dose was 6.4 ± 9.3 mg. The MTX dose prior to LEF was 14.5 ± 4.5 mg/m(2)/week. LEF dose and duration of therapy were 16.6 ± 5.2 mg/d and 3.6 ± 2.2 years, respectively. Nineteen patients (44.2%) interrupted LEF: 1 entered remission, 11 were nonresponsive, and 7 were intolerant (16.2%). Baseline DAS28 (5.57 ± 0.7) dropped to 3.7 ± 1.2 at final analysis (p < 0.001) and 16 patients (37.2%) had a low DAS28 [< 3.2; 12 (27.9%) while taking LEF + MTX and 4 (9.3%) while taking monotherapy]. At last followup, the number of patients with DAS28 > 5.1 dropped from 34 (79%) to 9 (20.9%) and CHAQ scores from 0.86 ± 0.7 to 0.44 ± 0.5 (p < 0.001). CONCLUSION LEF isolated or combined with MTX is effective and safe to treat JIA in patients refractory to MTX.
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Cobb JE, Hinks A, Thomson W. The genetics of juvenile idiopathic arthritis: current understanding and future prospects. Rheumatology (Oxford) 2013; 53:592-9. [DOI: 10.1093/rheumatology/ket314] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
PURPOSE OF REVIEW The role of vitamin D in situations other than calcium homeostasis and bone health has become very topical. It is apparent that vitamin D has significant effects on the immune system and as such may contribute to the pathogenesis of autoimmune disease. This review examines the evidence-to-date that vitamin D has a role in immune-mediated rheumatic disorders. RECENT FINDINGS Low vitamin D status is reported in many inflammatory rheumatic conditions. In some this extends to an association with disease activity. Vitamin D acts on a number of cells involved in both innate and acquired immunity biasing the adaptive immune system away from Th17 and Th1, towards Th2 and Tregs. Deficiency accordingly could encourage autoimmunity. Direct evidence for this plausible mechanism in specific diseases remains largely to be demonstrated. To date, there is a dearth of controlled trials of vitamin D in prophylaxis or therapy. SUMMARY Vitamin D deficiency may well be an important factor in autoimmune rheumatic disease, including initial disease development and worsening the disease once present. This is testable and there is a pressing need for therapeutic studies.
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Jung KH, Haam KK, Park S, Kim Y, Lee SR, Lee G, Kim M, Hong M, Shin M, Jung S, Bae H. The standardized herbal formula, PM014, ameliorated cigarette smoke-induced lung inflammation in a murine model of chronic obstructive pulmonary disease. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:219. [PMID: 24010767 PMCID: PMC3847199 DOI: 10.1186/1472-6882-13-219] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/29/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND In this study, we evaluated the anti-inflammatory effect of PM014 on cigarette smoke induced lung disease in the murine animal model of chronic obstructive pulmonary disease (COPD). METHODS Mice were exposed to cigarette smoke (CS) for 2 weeks to induce COPD-like lung inflammation. Two hours prior to cigarette smoke exposure, the treatment group was administered PM014 via an oral injection. To investigate the effects of PM014, we assessed PM014 functions in vivo, including immune cell infiltration, cytokine profiles in bronchoalveolar lavage (BAL) fluid and histopathological changes in the lung. The efficacy of PM014 was compared with that of the recently developed anti-COPD drug, roflumilast. RESULTS PM014 substantially inhibited immune cell infiltration (neutrophils, macrophages, and lymphocytes) into the airway. In addition, IL-6, TNF-α and MCP-1 were decreased in the BAL fluid of PM014-treated mice compared to cigarette smoke stimulated mice. These changes were more prominent than roflumilast treated mice. The expression of PAS-positive cells in the bronchial layer was also significantly reduced in both PM014 and roflumilast treated mice. CONCLUSIONS These data suggest that PM014 exerts strong therapeutic effects against CS induced, COPD-like lung inflammation. Therefore, this herbal medicine may represent a novel therapeutic agent for lung inflammation in general, as well as a specific agent for COPD treatment.
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Affiliation(s)
- Kyung-Hwa Jung
- Department of Physiology, College of Korean Medicine, Kyung Hee University, #1 Hoekidong, Dongdaemoonku, Seoul 130-701, Republic of Korea
| | - Kyoung-Keun Haam
- Department of Physiology, College of Korean Medicine, Kyung Hee University, #1 Hoekidong, Dongdaemoonku, Seoul 130-701, Republic of Korea
| | - Soojin Park
- Department of Physiology, College of Korean Medicine, Kyung Hee University, #1 Hoekidong, Dongdaemoonku, Seoul 130-701, Republic of Korea
| | - Youngeun Kim
- Department of Physiology, College of Korean Medicine, Kyung Hee University, #1 Hoekidong, Dongdaemoonku, Seoul 130-701, Republic of Korea
| | - Seung Ryel Lee
- Department of Physiology, College of Korean Medicine, Kyung Hee University, #1 Hoekidong, Dongdaemoonku, Seoul 130-701, Republic of Korea
| | - Geunhyeog Lee
- Central Research Institute, Hanlim Pharm. Co. Ltd., 1007 Yoobang Dong, Yongin, Kyounggi Do, Republic of Korea
| | - Miran Kim
- Central Research Institute, Hanlim Pharm. Co. Ltd., 1007 Yoobang Dong, Yongin, Kyounggi Do, Republic of Korea
| | - Moochang Hong
- Department of Physiology, College of Korean Medicine, Kyung Hee University, #1 Hoekidong, Dongdaemoonku, Seoul 130-701, Republic of Korea
| | - Minkyu Shin
- Department of Physiology, College of Korean Medicine, Kyung Hee University, #1 Hoekidong, Dongdaemoonku, Seoul 130-701, Republic of Korea
| | - Sungki Jung
- Division of Allergy and Respiratory System, Department of Internal Medicine, College of Korean Medicine, Kyung Hee University, #1 Hoekidong, Dongdaemoonku, Seoul 130-701, Republic of Korea
| | - Hyunsu Bae
- Department of Physiology, College of Korean Medicine, Kyung Hee University, #1 Hoekidong, Dongdaemoonku, Seoul 130-701, Republic of Korea
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