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Ramos FO, Zinterl C, Fonseca JE. A lifelong journey: Long-term perspectives on Juvenile Idiopathic Arthritis. Best Pract Res Clin Rheumatol 2024:101984. [PMID: 39068102 DOI: 10.1016/j.berh.2024.101984] [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: 03/29/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Juvenile Idiopathic Arthritis (JIA) represents a diverse group of chronic inflammatory conditions that begin in childhood or adolescence and continue into adulthood, with varying severity and outcomes. This review discusses the complexities of transitioning JIA patients emphasizing that inadequate transition from pediatric to adult care leads to loss of follow-up, treatment discontinuation, and increased disease activity. Furthermore, challenges in disease classification hinder continuity of care across lifespan. It is also pointed out that predicting long-term outcomes in JIA remains complex due to heterogeneity and evolving phenotypes. Factors such as disease category, joint involvement, and treatment influence disease activity, functional disability, and quality of life. Despite advancements in treatment strategies, a substantial proportion of patients experience long-term disability and joint damage. Finally, it is underscored that optimising long-term outcomes in adults with JIA requires a multifaceted approach encompassing structured transition processes, personalised treatment strategies, and comprehensive management of comorbidities. Further research is needed to refine predictive models, enhance disease monitoring tools, and understand the complex interplay between disease activity, treatment response, and long-term outcomes.
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Affiliation(s)
- Filipa Oliveira Ramos
- Unidade de Reumatologia Pediátrica, Hospital Universitário Santa Maria, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal.
| | - Carolina Zinterl
- Unidade de Reumatologia Pediátrica, Hospital Universitário Santa Maria, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Portugal
| | - João Eurico Fonseca
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal; Serviço de Reumatologia, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Portugal
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Roy LM, Neill A, Swampy K, Auger J, Campbell SM, Chatwood S, Al Sayah F, Johnson JA. Preference-based measures of health-related quality of life in Indigenous people: a systematic review. Qual Life Res 2024; 33:317-333. [PMID: 37715878 PMCID: PMC10850204 DOI: 10.1007/s11136-023-03499-7] [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] [Accepted: 07/25/2023] [Indexed: 09/18/2023]
Abstract
PURPOSE In many countries, there are calls to address health inequalities experienced by Indigenous people. Preference-based measures (PBMs) provide a measurement of health-related quality of life and can support resource allocation decisions. This review aimed to identify, summarize, and appraise the literature reporting the use and performance of PBMs with Indigenous people. METHODS Eleven major databases were searched from inception to August 31, 2022. Records in English that (1) assessed any measurement property of PBMs, (2) directly elicited health preferences, (3) reported the development or translation of PBMs for Indigenous people, or (4) measured health-related quality of life (HRQL) using PBMs were included. Ethically engaged research with Indigenous people was considered as an element of methodological quality. Data was synthesized descriptively (PROSPERO ID: CRD42020205239). RESULTS Of 3139 records identified, 81 were eligible, describing psychometric evaluation (n = 4), preference elicitation (n = 4), development (n = 4), translation (n = 2), and HRQL measurement (n = 71). 31 reported ethically engaged research. Reports originated primarily from Australia (n = 38), New Zealand (n = 20), USA (n = 9) and Canada (n = 6). Nearly all (n = 73) reported indirect, multi-attribute PBMs, the most common of which was the EQ-5D (n = 50). CONCLUSION A large number of recent publications from diverse disciplines report the use of PBMs with Indigenous people, despite little evidence on measurement properties in these populations. Understanding the measurement properties of PBMs with Indigenous people is important to better understand how these measures might, or might not, be used in policy and resource decisions affecting Indigenous people. (Funding: EuroQoL Research Foundation).
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Affiliation(s)
- Lilla M Roy
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- School of Nursing, Cape Breton University, Sydney, NS, Canada
| | - Aidan Neill
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Kristen Swampy
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | | | - Sandra M Campbell
- John W. Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | - Susan Chatwood
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Fatima Al Sayah
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Woolnough LU, Lentini L, Bhavsar PH, Thomas MF, Casella ZM, Vincent HK. Child and Caregiver Beliefs of Importance of Physical Function and Quality of Life in Juvenile Idiopathic Arthritis: A Survey Study. Pediatr Phys Ther 2024; 36:88-93. [PMID: 37820355 DOI: 10.1097/pep.0000000000001060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
PURPOSE To evaluate patient-caregiver beliefs of relative importance across 4 domains while living with juvenile idiopathic arthritis (JIA). METHODS This was a cross-sectional, anonymous survey study conducted in an academic medical center. Participants with JIA and caregivers (N = 151) completed a Likert-style survey to rate items by importance of knowledge about 4 domains: medications, physical activity, routine measures, and quality of life. RESULTS Knowledge of medication issues ranked higher than the remaining 3 domains (4.2 ± 0.7 points vs 4.0 ± 0.7, 4.1 ± 0.8, and 4.0 ± 0.9 points, respectively; P = .026; P = .026). Compared with caregivers, participants rated importance lower for all 4 domains. CONCLUSIONS Gait and physical activity and well-being are not uniformly measured as part of routine clinical care and disease tracking in JIA. Both participants and caregivers ranked knowledge of physical activity similarly to routine office measures and quality of life. Inclusion of these measures in routine care could improve people centeredness and inform treatment plans.
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Affiliation(s)
- Leandra U Woolnough
- Departments of Pediatrics (Dr Woolnough and Mr Lentini) and Physical Medicine and Rehabilitation (Dr Vincent), College of Medicine, University of Florida, Gainesville, Florida; Applied Physiology and Kinesiology Program (Mss Bhavsar and Thomas and Mr Casella), University of Florida, Gainesville, Florida
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Rosina S, Rebollo-Giménez AI, Consolaro A, Ravelli A. Treat-to-Target in Pediatric Rheumatic Diseases. Curr Rheumatol Rep 2023; 25:226-235. [PMID: 37584859 DOI: 10.1007/s11926-023-01112-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW To summarize the current evidence on the adoption of the treat-to-target (T2T) strategy in pediatric rheumatic diseases (PRD). RECENT FINDINGS The recent advances in the management of PRD have markedly increased the ability to achieve disease remission. Complete disease quiescence is regarded as the ideal therapeutic goal because its attainment leads to lesser long-term damage and physical disability, and to optimization of quality of life. Studies in adult rheumatic diseases have shown that patient outcomes are improved if complete suppression of the inflammatory process is aimed for by frequent adjustments of therapy according to quantitative indices. This approach, which underlies the T2T concept, has been applied in strategic trials in rheumatoid arthritis (RA). Furthermore, recommendations for the T2T have been issued for RA and other adult rheumatic diseases. There is currently a growing interest for the introduction of T2T in PRD, and recommendations for treating juvenile idiopathic arthritis (JIA) to target were promulgated. A similar initiative has been undertaken for childhood-onset systemic lupus erythematosus. Preliminary therapeutic studies have explored the T2T design in JIA. The T2T strategy is a modern therapeutic approach that holds the promise of improving the outcomes in patients with PRD.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia E Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | | | - Alessandro Consolaro
- UOC Reumatologia E Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento Di Neuroscienze, Scienze Materno-Infantili, Università Degli Studi Di Genova, RiabilitazioneGenoa, Oftalmologia, Geneticae , Italy
| | - Angelo Ravelli
- Dipartimento Di Neuroscienze, Scienze Materno-Infantili, Università Degli Studi Di Genova, RiabilitazioneGenoa, Oftalmologia, Geneticae , Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Nguyen K, Barsalou J, Basodan D, Batthish M, Benseler SM, Berard RA, Blanchette N, Boire G, Bolaria R, Bruns A, Cabral DA, Cameron B, Campillo S, Cellucci T, Chan M, Chédeville G, Chetaille AL, Chhabra A, Couture J, Dancey P, De Bruycker JJ, Demirkaya E, Dhalla M, Duffy CM, Feldman BM, Feldman DE, Gerschman T, Haddad E, Heale L, Herrington J, Houghton K, Huber AM, Human A, Johnson N, Jurencak R, Lang B, Larché M, Laxer RM, LeBlanc CM, Lee JJY, Levy DM, Lim L, Lim LSH, Luca N, McGrath T, McMillan T, Miettunen PM, Morishita KA, Ng HY, Oen K, Park J, Petty RE, Proulx-Gauthier JP, Ramsey S, Roth J, Rosenberg AM, Rozenblyum E, Rumsey DG, Schmeling H, Schneider R, Scuccimarri R, Shiff NJ, Silverman E, Soon G, Spiegel L, Stringer E, Tam H, Tse SM, Tucker L, Turvey S, Twilt M, Duffy KW, Yeung RSM, Guzman J. A decade of progress in juvenile idiopathic athritis treatments and outcomes in Canada: results from ReACCh-Out and the CAPRI registry. Rheumatology (Oxford) 2023:kead560. [PMID: 37851400 DOI: 10.1093/rheumatology/kead560] [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: 05/05/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To assess changes in juvenile idiopathic arthritis (JIA) treatments and outcomes in Canada, comparing a 2005-2010 and a 2017-2021 inception cohorts. METHODS Patients enrolled within three months of diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) and the Canadian Alliance of Pediatric Rheumatology Investigators Registry (CAPRI) cohorts were included. Cumulative incidences of drug starts and outcome attainment within 70 weeks of diagnosis were compared with Kaplan Meier survival analysis and multivariable Cox regression. RESULTS The 2005-2010 and 2017-2021 cohorts included 1128 and 721 patients, respectively. JIA category distribution and baseline clinical juvenile idiopathic arthritis disease activity (cJADAS10) scores at enrolment were comparable. By 70 weeks, 6% of patients (95% CI 5, 7) in the 2005-2010 and 26% (23, 30) in the 2017-2021 cohort had started a biologic DMARD (bDMARD), and 43% (40, 47) and 60% (56, 64) had started a conventional DMARD (cDMARD), respectively. Outcome attainment was 64% (61, 67) and 83% (80, 86) for Inactive disease (Wallace criteria), 69% (66, 72) and 84% (81, 87) for minimally active disease (cJADAS10 criteria), 57% (54, 61) and 63% (59, 68) for pain control (<1/10), and 52% (47, 56) and 54% (48, 60) for a good health-related quality of life. CONCLUSION Although baseline disease characteristics were comparable in the 2005-2010 and 2017-2021 cohorts, cDMARD and bDMARD use increased with a concurrent increase in minimally active and inactive disease. Improvements in parent and patient reported outcomes were smaller than improvements in disease activity.
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Affiliation(s)
- Kelly Nguyen
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Roxana Bolaria
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David A Cabral
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Mercedes Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Paul Dancey
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | | | | | | | | | | | - Tommy Gerschman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie Haddad
- Université de Montréal, Montréal, Quebec, Canada
| | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | | | - Kristin Houghton
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam M Huber
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Human
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Bianca Lang
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Lillian Lim
- University of Alberta, Edmonton, Alberta, Canada
| | - Lily S H Lim
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nadia Luca
- University of Ottawa, Ottawa, Ontario, Canada
| | - Tara McGrath
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | - Hon Yan Ng
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Ross E Petty
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Dax G Rumsey
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | - Gordon Soon
- Health Sciences North, Sudbury, Ontario, Canada
- North York General Hospital, North York, Toronto, Ontario, Canada
| | | | | | - Herman Tam
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori Tucker
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Turvey
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Jaime Guzman
- University of British Columbia, Vancouver, British Columbia, Canada
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Oliveira Ramos F, Rodrigues AM, Melo AT, Aguiar F, Brites L, Azevedo S, Duarte AC, Gomes JAM, Furtado C, Mourão AF, Sequeira G, Cunha I, Figueira R, Santos MJ, Fonseca JE. Influence of the timing of biological treatment initiation on Juvenile Idiopathic Arthritis long-term outcomes. Arthritis Res Ther 2023; 25:177. [PMID: 37735435 PMCID: PMC10512498 DOI: 10.1186/s13075-023-03166-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) treatment is aimed at inducing remission to prevent joint destruction and disability. However, it is unclear what is the long-term impact on health-related outcomes of the timing of biological disease-modifying antirheumatic drug (bDMARD) initiation in JIA. Our aim was to evaluate the long-term impact of the time between JIA onset and the initiation of a bDMARD in achieving clinical remission, on physical disability and health-related quality of life (HRQoL). METHODS Adult JIA patients registered in the Rheumatic Diseases Portuguese Register (Reuma.pt) and ever treated with bDMARD were included. Data regarding socio-demographic, JIA-related characteristics, disease activity, physical disability (HAQ-DI), HRQoL (SF-36), and treatments were collected at the last visit. Patients were divided into 3 groups (≤ 2 years, 2-5 years, or > 5 years), according to the time from disease onset to bDMARD initiation. Regression models were obtained considering remission on/off medication, HAQ-DI, SF-36, and joint surgeries as outcomes and time from disease onset to bDMARD start as an independent variable. RESULTS Three hundred sixty-one adult JIA patients were evaluated, with a median disease duration of 20.3 years (IQR 12.1; 30.2). 40.4% had active disease, 35.1% were in remission on medication, and 24.4% were in drug-free remission; 71% reported some degree of physical disability. Starting a bDMARD > 5 years after disease onset decreased the chance of achieving remission off medication (OR 0.24; 95% CI 0.06, 0.92; p = 0.038). Patients who started a bDMARD after 5 years of disease onset had a higher HAQ and worse scores in the physical component, vitality, and social function domains of SF-36, and more joint surgeries when compared to an earlier start. CONCLUSION Later initiation of bDMARDs in JIA is associated with a greater physical disability, worse HRQoL, and lower chance of drug-free remission in adulthood.
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Affiliation(s)
- Filipa Oliveira Ramos
- Pediatric Rheumatology Unit, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.
- Unidade de Investigação Em ReumatologiaInstituto de Medicina Molecular, Lisbon, Portugal.
- Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal.
| | - Ana Maria Rodrigues
- Centre for Chronic Diseases (CEDOC), Nova Medical School, Lisbon, Portugal
- Comprehensive Health Research Centre, Nova Medical School, Lisbon, Portugal
| | - Ana Teresa Melo
- Pediatric Rheumatology Unit, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Unidade de Investigação Em ReumatologiaInstituto de Medicina Molecular, Lisbon, Portugal
| | - Francisca Aguiar
- Young Adult and Pediatric Rheumatology Unit, Centro Hospitalar Universitário São João, University of Medicine of Porto University, Porto, Portugal
| | - Luísa Brites
- Rheumatology Department, Centro Hospitalar E Universitário de Coimbra, Coimbra, Portugal
| | - Soraia Azevedo
- Rheumatology Department, Unidade Local de Saúde Do Alto Minho, Ponte de Lima, Portugal
| | | | | | - Carolina Furtado
- Rheumatology Department, Hospital Do Divino Espírito Santo, Ponta Delgada, Portugal
| | - Ana Filipa Mourão
- Centre for Chronic Diseases (CEDOC), Nova Medical School, Lisbon, Portugal
- Rheumatology Department, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Graça Sequeira
- Rheumatology Department, Centro Hospitalar Universitário Do Algarve, Faro Unit, Faro, Portugal
| | - Inês Cunha
- Rheumatoloy Department, Centro Hospitalar Do Baixo Vouga, Aveiro, Portugal
| | - Ricardo Figueira
- Rheumatoloy Department, Hospital Central Do Funchal, Funchal, Portugal
| | - Maria José Santos
- Unidade de Investigação Em ReumatologiaInstituto de Medicina Molecular, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal
- Rheumatology Department, Hospital Garcia de Orta, Almada, Portugal
| | - João Eurico Fonseca
- Pediatric Rheumatology Unit, Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
- Unidade de Investigação Em ReumatologiaInstituto de Medicina Molecular, Lisbon, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisbon Academic Medical Center, Lisbon, Portugal
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Bailey NGN, Knott R, Grenier G, Craig KD, Kramer JLK. Physical pain among Indigenous Peoples in Canada: a scoping review. Can J Anaesth 2023; 70:1047-1063. [PMID: 37341897 DOI: 10.1007/s12630-023-02461-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/16/2023] [Accepted: 01/29/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE Pain is a multifaceted experience shaped by various factors including context of pain, previous life events, and ongoing ethnocultural circumstances. Moreover, the definition of pain is inconsistent across cultures. Western medicine views physical pain (e.g., associated with a bone fracture) and nonphysical mental pain (e.g., depression) as two distinct conditions. Indigenous perspectives are often more wholistic, encompassing mental, spiritual, emotional, and physical hurt. The subjective nature of pain invites ample opportunity for discrimination in both its assessment and management. As such, it is important to consider Indigenous perspectives of pain in research and clinical practice. To investigate which aspects of Indigenous pain knowledge are currently considered by Western research, we conducted a scoping review of the literature on pain in Indigenous Peoples of Canada. SOURCE In June 2021, we searched nine databases and downloaded 8,220 papers after removal of duplicates. Two independent reviewers screened abstracts and full-text articles. PRINCIPLE FINDINGS Seventy-seven papers were included in the analysis. Using grounded theory, five themes emerged: pain measures/scales (n = 7), interventions (n = 13), pharmaceuticals (n = 17), pain expression/experiences (n = 45), and pain conditions (n = 70). CONCLUSION This scoping review shows that there is a paucity of research on pain measurement in Indigenous Peoples of Canada. This finding is concerning in light of numerous studies reporting that Indigenous Peoples experience their pain as ignored, minimized, or disbelieved. Furthermore, a clear disconnect emerged between pain expression in Indigenous Peoples and assessment in medical professionals. We hope that this scoping review will serve to translate current knowledge to other non-Indigenous academics and to initiate meaningful collaboration with Indigenous partners. Future research led by Indigenous academics and community partners is critically needed to better address pain needs in Canada.
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Affiliation(s)
- Nicole G N Bailey
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada.
- Department of Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
| | - Robbie Knott
- Indigenous Research Support Initiative, The University of British Columbia, Vancouver, BC, Canada
| | - Georgia Grenier
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
| | - Kenneth D Craig
- Department of Psychology, Faculty of Arts, The University of British Columbia, Vancouver, BC, Canada
| | - John L K Kramer
- International Collaboration on Repair Discoveries (ICORD), The University of British Columbia, Vancouver, BC, Canada
- Department of Anesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
- Djavad Mowafaghian Centre for Brain Health, The University of British Columbia, Vancouver, BC, Canada
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McCarty G, Wyeth EH, Sullivan T, Crengle S, Nelson V, Derrett S. Health-related quality of life measures used with Indigenous children/youth in the Pacific Rim: a scoping review. BMJ Open 2023; 13:e070156. [PMID: 36997253 PMCID: PMC10069609 DOI: 10.1136/bmjopen-2022-070156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVE To identify and describe (1) which health-related quality of life (HRQoL) measures have been used with Indigenous children/youth (aged 8-17 years) within the Pacific Rim; and (2) studies that refer to Indigenous health concepts in the use of child/youth HRQoL measures. DESIGN A scoping review. DATA SOURCES Ovid (Medline), PubMed, Scopus, Web of Science and CINAHL were searched up until 25 June 2020. ELIGIBILITY CRITERIA Eligible papers were identified by two independent reviewers. Eligible papers were written in English, published between January 1990 and June 2020 and included an HRQoL measure used in research with Indigenous child/youth populations (aged between 8 and 17 years) in the Pacific Rim region. DATA EXTRACTION AND SYNTHESIS Data extracted included study characteristics (year, country, Indigenous population, Indigenous sample size, age group), HRQoL measure characteristics (generic or condition-specific measure, child or adult measure, who completed the measure(s), dimensions, items and response scale of measure) and consideration of Indigenous concepts (created for Indigenous population, modified for Indigenous population, validated for Indigenous population, reliability in Indigenous populations, Indigenous involvement, reference to Indigenous theories/models/frameworks). RESULTS After removing duplicates, 1393 paper titles and abstracts were screened, and 543 had full-text review for eligibility. Of these, 40 full-text papers were eligible, reporting on 32 unique studies. Twenty-nine HRQoL measures were used across eight countries. Thirty-three papers did not acknowledge Indigenous concepts of health, and only two measures were specifically created for use with Indigenous populations. CONCLUSIONS There is a paucity of research investigating HRQoL measures used with Indigenous children/youth and a lack of involvement of Indigenous peoples in the development and use of HRQoL measures. We strongly recommend explicit consideration of Indigenous concepts when developing, validating, assessing and using HRQoL measures with Indigenous populations.
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Affiliation(s)
- Georgia McCarty
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Emma H Wyeth
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Preventive and Social Medicine, University of Otago Dunedin School of Medicine, Dunedin, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Vicky Nelson
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Ngāi Tahu Māori Health Research Unit, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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El Haddad R, El Asmar K, Hascoët C, Rossi-Semerano L, Dusser P. Well-being in chronic pediatric inflammatory rheumatic diseases: the experience of a French healthcare network. Orphanet J Rare Dis 2023; 18:46. [PMID: 36882869 PMCID: PMC9990204 DOI: 10.1186/s13023-023-02655-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE Current management of patients with pediatric rheumatic diseases (PRD) should aim at achieving the best possible well-being. To identify sociodemographic/clinical characteristics, needed paramedical services and school accommodations associated with well-being in patients at inclusion in a French health network Réseau pour les Rhumatismes Inflammatoires Pédiatriques (RESRIP) that supports coordination of the patient's health pathway. To evaluate the evolution of well-being over time in this patients benefiting from such support. METHODS Patients > 3 years old enrolled in RESRIP (2013-2020) were included. At enrollment, data were collected on sociodemographic/clinical characteristics, ongoing medications, and paramedical and educational actions to be implemented by RESRIP. Well-being during the last 6 months was reported with a standardized questionnaire at enrollment and every 6 months. A well-being score was calculated with scores ranging from 0 to 18, 18 corresponding to absolute well-being. Patients were followed up from inclusion until June 2020. RESULTS In total, 406 patients were included and followed up for 36 months on average: 205 juvenile idiopathic arthritis, 68 connective tissue diseases, 81 auto-inflammatory diseases and 52 other diseases. The well-being score did not differ between the groups and improved significantly, by 0.04 score units, every 6 months (95% confidence interval [0.03; 0.06]). At inclusion, use of homeopathy, need for implementation of hypnosis or psychological support, occupational therapy or for adjustment of school tests were associated with worse well-being score. CONCLUSION Well-being seems associated more with the impact of chronic illness than the type of PRD underlining the importance of a comprehensive patient care.
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Affiliation(s)
- Rita El Haddad
- Réseau Rhumatismes Inflammatoires Pédiatriques (RESRIP), Bourg-la-Reine, France
- Public Health Faculty, Lebanese University, Fanar, Lebanon
- Faculty of Medicine, Université Paris-Saclay, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Khalil El Asmar
- Faculty of Medicine, Université Paris-Saclay, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Chrystelle Hascoët
- Réseau Rhumatismes Inflammatoires Pédiatriques (RESRIP), Bourg-la-Reine, France
| | - Linda Rossi-Semerano
- Réseau Rhumatismes Inflammatoires Pédiatriques (RESRIP), Bourg-la-Reine, France
- Paediatric Rheumatology Department, APHP, Bicêtre Hospital, Université Paris-Saclay, 94270, Le Kremlin-Bicêtre, France
- Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses Inflammatoire (CEREMAIA), Le Kremlin Bicêtre, France
| | - Perrine Dusser
- Réseau Rhumatismes Inflammatoires Pédiatriques (RESRIP), Bourg-la-Reine, France.
- Paediatric Rheumatology Department, APHP, Bicêtre Hospital, Université Paris-Saclay, 94270, Le Kremlin-Bicêtre, France.
- Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses Inflammatoire (CEREMAIA), Le Kremlin Bicêtre, France.
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10
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Smith AD, Saqib B, Lee RR, Shoop-Worrall S, Hyrich KL, McDonagh JE, Cordingley L. Is time a healer? How quality of life changes over time reported by parents of children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2023; 62:794-803. [PMID: 35608307 PMCID: PMC9891422 DOI: 10.1093/rheumatology/keac312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To investigate changes in health-related quality of life (HRQoL) in children and young people with JIA (Juvenile Idiopathic Arthritis) over 3 years following diagnosis. METHODS Data on children and young people recruited to the Childhood Arthritis Prospective Study (CAPS) were selected if >5 years of age at diagnosis. HRQoL was assessed at diagnosis (baseline), 1 year and 3 years using the proxy-reported Child Health Questionnaire (CHQ) completed by a parent or guardian. The CHQ measures aspects of HRQoL including physical functioning and mental health. Analyses included descriptive statistics, comparison with a US reference population and analysis of CHQ scores longitudinally and by gender and age of onset. RESULTS Using CHQ data from parents/guardians of 182 CAPS study participants [median age 9.6 years (interquartile range 7.2-12.2)], all HRQoL domains significantly improved over the 3 year follow-up, except general health perceptions. Physical health domains showed greater improvement than psychosocial domains, although psychosocial scores were generally higher than physical scores throughout. Although similar at diagnosis, at 1 year females had significantly worse HRQoL than males in physical functioning (P = 0.03), bodily pain (P = 0.03), mental health (P = 0.00), social-emotional (P = 0.02) and social-physical (P < 0.001). Differences largely remained at 3 years. Age at onset was not significantly associated with HRQoL. CONCLUSION Children and young people with JIA have low HRQoL across domains compared with the reference population. This improves within 3 years of diagnosis, with the greatest improvement within the first year. Early developmentally appropriate clinical intervention is recommended to reduce both psychosocial and physical impact of JIA. The lower HRQoL scores of females require further investigation.
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Affiliation(s)
- Andrew D Smith
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Bishma Saqib
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research
| | - Rebecca Rachael Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Stephanie Shoop-Worrall
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- Centre for Health Informatics, University of Manchester
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
- Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals Trust, Manchester, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre
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11
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Weitzman ER, Gaultney A, von Scheven E, Ringold S, Mann CM, Magane KM, Lin L, Leverty R, Dennos A, Hernandez A, Lippmann SJ, Dedeoglu F, Marin AC, Cox R, Reeve BB, Schanberg LE. Construct validity of Patient-Reported Outcomes Measurement Information System Paediatric measures in juvenile idiopathic arthritis and systemic lupus erythematosus: cross-sectional evaluation. BMJ Open 2023; 13:e063675. [PMID: 36707118 PMCID: PMC9884859 DOI: 10.1136/bmjopen-2022-063675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Evaluate construct validity of Patient-Reported Outcomes Measurement Information System (PROMIS) Paediatric measures of symptoms and functioning against measures of disease activity among youth with juvenile idiopathic arthritis (JIA) or systemic lupus erythematosus (SLE). DESIGN Cross-sectional associations among PROMIS measures and clinical metrics of disease activity were estimated. SETTING Seven clinical sites of the Childhood Arthritis and Rheumatology Alliance (CARRA) in the USA. PARTICIPANTS Youth aged 8-17 years enrolled in the CARRA Registry. INTERVENTION PROMIS measures were collected and associations with clinical measures of disease activity estimated, by condition, in bivariate and multivariable analyses with adjustment for sociodemographics, insurance status, medications and disease duration. MAIN OUTCOME MEASURES PROMIS Paediatric measures of mobility, physical activity, fatigue, pain interference, family relationships, peer relationships, depressive symptoms, psychological stress, anxiety, and meaning and purpose, and clinical metrics of disease. RESULTS Among 451 youth (average age 13.8 years, 71% female), most (n=393, 87%) had a JIA diagnosis and the remainder (n=58, 13%) had SLE. Among participants with JIA, those with moderate/high compared with low/inactive disease had, on average, worse mobility (multivariable regression coefficient and 95% CIs) (-7.40; -9.30 to -5.50), fatigue (3.22; 1.02 to 5.42), pain interference (4.76; 3.04 to 6.48), peer relationships (-2.58; -4.52 to -1.64), depressive symptoms (3.00; 0.96 to 5.04), anxiety (2.48; 0.40 to 4.56) and psychological stress (2.52; 0.68 to 4.36). For SLE, youth with active versus inactive disease had on average worse mobility (-5.07; -10.15 to 0.01) but PROMIS Paediatric measures did not discriminate participants with active and inactive disease in adjusted analyses. CONCLUSIONS Seven PROMIS Paediatric measures discriminated between active and inactive disease in youth with JIA. Results advance the usefulness of PROMIS for understanding well-being and improving interventions for youth with JIA, but larger studies are needed to determine utility in SLE cohorts. TRIAL REGISTRATION NUMBER National Institute of Arthritis and Musculoskeletal and Skin Diseases (U19AR069522).
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Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amy Gaultney
- Pediatric Rheumatology, Children's Hospital of Orange County, Orange, California, USA
| | - Emily von Scheven
- Pediatric Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Sarah Ringold
- Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Courtney M Mann
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kara M Magane
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Li Lin
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Renee Leverty
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anne Dennos
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexy Hernandez
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven J Lippmann
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Fatma Dedeoglu
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alexandra C Marin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachele Cox
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Bryce B Reeve
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura E Schanberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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12
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van Straalen JW, de Roock S, Giancane G, Consolaro A, Rygg M, Nordal EB, Rubio-Pérez N, Jelusic M, De Inocencio J, Vojinovic J, Wulffraat NM, Bruijning-Verhagen PCJ, Ruperto N, Swart JF, Scala S, Angioloni S, Villa L. Real-world comparison of the effects of etanercept and adalimumab on well-being in non-systemic juvenile idiopathic arthritis: a propensity score matched cohort study. Pediatr Rheumatol Online J 2022; 20:96. [PMID: 36376976 PMCID: PMC9664631 DOI: 10.1186/s12969-022-00763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 10/29/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Etanercept (ETN) and adalimumab (ADA) are considered equally effective biologicals in the treatment of arthritis in juvenile idiopathic arthritis (JIA) but no studies have compared their impact on patient-reported well-being. The objective of this study was to determine whether ETN and ADA have a differential effect on patient-reported well-being in non-systemic JIA using real-world data. METHODS Biological-naive patients without a history of uveitis were selected from the international Pharmachild registry. Patients starting ETN were matched to patients starting ADA based on propensity score and outcomes were collected at time of therapy initiation and 3-12 months afterwards. Primary outcome at follow-up was the improvement in Juvenile Arthritis Multidimensional Assessment Report (JAMAR) visual analogue scale (VAS) well-being score from baseline. Secondary outcomes at follow-up were decrease in active joint count, adverse events and uveitis events. Outcomes were analyzed using linear and logistic mixed effects models. RESULTS Out of 158 eligible patients, 45 ETN starters and 45 ADA starters could be propensity score matched resulting in similar VAS well-being scores at baseline. At follow-up, the median improvement in VAS well-being was 2 (interquartile range (IQR): 0.0 - 4.0) and scores were significantly better (P = 0.01) for ETN starters (median 0.0, IQR: 0.0 - 1.0) compared to ADA starters (median 1.0, IQR: 0.0 - 3.5). The estimated mean difference in VAS well-being improvement from baseline for ETN versus ADA was 0.89 (95% CI: -0.01 - 1.78; P = 0.06). The estimated mean difference in active joint count decrease was -0.36 (95% CI: -1.02 - 0.30; P = 0.28) and odds ratio for adverse events was 0.48 (95% CI: 0.16 -1.44; P = 0.19). One uveitis event was observed in the ETN group. CONCLUSIONS Both ETN and ADA improve well-being in non-systemic JIA. Our data might indicate a trend towards a slightly stronger effect for ETN, but larger studies are needed to confirm this given the lack of statistical significance.
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Affiliation(s)
- Joeri W. van Straalen
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Sytze de Roock
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Gabriella Giancane
- grid.419504.d0000 0004 1760 0109Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento Di NeuroscienzeRiabilitazioneOftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università Degli Studi Di Genova, Genoa, Italy
| | - Alessandro Consolaro
- grid.419504.d0000 0004 1760 0109Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy ,grid.5606.50000 0001 2151 3065Dipartimento Di NeuroscienzeRiabilitazioneOftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università Degli Studi Di Genova, Genoa, Italy
| | - Marite Rygg
- grid.5947.f0000 0001 1516 2393Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Pediatrics, St. Olavs University Hospital of Trondheim, Trondheim, Norway
| | - Ellen B. Nordal
- grid.412244.50000 0004 4689 5540Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway ,grid.10919.300000000122595234Department of Clinical Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Nadina Rubio-Pérez
- grid.411455.00000 0001 2203 0321Departamento de Pediatria, Facultad de Medicina, Hospital Universitario “Dr. J. E. González”, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Marija Jelusic
- grid.4808.40000 0001 0657 4636Department of Paediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Jaime De Inocencio
- grid.144756.50000 0001 1945 5329Department of Pediatric Rheumatology, University Hospital 12 de Octubre, Madrid, Spain
| | - Jelena Vojinovic
- grid.11374.300000 0001 0942 1176Department of Pediatric Immunology and Rheumatology, Faculty of Medicine, University of Nis, Nis, Serbia ,grid.418653.d0000 0004 0517 2741Department of Pediatric Rheumatology, Clinic of Pediatrics, Clinical Center Nis, Nis, Serbia
| | - Nico M. Wulffraat
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
| | - Patricia C. J. Bruijning-Verhagen
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109UOSID Centro Trial, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F. Swart
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, the Netherlands
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13
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Grazziotin LR, Currie G, Twilt M, IJzerman MJ, Kip MMA, Koffijberg H, Bonsel G, Benseler SM, Swart JF, Vastert SJ, Wulffraat NM, Yeung RSM, Armbrust W, van den Berg JM, Marshall DA. Factors associated with care- and health-related quality of life of caregivers of children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20:51. [PMID: 35870932 PMCID: PMC9308305 DOI: 10.1186/s12969-022-00713-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study investigates the relationship of child, caregiver, and caring context measurements with the care-related quality of life (CRQoL) and health-related quality of life (HRQoL) of caregivers of children with juvenile idiopathic arthritis (JIA). METHODS We performed a cross-sectional analysis of baseline data on caregivers of children with JIA from Canada and the Netherlands collected for the "Canada-Netherlands Personalized Medicine Network in Childhood Arthritis and Rheumatic Diseases" study from June 2019 to September 2021. We used the CRQoL questionnaire (CarerQoL), adult EQ-5D-5L, and proxy-reported Youth 5-Level version of EuroQoL (EQ-5D-5L-Y) to assess caregiver CRQoL, caregiver HRQoL, and child HRQoL, respectively. We used a multivariate analysis to assess the relationship between both caregiver CRQoL and HRQoL and patient, caregiver, and caring context measurements. RESULTS A total of 250 caregivers were included in this study. Most of the caregivers were from the Netherlands (n = 178, 71%) and 77% were females (n = 193). The mean CarerQoL scores was 82.7 (standard deviation (SD) 11.4) and the mean EQ-5D-5L utility score was 0.87 (SD 0.16). Child HRQoL and employment had a positive relationship with both caregiver CarerQoL and EQ-5D-5L utility scores (p < 0.05), while receiving paid or unpaid help had a negative relationship with both scores (p < 0.05). CONCLUSION Our findings indicated that to understand the impact of JIA on families, we need to consider socio-economic factors, such as employment and support to carry caregiving tasks, in addition to child HRQoL.
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Affiliation(s)
- Luiza R. Grazziotin
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697O’Brien Institute for Public Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Gillian Currie
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697O’Brien Institute for Public Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Marinka Twilt
- grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
| | - Maarten J. IJzerman
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Michelle M. A. Kip
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Hendrik Koffijberg
- grid.6214.10000 0004 0399 8953Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Gouke Bonsel
- grid.478988.20000 0004 5906 3508EuroQol Research Foundation, Rotterdam, the Netherlands
| | - Susanne M. Benseler
- grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada ,grid.413574.00000 0001 0693 8815Alberta Health Services, Calgary, Alberta Canada
| | - Joost F. Swart
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital / UMC Utrecht, Utrecht, Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Sebastiaan J. Vastert
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital / UMC Utrecht, Utrecht, Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Nico M. Wulffraat
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital / UMC Utrecht, Utrecht, Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Rae S. M. Yeung
- grid.17063.330000 0001 2157 2938Departments of Paediatrics, Immunology and Medical Science, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Wineke Armbrust
- grid.4494.d0000 0000 9558 4598Wineke Armbrust University of Groningen, University Medical Center Groningen (UMCG), Beatrix Childrens Hospital, Dept Pediatric Rheumatology-Immunology, Groningen, Netherlands
| | - J. Merlijn van den Berg
- grid.7177.60000000084992262Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children’s Hospital, Amsterdam University Medical Centers (Amsterdam UMC), University of Amsterdam, Amsterdam, Netherlands
| | - Deborah A. Marshall
- grid.22072.350000 0004 1936 7697Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697McCaig Institute for Bone and Joint Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697O’Brien Institute for Public Health, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada ,grid.22072.350000 0004 1936 7697Alberta Children’s Hospital Research Institute, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
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14
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Oen K, Toupin-April K, Feldman BM, Berard RA, Duffy CM, Tucker LB, Tian J, Rumsey DG, Guzman J. Validation of the parent global assessment as a health-related quality of life measure in juvenile idiopathic arthritis: results from ReACCh-Out. Rheumatology (Oxford) 2022; 62:SI152-SI162. [PMID: 35713497 PMCID: PMC9949712 DOI: 10.1093/rheumatology/keac350] [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: 03/31/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To (i) validate the JIA parent global assessment (parent global) as a health-related quality of life (HRQoL) instrument; (ii) evaluate measurement properties of accepted HRQoL measures relative to those of the parent global; and (iii) assess causal pathways determining parent global scores. METHODS Data from the Research in Arthritis in Canadian Children emphasizing outcomes (ReACCh-Out) cohort were used. Measurement properties were assessed in 344 patients at enrolment and 6 months later. Causal pathways were tested by structural equation modelling to understand root causes and mediators leading to parent global scores. RESULTS Construct validity was supported by Spearman correlations of 0.53-0.70 for the parent global with the Juvenile Arthritis Quality of Life Questionnaire, Quality of My Life health scale (HRQoML), Pediatric Quality of Life Inventory (PedsQL)-Parent, and Child Health Questionnaire (CHQ)-Physical. Exceptions were PedsQL-Child (0.44) and CHQ-Psychosocial (0.31). Correlations were lower (0.14-0.49) with disease activity measures (physician global assessment of disease activity, active joint count, ESR). Responsiveness of the parent global to improvement according to parent ratings (0.51) was acceptable and within the range (0.32-0.71) of that of other measures. Reliability estimates and measurement errors for all measures were unsatisfactory, likely due to the prolonged time between assessments. Causal pathways for the parent global matched those previously reported for HRQoML. CONCLUSIONS Our results offer support for the parent global as a valid measure of HRQoL for JIA. If confirmed, existing studies using the parent global may be re-interpreted, enhancing our knowledge of HRQoL in children with JIA.
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Affiliation(s)
- Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg
| | - Karine Toupin-April
- School of Rehabilitation Sciences and Department of Pediatrics, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute and Institut du Savoir Montfort, Ottawa
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, and Departments of Pediatrics and Medicine, and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto
| | - Roberta A Berard
- Pediatric Rheumatology, Children’s Hospital, London Health Sciences Centre, London
| | - Ciẚran M Duffy
- Children’s Hospital of Eastern Ontario and Department of Pediatrics, University of Ottawa, Ottawa
| | - Lori B Tucker
- Division of Pediatric Rheumatology, British Columbia Children’s Hospital, and Department of Pediatrics, University of British Columbia, Vancouver
| | - Jiahao Tian
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby
| | - Dax G Rumsey
- Paediatric Rheumatology, Stollery Children’s Hospital and Department of Pediatrics, University of Alberta, Edmonton, Canada
| | - Jaime Guzman
- Correspondence to: Jaime Guzman, BC Children’s Hospital, 4500 Oak Street, Room K4-122 Vancouver, BC V6H 3N1, Canada. E-mail:
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15
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El Tal T, Ryan ME, Feldman BM, Bingham A, Burnham J, Batthish M, Bullock D, Ferraro K, Gilbert M, Gillispie-Taylor M, Gottlieb B, Harris JG, Hazen M, Laxer RM, Lee TC, Lovell D, Mannion M, Noonan L, Oberle E, Taylor J, Weiss JE, Yildirim Toruner C, Morgan EM. Consensus Approach to a Treat to Target Strategy in Juvenile Idiopathic Arthritis Care: Report from the 2020 PR-COIN Consensus Conference. J Rheumatol 2022; 49:497-503. [DOI: 10.3899/jrheum.210709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 11/22/2022]
Abstract
Objective Treat to target (T2T) is a strategy of adjusting treatment until a target is reached. An international task force recommended T2T for juvenile idiopathic arthritis (JIA) treatment. Implementing T2T in a standard and reliable way in clinical practice requires agreement on critical elements of: (1) target setting, (2) T2T strategy, (3) identifying barriers to implementation, and (4) eligible patients. A consensus conference was held amongst Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) stakeholders to inform a statement of understanding regarding the PR-COIN approach to T2T. Methods PR-COIN stakeholders including health care providers (16) and parents (4), were invited to form a voting panel. Using the nominal group technique, two rounds of voting were held to address the above four areas to select the top 10 responses in rank order. Results Incorporation of patient goals ranked most important when setting a treatment target. Use of shared decision making (SDM), tracking measurable outcomes, and adjusting treatment to achieve goals were voted as top elements of T2T strategy. Workflow considerations, and provider buy-in were identified as key barriers to T2T implementation. Patients with JIA, with poor prognostic factors and at risk for high disease burden were leading candidates for a T2T approach. Conclusion This consensus conference identified the importance of incorporating patient goals as part of target setting, and influence of patient stakeholder involvement in drafting treatment recommendations. The network approach to T2T will be modified to address the above findings including solicitation of patient goals, optimizing SDM, and better workflow integration.
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16
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Abstract
Juvenile idiopathic arthritis (JIA) is an umbrella term for arthritis of unknown origin, lasting for >6 weeks with onset before 16 years of age. JIA is the most common chronic inflammatory rheumatic condition of childhood. According to the International League Against Rheumatism (ILAR) classification, seven mutually exclusive categories of JIA exist based on disease manifestations during the first 6 months of disease. Although the ILAR classification has been useful to foster research, it has been criticized mainly as it does not distinguish those forms of chronic arthritis observed in adults and in children from those that may be unique to childhood. Hence, efforts to provide a new evidence-based classification are ongoing. Similar to arthritis observed in adults, pathogenesis involves autoimmune and autoinflammatory mechanisms. The field has witnessed a remarkable improvement in therapeutic possibilities of JIA owing to the availability of new potent drugs and the possibility to perform controlled trials with support from legislative interventions and large networks availability. The goal of drug therapy in JIA is to rapidly reduce disease activity to inactive disease or clinical remission, minimize drug side effects and achieve a quality of life comparable to that of healthy peers. As JIA can influence all aspects of a child's and their family's life, researchers increasingly recognize improvement of health-related quality of life as a key treatment goal.
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17
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Sunthornsup W, Vilaiyuk S, Soponkanaporn S. Effect of educational brochure compared with video on disease-related knowledge in patients with juvenile idiopathic arthritis: A randomized controlled trial. Front Pediatr 2022; 10:1048949. [PMID: 36568417 PMCID: PMC9780585 DOI: 10.3389/fped.2022.1048949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Patient education plays an important role in the management of chronic diseases such as juvenile idiopathic arthritis (JIA). This study compared the effectiveness of a brochure and a video regarding JIA-related knowledge immediately after the intervention, and at 4 weeks post-intervention. METHODS A prospective randomized controlled trial was conducted. Patients with JIA or parents were randomized to receive education from either a brochure (n = 50) or a video (n = 50) at the clinic. Participants answered questionnaires about disease-specific knowledge before the intervention (T0), immediately after the intervention (T1), and at follow-up 4 weeks later (T2). The questionnaire comprised 15 multiple-choice questions. Final scores ranged from 0 to 15, and were scaled from 0% to 100% to calculate the percentage of knowledge scores. Ninety participants completed the questionnaire at T2 (42 in the brochure and 48 in the video group). RESULTS The mean percentage of knowledge scores at T0 was not significantly different between the brochure group and the video group. At T1, the mean percentage of knowledge scores was significantly higher in the video group compared with the brochure group (86.7 ± 12.9% vs. 76.0 ± 21.4%, p = 0.003). Among parents with an educational level below secondary school, the mean percentage of knowledge scores at T1 was significantly higher in the video group compared with the brochure group (83.5 ± 14.4% vs. 69.1 ± 23.2%, p = 0.006). Participants in both groups had significantly higher mean percentage of knowledge scores at T2 compared with T0 (72.7 ± 20.3% vs. 51.1 ± 24.7%, p < 0.001 in the brochure group and 78.3 ± 15.7% vs. 56.1 ± 21.9%, p < 0.001 in the video group). There was no significant difference in the mean percentage of total score change between T2 and T1 between the brochure and video groups (-4.7 ± 13.3% vs. -8.5 ± 11.0%, p = 0.152). CONCLUSION The video was more effective for improving disease-related knowledge immediately post-intervention, particularly in participants with limited education. Although both educational tools had lasting effects on knowledge, the retention rate declined at 4 weeks after both interventions. TRIAL REGISTRATION Thai Clinical Trials Registry (TCTR)20200310004, retrospectively registered since 06/03/2020.
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Affiliation(s)
- Waraporn Sunthornsup
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Soamarat Vilaiyuk
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sirisucha Soponkanaporn
- Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.,Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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18
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Taxter A, Johnson L, Tabussi D, Kimura Y, Donaldson B, Lawson E, Del Gaizo V, Vitelli D, Pinter C, Van Citters A, Nelson E, Lee T. Co-Design of an Electronic Dashboard to Support Coproduction of Care in Pediatric Rheumatic Disease: Human-Centered Design and Usability Testing (Preprint). J Particip Med 2021; 14:e34735. [PMID: 35133283 PMCID: PMC9077505 DOI: 10.2196/34735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 01/09/2022] [Accepted: 02/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alysha Taxter
- Nationwide Children's Hospital, Columbus, OH, United States
| | | | - Doreen Tabussi
- Hackensack University Medical Center, Hackensack, NJ, United States
| | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ, United States
| | | | - Erica Lawson
- University of California San Francisco, San Francisco, CA, United States
| | - Vincent Del Gaizo
- Childhood Arthritis and Rheumatology Research Alliance (CARRA), Milwaukee, WI, United States
| | | | | | | | | | - Tzielan Lee
- Stanford Children's Health, Palo Alto, CA, United States
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19
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Oen K, Tian J, Loughin TM, Shiff NJ, Tucker LB, Huber AM, Berard RA, Levy DM, Rumsey DG, Tse SM, Chan M, Feldman BM, Duffy CM, Guzman J. Causal pathways to health-related quality of life in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Rheumatology (Oxford) 2021; 60:4691-4702. [PMID: 33506861 DOI: 10.1093/rheumatology/keab079] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/04/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Structural equation modelling was applied to data from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort to help elucidate causal pathways to decreased health-related quality of life (HRQoL) in children with JIA. METHODS Based on published literature and clinical plausibility, a priori models were constructed with explicit root causes (disease activity, treatment intensity) and mediators (pain, disease symptoms, functional impairments) leading to HRQoL [measured by the Quality of my Life (QoML) scale and the Juvenile Arthritis Quality of Life Questionnaire (JAQQ)] at five disease stages: (i) diagnosis, (ii) 3-9 months after diagnosis, (iii) flare, (iv) remission on medications, (v) remission off medications. Following structural equation modelling, a posteriori models were selected based on data fit and clinical plausibility. RESULTS We included 561, 887, 137, 186 and 182 patients at each stage, respectively. In a posteriori models for active disease stages, paths from disease activity led through pain, functional impairments, and disease symptoms, directly or through restrictions in participation, to decreased QoML scores. Treatment intensity had detrimental effects through psychosocial domains; while treatment side effects had a lesser role. Pathways were similar for QoML and JAQQ, but JAQQ models provided greater specificity. Models for remission stages were not supported by the data. CONCLUSION Our findings support disease activity and treatment intensity as being root causes of decreased HRQoL in children with JIA, with pain, functional impairments, and participation restrictions being mediators for disease activity; they support psychosocial effects and side effects as being mediators for treatment intensity.
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Affiliation(s)
- Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Jiahao Tian
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia
| | - Thomas M Loughin
- Department of Statistics and Actuarial Science, Simon Fraser University, Burnaby, British Columbia
| | - Natalie J Shiff
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Lori B Tucker
- Division of Pediatric Rheumatology, British Columbia Children's Hospital.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam M Huber
- Division of Pediatric Rheumatology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Roberta A Berard
- Pediatric Rheumatology, Children's Hospital, London Health Sciences Centre, London
| | - Deborah M Levy
- Division of Rheumatology, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Dax G Rumsey
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Shirley M Tse
- Division of Rheumatology, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Mercedes Chan
- Division of Pediatric Rheumatology, British Columbia Children's Hospital.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children and Departments of Pediatrics, Medicine, and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto
| | - Ciaran M Duffy
- Children's Hospital of Eastern Ontario and Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Jaime Guzman
- Division of Pediatric Rheumatology, British Columbia Children's Hospital.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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20
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Yue X, Huang B, Hincapie AL, Wigle PR, Li Y, Qiu T, Lovell DJ, Morgan EM, Guo JJ. Comparative effectiveness and persistence of TNFi and non-TNFi in juvenile idiopathic arthritis: a large paediatric rheumatology centre in the USA. Rheumatology (Oxford) 2021; 60:4063-4073. [PMID: 34469569 PMCID: PMC10452955 DOI: 10.1093/rheumatology/keaa877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/25/2020] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To evaluate the persistence and effectiveness of TNF inhibitors (TNFi) vs non-TNFi among newly diagnosed JIA patients after initiation of biologic DMARD (bDMARD). METHODS Using longitudinal patient-level data extracted from electronic medical records in a large Midwestern paediatric hospital from 2009 to 2018, we identified JIA patients initiating TNFi and non-TNFi treatment. Treatment effectiveness was assessed based on disease activity. Inverse probability of treatment weighting of propensity score was used to estimate the treatment effectiveness and Kaplan-Meier analyses were conducted to assess persistence. RESULTS Of 667 JIA patients, most (92.0%) were prescribed one of the class of TNFi as their initial biologic treatment. Etanercept was the most frequently prescribed (67.1%) treatment, followed by adalimumab (27.5%). Only around 5% of patients were prescribed off-label bDMARDs as their first-course treatment; however, >20% were prescribed off-label biologics as their second-course therapy. Some 7.2% of patients received four or more bDMARDs. The median persistence of the first-course bDMARD is 320 days, with TNFi being significantly longer than the non-TNFi (395 vs 320 days, P = 0.010). The clinical Juvenile Disease Activity Score (cJADAS) reduction of TNFi users (6.6, 95% CI 5.7, 7.5) was significant greater compared with non-TNFi users (3.0, 95% CI 1.5, 4.6, P < 0.0001) at 6-month follow-up visit. CONCLUSION Persistence was significantly longer among patients initiating TNFi as their first biologic therapy than those receiving non-TNFi. Patients receiving TNF therapy had significant greater reduction of cJADAS at the 6-month follow-up visit compared with patients in the non-TNF cohort.
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Affiliation(s)
- Xiaomeng Yue
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
- Department of Pediatrics, University of Cincinnati College of Medicine
| | - Ana L Hincapie
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center
| | - Patricia R Wigle
- Division of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati Academic Health Center
| | - Yuxiang Li
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine
| | - Tingting Qiu
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center
| | - Daniel J Lovell
- Department of Pediatrics, University of Cincinnati College of Medicine
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Esi M Morgan
- Department of Pediatrics, University of Cincinnati College of Medicine
- Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
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21
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Lee JJY, Laxer RM, Feldman BM, Barber CEH, Batthish M, Berard R, Tucker LB, Levy DM. Variations in Pediatric Rheumatology Workforce and Care Processes Across Canada. J Rheumatol 2021; 49:197-204. [PMID: 34334367 DOI: 10.3899/jrheum.201611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine Canadian pediatric rheumatology workforce and care processes. METHODS Pediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic centre provided workforce information including number of providers, total and breakdown of full-time equivalents (FTE), and triage processes. We calculated the clinical care FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices. RESULTS The response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centres. The median number of rheumatologists per centre was 3 (IQR:3) and median cFTE was 1.8 (IQR:1.5). The median cFTE per 75,000 was 0.2 (IQR:0.3) with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit but a regional maldistribution of rheumatologists. All centres engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤1. Most centres (87%) utilized a centralized triage process. Of 9 (60%) centres that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as pre-visit planning (68%), post-visit planning (68%), and periodic health outcome monitoring (36-59%). CONCLUSION This study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.
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Affiliation(s)
- Jennifer J Y Lee
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Ronald M Laxer
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Brian M Feldman
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Claire E H Barber
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Michelle Batthish
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Roberta Berard
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Lori B Tucker
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
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22
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Yu JY, Goldberg T, Lao N, Feldman BM, Goh YI. Electronic forms for patient reported outcome measures (PROMs) are an effective, time-efficient, and cost-minimizing alternative to paper forms. Pediatr Rheumatol Online J 2021; 19:67. [PMID: 33941208 PMCID: PMC8091685 DOI: 10.1186/s12969-021-00551-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient reported outcome measures (PROMs) provide valuable insight on patients' well-being and facilitates communication between healthcare providers and their patients. The increased integration of the technology within the healthcare setting presents the opportunity to collect PROMs electronically, rather than on paper. The Childhood Health Assessment Questionnaire (CHAQ) and Quality of My Life (QoML) are common PROMs collected from pediatric rheumatology patients. The objectives of this study are to (a) determine the equivalence of the paper and electronic forms (e-form) of CHAQ and QoML questionnaires; (b) identify potential benefits and barriers associated with using an e-form to capture PROMs; and (c) gather feedback on user experience. METHODS Participants completed both a paper and an e-form of the questionnaires in a randomized order, following which they completed a feedback survey. Agreement of the scores between the forms were statistically analyzed using the intraclass correlation coefficient (ICC) (95 % Confidence Interval (CI)) and bias was assessed using a Bland-Altman plot. Completion and processing times of the forms were compared using mean and median measures. Quantitative analysis was performed to assess user experience ratings, while comments were qualitatively analyzed to identify important themes. RESULTS 196 patients participated in this project. Scores on the forms had high ICC agreement > 0.9. New patients took longer than returning patients to complete the forms. Overall, the e-form was completed and processed in a shorter amount of time than the paper form. 83 % of survey respondents indicated that they either preferred the e-form or had no preference. Approximately 10 % of respondents suggested improvements to improve the user interface. CONCLUSIONS E-forms collect comparable information in an efficient manner to paper forms. Given that patients and caregivers indicated they preferred completing PROMs in this manner, we will implement their suggested changes and incorporate e-forms as standard practice for PROMs collection in our pediatric rheumatology clinic.
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Affiliation(s)
- Jennifer Y. Yu
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Talia Goldberg
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Nicholas Lao
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada
| | - Brian M. Feldman
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada ,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario Canada ,Department of Pediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario Canada ,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario Canada
| | - Y. Ingrid Goh
- The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 Canada ,Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario Canada
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23
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Doeleman MJH, de Roock S, Buijsse N, Klein M, Bonsel GJ, Seyfert-Margolis V, Swart JF, Wulffraat NM. Monitoring patients with juvenile idiopathic arthritis using health-related quality of life. Pediatr Rheumatol Online J 2021; 19:40. [PMID: 33752695 PMCID: PMC7986307 DOI: 10.1186/s12969-021-00527-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 03/05/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Pediatric patients with juvenile idiopathic arthritis (JIA) are at risk for a lower health-related quality of life compared to their healthy peers. Remote monitoring of health-related quality of life using electronic patient-reported outcomes could provide important information to treating physicians. The aim of this study was to investigate if self-assessment with the EuroQol five-dimensional 'youth' questionnaire with five levels (EQ-5D-Y-5 L) inside a mobile E-health application could identify JIA patients in need of possible treatment adjustments. METHODS The EQ-5D-Y-5 L was completed via a mobile application (Reuma2Go) between October 2017 and January 2019. The clinical juvenile arthritis disease activity score with 71 joint count (cJADAS-71) was reported at every corresponding visit as reference for disease activity. Previously described cJADAS-71 thresholds were used to identify patients in possible need of treatment adjustments. Discriminatory power of the EQ-5D-Y-5 L was assessed by ROC-curves and diagnostic characteristics. RESULTS Sixty-eight JIA patients completed the EQ-5D-Y-5 L questionnaire. Median cJADAS-71 indicated low disease activity overall in the studied population. ROC curves and diagnostic characteristics demonstrated that self-assessment with the EQ-5D-Y-5 L could distinguish between patients with inactive disease (or minimal disease activity) and moderate to high disease activity with good accuracy (87%), sensitivity (85%), specificity (89%) and negative predictive value (86%). CONCLUSIONS Results demonstrate that the EQ-5D-Y-5 L was able to identify JIA patients in need of possible treatment adjustments in our studied population. Remote monitoring of health-related quality of life and patient-reported outcomes via E-health applications could provide important additional information to determine the frequency of clinical visits, assess therapeutic efficacy and guide treat-to-target strategies in pediatric patients with JIA.
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Affiliation(s)
- Martijn J. H. Doeleman
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sytze de Roock
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nathan Buijsse
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Mark Klein
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands
| | - Gouke J. Bonsel
- grid.478988.20000 0004 5906 3508The EuroQol Research Foundation, Rotterdam, The Netherlands ,grid.5645.2000000040459992XDepartment of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Joost F. Swart
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nico M. Wulffraat
- grid.417100.30000 0004 0620 3132Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, P.O. Box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
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Shoop-Worrall SJW, Hyrich KL, Wedderburn LR, Thomson W, Geifman N. Patient-reported wellbeing and clinical disease measures over time captured by multivariate trajectories of disease activity in individuals with juvenile idiopathic arthritis in the UK: a multicentre prospective longitudinal study. THE LANCET. RHEUMATOLOGY 2021; 3:e111-e121. [PMID: 33554133 PMCID: PMC7843954 DOI: 10.1016/s2665-9913(20)30269-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a heterogeneous disease, the signs and symptoms of which can be summarised with use of composite disease activity measures, including the clinical Juvenile Arthritis Disease Activity Score (cJADAS). However, clusters of children and young people might experience different global patterns in their signs and symptoms of disease, which might run in parallel or diverge over time. We aimed to identify such clusters in the 3 years after a diagnosis of JIA. The identification of these clusters would allow for a greater understanding of disease progression in JIA, including how physician-reported and patient-reported outcomes relate to each other over the JIA disease course. METHODS In this multicentre prospective longitudinal study, we included children and young people recruited before Jan 1, 2015, to the Childhood Arthritis Prospective Study (CAPS), a UK multicentre inception cohort. Participants without a cJADAS score were excluded. To assess groups of children and young people with similar disease patterns in active joint count, physician's global assessment, and patient or parental global evaluation, we used latent profile analysis at initial presentation to paediatric rheumatology and multivariate group-based trajectory models for the following 3 years. Optimal models were selected on the basis of a combination of model fit, clinical plausibility, and model parsimony. FINDING Between Jan 1, 2001, and Dec 31, 2014, 1423 children and young people with JIA were recruited to CAPS, 239 of whom were excluded, resulting in a final study population of 1184 children and young people. We identified five clusters at baseline and six trajectory groups using longitudinal follow-up data. Disease course was not well predicted from clusters at baseline; however, in both cross-sectional and longitudinal analyses, substantial proportions of children and young people had high patient or parent global scores despite low or improving joint counts and physician global scores. Participants in these groups were older, and a higher proportion of them had enthesitis-related JIA and lower socioeconomic status, compared with those in other groups. INTERPRETATION Almost one in four children and young people with JIA in our study reported persistent, high patient or parent global scores despite having low or improving active joint counts and physician's global scores. Distinct patient subgroups defined by disease manifestation or trajectories of progression could help to better personalise health-care services and treatment plans for individuals with JIA. FUNDING Medical Research Council, Versus Arthritis, Great Ormond Street Hospital Children's Charity, Olivia's Vision, and National Institute for Health Research.
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Affiliation(s)
- Stephanie J W Shoop-Worrall
- Centre for Health Informatics, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Lucy R Wedderburn
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, University College London Hospitals and Great Ormond Street Hospital, London, UK
- Infection Inflammation and Rheumatology, UCL Great Ormond Street Institute of Child Health, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Wendy Thomson
- Centre for Genetics and Genomics Versus Arthritis, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Nophar Geifman
- Centre for Health Informatics, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
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Wu HH, Wu FQ, Li Y, Lai JM, Su GX, Cui SH, Chen Z, Li H. The quality of life in Chinese juvenile idiopathic arthritis patients: psychometric properties of the pediatric quality of life inventor generic core scales and rheumatology module. Health Qual Life Outcomes 2021; 19:37. [PMID: 33516223 PMCID: PMC7847010 DOI: 10.1186/s12955-021-01683-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 01/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) may seriously affects patients' quality of life (QoL), but it was rarely focused and studied in China, so we explore JIA children's QoL using Chinese version of the PedsQL4.0 Generic Core and PedsQL3.0 Rheumatology Module scale, and analyzed the psychometric properties of these two Scales among Chinese JIA children. METHODS We recruited 180 JIA patients from Children's Hospital Affiliated to Capital Institute of Pediatrics and Hebei Yanda Hospital from July 2018 to August 2019. The questionnaires include information related on JIA, PedsQL4.0 generic core and PedsQL3.0 Rheumatology Module scales. According to the disease type, onset age of and course of JIA, we divided them into different groups, then compared the QoL status among different groups. Moreover, we analyzed the reliability and validity of these two scales in these 180 JIA children. RESULTS The mean score of PedsQL4.0 generic core scale on these 180 patients was 82.85 ± 14.82, for these in active period was 72.05 ± 15.29, in remission period was 89.77 ± 9.23; the QoL score of systemic, polyarticular and oligoarticular JIA patients were 77.05 ± 19.11, 84.33 ± 12.46 and 87.12 ± 10.23. The mean score of PedsQL3.0 Rheumatology Module scale on 180 patients was 91.22 ± 9.45, for these in active period was 84.70 ± 11.37, in remission period was 95.43 ± 4.48; the QoL score of systemic, polyarticular and oligoarticular JIA patients were 89.41 ± 11.54, 89.38 ± 10.08 and 93.71 ± 6.92. In the PedsQL 4.0 Generic Core scale, the α coefficients of total scale and almost every dimension are all greater than 0.8 except for the school activity dimension of 0.589; the correlation coefficients of 22 items' scores (total 23 items) with the scores of dimensions they belong to are greater than 0.5 (maximum value is 0.864), and the other one is 0.406. In PedsQL3.0 Rheumatology Module scale, except for the treatment and worry dimensions of 0.652 and 0.635, the α coefficients of other dimensions and the total scale are all greater than 0.7; the correlation coefficients of all items' score were greater than 0.5 (the maximum is 0.933, the minimum is 0.515). CONCLUSIONS The QoL of Chinese JIA children is worse than their healthy peers, these in active period and diagnosed as systemic type were undergoing worst quality of life. The reliability and validity of PedsQL 4.0 Generic Core and PedsQL3.0 Rheumatology Module scale in Chinese JIA children are satisfactory, and can be used in clinical and scientific researches.
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Affiliation(s)
- Hua-Hong Wu
- Department of Growth and Development, Capital Institute of Pediatrics, YaBao Road, ChaoYang District, Beijing, 100020, China
| | - Feng-Qi Wu
- Department of Rheumatism and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Yang Li
- Department of Growth and Development, Capital Institute of Pediatrics, YaBao Road, ChaoYang District, Beijing, 100020, China
| | - Jian-Ming Lai
- Department of Rheumatism and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | - Gai-Xiu Su
- Department of Rheumatism and Immunology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing, China
| | | | - Zheng Chen
- Hebei Yanda Hospital, Yanjiao, Hebei, China
| | - Hui Li
- Department of Growth and Development, Capital Institute of Pediatrics, YaBao Road, ChaoYang District, Beijing, 100020, China.
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Ruperto N, Brunner HI, Ramanan AV, Horneff G, Cuttica R, Henrickson M, Anton J, Boteanu AL, Penades IC, Minden K, Schmeling H, Hufnagel M, Weiss JE, Pardeo M, Nanda K, Roth J, Rubio-Pérez N, Hsu JC, Wimalasundera S, Wells C, Bharucha K, Douglass W, Bao M, Mallalieu NL, Martini A, Lovell D, De Benedetti F. Subcutaneous dosing regimens of tocilizumab in children with systemic or polyarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 60:4568-4580. [PMID: 33506875 PMCID: PMC8487273 DOI: 10.1093/rheumatology/keab047] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/09/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives To determine s.c. tocilizumab (s.c.-TCZ) dosing regimens for systemic JIA (sJIA) and polyarticular JIA (pJIA). Methods In two 52-week phase 1 b trials, s.c.-TCZ (162 mg/dose) was administered to sJIA patients every week or every 2 weeks (every 10 days before interim analysis) and to pJIA patients every 2 weeks or every 3 weeks with body weight ≥30 kg or <30 kg, respectively. Primary end points were pharmacokinetics, pharmacodynamics and safety; efficacy was exploratory. Comparisons were made to data from phase 3 trials with i.v. tocilizumab (i.v.-TCZ) in sJIA and pJIA. Results Study participants were 51 sJIA patients and 52 pJIA patients aged 1–17 years who received s.c.-TCZ. Steady-state minimum TCZ concentration (Ctrough) >5th percentile of that achieved with i.v.-TCZ was achieved by 49 (96%) sJIA and 52 (100%) pJIA patients. In both populations, pharmacodynamic markers of disease were similar between body weight groups. Improvements in Juvenile Arthritis DAS-71 were comparable between s.c.-TCZ and i.v.-TCZ. By week 52, 53% of sJIA patients and 31% of pJIA patients achieved clinical remission on treatment. Safety was consistent with that of i.v.-TCZ except for injection site reactions, reported by 41.2% and 28.8% of sJIA and pJIA patients, respectively. Infections were reported in 78.4% and 69.2% of patients, respectively. Two sJIA patients died; both deaths were considered to be related to TCZ. Conclusion s.c.-TCZ provides exposure and risk/benefit profiles similar to those of i.v.-TCZ. S.c. administration provides an alternative administration route that is more convenient for patients and caregivers and that has potential for in-home use. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904292 and NCT01904279
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Affiliation(s)
- Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia-PRINTO, Genoa, Italy
| | - Hermine I Brunner
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany.,Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Rubén Cuttica
- Rheumatology Section, Hospital Pedro de Elizalde, Buenos Aires, Argentina
| | - Michael Henrickson
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jordi Anton
- Hospital Sant Joan de Déu, Universitat de Barcelona, Unidad de Reumatología Pediátrica, Esplugues de Llobregat (Barcelona), Spain
| | | | | | - Kirsten Minden
- German Rheumatism Research Centre Berlin, and Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Heinrike Schmeling
- Department of Pediatrics, Alberta Children's Hospital and Cumming School of Medicine/University of Calgary, Alberta, Canada
| | - Markus Hufnagel
- University Medical Center Freiburg, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases and Rheumatology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Jennifer E Weiss
- Hackensack University Medical Center, Pediatric Rheumatology, Hackensack, NJ, USA
| | - Manuela Pardeo
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Johannes Roth
- University of Ottawa and Division of Pediatric Dermatology & Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nadina Rubio-Pérez
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Pediatria, Hospital Universitario "Dr. J. E. González", Monterrey, NL, Mexico
| | - Joy C Hsu
- Roche Innovation Center, New York, NY, USA
| | | | | | | | | | - Min Bao
- Genentech, South San Francisco, CA, USA
| | | | - Alberto Martini
- Università degli Studi di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Genoa, Italy
| | - Daniel Lovell
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Morgan EM, Carle AC. Measures of Health Status and Quality of Life in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:565-576. [PMID: 33091241 DOI: 10.1002/acr.24372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/04/2023]
Affiliation(s)
- Esi M Morgan
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Adam C Carle
- University of Cincinnati College of Arts and Sciences, Cincinnati, Ohio
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Predicting disease severity and remission in juvenile idiopathic arthritis: are we getting closer? Curr Opin Rheumatol 2020; 31:436-449. [PMID: 31085941 DOI: 10.1097/bor.0000000000000620] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To summarize current research on the prediction of severe disease or remission in children with juvenile arthritis, and define further steps needed towards developing prediction tools with sufficient accuracy for clinical use. RECENT FINDINGS High disease activity, poor patient-reported outcomes, ankle or wrist involvement, and a longer time from onset to the start of treatment herald a severe disease course and a low chance of remission. Other studies confirmed that age less than 7 years and positive ANA are the strongest predictors of uveitis development. Preliminary evidence suggests ultrasound findings may predict flare in patients with clinically inactive disease, and several new biomarkers show promise. A few prediction tools that combine predictors to estimate the chance of remission or a severe disease course in the medium-term to long-term have shown good accuracy when internally validated in the population in which they were developed. SUMMARY Promising candidate tools for predicting disease severity and long-term remission in juvenile arthritis are now available. These tools need external validation in other populations, and ideally formal trials to assess whether their use in practice improves patient outcomes. We are definitively getting closer, but we are not there yet.
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Barendregt AM, Mazzoli V, van Gulik EC, Schonenberg-Meinema D, Nassar-Sheikh Rashid A, Nusman CM, Dolman KM, van den Berg JM, Kuijpers TW, Nederveen AJ, Maas M, Hemke R. Juvenile Idiopathic Arthritis: Diffusion-weighted MRI in the Assessment of Arthritis in the Knee. Radiology 2020; 295:373-380. [PMID: 32154774 DOI: 10.1148/radiol.2020191685] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Diffusion-weighted imaging (DWI) can depict the inflamed synovial membrane in arthritis. Purpose To study the diagnostic accuracy of DWI for the detection of arthritis compared with the clinical reference standard and to compare DWI to contrast material-enhanced MRI for the detection of synovial inflammation. Materials and Methods In this institutional review board-approved prospective study, 45 participants with juvenile idiopathic arthritis (JIA) or suspected of having JIA (seven boys, 38 girls; median age, 14 years [interquartile range, 12-16 years]) were included between December 2015 and December 2018. Study participants underwent pre- and postcontrast 3.0-T MRI of the knee with an additional DWI sequence. For the clinical reference standard, a multidisciplinary team determined the presence or absence of arthritis on the basis of clinical, laboratory, and imaging findings (excluding DWI). Two data sets were scored by two radiologists blinded to all clinical data; data set 1 contained pre- and postcontrast sequences (contrast-enhanced MRI), and data set 2 contained precontrast and DWI sequences (DWI). Diagnostic accuracy was determined by comparing the scores of the DWI data set to those of the clinical reference standard. Second, DWI was compared with contrast-enhanced MRI regarding detection of synovial inflammation. Results Sensitivity for detection of arthritis for DWI was 93% (13 of the 14 participants with arthritis were correctly classified with DWI; 95% confidence interval [CI]: 64%, 100%) and specificity was 81% (25 of 31 participants without arthritis were correctly classified with DWI; 95% CI: 62%, 92%). Scores for synovial inflammation at DWI and contrast-enhanced MRI agreed in 37 of 45 participants (82%), resulting in a sensitivity of 92% (12 of 13 participants; 95% CI: 62%, 100%) and specificity of 78% (25 of 32 participants; 95% CI: 60%, 90%) with DWI when contrast-enhanced MRI was considered the reference standard. Conclusion Diffusion-weighted imaging (DWI) was accurate in detecting arthritis in pediatric participants with juvenile idiopathic arthritis (JIA) or suspected of having JIA and showed agreement with contrast-enhanced MRI. The results indicate that DWI could replace contrast-enhanced MRI for imaging of synovial inflammation in this patient group. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Anouk M Barendregt
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - Valentina Mazzoli
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - E Charlotte van Gulik
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - Dieneke Schonenberg-Meinema
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - Amara Nassar-Sheikh Rashid
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - Charlotte M Nusman
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - Koert M Dolman
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - J Merlijn van den Berg
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - Taco W Kuijpers
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - Aart J Nederveen
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - Mario Maas
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
| | - Robert Hemke
- From the Department of Radiology and Nuclear Medicine (A.M.B., E.C.v.G., A.J.N., M.M., R.H.), Department of Pediatric Immunology, Rheumatology and Infectious Disease (A.M.B., E.C.v.G., D.S.M., A.N.S.a.R., J.M.v.d.B., T.W.K.), and Department of Pediatrics (C.M.N.), Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Department of Radiology, Lucas Center for Imaging, Stanford University, Stanford, Calif (V.M.); Department of Pediatric Rheumatology, Reade, Amsterdam, the Netherlands (K.M.D.); and Department of Pediatrics, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (K.M.D.)
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Schoemaker CG, Swart JF, Wulffraat NM. Treating juvenile idiopathic arthritis to target: what is the optimal target definition to reach all goals? Pediatr Rheumatol Online J 2020; 18:34. [PMID: 32299430 PMCID: PMC7164231 DOI: 10.1186/s12969-020-00428-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/03/2020] [Indexed: 12/28/2022] Open
Abstract
In 2018, an international Task Force formulated recommendations for treating Juvenile Idiopathic Arthritis (JIA) to target. The Task Force has not yet resolved three issues. The first issue is the lack of a single "best" target. The Task Force decided not to recommend the use of a specific instrument to assess inactive disease or remission. Recent studies underscore the use of a broad target definition. The second issue is the basic assumption that a treatment aggressively aimed at the target will have 'domino effects' on other treatment goals as well. Thus far, this assumption was not confirmed for pain, fatigue and stiffness. The third issue is shared decision-making, and the role of individual patient targets. Nowadays, patients and parents should have a more active role in choosing targets and their personal treatment goals. In our department the electronic medical records have been restructured in such a way that the patient's personal treatment goals with a target date appears on the front page. The visualization of their specific personal goals helps us to have meaningful discussions on the individualized treatment strategy and to share decisions. In conclusion, a joint treat to target (T2T) strategy is a promising approach for JIA. The Task Force formulated valuable overarching principles and a first version of recommendations. However, implementation of T2T needs to capture more than just inactive disease. Patients and parents should have an active role in choosing personal targets as well.
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Affiliation(s)
- Casper G. Schoemaker
- grid.7692.a0000000090126352Department of Pediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands ,Netherlands JIA Patient and Parent Organisation, member of ENCA, Rijssen, The Netherlands
| | - Joost F. Swart
- grid.7692.a0000000090126352Department of Pediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nico M. Wulffraat
- grid.7692.a0000000090126352Department of Pediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands ,grid.5477.10000000120346234Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
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Rumsey DG, Guzman J, Rosenberg AM, Huber AM, Scuccimarri R, Shiff NJ, Bruns A, Feldman BM, Eurich DT, Benseler S, Berard R, Boire G, Bolaria R, Cabral D, Cameron B, Campillo S, Chan M, Chédeville G, Chetaille A, Dancey P, Dorval J, Duffy C, Ellsworth J, Feldman D, Gross K, Haddad E, Houghton K, Johnson N, Jurencak R, Lang B, Larché M, Laxer R, LeBlanc C, Levy D, Luca N, Miettunen P, Morishita K, Oen K, Petty R, Ramsey S, Roth J, Saint‐Cyr C, Schmeling H, Schneider R, Silverman E, Spiegel L, Stringer E, Tse S, Tucker L, Turvey S, Watanabe Duffy K, Yeung R. Worse Quality of Life, Function, and Pain in Children With Enthesitis, Irrespective of Their Juvenile Arthritis Category. Arthritis Care Res (Hoboken) 2020; 72:441-446. [DOI: 10.1002/acr.23844] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/05/2019] [Indexed: 11/07/2022]
Affiliation(s)
| | - Jaime Guzman
- University of British Columbia Vancouver British Columbia Canada
| | | | | | | | | | | | - Brian M. Feldman
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
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Batthish M, Berard R, Cabral D, Bolaria R, Chédeville G, Duffy C, Gerhold K, Gerschman T, Huber A, Proulx-Gauthier JP, Rosenberg A, Rumsey D, Schmeling H, Shiff N, Soon G, Bruns A, Tucker L, Guzman J. A new Canadian inception cohort for juvenile idiopathic arthritis: The Canadian Alliance of Pediatric Rheumatology Investigators Registry. Rheumatology (Oxford) 2020; 59:2796-2805. [DOI: 10.1093/rheumatology/keaa006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The aim was to describe the design, methods and initial findings of a new Canadian inception cohort of children with JIA, The Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) JIA Registry.
Methods
The CAPRI JIA Registry was started in 2017 to collect information prospectively on children enrolled within 3 months of JIA diagnosis across Canada. The registry has a non-traditional modular design, with no artificially set times for registry visits to occur, streamlined multi-method data collection that requires 2–4 min per visit, and reports cumulative incidence of treatments, outcomes and adverse events calculated by Kaplan–Meier survival methods.
Results
A total of 166 patients, enrolled a median of 6 weeks after JIA diagnosis at 10 centres, were included. The median age at diagnosis was 9 years [interquartile range (IQR) 3, 13], 61% were female and 51% had oligoarticular JIA. The median three-variable clinical Juvenile Arthritis Disease Activity Score was 6.5 (IQR 4, 10) at enrolment, and the median time to first attainment of clinically inactive disease (CID) was 24 weeks (by 1 year, 81%). Within 1 year of diagnosis, 70% of patients had started a DMARD and 35% a biologic agent. The rates of adverse events and serious adverse events were 60 and 5.8 per 100 patient-years, respectively.
Conclusion
This streamlined and flexible registry minimizes the burden of data collection and interference with clinic operations. Initial findings suggest that treatments for newly diagnosed patients with JIA in Canada have intensified, and now 81% of patients attain CID within 1 year of diagnosis.
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Affiliation(s)
- Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Roberta Berard
- Division of Rheumatology, Department of Pediatrics, Western University, London, Ontario
| | - David Cabral
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Roxana Bolaria
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Gaëlle Chédeville
- Division of Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec
| | - Ciaran Duffy
- Division of Rheumatology, Department of Pediatrics, University of Ottawa, Ottawa, Ontario
| | - Kerstin Gerhold
- Division of Rheumatology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
| | - Tommy Gerschman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Adam Huber
- Division of Rheumatology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | | | - Alan Rosenberg
- Division of Rheumatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Dax Rumsey
- Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Heinrike Schmeling
- Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Natalie Shiff
- Division of Rheumatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Gordon Soon
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Alessandra Bruns
- Division of Rheumatology, Department of Pediatrics, University de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lori Tucker
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Jaime Guzman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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Minden K, Horneff G, Niewerth M, Seipelt E, Aringer M, Aries P, Foeldvari I, Haas JP, Klein A, Tatsis S, Tenbrock K, Zink A, Klotsche J. Time of Disease-Modifying Antirheumatic Drug Start in Juvenile Idiopathic Arthritis and the Likelihood of a Drug-Free Remission in Young Adulthood. Arthritis Care Res (Hoboken) 2020; 71:471-481. [PMID: 30044538 DOI: 10.1002/acr.23709] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/17/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To study juvenile idiopathic arthritis (JIA) long-term outcomes in relation to the time of initiation of biologic disease-modifying antirheumatic drug (bDMARD). METHODS Outcomes of JIA patients prospectively followed by the Biologika in der Kinderrheumatologie (BiKeR) and Juvenile Arthritis Methotrexate/Biologics Long-Term Observation (JuMBO) registers were analyzed with regard to drug-free remission and inactive disease, functional status and quality of life, and surgery. To analyze the influence of early bDMARD therapy on outcomes, patients were assigned to 3 groups based on the time from symptom onset to bDMARD start (G1: ≤2 years, G2: >2 to ≤5 years, and G3: >5 years). Propensity score-adjusted outcome differences were analyzed by multinomial logistic regression analyses among the groups. RESULTS A total of 701 JIA patients were observed for mean ± SD 9.1 ± 3.7 years. At the last follow-up (disease duration mean ± SD 14.3 ± 6.1 years), 11.7% of patients were in drug-free remission, and 40.0% had inactive disease. More than half of the patients reported no functional limitation, while 5% had undergone arthroplasty, and 3% had eye surgery. At the 10-year time point, patients in G1 (n = 108) were significantly more likely to be in drug-free remission than those patients who began treatment later (G2, n = 199; G3, n = 259), with 18.5%, 10.1%, and 4.9%, respectively. Patients in G1 had significantly lower disease activity (clinical Juvenile Arthritis Disease Activity Score in 10 joints = 4.9), a better overall well-being (18.2% patient global assessment score = 0), and higher functional status (59.2% Health Assessment Questionnaire score = 0), compared to patients in G3 (7.1, 8.4%, and 43.7%, respectively). G1 patients required arthroplasty significantly less frequently than G3 patients and had significantly lower disease activity over time than patients in both G2 and G3. CONCLUSION Early DMARD treatment is associated with better disease control and outcomes, which supports the concept of a "window of opportunity" for JIA.
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Affiliation(s)
- Kirsten Minden
- German Rheumatism Research Center and Charité-University Medicine Berlin, Berlin, Germany
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin GmbH, Sankt Augustin, and University Hospital of Cologne, Cologne, Germany
| | | | | | - Martin Aringer
- University Medical Center Carl Gustav Carus at the Technische Universität Dresden, Dresden, Germany
| | - Peer Aries
- Rheumatologie im Struensee-Haus, Hamburg, Germany
| | - Ivan Foeldvari
- Centre for Pediatric and Adolescent Rheumatology, Hamburg, Germany
| | - Johannes-Peter Haas
- German Centre for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Ariane Klein
- Asklepios Clinic Sankt Augustin GmbH, Sankt Augustin, Germany
| | | | - Klaus Tenbrock
- Rheinisch-Westfälische Technische Hochschule Aachen University, Aachen, Germany
| | - Angela Zink
- German Rheumatism Research Center and Charité-University Medicine Berlin, Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Center and Charité-University Medicine Berlin, Berlin, Germany
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Health-related quality of life during early aggressive treatment in patients with polyarticular juvenile idiopathic arthritis: results from randomized controlled trial. Pediatr Rheumatol Online J 2019; 17:80. [PMID: 31842940 PMCID: PMC6915981 DOI: 10.1186/s12969-019-0370-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) may cause significant impairment in health-related quality of life (HrQoL), despite effective therapies. The aim of this study was to assess HrQoL during first-year treatment in patients with new-onset polyarticular JIA, and to compare treatment strategies. METHODS In ACUTE-JIA Study, 60 patients with new-onset JIA were randomized to receive either infliximab with methotrexate (IFX+MTX); a triple therapy of methotrexate, hydroxychloroquine, and sulfasalazine (Triple); or methotrexate monotherapy (MTX). Efficacy was measured with American College of Rheumatology pediatric (ACRp) score, and juvenile arthritis disease activity score (JADAS). HrQoL was evaluated with Child Health Questionnaire (CHQ), which includes physical and psychosocial summary scores (PhS and PsS). Linear mixed models were utilized to compare groups over time. RESULTS In the whole group of 60 patients, mean physical summary score (PhS) improved from 26.2 (SD 8.7) at week 0 to 49.7 (SD 13.2) at week 54 (p=0.046). Mean improvement of PhS was 20.3 (95% CI -15.5 to 56.2); 22.6 (-19.5 to 64.7); and 26.6 (-12.1 to 65.3) in IFX+MTX, Triple, and MTX, respectively. Changes in psychosocial summary score (PsS) were smaller: from 51.0 (SD 8.5) to 54.7 (6.3) (p=0.019) in all patients. No differences between the three treatment groups were detected in either of the measures. In multivariate analyses, Child Health Assessment Questionnaire (CHAQ), pain VAS, and time spent in inactive disease contributed to improvement in PhS; gender and CHAQ to PsS. CONCLUSIONS HrQol improved during the first year on therapy for JIA irrespective of the treatment strategy. The timing of change in the different dimensions of HrQoL varied; improvement occurred earlier in physical than psychosocial domains of HrQol. TRIAL REGISTRATION This study was registered within the Hospital District of Helsinki and Uusimaa (http://www.hus.fi) clinical trials, number 211864 in October 2002, and later on with ClinicalTrials.gov, number NCT01015547.
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Bucci R, Rongo R, Amato A, Martina S, D'Antò V, Valletta R. The Psychological Impact of Dental Aesthetics in Patients with Juvenile Idiopathic Arthritis Compared with Healthy Peers: A Cross-Sectional Study. Dent J (Basel) 2019; 7:dj7040098. [PMID: 31581530 PMCID: PMC6960518 DOI: 10.3390/dj7040098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 02/02/2023] Open
Abstract
This study aimed to assess whether dental aesthetics had a different impact on the psychosocial domains of adolescents with juvenile idiopathic arthritis (JIA) as compared with healthy peers. Fifty JIA patients and eighty controls aged between 13 and 17 years were enrolled. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was administered along with tools for the self-assessment of malocclusion and self-esteem. An objective evaluation of malocclusion severity was performed through a clinical evaluation with the Dental Aesthetic Index (DAI). The sample was divided according to the DAI stages of malocclusion severity; a two-way analysis of variance (ANOVA) was performed to assess whether there was a difference in the studied variables according to the malocclusion and the presence of JIA. The results showed no interaction between the malocclusion severity and the presence of JIA in all analyzed variables (all p > 0.05). According to the DAI stages, the Dental Self-Confidence domain of the PIDAQ and the Perception of Occlusion Scale showed statistically significant differences only within the controls (p = 0.027 and p = 0.014, respectively). Therefore, JIA adolescents seem to be less concerned about their dental aesthetics compared with healthy peers, and clinicians should take particular care when proposing orthodontic treatments aiming only to improve dental aesthetics.
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Affiliation(s)
- Rosaria Bucci
- Department of Neurosciences, Reproductive Science and Oral Sciences, Division of Orthodontics, University of Naples Federico II, Naples, 80131, Italy.
| | - Roberto Rongo
- Department of Neurosciences, Reproductive Science and Oral Sciences, Division of Orthodontics, University of Naples Federico II, Naples, 80131, Italy.
| | - Alessandra Amato
- Department of Neurosciences, Reproductive Science and Oral Sciences, Division of Orthodontics, University of Naples Federico II, Naples, 80131, Italy.
| | - Stefano Martina
- Department of Neurosciences, Reproductive Science and Oral Sciences, Division of Orthodontics, University of Naples Federico II, Naples, 80131, Italy.
| | - Vincenzo D'Antò
- Department of Neurosciences, Reproductive Science and Oral Sciences, Division of Orthodontics, University of Naples Federico II, Naples, 80131, Italy.
| | - Rosa Valletta
- Department of Neurosciences, Reproductive Science and Oral Sciences, Division of Orthodontics, University of Naples Federico II, Naples, 80131, Italy.
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Arnstad ED, Rypdal V, Peltoniemi S, Herlin T, Berntson L, Fasth A, Nielsen S, Glerup M, Ekelund M, Zak M, Aalto K, Nordal E, Romundstad PR, Rygg M. Early Self‐Reported Pain in Juvenile Idiopathic Arthritis as Related to Long‐Term Outcomes: Results From the Nordic Juvenile Idiopathic Arthritis Cohort Study. Arthritis Care Res (Hoboken) 2019; 71:961-969. [DOI: 10.1002/acr.23715] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 07/24/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Ellen Dalen Arnstad
- Levanger HospitalNord‐Trøndelag Hospital Trust, Levanger, and Norwegian University of Science and Technology Trondheim Norway
| | - Veronika Rypdal
- University Hospital of North Norway and Arctic University of Norway Tromsø Norway
| | - Suvi Peltoniemi
- Hospital for Children and AdolescentsUniversity of Helsinki Helsinki Finland
| | | | | | | | - Susan Nielsen
- Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Mia Glerup
- Aarhus University Hospital Aarhus Denmark
| | - Maria Ekelund
- Uppsala University, Uppsala, and Ryhov County Hospital Jonkoping Sweden
| | - Marek Zak
- Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Kristiina Aalto
- Hospital for Children and AdolescentsUniversity of Helsinki Helsinki Finland
| | - Ellen Nordal
- University Hospital of North Norway and Arctic University of Norway Tromsø Norway
| | | | - Marite Rygg
- Norwegian University of Science and Technology and St. Olavs Hospital Trondheim Norway
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Sengler C. [New therapy approaches, better outcomes? : Results from inception cohorts for patients with juvenile idiopathic arthritis]. Z Rheumatol 2019; 78:610-619. [PMID: 31127369 DOI: 10.1007/s00393-019-0648-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Prospective cohort studies collect demographic and clinical data of newly diagnosed patients using standardized questionnaires and validated measuring instruments. Therefore, they are a valuable data source for evaluating disease progression, outcome parameters and predictors. In this article a selection of results from four inception cohorts on juvenile idiopathic arthritis (JIA) are presented. In all cohorts, one half to three quarters of the patients achieved an inactive disease within the first year under observation but there were relevant differences between the different JIA categories. The time from symptom onset to diagnosis could be identified as an important predictor of this outcome. Data from the German JIA cohort showed that the health-related quality of life of patients and healthy control subjects had largely converged 3 years after inclusion. Young children with JIA and the detection of antinuclear antibodies have an increased risk of developing JIA-associated uveitis. Of these, the uveitis was inactive in approximately 80% after 1 year; however, at the time of diagnosis, almost 30% of patients already had uveitis-related complications. The previous therapy with methotrexate proved to be preventive for the development of uveitis. The early outcome of JIA patients is generally good. The differences in the JIA categories indicate the need to further individualize the therapy and to adapt it better to the risk profile of the individual patient. Data on long-term outcomes will provide information on which factors have a decisive influence on the course of the disease and how the care of children and adolescents with JIA can be further improved.
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Affiliation(s)
- C Sengler
- Programmbereich Epidemiologie, Arbeitsgruppe Kinder- und Jugendrheumatologie, Deutsches Rheuma-Forschungszentrum Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Lin CY, Loyola-Sanchez A, Hurd K, Ferucci ED, Crane L, Healy B, Barnabe C. Characterization of indigenous community engagement in arthritis studies conducted in Canada, United States of America, Australia and New Zealand. Semin Arthritis Rheum 2019; 49:145-155. [PMID: 30598333 DOI: 10.1016/j.semarthrit.2018.11.009] [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] [Received: 03/29/2018] [Revised: 10/21/2018] [Accepted: 11/20/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Research adhering to community engagement processes leads to improved outcomes. The level of Indigenous communities' engagement in rheumatology research is unknown. OBJECTIVE To characterize the frequency and level of community engagement reporting in arthritis studies conducted in Australia (AUS), Canada (CAN), New Zealand (NZ) and the United States of America (USA). METHODS Studies identified through systematic reviews on topics of arthritis epidemiology, disease phenotypes and outcomes, health service utilization and mortality in Indigenous populations of AUS, CAN, NZ and USA, were evaluated for their descriptions of community engagement. The level of community engagement during inception, data collection and results interpretation/dissemination stages of research was evaluated using a custom-made instrument, which ranked studies along the community engagement spectrum (i.e. inform-consult-involve-collaborate-empower). Meaningful community engagement was defined as involving, collaborating or empowering communities. Descriptive analyses for community engagement were performed and secondary non-parametric inferential analyses were conducted to evaluate the possible associations between year of publication, origin of the research idea, publication type and region of study; and meaningful community engagement. RESULTS Only 34% (n = 69) of the 205 studies identified reported community engagement at ≥ 1 stage of research. Nearly all studies that engaged communities (99% (n = 68)) did so during data collection, while only 10% (n = 7) did so at the inception of research and 16% (n = 11) described community engagement at the results' interpretation/dissemination stage. Most studies provided community engagement descriptions that were assessed to be at the lower end of the spectrum. At the inception of research stage, 3 studies reported consulting communities, while 42 studies reported community consultation at data collection stage and 4 studies reported informing or consulting communities at the interpretation/dissemination of results stage. Only 4 studies described meaningful community engagement through all stages of the research. Inferential statistics identified that studies with research ideas that originated from the Indigenous communities involved were significantly more associated with achieving meaningful community engagement. CONCLUSIONS The reporting of Indigenous community engagement in published arthritis studies is limited in frequency and is most frequently described at the lower end of the community engagement spectrum. Processes that support meaningful community engagement are to be promoted.
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Affiliation(s)
- Chu Yang Lin
- Faculty of Medicine & Dentistry, University of Alberta, Canada.
| | | | - Kelle Hurd
- Cumming School of Medicine, University of Calgary, Canada.
| | | | | | - Bonnie Healy
- Alberta First Nations Information Governance Center, Canada.
| | - Cheryl Barnabe
- Departments of Medicine and Community Health Sciences, University of Calgary and Rheumatologist, Alberta Health Services, 3330 Hospital Drive NW, T2N 4N1, Calgary, Alberta, Canada.
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39
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Swart J, Giancane G, Horneff G, Magnusson B, Hofer M, Alexeeva Е, Panaviene V, Bader-Meunier B, Anton J, Nielsen S, De Benedetti F, Kamphuis S, Staņēviča V, Tracahana M, Ailioaie LM, Tsitsami E, Klein A, Minden K, Foeldvari I, Haas JP, Klotsche J, Horne AC, Consolaro A, Bovis F, Bagnasco F, Pistorio A, Martini A, Wulffraat N, Ruperto N. Pharmacovigilance in juvenile idiopathic arthritis patients treated with biologic or synthetic drugs: combined data of more than 15,000 patients from Pharmachild and national registries. Arthritis Res Ther 2018; 20:285. [PMID: 30587248 PMCID: PMC6307151 DOI: 10.1186/s13075-018-1780-z] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The availability of methotrexate and the introduction of multiple biological agents have revolutionized the treatment of juvenile idiopathic arthritis (JIA). Several international and national drug registries have been implemented to accurately monitor the long-term safety/efficacy of these agents. This report aims to present the combined data coming from Pharmachild/PRINTO registry and the national registries from Germany (BiKeR) and Sweden. METHODS Descriptive statistics was used for demographic, clinical data, drug exposure, adverse events (AEs) and events of special interest (ESIs). For the Swedish register, AE data were not available. RESULTS Data from a total of 15,284 patients were reported: 8274 (54%) from the Pharmachild registry and 3990 (26%) and 3020 (20%) from the German and the Swedish registries, respectively. Pharmachild children showed a younger age (median of 5.4 versus 7.6 years) at JIA onset and shorter disease duration at last available visit (5.3 versus 6.1-6.8) when compared with the other registries. The most frequent JIA category was the rheumatoid factor-negative polyarthritis (range of 24.6-29.9%). Methotrexate (61-84%) and etanercept (24%-61.8%) were the most frequently used synthetic and biologic disease-modifying anti-rheumatic drugs (DMARDs), respectively. There was a wide variability in glucocorticoid use (16.7-42.1%). Serious AEs were present in 572 (6.9%) patients in Pharmachild versus 297 (7.4%) in BiKeR. Infection and infestations were the most frequent AEs (29.4-30.1%) followed by gastrointestinal disorders (11.5-19.6%). The most frequent ESIs were infections (75.3-89%). CONCLUSIONS This article is the first attempt to present a very large sample of data on JIA patients from different national and international registries and represents the first proposal for data merging as the most powerful tool for future analysis of safety and effectiveness of immunosuppressive therapies in JIA. REGISTRY REGISTRATION The Pharmachild registry is registered at ClinicalTrials.gov ( NCT01399281 ) and at the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) ( http://www.encepp.eu/encepp/viewResource.htm?id=19362 ). The BiKeR registry is registered at ENCePP ( http://www.encepp.eu/encepp/viewResource.htm?id=20591 ).
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Affiliation(s)
- Joost Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Lundlaan, 6 PO box 85090, Utrecht, The Netherlands
| | - Gabriella Giancane
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, Arnold-Janssen strasse 29, Sankt Augustin, Germany.,Department of Pediatric and Adolescents medicine, Medical faculty, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Bo Magnusson
- Karolinska University Hospital, Pediatric Rheumatology Unit, Stockholm, Sweden
| | - Michael Hofer
- Unité Romande d'Immuno-Rhumatologie Pediatrique/Centre Hospitalier Universitaire Vaudois (CHUV), Pediatrie, University of Lausanne, Av Bugnon 46, Lausanne, Switzerland.,University Hospital of Geneva, Geneva, Switzerland
| | - Еkaterina Alexeeva
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" of the Ministry of Health of the Russian Federation, LOMONOSOVSKIJ PR-T,2/62, Moscow, Russia.,Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Violeta Panaviene
- Vilnius University, Clinic of Children's Diseases, Vilnius, Lithuania and Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Santariskiu, 4, Vilnius, Lithuania
| | - Brigitte Bader-Meunier
- Université Paris-Descartes, Institut IMAGINE, Centre de référence national pour les Rhumatismes inflammatoires et les maladies Auto-Immunes Systémiques rares de l'Enfant (RAISE), Unité d'Immunologie, Hématologie et Rhumatologie Pediatrique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, 149 Rue De Sevres, Paris, France
| | - Jordi Anton
- Hospital Sant Joan de Déu, Universitat de Barcelona, Unidad de Reumatología Pediátrica, Esplugues de Llobregat, Passeig Sant Joan de Deu 2, Barcelona, Spain
| | - Susan Nielsen
- Juliane Marie Centret, Rigshospitalet, Paediatric Rheumatology Unit, Blegdamsvej 9, Copenhagen, Denmark
| | - Fabrizio De Benedetti
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza S. Onofrio, 4, Rome, Italy
| | - Sylvia Kamphuis
- Sophia Children's Hospital, Department of Paediatric Rheumatology, Erasmus University Medical Centre, Dr Molewaterplein 60, Rotterdam, The Netherlands.,Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Valda Staņēviča
- Riga Stradins University, Department of Pediatrics, Children University Hospital, Vienibas gatve 45, Riga, LV, Latvia
| | - Maria Tracahana
- Hippokration General Hospital, First Department of pediatrics, Thessaloniki University School of Medicine, Konstantinoupoleos 49, Thessaloniki, Greece
| | | | - Elena Tsitsami
- Aghia Sophia Childrens Hospital, First Department of Pediatrics, University of Athens Medical School, Thivon 1, Athens, Greece
| | - Ariane Klein
- Asklepios Clinic Sankt Augustin, Arnold-Janssen strasse 29, Sankt Augustin, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre, Berlin, Germany.,Charité University Medicine, Charitéplatz 1, Berlin, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Dehnhaide 120, Hamburg, Germany
| | - Johannes Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Zentrum für Schmerztherapie junger Menschen, Gehfeldstrasse 24, Garmisch-Partenkirchen, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre, Berlin, Germany.,Charité University Medicine, Charitéplatz 1, Berlin, Germany
| | - Anna Carin Horne
- Karolinska University Hospital, Pediatric Rheumatology Unit, Stockholm, Sweden
| | - Alessandro Consolaro
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, via Gaslini 5, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Francesca Bovis
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy
| | - Francesca Bagnasco
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy
| | - Angela Pistorio
- IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, via Gaslini 5, Genoa, Italy
| | - Alberto Martini
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, via Gaslini 5, Genoa, Italy
| | - Nico Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Lundlaan, 6 PO box 85090, Utrecht, The Netherlands
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy.
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Rose-Davis B, Curran J, Wright J, Cellucci T, Duffy CM, Tucker LB, Batthish M, Huber AM, Lang B, Levy DM, Rumsey DG, Watanabe Duffy KN, Stringer E. Factors Influencing the Uptake of Canadian Research Findings into the Care of Children with Arthritis: A Healthcare Provider Perspective. J Rheumatol 2018; 46:294-300. [PMID: 30442824 DOI: 10.3899/jrheum.180282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2018] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To determine barriers and facilitators to the uptake of findings from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) study into clinical care by pediatric rheumatologists (PR) and allied health professionals (AHP) caring for children with juvenile idiopathic arthritis (JIA) in Canada. METHODS PR and AHP participated in this qualitative study through telephone interviews. Interview guides were developed using the Theoretical Domains Framework and focused on the use of information from the ReACCh-Out study in the practice of counseling patients and families. A directed content analysis approach was used for coding. RESULTS Nineteen interviews (8 PR and 11 AHP) were completed. All PR had knowledge of the ReACCh-Out study. Three major themes were identified: (1) both groups are motivated to use information from research in clinical care; (2) volume and emotional effect of information on families are barriers; and (3) specific timepoints in care trigger providing this information. AHP had less knowledge of the ReACCh-Out study, did not feel it was their primary role to provide this information, and have a desire for more opportunity to participate in academic forums related to research. CONCLUSION We have described a comprehensive overview of the barriers and facilitators perceived by healthcare providers in the translation of knowledge from JIA research into use in clinical practice. These findings provide a foundation for the development of knowledge translation strategies in the care of children with JIA and other rheumatic diseases.
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Affiliation(s)
- Benjamin Rose-Davis
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Janet Curran
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Julia Wright
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Tania Cellucci
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Ciarån M Duffy
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Lori B Tucker
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Michelle Batthish
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Adam M Huber
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Bianca Lang
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Deborah M Levy
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Dax G Rumsey
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Karen N Watanabe Duffy
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada.,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre
| | - Elizabeth Stringer
- From the IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; British Columbia Children's Hospital, Division of Rheumatology, and University of British Columbia, Vancouver, British Columbia; McMaster Children's Hospital, Division of Rheumatology, and McMaster University, Hamilton; Hospital for Sick Children and University of Toronto, Toronto, Ontario; Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada. .,B. Rose-Davis, BA, IWK Health Centre; J. Curran, BN, MEd, PhD, Clinician Scientist, Pediatrics and Emergency Medicine, Associate Professor of Nursing, IWK Health Centre; J. Wright, BSc, Dalhousie University; T. Cellucci, MD, FRCPC, MScCH, Pediatric Rheumatologist, Associate Professor of Pediatrics, McMaster University; C.M. Duffy, MB, BCh, MSc, FRCPC, FRCPI, Pediatric Rheumatologist, Professor of Pediatrics, Children's Hospital of Eastern Ontario; L.B. Tucker, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, British Columbia Children's Hospital, Division of Rheumatology; M. Batthish, MSc, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, McMaster Children's Hospital, Division of Rheumatology; A.M. Huber, MD, MSc, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; B. Lang, MD, FRCPC, Pediatric Rheumatologist, Professor of Pediatrics, IWK Health Centre; D.M. Levy, MD, MS, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Hospital for Sick Children and University of Toronto; D.G. Rumsey, MD, FRCPC, Pediatric Rheumatologist, Assistant Professor of Pediatrics, University of Alberta; K.N. Watanabe Duffy, MD, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, Children's Hospital of Eastern Ontario; E. Stringer, MD, MSc, FRCPC, Pediatric Rheumatologist, Associate Professor of Pediatrics, IWK Health Centre.
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O’Sullivan G, O’Higgins S, Caes L, Saetes S, McGuire BE, Stinson J. Self-management needs of Irish adolescents with Juvenile Idiopathic Arthritis (JIA): how can a Canadian web-based programme meet these needs? Pediatr Rheumatol Online J 2018; 16:68. [PMID: 30409209 PMCID: PMC6225653 DOI: 10.1186/s12969-018-0287-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) affects over 1000 children and adolescents in Ireland, potentially impacting health-related quality-of-life. Accessible self-management strategies, including Internet-based interventions, can support adolescents in Ireland where specialist rheumatology care is geographically-centralised within the capital city. This study interviewed adolescents with JIA, their parents, and healthcare professionals to (i) explore the self-management needs of Irish adolescents; and (ii) evaluate the acceptability of an adapted version of a Canadian JIA self-management programme (Teens Taking Charge: Managing Arthritis Online, or TTC) for Irish users. METHODS Focus groups and interviews were conducted with Irish adolescents with JIA (N = 16), their parents (N = 13), and Irish paediatric healthcare professionals (HCPs; N = 22). Adolescents were aged 12-18 (Mage = 14.19 years), and predominantly female (62.5%). Participants identified the needs of adolescents with JIA and evaluated the usefulness of the TTC programme. Data were analysed using a thematic analysis approach. RESULTS Five themes emerged: independent self-management; acquiring skills and knowledge to manage JIA; unique challenges of JIA in Ireland; views on web-based interventions; and understanding through social support. Adolescents acknowledged the need for independent self-management and gradually took additional responsibilities to achieve this goal. However, they felt they lacked information to manage their condition independently. Parents and adolescents emphasised the need for social support and felt a peer-support scheme could provide additional benefit to adolescents if integrated within the TTC programme. All participants endorsed the TTC programme to gain knowledge about JIA and offered suggestions to make the programme relevant to Irish users. CONCLUSIONS There is scope for providing easily-accessible, accurate information to Irish families with JIA. The acceptability of adapting an existing JIA self-management intervention for Irish users was confirmed.
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Affiliation(s)
- Grace O’Sullivan
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Siobhán O’Higgins
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Line Caes
- Division of Psychology; Faculty of Natural Sciences, University of Stirling, Stirling, Scotland, UK
| | - Sophia Saetes
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Brian E. McGuire
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Jennifer Stinson
- The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Listing M, Mönkemöller K, Liedmann I, Niewerth M, Sengler C, Listing J, Foell D, Heiligenhaus A, Klein A, Horneff G, Ganser G, Haas JP, Klotsche J, Minden K. The majority of patients with newly diagnosed juvenile idiopathic arthritis achieve a health-related quality of life that is similar to that of healthy peers: results of the German multicenter inception cohort (ICON). Arthritis Res Ther 2018; 20:106. [PMID: 29848349 PMCID: PMC5977761 DOI: 10.1186/s13075-018-1588-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Achieving the best possible health-related quality of life (HRQoL) for a patient is an important treatment goal in juvenile idiopathic arthritis (JIA). We investigated the 36-month trajectories of HRQoL in children with JIA compared with healthy peers and identified the predictors of an unfavorable HRQoL. Methods Patients with a recent JIA diagnosis were enrolled in the German inception cohort study ICON. As a peer group, friends of patients of the same age and sex were asked to cooperate. Children were prospectively followed and regularly questioned about their HRQoL using the Pediatric Quality of Life Inventory 4.0 (PedsQL). Disease activity was assessed by the clinical Juvenile Arthritis Disease Activity Score (cJADAS-10), and the burden of the child’s chronic illness on their family was assessed by the Family Burden Questionnaire (FaBel). Linear mixed models were used to compare the HRQoL of the patients and their peers. Associations between the health status of a patient at enrollment and an unfavorable HRQoL (PedsQL total < 79.3) at their 3-year follow-up (FU) were analyzed by logistic regression. Results Data from 953 patients (median symptom duration 6 months, mean age 7.9 years) and 491 healthy peers (aged 8.4 years) were analyzed. During 3 years of FU, the disease activity and HRQoL of the patients improved significantly (cJADAS-10 from 9.8 (6.2) to 2.7 (3.6) and PedsQL total score from 71.7 (18.2) to 87.3 (13.9)). While the HRQoL of the patients varied among the several JIA categories at the time of enrollment, no significant differences were found at the 3-year FU. After 36 months, the HRQoL of the patients had largely converged with that of their healthy peers. JIA patients had a psychosocial health status comparable with their healthy peers, whereas a small significant mean difference remained in physical health (5.8, 95% confidence interval (CI) 4.1–7.6). Up to the 36-month FU, three-quarters of JIA patients attained a favorable HRQoL (PedsQL ≥ 79.3) which was achieved by 90% of the peers. A higher family burden, higher pain level, and lower well-being at enrollment were associated with an unfavorable HRQoL. Conclusions Under current therapeutic conditions, an HRQoL corresponding with that of healthy children is a realistic treatment goal in JIA.
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Affiliation(s)
- Miriam Listing
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany.
| | - Kirsten Mönkemöller
- Kinderkrankenhaus Amsterdamer Straße, Kliniken der Stadt Köln gGmbH, Köln, Germany
| | - Ina Liedmann
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Martina Niewerth
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Claudia Sengler
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Joachim Listing
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University of Münster, Münster, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology at St. Franziskus Hospital Münster, University of Duisburg-Essen, Duisburg, Germany
| | - Ariane Klein
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Gerd Horneff
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Gerd Ganser
- St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Johannes-Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Garmisch-Partenkirchen, Germany
| | - Jens Klotsche
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Kirsten Minden
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany
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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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Lim LSH, Pullenayegum E, Feldman BM, Lim L, Gladman DD, Silverman ED. From Childhood to Adulthood: Disease Activity Trajectories in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2018; 70:750-757. [DOI: 10.1002/acr.23319] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/11/2017] [Indexed: 01/13/2023]
Affiliation(s)
- Lily Siok Hoon Lim
- University of Manitoba, Winnipeg, Manitoba, Canada; and Institute of Health Policy Management & Evaluation; Toronto Ontario Canada
| | | | - Brian M. Feldman
- The Hospital for Sick Children (SickKids); Toronto Ontario Canada
| | - Lillian Lim
- The Hospital for Sick Children (SickKids); Toronto Ontario Canada
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