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Akgün G, Sözeri B, Başar EZ, Şahin N, Bayrak YE, Ulu K, Güngör HS, Doğan M, Öner T, Karacan M, Babaoğlu K, Anık Y, Sönmez HE. Cardiac evaluation of patients with juvenile dermatomyositis. Pediatr Res 2024:10.1038/s41390-024-03336-8. [PMID: 38909159 DOI: 10.1038/s41390-024-03336-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 05/14/2024] [Accepted: 05/31/2024] [Indexed: 06/24/2024]
Abstract
BACKGROUND The present study aims to evaluate possible cardiac involvement in juvenile dermatomyositis (JDM) patients by conventional methods and cardiac magnetic resonance imaging (MRI) along with a systematic review of the literature on cardiac features in JDM. METHODS The study group consisted of JDM patients who underwent cardiac MRI. We conducted a systematic review of the published literature involving JDM patients with cardiac involvement. RESULTS In the present study, although baseline cardiologic evaluations including electrocardiography and echocardiography were within normal limits, we showed late gadolinium enhancement on cardiac MRI in 3 of 11 JDM patients. In the literature review, we identified 25 articles related to cardiac involvement in JDM. However, none of them, except one case report, included cardiac MRI of JDM patients. CONCLUSION Cardiac abnormalities have been reported among the less frequent findings in patients with JDM. Cardiovascular complications during the long-term disease course are a leading cause of morbidity and mortality in these patients. Early detection of cardiac involvement by cardiac MRI in patients with JDM and aggressive treatment of them may improve the clinical course of these patients. IMPACT The myocardium in patients with JDM may be involved by inflammation. Myocardial involvement may be evaluated by using contrast-enhanced cardiac MRI. This is the first study evaluating cardiac involvement by cardiac MRI in JDM patients. MRI may show early cardiac involvement in patients whose baseline cardiologic evaluations are within normal limits. Early detection of cardiac involvement by cardiac MRI may improve the long-term prognosis of patients with JDM.
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Affiliation(s)
- Gökmen Akgün
- Department of Pediatric Cardiology, City Hospital, Kocaeli, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Eviç Zeynep Başar
- Department of Pediatric Cardiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Nihal Şahin
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Yunus Emre Bayrak
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Kadir Ulu
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Hüseyin Salih Güngör
- Department of Pediatric Cardiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Mustafa Doğan
- Department of Pediatric Cardiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Taliha Öner
- Department of Pediatric Cardiology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Mehmet Karacan
- Department of Pediatric Cardiology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Yonca Anık
- Department of Radiology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey.
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Papadopoulou C, Chew C, Wilkinson MGL, McCann L, Wedderburn LR. Juvenile idiopathic inflammatory myositis: an update on pathophysiology and clinical care. Nat Rev Rheumatol 2023; 19:343-362. [PMID: 37188756 PMCID: PMC10184643 DOI: 10.1038/s41584-023-00967-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The childhood-onset or juvenile idiopathic inflammatory myopathies (JIIMs) are a heterogenous group of rare and serious autoimmune diseases of children and young people that predominantly affect the muscles and skin but can also involve other organs, including the lungs, gut, joints, heart and central nervous system. Different myositis-specific autoantibodies have been identified that are associated with different muscle biopsy features, as well as with different clinical characteristics, prognoses and treatment responses. Thus, myositis-specific autoantibodies can be used to subset JIIMs into sub-phenotypes; some of these sub-phenotypes parallel disease seen in adults, whereas others are distinct from adult-onset idiopathic inflammatory myopathies. Although treatments and management have much improved over the past decade, evidence is still lacking for many of the current treatments and few validated prognostic biomarkers are available with which to predict response to treatment, comorbidities (such as calcinosis) or outcome. Emerging data on the pathogenesis of the JIIMs are leading to proposals for new trials and tools for monitoring disease.
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Affiliation(s)
- Charalampia Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
| | - Christine Chew
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Meredyth G Ll Wilkinson
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy R Wedderburn
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK.
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK.
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK.
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Barroso de Queiroz Davoli G, Bartels B, Mattiello-Sverzut AC, Takken T. Cardiopulmonary exercise testing in neuromuscular disease: a systematic review. Expert Rev Cardiovasc Ther 2021; 19:975-991. [PMID: 34826261 DOI: 10.1080/14779072.2021.2009802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cardiopulmonary exercise testing (CPET) is increasingly used to determine aerobic fitness in health and disability conditions. Patients with neuromuscular diseases (NMDs) often present with symptoms of cardiac and/or skeletal muscle dysfunction and fatigue that might impede the ability to deliver maximal cardiopulmonary effort. Although an increasing number of studies report on NMDs' physical fitness, the applicability of CPET remains largely unknown. AREAS COVERED This systematic review synthesized evidence about the quality and feasibility of CPET in NMDs and patient's aerobic fitness. The review followed the PRISMA guidelines (PROSPERO number CRD42020211068). Between September and October 2020 one independent reviewer searched the PubMed/MEDLINE, EMBASE, SCOPUS, and Web of Science databases. Excluding reviews and protocol description articles without baseline data, all study designs using CPET to assess adult or pediatric patients with NMDs were included. The methodological quality was assessed according to the American Thoracic Society/American College of Chest Physicians (ATS/ACCP) recommendations. EXPERT OPINION CPET is feasible for ambulatory patients with NMDs when their functional level and the exercise modality are taken into account. However, there is still a vast potential for standardizing and designing disease-specific CPET protocols for patients with NMDs. Moreover, future studies are urged to follow the ATS/ACCP recommendations.
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Affiliation(s)
| | - Bart Bartels
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Dover S, Stephens S, Schneiderman JE, Pullenayegum E, Wells GD, Levy DM, Marcuz JA, Whitney K, Schulze A, Tein I, Feldman BM. The Effect of Creatine Supplementation on Muscle Function in Childhood Myositis: A Randomized, Double-blind, Placebo-controlled Feasibility Study. J Rheumatol 2020; 48:434-441. [PMID: 32739897 DOI: 10.3899/jrheum.191375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the feasibility of studying creatine in juvenile dermatomyositis (JDM). Secondary objectives were to determine the effect of creatine on muscle function and metabolism, aerobic capacity, fatigue, physical activity, and quality of life (QOL), as well as its safety. METHODS We conducted a 6-month, double-blind, randomized, multiple-baseline design; patients were assigned to creatine or placebo. Feasibility was assessed using attended study visits, completed study procedures, and adherence. Muscle function, aerobic capacity, and muscle strength were assessed with standardized exercise tests. Muscle metabolism was assessed using a 31-Phosphorus Magnetic Resonance Spectroscopy protocol. Fatigue, physical activity, and QOL were assessed by questionnaires. Statistical significance was estimated using a randomization (permutation) test. Changes in outcome measures taken at baseline and end-of-study were calculated using paired t-tests. RESULTS Median (range) adherence to the study drug was 88.5% (20.5-95.5%) and the proportion of subjects with 80% adherence or higher was 76.9%. There were no missed study visits. There were no statistically significant changes in muscle function, strength, aerobic capacity, disease activity, fatigue, physical activity, or QOL while subjects were receiving creatine compared to placebo. There were statistically significant adaptations in muscle metabolism (e.g., decrease in change in muscle pH following exercise, and decrease in phosphate/phosphocreatine ratio) at the end-of-study compared to baseline. There were no significant adverse effects. CONCLUSION Creatine supplementation in children with JDM is feasible to study, and is safe and well-tolerated; it may lead to improvements in muscle metabolism.
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Affiliation(s)
- Saunya Dover
- S. Dover, MSc, Child Health Evaluative Sciences, The Hospital for Sick Children
| | - Samantha Stephens
- S. Stephens, PhD, Neurosciences and Mental Health, The Hospital for Sick Children
| | - Jane E Schneiderman
- J.E. Schneiderman, PhD, RKin, CEP, Clinical Research Services, Research Institute, The Hospital for Sick Children, and Faculty of Kinesiology and Physical Education, University of Toronto
| | - Eleanor Pullenayegum
- E. Pullenayegum, PhD, Child Health Evaluative Sciences, The Hospital for Sick Children, and Institute of Health Policy, Management and Evaluation, the Dalla Lana School of Public Health, University of Toronto
| | - Greg D Wells
- G.D. Wells, PhD, Translational Medicine, The Hospital for Sick Children
| | - Deborah M Levy
- D.M. Levy, MD, MS, FRCPC, Child Health Evaluative Sciences, The Hospital for Sick Children, and Department of Pediatrics, Faculty of Medicine, University of Toronto, and Division of Rheumatology, The Hospital for Sick Children
| | - Jo-Anne Marcuz
- J.A. Marcuz, MScPT, K. Whitney, MSc, BScPT, Division of Rheumatology, The Hospital for Sick Children, and Department of Rehabilitation, The Hospital for Sick Children
| | - Kristi Whitney
- J.A. Marcuz, MScPT, K. Whitney, MSc, BScPT, Division of Rheumatology, The Hospital for Sick Children, and Department of Rehabilitation, The Hospital for Sick Children
| | - Andreas Schulze
- A. Schulze, MD, PhD, Clinical and Metabolic Genetics, The Hospital for Sick Children
| | - Ingrid Tein
- I. Tein, MD, FRCPC, Division of Neurology, Department of Pediatrics and Genetics and Genome Biology Program, The Hospital for Sick Children, and Department of Laboratory Medicine and Pathobiology, University of Toronto
| | - Brian M Feldman
- B.M. Feldman, MD, MSc, FRCPC, Child Health Evaluative Sciences, The Hospital for Sick Children, and Institute of Health Policy, Management & Evaluation, the Dalla Lana School of Public Health, University of Toronto, and Department of Pediatrics, Faculty of Medicine, University of Toronto, and Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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5
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Zhong D, Wu C, Bai J, Xu D, Zeng X, Wang Q. Co-expression network analysis reveals the pivotal role of mitochondrial dysfunction and interferon signature in juvenile dermatomyositis. PeerJ 2020; 8:e8611. [PMID: 32110496 PMCID: PMC7034382 DOI: 10.7717/peerj.8611] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/21/2020] [Indexed: 12/14/2022] Open
Abstract
Background Juvenile dermatomyositis (JDM) is an immune-mediated disease characterized by chronic organ inflammation. The pathogenic mechanisms remain ill-defined. Methods Raw microarray data of JDM were obtained from the gene expression omnibus (GEO) database. Based on the GSE3307 dataset with 39 samples, weighted correlation network analysis (WGCNA) was performed to identify key modules associated with pathological state. Functional enrichment analyses were conducted to identify potential mechanisms. Based on the criteria of high connectivity and module membership, candidate hub genes were selected. A protein-protein interaction network was constructed to identify hub genes. Another dataset (GSE11971) was used for the validation of real hub genes. Finally, the real hub genes were used to screen out small-molecule compounds via the Connectivity map database. Results Three modules were considered as key modules for the pathological state of JDM. Functional enrichment analysis indicated that responses to interferon and metabolism were dysregulated. A total of 45 candidate hub genes were selected according to the pre-established criteria, and 20 genes could differentiate JDM from normal controls by validation of another external dataset (GSE11971). These real hub genes suggested the pivotal role of mitochondrial dysfunction and interferon signature in JDM. Furthermore, drug repositioning highlighted the importance of acacetin, helveticoside, lanatoside C, deferoxamine, LY-294002, tanespimycin and L01AD from downregulated genes with the potential to perturb the development of JDM, while betonicine, felodipine, valproic acid, trichostatin A and sirolimus from upregulated genes provided potentially therapeutic goals for JDM. Conclusions There are 20 real hub genes associated with the pathological state of JDM, suggesting the pivotal role of mitochondrial dysfunction and interferon signature in JDM. This analysis predicted several kinds of small-molecule compounds to treat JDM.
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Affiliation(s)
- Danli Zhong
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chanyuan Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jingjing Bai
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China.,Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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Assessment of the Clinical Effects of Aquatic-based Exercises in the Treatment of Children With Juvenile Dermatomyositis: A 2x2 Controlled-Crossover Trial. Arch Rheumatol 2019; 35:97-106. [PMID: 32637925 DOI: 10.5606/archrheumatol.2020.7548] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 05/08/2019] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to compare the effect of aquatic-based exercises (AQBEs) and land-based exercises (LBEs) on muscle strength, fatigue and quality of life (QoL), and skin disease activity in children with juvenile dermatomyositis (JDM). Patients and methods The design of the study was an assessor-blinded, controlled 2x2 crossover trial. Fourteen children (4 boys, 10 girls; mean age 11.7±2.2 years; range, 10 to 16 years) were evaluated. AQBEs and LBEs were applied through two treatment sequences as half of the children received AQBEs first while the second half received LBEs first. Isometric muscle strength, fatigue level and QoL (Pediatric Quality of Life Inventory Multidimensional Fatigue Scale [PedsQL-MFS]), and skin disease activity score (DASskin) were measured at four occasions for each treatment sequence. Results The AQBEs had significant superiority over LBEs with improved hip flexors' strength (p=0.007) and hip abductors' strength (p=0.001), while both types of treatment had the same effect in increasing strength of shoulder flexors and abductors (p<0.05). AQBEs improved PedsQL-MFS, and DASskin significantly more than LBEs (p<0.001). For all outcome measures, there was no significant difference in the treatment sequence the children received first. Conclusion Supervised AQBEs are more effective in improving muscle strength, fatigue and QoL, and skin disease activity than LBEs in children with JDM. Furthermore, the treatment sequence had no significant effect on measured variables.
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Berntsen KS, Edvardsen E, Hansen BH, Flatø B, Sjaastad I, Sanner H. Cardiorespiratory fitness in long-term juvenile dermatomyositis: a controlled, cross-sectional study of active/inactive disease. Rheumatology (Oxford) 2019; 58:492-501. [PMID: 30508195 DOI: 10.1093/rheumatology/key342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/15/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To compare cardiorespiratory fitness (CRF) expressed as maximal oxygen uptake (VO2max) between patients with long-term JDM and controls and between patients with active and inactive disease, as well as to explore exercise limiting factors and associations between CRF and disease variables. METHODS JDM patients (n = 45) and age- and gender-matched controls (n = 45) performed a cardiopulmonary exercise test (CPET) on a treadmill until exhaustion. Physical activity was measured by accelerometers. Disease activity, damage and muscle strength/function were assessed by validated tools. Clinically inactive disease was defined according to PRINTO criteria. RESULTS The mean disease duration was 20.8 (s.d. 11.9) years and 29/45 (64%) patients had inactive disease. A low VO2max was found in 27% of patients vs 4% of controls (P = 0.006). The mean VO2max and maximal ventilation (VEmax) were lower in patients with active and inactive disease compared with controls. Patients with active disease also had lower maximal voluntary ventilation (MVV) compared with controls and lower VEmax and MVV compared with those with inactive disease. Patients with inactive disease had lower physical activity levels compared with controls. VO2max correlated negatively with disease damage in patients with inactive disease and positively with muscle strength/function in patients with active disease. CONCLUSION CRF was lower in JDM patients, both with active and inactive disease, compared with controls after a mean 20 years disease duration. Cardiopulmonary exercise test results suggested different limiting factors contributing to the reduced CRF according to disease activity, including deconditioning in inactive disease and reduced ventilatory capacity in active disease. Further research is needed to verify this.
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Affiliation(s)
| | - Elisabeth Edvardsen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo University Hospital, Ullevål, Norway
- Department of Pulmonary Medicine, Oslo University Hospital, Ullevål, Norway
| | - Bjørge Herman Hansen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo University Hospital, Ullevål, Norway
| | - Berit Flatø
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Ullevål, Norway
- K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Helga Sanner
- Department of Rheumatology, Oslo University Hospital, Rikshospitalet, Norway
- Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Rikshospitalet, Norway
- Bjørknes University College, Oslo, Norway
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Blom KJ, Takken T, Huijgen BCH, Wienke J, van Royen-Kerkhof A, van Brussel M. Trajectories of cardiorespiratory fitness in patients with juvenile dermatomyositis. Rheumatology (Oxford) 2017; 56:2204-2211. [PMID: 29029283 DOI: 10.1093/rheumatology/kex366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives Previous research demonstrated decreased cardiorespiratory fitness (CRF) in patients with JDM during active disease and remission. However, longitudinal data regarding trajectories of CRF are currently lacking. The objective of this study was to determine trajectories of CRF in patients with both monocyclic and chronic JDM, and to identify potential predictors of these trajectories. Methods Thirty-six patients with JDM [median age (interquartile range) at diagnosis: 8.3 (6.3-15.4) years] treated in our paediatric rheumatology outpatient clinic were included. All patients performed multiple cardiopulmonary exercise tests between 2003 and 2016. Relevant CRF parameters were analysed, including peak oxygen uptake, maximal workload, mechanical efficacy and oxygen uptake at ventilatory anaerobic threshold. We analysed trajectories up to 10 years after diagnosis and determined predictors of CRF outcome parameters by multilevel analyses. Results Trajectories demonstrated significant declines in CRF during the active phase of the disease with subsequent improvement in CRF during the initial years after diagnosis. However, hereafter no further improvements, and even a decrease, in CRF were observed over time in both monocyclic and chronic subtypes of JDM. We found that a longer disease duration, younger age of onset and higher prednisone dose negatively influence CRF. Conclusion Patients with both monocyclic and chronic JDM show decreases in long-term CRF trajectories. Longer disease duration, younger age of onset and higher prednisone dose negatively influence CRF. This study stresses the need for regular evaluation of CRF and implementation of (exercise) interventions to improve CRF in patients with JDM, even in monocyclic patients.
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Affiliation(s)
- Kiki J Blom
- Child Development and Exercise Centre, Wilhelmina Children's Hospital, University Medical Centre Utrecht.,Centre for Human Movement Sciences, University of Groningen, University Medical Centre Groningen, Groningen
| | - Tim Takken
- Child Development and Exercise Centre, Wilhelmina Children's Hospital, University Medical Centre Utrecht
| | - Barbara C H Huijgen
- Centre for Human Movement Sciences, University of Groningen, University Medical Centre Groningen, Groningen
| | - Judith Wienke
- Paediatric Immunology, Laboratory of Translational Immunology LTI
| | - Annet van Royen-Kerkhof
- Department of paediatric rheumatology/immunology, Wilhelmina Children's Hospital, University Medical Centre Utrecht, the Netherlands
| | - Marco van Brussel
- Child Development and Exercise Centre, Wilhelmina Children's Hospital, University Medical Centre Utrecht
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Habers GEA, Bos GJ, van Royen-Kerkhof A, Lelieveld OT, Armbrust W, Takken T, van Brussel M. Muscles in motion: a randomized controlled trial on the feasibility, safety and efficacy of an exercise training programme in children and adolescents with juvenile dermatomyositis. Rheumatology (Oxford) 2016; 55:1251-62. [DOI: 10.1093/rheumatology/kew026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Indexed: 01/13/2023] Open
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van der Stap DK, Rider LG, Alexanderson H, Huber AM, Gualano B, Gordon P, van der Net J, Mathiesen P, Johnson LG, Ernste FC, Feldman BM, Houghton KM, Singh-Grewal D, Kutzbach AG, Munters LA, Takken T. Proposal for a Candidate Core Set of Fitness and Strength Tests for Patients with Childhood or Adult Idiopathic Inflammatory Myopathies. J Rheumatol 2016; 43:169-76. [PMID: 26568594 PMCID: PMC4698199 DOI: 10.3899/jrheum.150270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Currently there are no evidence-based recommendations regarding fitness and strength tests for patients with childhood or adult idiopathic inflammatory myopathies (IIM). This hinders clinicians and researchers in choosing the appropriate fitness- or muscle strength-related outcome measures for these patients. Through a Delphi survey, we aimed to identify a candidate core set of fitness and strength tests for children and adults with IIM. METHODS Fifteen experts participated in a Delphi survey that consisted of 5 stages to achieve a consensus. Using an extensive search of published literature and through the work of experts, a candidate core set based on expert opinion and clinimetrics properties was developed. Members of the International Myositis Assessment and Clinical Studies Group were invited to review this candidate core set during the final stage, which led to a final candidate core set. RESULTS A core set of fitness- and strength-related outcome measures was identified for children and adults with IIM. For both children and adults, different tests were identified and selected for maximal aerobic fitness, submaximal aerobic fitness, anaerobic fitness, muscle strength tests, and muscle function tests. CONCLUSION The core set of fitness- and strength-related outcome measures provided by this expert consensus process will assist practitioners and researchers in deciding which tests to use in patients with IIM. This will improve the uniformity of fitness and strength tests across studies, thereby facilitating the comparison of study results and therapeutic exercise program outcomes among patients with IIM.
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Affiliation(s)
- Djamilla K.D. van der Stap
- Faculty of Human Movement Sciences, Free University, Amsterdam, The Netherlands
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa G. Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Helene Alexanderson
- Department of Neurobiology, Care Science and Society, Division of Physical Therapy, Karolinska Institutet and the Physical Therapy Clinic, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Patrick Gordon
- Department of rheumatology, King’s College Hospital, London, UK
| | - Janjaap van der Net
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pernille Mathiesen
- Paediatric Rheumatology Clinic, Paediatric Department, Rigshospitalet, Copenhagen, Denmark
| | - Liam G. Johnson
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Floranne C. Ernste
- Mayo Clinic in Rochester MN, Department of Internal Medicine, Division of Rheumatology
| | - Brian M. Feldman
- Departments of Pediatrics, Medicine and the Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | | | - Davinder Singh-Grewal
- The Sydney Children's Hospitals Network Randwick and Westmead Campuses
- The University of Sydney, School of Paediatrics and Child Health
- The University of New South Wales, Discipline of Child and Maternal Health
- The University of Western Sydney Department of Paediatrics, Sydney, Australia
- The John Hunter Children’s Hospital, Newcastle Australia
| | - Abraham Garcia Kutzbach
- Director of the postgraduate Program of Rheumatology AGAR, School of Medicine University Francisco Marroquin, Guatemala
- Professor of Medicine and History of Medicine, School of Medicine University Francisco Marroquin, Guatemala
- Member of the executive Committee Hospital Herrera Llerandi Guatemala
| | - Li Alemo Munters
- Physical Therapy Clinic, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University, Nashville, USA
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
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Aerobic training in persons who have recovered from juvenile dermatomyositis. Neuromuscul Disord 2013; 23:962-8. [DOI: 10.1016/j.nmd.2013.09.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 08/17/2013] [Accepted: 09/03/2013] [Indexed: 12/15/2022]
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Abresch RT, Carter GT, Han JJ, McDonald CM. Exercise in neuromuscular diseases. Phys Med Rehabil Clin N Am 2013; 23:653-73. [PMID: 22938880 DOI: 10.1016/j.pmr.2012.06.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article reviews the current knowledge regarding the benefits and contraindications of exercise on individuals with neuromuscular diseases (NMDs). Specific exercise prescriptions for individuals with NMDs do not exist because the evidence base is limited. Understanding the effect of exercise on individuals with NMDs requires the implementation of a series of multicenter, randomized controlled trials that are sufficiently powered and use reliable and valid outcome measures to assess the effect of exercise interventions-a major effort for each NMD. In addition to traditional measures of exercise efficacy, outcome variables should include measures of functional status and health-related quality of life.
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Affiliation(s)
- R Ted Abresch
- Department of Rehabilitation Medicine, University of California, Davis, 4860 Y Street Suite, 3850, Sacramento, CA 95817, USA.
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Habers GEA, De Knikker R, Van Brussel M, Hulzebos E, Stegeman DF, Van Royen A, Takken T. Near-infrared spectroscopy during exercise and recovery in children with juvenile dermatomyositis. Muscle Nerve 2012; 47:108-15. [DOI: 10.1002/mus.23484] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2012] [Indexed: 11/11/2022]
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Mathiesen PR, Orngreen MC, Vissing J, Andersen LB, Herlin T, Nielsen S. Aerobic fitness after JDM--a long-term follow-up study. Rheumatology (Oxford) 2012; 52:287-95. [DOI: 10.1093/rheumatology/kes232] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Exercise in inflammatory myopathies, including inclusion body myositis. Curr Rheumatol Rep 2012; 14:244-51. [PMID: 22467380 DOI: 10.1007/s11926-012-0248-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Exercise is an important part of treatment in patients with idiopathic inflammatory myopathies. Improved functioning, ability to perform activities of daily living, and health-related quality of life have been reported in adult polymyositis, dermatomyositis, and also recently inclusion body myositis following different exercise regimens, with no signs of increased muscle inflammation. Intensive resistance training could reduce clinical disease activity and reduce expression of genes regulating inflammation and fibrosis in chronic polymyositis and dermatomyositis. Today, exercise research in adult myositis is focused on understanding mechanisms for muscle impairment and improved muscle function in relation to exercise and verifying results from small, open studies in larger settings. There are no studies evaluating the effects of exercise over weeks or months in juvenile dermatomyositis, other than a case report; however, there is to our knowledge an ongoing effort to evaluate the safety and effects of exercise in patients with juvenile dermatomyositis.
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Habers EA, van Brussel M, Langbroek-Amersfoort AC, van Royen-Kerkhof A, Takken T. Design of the muscles in motion study: a randomized controlled trial to evaluate the efficacy and feasibility of an individually tailored home-based exercise training program for children and adolescents with juvenile dermatomyositis. BMC Musculoskelet Disord 2012; 13:108. [PMID: 22721424 PMCID: PMC3478183 DOI: 10.1186/1471-2474-13-108] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Accepted: 06/08/2012] [Indexed: 12/04/2022] Open
Abstract
Background Juvenile dermatomyositis (JDM) is a rare, often chronic, systemic autoimmune disease of childhood, characterized by inflammation of the microvasculature of the skeletal muscle and skin. Prominent clinical features include significant exercise intolerance, muscle weakness, and fatigue. Despite pharmacological improvements, these clinical features continue to affect patients with JDM, even when the disease is in remission. Exercise training is increasingly utilized as a non-pharmacological intervention in the clinical management of (adult) patients with chronic inflammatory conditions; however no randomized controlled trials (RCT) have been performed in JDM. In the current study, the efficacy and feasibility of an exercise training program in patients with JDM will be examined. Methods/design Subjects (n = 30) will include 8–18 year olds diagnosed with JDM. The intervention consists of an individually tailored 12-weeks home-based exercise training program in which interval training on a treadmill is alternated with strength training during each session. The program is based on previous literature and designed with a defined frequency, intensity, time, and type of exercise (FITT principles). Primary outcome measures include aerobic exercise capacity, isometric muscle strength, and perception of fatigue. The study methodology has been conceived according to the standards of the CONSORT guidelines. The current study will be a multi-center (4 Dutch University Medical Centers) RCT, with the control group also entering the training arm directly after completion of the initial protocol. Randomization is stratified according to age and gender. Discussion The current study will provide evidence on the efficacy and feasibility of an individually tailored 12-week home-based exercise training program in youth with JDM. Trial registration Medical Ethics Committee of the University Medical Center Utrecht, the Netherlands: 11–336; Netherlands Trial Register (NTR): NTR 3184.
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Affiliation(s)
- Esther A Habers
- Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Exercise as a therapeutic modality in patients with idiopathic inflammatory myopathies. Curr Opin Rheumatol 2012; 24:201-7. [DOI: 10.1097/bor.0b013e32834f19f5] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abresch RT, Han JJ, Carter GT. Rehabilitation management of neuromuscular disease: the role of exercise training. J Clin Neuromuscul Dis 2009; 11:7-21. [PMID: 19730017 DOI: 10.1097/cnd.0b013e3181a8d36b] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This paper summarizes the current state of knowledge regarding exercise and neuromuscular diseases/disorders (NMDs) and reviews salient studies in the literature. Unfortunately, there is inadequate evidence in much of the NMDs to make specific recommendations regarding exercise prescriptions. This review focuses on the role of exercise in a few of the specific NMDs where most research has taken place and recommends future research directions.
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Affiliation(s)
- R Ted Abresch
- Department of Physical Medicine and Rehabilitation, University of California, Davis, Davis, CA, USA
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Abstract
Juvenile dermatomyositis, the most common inflammatory myopathy of childhood, is a rare systemic autoimmune vasculopathy that is characterised by weakness in proximal muscles and pathognomonic skin rashes. The length of time before the initiation of treatment affects presenting symptoms, laboratory measures, and pathophysiology. It also affects disease outcomes, including the development of pathological calcifications, which are associated with increased morbidity. Both genetic and environmental risk factors seem to have a role in the cause of juvenile dermatomyositis; HLA B8-DRB1*0301 ancestral haplotype is a strong immunogenetic risk factor, and antecedent infections and birth seasonality suggest that environmental stimuli might increase risk. Activation of dendritic cells with upregulation of genes induced by type-1 interferon (alpha) in muscle and peripheral blood seems to be central to disease pathogenesis. Treatment often includes combinations of corticosteroids, methotrexate, and other immunosuppressive agents. Disease outcome, if treatment is initiated early, is generally good. Randomised controlled trials are needed to define the most effective treatments.
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Affiliation(s)
- Brian M Feldman
- Departments of Pediatrics, Health Policy Management and Evaluation, and Public Health Sciences, University of Toronto, Division of Rheumatology, Hospital for Sick Children, Toronto, ON, Canada.
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Abstract
Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important role in determining whether a child with a health condition should participate in certain sports by assessing the child's health status, suggesting appropriate equipment or modifications of sports to decrease the risk of injury, and educating the athlete, parent(s) or guardian, and coach regarding the risks of injury as they relate to the child's condition. This report updates a previous policy statement and provides information for pediatricians on sports participation for children and adolescents with medical conditions.
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Productos de activación del complemento (C3a y C5b-9) como marcadores de actividad de la dermatomiositis. Comparación con parámetros bioquímicos tradicionales. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s0001-7310(07)70093-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Takken T, van der Net J, Engelbert RHH, Pater S, Helders PJM. Responsiveness of exercise parameters in children with inflammatory myositis. ACTA ACUST UNITED AC 2007; 59:59-64. [DOI: 10.1002/art.23250] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Campo A, Hausmann G, Martí R, Estrach T, Grau J, Porcel J, Herrero C. Complement Activation Products (C3a and C5b-9) as Markers of Activity of Dermatomyositis. Comparison With Tradicional Laboratory Markers. ACTAS DERMO-SIFILIOGRAFICAS 2007. [DOI: 10.1016/s1578-2190(07)70473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Finsterer J, Stöllberger C, Avanzini M, Rauschka H. Restrictive cardiomyopathy in dermatomyositis. Scand J Rheumatol 2006; 35:229-32. [PMID: 16766371 DOI: 10.1080/03009740500474495] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The association between dermatomyositis and restrictive cardiomyopathy has not been reported before. We present here the clinical, echocardiographic and muscle biopsy data for a patient with dermatomyositis and restrictive cardiomyopathy. In a 78-year-old male with a history of arterial hypertension, recurrent episodes of atrial fibrillation and syncopes, rupture of an infra-renal aortic aneurysm with complications (recurrent QT-prolongation, lumbo-sacral plexopathy, transient ischaemic attack, peripheral embolism), monoclonal gammopathy, subdural haematoma, focal seizures, megaloblastic anaemia, leucopenia, eosinophilia, elevated muscle enzymes and increasing tiredness, dermatomyositis was diagnosed upon clinical presentation, muscle enzyme and muscle biopsy findings. Cardiological examination revealed atrial fibrillation, left anterior hemiblock and restrictive cardiomyopathy. After the exclusion of various differentials for restrictive cardiomyopathy, a causative relationship between restrictive cardiomyopathy and dermatomyositis was assumed. This case suggests the need for suspecting restrictive cardiomyopathy in patients with dermatomyositis. Patients with dermatomyositis should undergo a comprehensive cardiological investigation as soon as the neurological diagnosis is established.
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Huber A, Feldman BM. Long-term outcomes in juvenile dermatomyositis: How did we get here and where are we going? Curr Rheumatol Rep 2005; 7:441-6. [PMID: 16303103 DOI: 10.1007/s11926-005-0048-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Juvenile dermatomyositis (JDM) affects two to four children per million. Prior to treatment with corticosteroids, JDM had a high mortality rate (> 30%) and left 50% of those who survived with serious permanent impairments. After the introduction of corticosteroids, mortality rapidly dropped to less than 10%, and is currently reported to be less than 2% to 3%. Because most children now survive this illness, there is greater interest in long term outcomes. However, review of the literature shows while much is known about mortality, relatively little is known about long term outcomes such as physical function, quality of life, pain, educational and vocational achievement, patient satisfaction, and ongoing disease activity. Furthermore, the literature that has been published has not typically used the same outcomes making comparisons across studies difficult. Current efforts to identify key outcomes and validate measures for those outcomes will allow researchers in the future to provide this much needed information.
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Affiliation(s)
- Adam Huber
- Division of Pediatric Rheumatology, IWK Health Centre, Halifax, Nova Scotia, Canada.
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Takken T, van der Net J, Helders PJM. Anaerobic exercise capacity in patients with juvenile-onset idiopathic inflammatory myopathies. ACTA ACUST UNITED AC 2005; 53:173-7. [PMID: 15818720 DOI: 10.1002/art.21066] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To 1) report the feasibility of an "all-out" 30-second cycling exercise test (Wingate Anaerobic Exercise Test [WAnT]) in juvenile-onset idiopathic inflammatory myopathy (JIIM) patients, 2) describe the anaerobic exercise capacity in juvenile dermatomyositis patients, and 3) determine if the anaerobic exercise capacity could be related to disease duration or disease phase. METHODS Twenty patients (age 14.13 +/- 5.4 years) with JIIM participated in this study. All patients were able to perform the WAnT without adverse events. RESULTS Comparison with healthy controls revealed a -29.3 +/- 26.58% (P = 0.001) and -27.6 +/- 25.7% (P = 0.002) impairment in mean power and peak power on the WAnT, respectively. The WAnT correlated with disease phase and with knee extensor muscle strength. CONCLUSION The WAnT might be a valuable adjunct next to other assessment tools in the followup of JIIM patients.
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Affiliation(s)
- Tim Takken
- University Hospital for Children and Youth "Het Wilhelmina Kinderziekenhuis," University Medical Center Utrecht, Utrecht, The Netherlands.
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Lohmann Siegel K, Hicks JE, Koziol DE, Gerber LH, Rider LG. Walking ability and its relationship to lower-extremity muscle strength in children with idiopathic inflammatory myopathies. Arch Phys Med Rehabil 2004; 85:767-71. [PMID: 15129401 DOI: 10.1016/j.apmr.2003.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe gait deficits and their association with lower-extremity muscle strength in children with juvenile idiopathic inflammatory myopathies (IIM). DESIGN Cross-sectional, descriptive study. SETTING Clinical research center. PARTICIPANTS Consecutive sample of 25 ambulatory children diagnosed with juvenile IIM. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Manual muscle test (MMT) of bilateral hip flexor, extensor, and abductor; knee extensor; and ankle plantarflexor strength, all measured on a 0- to 10-point scale and summary strength measures. Video-based movement analysis to determine walking speed; gait cycle time; right and left step time; stride length; right and left step length; and stance, swing, and double-limb support phase durations. RESULTS Walking speed (1.03+/-0.27 m/s) was reduced because of shortened stride lengths (1.03+/-0.21 m) more than prolonged gait cycle times (1.05+/-0.22s). Walking speed highly correlated with the number of muscle groups weaker than grade 7 out of 10 (r=-.89) and the strength of the hip flexors (r=.85). CONCLUSIONS Lower-extremity strength measures, including MMT scores of individual muscle groups and the number of weak muscle groups, were predictive of gait limitations in children with juvenile IIM.
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Affiliation(s)
- Karen Lohmann Siegel
- Rehabilitation Medicine Department, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
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Huber AM, Feldman BM, Rennebohm RM, Hicks JE, Lindsley CB, Perez MD, Zemel LS, Wallace CA, Ballinger SH, Passo MH, Reed AM, Summers RM, White PH, Katona IM, Miller FW, Lachenbruch PA, Rider LG. Validation and clinical significance of the Childhood Myositis Assessment Scale for assessment of muscle function in the juvenile idiopathic inflammatory myopathies. ACTA ACUST UNITED AC 2004; 50:1595-603. [PMID: 15146430 DOI: 10.1002/art.20179] [Citation(s) in RCA: 132] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine the measurement characteristics of the Childhood Myositis Assessment Scale (CMAS) in children with juvenile idiopathic inflammatory myopathy (juvenile IIM), and to obtain preliminary data on the clinical significance of CMAS scores. METHODS One hundred eight children with juvenile IIM were evaluated on 2 occasions, 7-9 months apart, using various measures of physical function, strength, and disease activity. Interrater reliability, construct validity, and responsiveness of the CMAS were examined. The minimum clinically important difference (MID) and CMAS scores corresponding to various degrees of physical disability were estimated. RESULTS The intraclass correlation coefficient for 26 patients assessed by 2 examiners was 0.89, indicating very good interrater reliability. The CMAS score correlated highly with the Childhood Health Assessment Questionnaire (C-HAQ) score and with findings on manual muscle testing (MMT) (r(s) = -0.73 and 0.73, respectively) and moderately with physician-assessed global disease activity and skin activity, parent-assessed global disease severity, and muscle magnetic resonance imaging (r(s) = -0.44 to -0.61), thereby demonstrating good construct validity. The standardized response mean was 0.81 (95% confidence interval 0.53, 1.09) in patients with at least 0.8 cm improvement on a 10-cm visual analog scale for physician-assessed global disease activity, indicating strong responsiveness. In bivariate regression models predicting physician-assessed global disease activity, MMT remained significant in models containing the CMAS (P = 0.03) while the C-HAQ did not (P = 0.4). Estimates of the MID ranged from 1.5 to 3.0 points on a 0-52-point scale. CMAS scores corresponding to no, mild, mild-to-moderate, and moderate physical disability, respectively, were 48, 45, 39, and 30. CONCLUSION The CMAS exhibits good reliability, construct validity, and responsiveness, and is therefore a valid instrument for the assessment of physical function, muscle strength, and endurance in children with juvenile IIM. Preliminary data on MID and corresponding levels of disability should aid in the clinical interpretation of CMAS scores when assessing patients with juvenile IIM.
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Affiliation(s)
- Adam M Huber
- IWK Health Centre and Dalhousie University, 5850 University Avenue, Halifax, Nova Scotia B3J 3G9, Canada.
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Drinkard BE, Hicks J, Danoff J, Rider LG. Fitness as a determinant of the oxygen uptake/work rate slope in healthy children and children with inflammatory myopathy. ACTA ACUST UNITED AC 2004; 28:888-97. [PMID: 14992126 DOI: 10.1139/h03-063] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
UNLABELLED There is evidence that the slope of the change in oxygen uptake accompanying changes in work rate (delta VO2/delta W). during moderate incremental exercise is influenced by fitness (peak VO2). We set out to determine whether delta VO2/delta W was related to fitness in a group of healthy children and in children with juvenile dermatomyositis (JDM), a condition associated with decreased peak VO2. We also hypothesized that delta VO2/delta would be significantly decreased in children with JDM compared to healthy children. METHODS Twelve children (2 boys) with JDM, mean age 11.6 +/- 3.6 yrs, and 20 healthy children (4 boys), mean age 11.3 +/- 2.9 years, performed an incremental exercise test using a cycle ergometer. delta VO2/delta W below the anaerobic threshold was analyzed using linear regression. Correlations between peak VO2 and delta VO2/delta W were calculated, and differences between the JDM and healthy groups were analyzed using independent t-tests. RESULTS The delta VO2/delta W was significantly correlated with peak VO2 for children with JDM (r = 0.71, p < 0.01), healthy children (r = 0.53, p < 0.01), and all children combined (r = 0.78, p < 0.001). The delta VO2/delta W (7.4 +/- 1.4 vs. 10.8 +/- 1.2 ml O2.min-1.watt-1) and peak oxygen uptake (VO2peak) (19.2 +/- 5.0 vs. 31.4 +/- 7.2 ml O2.kg-1, min-1) were significantly lower in children with JDM than in healthy children, respectively (all p < or = 0.001). CONCLUSION Fitness is significantly related to delta VO2/delta W in healthy children and those with JDM. Children with JDM have a significantly lower delta VO2/delta W than healthy children. Further study is needed to identify specific factors influencing delta VO2/delta W.
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Affiliation(s)
- Bart E Drinkard
- Dept. of Rehabilitation Medicine, National Institute of Environmental Health Sciences, National Institutes of Health, 10 Center Dr., Bethesda, MD 20892-1604, USA
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Cade WT, Fantry LE, Nabar SR, Keyser RE. Decreased peak arteriovenous oxygen difference during treadmill exercise testing in individuals infected with the human immunodeficiency virus. Arch Phys Med Rehabil 2003; 84:1595-603. [PMID: 14639557 DOI: 10.1053/s0003-9993(03)00275-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine if arteriovenous oxygen difference was lower in asymptomatic individuals with human immunodeficiency virus (HIV) infection than in sedentary but otherwise healthy controls. DESIGN Quasi-experimental cross-sectional. SETTING Clinical exercise laboratory. PARTICIPANTS Fifteen subjects (10 men, 5 women) with HIV and 15 healthy gender- and activity level-matched controls (total N=30). INTERVENTION Participants performed an incremental maximal exercise treadmill test to exhaustion. Electrocardiogram, metabolic, and noninvasive cardiac output measurements were evaluated at rest and throughout the tests. Data were analyzed by using analysis of covariance. MAIN OUTCOME MEASURES Peak oxygen consumption (Vo(2)), cardiac output, stroke volume, and arteriovenous oxygen difference. The arteriovenous oxygen difference was determined indirectly using the Fick equation. RESULTS Peak VO(2) was significantly lower (P<.0005) in participants with HIV (24.6+/-1.2mL.kg(-1).min(-1)) compared with controls (32.0+/-1.2mL.kg(-1).min(-1)). There were no significant intergroup differences in cardiac output or stroke volume at peak exercise. Peak arteriovenous oxygen difference was significantly lower (P<.04) in those infected with HIV (10.8+/-0.5 volume %) than in controls (12.4+/-0.5 volume %). CONCLUSION The observed deficit in aerobic capacity in the participants with HIV appeared to be the result of a peripheral tissue oxygen extraction or utilization limitation. In addition to deconditioning, potential mechanisms for this significant attenuation may include HIV infection and inflammation, highly active antiretroviral therapy medication regimens, or a combination of these factors.
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Affiliation(s)
- W Todd Cade
- Department of Physical Therapy, University of Maryland School of Medicine, Baltimore, 21201-1082, USA.
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Abstract
PURPOSE OF REVIEW The sequelae associated with idiopathic inflammatory myopathy (IIM) often result in disability and decreased quality of life. Our understanding of how exercise mitigates disability may be facilitated through the use of a conceptual model. This review describes the enablement-disablement model applied to myositis and explores the role of physical activity in the enablement process. RECENT FINDINGS National and international organizations have revised their disablement models by acknowledging disability as a relational concept, refining the relationship of disability to quality of life, and incorporating the role of intervention through the enablement process. Disability associated with IIM may be complicated by aging-related comorbidities and decreased physical activity. However, data indicate that both short-term and long-term aerobic training results in improved aerobic capacity and decreased disability in adults with IIM. Strengthening regimens have also resulted in decreased functional limitations and disability for adults with polymyositis and dermatomyositis. While comprehensive exercise programs have not been shown to exacerbate disease activity or damage in people with IIM, their effectiveness for individuals with inclusion body myositis (IBM) remains uncertain. SUMMARY Physical activity constitutes a valuable enablement strategy that can reduce disability in adults with IIM. Use of the disablement-enablement model and ICF taxonomy in conjunction with outcomes across disablement domains may augment further investigation of the effectiveness of exercise interventions. Additional research is needed to better understand the relationship between disease severity and optimal exercise dosage, the effects of long-term exercise in children with IIM, and the physiologic response to exercise in people with IBM.
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Affiliation(s)
- Michael O Harris-Love
- Rehabilitation Medicine Department, National Institute of Health, Bethesda, MD 20892, USA.
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Abstract
Through the recent efforts of multi-center collaborative study groups, a number of measures have been developed and partially validated to assess disease activity, disease damage, and health-related quality of life in adult and juvenile patients with IIM. Preliminary core set domains and core set measures of activity and damage have also been developed for adult and juvenile patients with myositis. Validated definitions of improvement and disability should be forthcoming in the next few years. These extraordinary developments will enable much-needed standardization in the assessment of the IIM, particularly in therapeutic and other clinical research studies. Despite this substantial progress, there is a need to develop more sensitive measures to assess IIM disease activity and damage, to further validate the existing tools, to define their performance characteristics in various IIM subgroups, to develop improved imaging techniques that are also quantitative, and to validate activation markers as surrogate measures. The ongoing cooperation of multiple specialists with expertise in these disorders, combined with emerging novel technologies, should continue to enhance the assessment of myositis. Improved clinical care and more rapid development of new therapies for patients with myositis will be the ultimate gains realized from these efforts.
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Affiliation(s)
- Lisa G Rider
- National Institute of Environmental Health Sciences, NIH 9 Memorial Drive, Room 1W107, MSC 0958 Bethesda, MD 20892, USA.
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