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Balay-Dustrude E, Weiss NS, Sutton A, Shenoi S. Predictors of Disease Activity in Patients With Juvenile Idiopathic Arthritis at 12 and 24 Months After Diagnosis. ACR Open Rheumatol 2024. [PMID: 38885948 DOI: 10.1002/acr2.11701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 05/02/2024] [Accepted: 05/13/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVE Identification of characteristics associated with active disease in juvenile idiopathic arthritis (JIA) could inform early disease treatment strategies. This study evaluated characteristics associated with active disease at 12 and 24 months after JIA diagnosis in the era in which biologic disease-modifying antirheumatic drugs (DMARDs) became available for JIA. METHODS This single-center retrospective study from 2004 through 2018 assessed characteristics associated with active nonsystemic categories of JIA at 12 and 24 months after diagnosis. Relative prevalence (RP) of disease activity was evaluated in relation to prespecified characteristics. Using RP, the effect of increasing biologic DMARD availability on these predictors was assessed at 12 months. RESULTS A total of 1,151 patients with JIA were included. At 12 months, a 40% to 45% higher point prevalence of active disease was noted in older children (>5 years). Patients with active disease at 3 months had a greater prevalence of active disease at 12 months (RP 1.5, 95% confidence interval [CI] 1.2-1.8) and 24 months (RP 1.3, 95% CI 1-1.6). Compared to oligoarticular JIA, polyarticular RF-negative, psoriatic, and enthesitis-related JIA had a greater prevalence of active disease at 12 and 24 months. At 24 months, a greater prevalence of active disease was observed in children ≥10 years. RP of active disease was 25% lower in the late cohort (2013-2018) than in the earliest cohort (2004-2008; RP 0.75, 95% CI 0.62-0.92) when more biologic medications were available, but disease activity predictors were broadly similar over time. CONCLUSION Patients with JIA with active disease at 12 and 24 months were older at diagnosis, categorized as polyarticular RF-negative, psoriatic, or enthesitis-related JIA. Active disease at 3 months after diagnosis was associated with worse outcomes at 12 and 24 months.
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Affiliation(s)
- Erin Balay-Dustrude
- University of Washington and Seattle Children's Hospital and Research Center
| | - Noel S Weiss
- University of Washington and Fred Hutchinson Cancer Center, Seattle
| | | | - Susan Shenoi
- University of Washington and Seattle Children's Hospital and Research Center
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Polat MC, Çelikel E, Tekin ZE, Kurt T, Kaplan MM, Güngörer V, Tekgöz N, Sezer M, Karagöl C, Coşkun S, Öner N, Sezer S, Acar BÇ. When should the use of biological agents be considered in persistent oligoarticular juvenile idiopathic arthritis patients? Eur J Pediatr 2024:10.1007/s00431-024-05538-y. [PMID: 38554171 DOI: 10.1007/s00431-024-05538-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/01/2024]
Abstract
The purpose of this study was to compare the demographic and clinical characteristics of the groups with and without bDMARDs added to the treatment of persistent oligoarticular juvenile idiopathic arthritis (JIA) patients on methotrexate (MTX) and also to determine the predictors of adding bDMARDs to treatment. This study included 86 oligoarticular JIA patients on MTX. Patients were divided into two groups receiving MTX (n = 69) and MTX plus bDMARD (n = 17). Predictors of adding bDMARDs were investigated by comparing demographic, clinical features and laboratory findings. Gender, age at diagnosis, time elapsed from the onset of symptoms to diagnosis, and disease duration, the number and distribution of affected joint at the time of diagnosis were similar in both groups. The mean JADAS10 at the time of diagnosis were 18.8 ± 4.2 and 19.5 ± 6.4 in the MTX and MTX plus bDMARDs groups, respectively (p = 0.68). JADAS10 at 3rd and 6th month were significantly higher in patients on MTX plus bDMARDs (p = 0.001, p = 0.004, respectively). In multivariate analysis, the risk of adding bDMARD was shown to increase 1.24-fold (p = 0.004, 95% CI: 1.07-1.43) for each point increase on the JADAS 10 at 3rd months. The number (p = 0.64) or type (p = 0.18) of joint involvement at disease onset were not predictors of adding a bDMARD. CONCLUSION JADAS10 indicating ongoing severe disease activity at 3rd and 6th months rather than baseline JADAS10 is associated with the addition of bDMARDs. WHAT IS KNOWN • Oligoarticular JIA patients have the best outcomes among JIA categories and respond favorably to first-line therapies such as non-steroidal anti-inflammatory drugs and intraarticular corticosteroid injections. • Clinically inactive disease rates have increased with the widespread use of biological agents in oligoarticular JIA patients who have not responded to initial therapies. WHAT IS NEW • Approximately one-fifth of patients with persistent oligoarticular JIA on methotrexate may require the addition of a biological disease modifying anti-rheumatic drug during follow-up. • The JADAS10 calculated at 3 and 6 months is a valuable tool to identify patients who should be added biological disease modifying anti-rheumatic drugs in persistent oligoarticular JIA.
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Affiliation(s)
- Merve Cansu Polat
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey.
| | - Elif Çelikel
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Zahide Ekici Tekin
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Tuba Kurt
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Melike Mehveş Kaplan
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Vildan Güngörer
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Nilüfer Tekgöz
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Müge Sezer
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Cüneyt Karagöl
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Serkan Coşkun
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Nimet Öner
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
| | - Serdar Sezer
- Division of Rheumatology, Department of Internal Medicine, Ankara Training and Research Hospital, 06230-Altındağ, Ankara, Turkey
| | - Banu Çelikel Acar
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, 06800-Bilkent, Ankara, Turkey
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Simonds MM, Freer ST, Brescia AMC. Methotrexate inhibits BMP4 and abrogates the hypertrophic chondrocyte phenotype of synovial fibroblasts in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2024; 22:6. [PMID: 38166938 PMCID: PMC10763212 DOI: 10.1186/s12969-023-00940-6] [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] [Received: 07/31/2023] [Accepted: 12/08/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) induces growth disturbances in affected joints. Fibroblast-like synoviocytes (FLS) play a crucial role in JIA pathogenesis. FLS overexpress bone morphogenetic protein 4 (BMP4) and have a chondrocyte-like phenotype. FLS contribute directly to joint growth disturbances through endochondral bone formation. We investigated the ability of methotrexate to inhibit BMP4 expression and alter the hypertrophic chondrocyte-like phenotype of JIA FLS. METHODS We selected primary cells from three subjects with persistent oligoarticular JIA, three subjects who eventually extended to a polyarticular disease course, which we termed extended-to-be (ETB), and three subjects who had polyarticular arthritis at time of diagnosis. We treated cells with methotrexate and two BMP4 inhibitors: noggin and chordin. We measured protein concentration from three chondrocyte cell markers: collagen II, aggrecan, and collagen X as well as BMP4. RESULTS ColX, marker of chondrocyte hypertrophy, was significantly increased in polyarticular FLS when compared to both persistent FLS and ETB FLS, making polyarticular FLS the most like hypertrophic chondrocytes. Methotrexate caused significant decreases in BMP4 and ColX expression in persistent, ETB, and polyarticular FLS when compared to respective untreated cells. Ligand-binding BMP4 antagonists, noggin and chordin, caused significant decreases in ColX expression in FLS from all three disease courses and significant increases in collagen II protein, an early chondrocyte marker, when compared to respective untreated cells. CONCLUSIONS Methotrexate, the first-line therapy in the treatment of JIA, mimics BMP4 antagonists by effectively lowering BMP4 and ColX expression in FLS. Inhibiting FLS from undergoing hypertrophy could prevent these cells from contributing to joint growth disturbances via endochondral bone formation.
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Affiliation(s)
- Megan M Simonds
- Nemours Biomedical Research, 1600 Rockland Rd, Wilmington, DE, 19803, USA.
- Nemours Children's Health, Delaware, 1600 Rockland Rd, Wilmington, DE, 19803, USA.
| | - Samuel T Freer
- Nemours Biomedical Research, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Anne Marie C Brescia
- Nemours Children's Health, Delaware, 1600 Rockland Rd, Wilmington, DE, 19803, USA
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4
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Pelassa S, Raggi F, Rossi C, Bosco MC. MicroRNAs in Juvenile Idiopathic Arthritis: State of the Art and Future Perspectives. BIOLOGY 2023; 12:991. [PMID: 37508421 PMCID: PMC10376583 DOI: 10.3390/biology12070991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
Juvenile Idiopathic Arthritis (JIA) represents the most common chronic pediatric arthritis in Western countries and a leading cause of disability in children. Despite recent clinical achievements, patient management is still hindered by a lack of diagnostic/prognostic biomarkers and targeted treatment protocols. MicroRNAs (miRNAs) are short non-coding RNAs playing a key role in gene regulation, and their involvement in many pathologies has been widely reported in the literature. In recent decades, miRNA's contribution to the regulation of the immune system and the pathogenesis of autoimmune diseases has been demonstrated. Furthermore, miRNAs isolated from patients' biological samples are currently under investigation for their potential as novel biomarkers. This review aims to provide an overview of the state of the art on miRNA investigation in JIA. The literature addressing the expression of miRNAs in different types of biological samples isolated from JIA patients was reviewed, focusing in particular on their potential application as diagnostic/prognostic biomarkers. The role of miRNAs in the regulation of immune responses in affected joints will also be discussed along with their potential utility as markers of patients' responses to therapeutic approaches. This information will be of value to investigators in the field of pediatric rheumatology, encouraging further research to increase our knowledge of miRNAs' potential for future clinical applications in JIA.
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Affiliation(s)
- Simone Pelassa
- UOC Rheumatology and Autoinflammatory Diseases, Department of Pediatric Sciences, Istituto Giannina Gaslini, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 16147 Genova, Italy
| | - Federica Raggi
- UOC Rheumatology and Autoinflammatory Diseases, Department of Pediatric Sciences, Istituto Giannina Gaslini, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 16147 Genova, Italy
| | - Chiara Rossi
- UOC Rheumatology and Autoinflammatory Diseases, Department of Pediatric Sciences, Istituto Giannina Gaslini, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 16147 Genova, Italy
| | - Maria Carla Bosco
- UOC Rheumatology and Autoinflammatory Diseases, Department of Pediatric Sciences, Istituto Giannina Gaslini, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 16147 Genova, Italy
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5
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Simonds MM, Sullivan KE, Brescia AC. Single-cell analysis reveals heterogeneity of juvenile idiopathic arthritis fibroblast-like synoviocytes with implications for disease subtype. Arthritis Res Ther 2022; 24:225. [PMID: 36167601 PMCID: PMC9513865 DOI: 10.1186/s13075-022-02913-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022] Open
Abstract
Background Fibroblast-like synoviocytes (FLS) play a crucial role in JIA pathogenesis; however, the mechanisms by which they contribute to disease progression are not well described. Previous studies demonstrated that rheumatoid arthritis FLS are heterogeneous, and subpopulations with transformed, aggressive phenotypes cause invasive and destructive disease activity. We employ single-cell RNA-sequencing (scRNA-seq) to investigate JIA FLS heterogeneity and gene expression that distinguishes JIA subtypes. Methods JIA FLS cell lines from three persistent oligoarticular, three pre-extension oligoarticular, and three polyarticular subtypes were cultured. scRNA-seq was performed by Genewiz according to 10 × Genomics Chromium protocols. SeuratR package was used for QC, analysis, and exploration of data. Results FLS are heterogeneous and have characteristics of fibroblasts, chondrocytes, and smooth muscle cells. The chondrocyte-like subpopulation is the predominant cell type and percentages of this subpopulation increase with disease severity. Despite overlapping subpopulations, the chondrocyte-like cells have unique genetic fingerprints that distinguish between JIA subtypes. LRRC15, GREM1, and GREM2 are overexpressed in chondrocyte-like cells from persistent oligoarticular JIA FLS compared to pre-extension oligoarticular JIA FLS. S100A4, TIMP3, and NBL1 are overexpressed in pre-extension oligoarticular JIA FLS compared to polyarticular JIA FLS. CRLF1, MFAP5, and TNXB are overexpressed in persistent oligoarticular JIA FLS compared to polyarticular JIA FLS. Conclusions We found biologically relevant differences in gene expression between JIA subtypes that support a critical role for FLS in pathogenesis. We also demonstrate that gene expression within the chondrocyte-like subpopulation can be used to distinguish between these subtypes. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02913-8.
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Affiliation(s)
- Megan M Simonds
- Nemours Biomedical Research, Nemours Children's Health, Delaware, 1701 Rockland Rd, Wilmington, DE, 19803, USA.
| | - Kathleen E Sullivan
- Allergy and Immunology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2022; 74:521-537. [PMID: 35233986 PMCID: PMC10124899 DOI: 10.1002/acr.24853] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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7
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2022; 74:553-569. [PMID: 35233993 PMCID: PMC10161784 DOI: 10.1002/art.42037] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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Neskovska-Sumenkovska M, Sofijanova A, Kacarska R, Kuzevska-Maneva K, Gjurkova Angelovska B, Jovanovska V. Evaluation of pediatric patients with јuvenile idiopathic arthritis treated with biological therapy Tocilizumab (Actemra). Arch Public Health 2021. [DOI: 10.3889/aph.2021.6016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic disease in childhood. It manifests a heterogenic group of symptoms of arthritis, lasting at least 6 weeks and it appears before the age of 16. Patients who had no good therapeutic response to conventional therapy with Methotrexate were treated with biological therapy. The aim of this paper was to evaluate 9 patients who were receiving Tocilizumab at the Department of Rheumocardiology, University Clinic of Pediatric Diseases in Skopje. Materials and methods: Our study included 9 patients treated at our Department with biological therapy with Tocilizumab. Prior to initiation of the biological therapy, all patients underwent laboratory investigations, purified protein derivative (PPD) skin test for tuberculosis, X ray of the lungs and heart, and analysis of hepatitis markers. All patients were treated with amp. Actemra (tocilizumab) 8 mg/kg/tt i.v. Two of the patients had a severe form of the disease (one with severe systemic form and one with severe oligoarticular form of JIA). All presented patients had clinical remission of the disease. Conclusion: Therapy with tocilizumab in patients with juvenile idiopathic arthritis is a good therapeutic choice. The results obtained in our study have shown a significant therapeutic effect of tocilizumab even in severe forms of the disease.
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Rosina S, Natoli V, Santaniello S, Trincianti C, Consolaro A, Ravelli A. Novel biomarkers for prediction of outcome and therapeutic response in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2021; 17:853-870. [PMID: 34139935 DOI: 10.1080/1744666x.2021.1945441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION The search for biomarkers in juvenile idiopathic arthritis (JIA) is a promising and rapidly expanding field of investigation. The biomarkers identified so far may help to dissect the clinical heterogeneity of the illness, measure the level of disease activity, predict clinical remission, relapse, response to medications, course over time, complications, and forestall disease flares. AREAS COVERED We provide a summary of the most recent advances in the development and application of biomarkers in JIA. We performed a PubMed search for significant articles combining predetermined keywords related to biomarkers in non-systemic and systemic JIA, chronic uveitis, and macrophage activation syndrome (MAS). The biomarkers available or under study are presented and discussed separately for non-systemic and systemic subtypes and for the two main disease complications, uveitis and MAS. EXPERT OPINION The incorporation of valid and reliable biomarkers in standard clinical care may help to design better patient-tailored treatment regimens and to improve the therapeutic strategies based on the treat-to-target approach. The establishment of biomarkers that predict the risk of disease flare may lead to define the optimal modalities for treatment discontinuation after the achievement of clinical remission.
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Affiliation(s)
- Silvia Rosina
- UOC Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Valentina Natoli
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Stefania Santaniello
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Chiara Trincianti
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Alessandro Consolaro
- UOC Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy
| | - Angelo Ravelli
- UOC Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica E Scienze Materno-Infantili (Dinogmi), Università Degli Studi Di Genova, Genoa, Italy.,Sechenov First Moscow State Medical University, Moscow, Russian Federation
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10
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Ozdel S, Baglan E, Cakıcı EK, Yazılıtas F, Yücel H, Senel S, Bulbul M. Clinical features in 305 patients with juvenile idiopathic arthritis: A single center Turkish Study. Pediatr Int 2021; 63:636-642. [PMID: 32969552 DOI: 10.1111/ped.14481] [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] [Received: 05/04/2020] [Revised: 08/11/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatologic disease of childhood. The various subtypes of JIA differ in clinical features and treatments. The aim of this study was to analyze the frequency of JIA subtypes, patient demographic and clinical features, as well as the rates of macrophage activation syndrome, uveitis, and remission in Turkish JIA patients treated at a single center, and to compare the findings to those in the literature. METHODS The files of all JIA patients treated at our pediatric rheumatology department between January 2017 and January 2019 were retrospectively reviewed. Patient demographic, clinical, and laboratory data were obtained from the patients' files and the hospital database. RESULTS The study included 305 patients (180 females) with a mean age at onset of 7.83 ± 4.62 years. Among all the JIA subtypes, the most frequent was oligoarthritis (41.6%), followed by enthesitis-related arthritis (29.2%), rheumatoid factor (RF)-negative polyarthritis (13.4%), systemic arthritis (9.5%), RF-positive polyarthritis (2.6%), psoriatic arthritis (2.0%), and undifferentiated arthritis (1.6%). At the time of data collection, 278 patients (91.0%) were in remission, whereas 27 patients (9.0%) had active disease. Macrophage activation syndrome developed in 12 of the 29 (41.0%) systemic arthritis. Uveitis was noted in 32 (10.0%) patients. Biological agents were administered in 142 of the patients. CONCLUSIONS The available data indicate that JIA as a whole is a heterogeneous disease with significant variability in course and long-term outcome. As such, each patient should be evaluated according to his / her disease subtype.
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Affiliation(s)
- Semanur Ozdel
- Departments of, Department of, Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Esra Baglan
- Departments of, Department of, Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Evrim Kargın Cakıcı
- Departments of, Department of, Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Fatma Yazılıtas
- Departments of, Department of, Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Hüsniye Yücel
- Department of, Pediatrics, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Saliha Senel
- Department of, Pediatrics, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Mehmet Bulbul
- Departments of, Department of, Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
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11
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Simonds MM, Schlefman AR, McCahan SM, Sullivan KE, Rose CD, Brescia AMC. The culture microenvironment of juvenile idiopathic arthritis synovial fibroblasts is favorable for endochondral bone formation through BMP4 and repressed by chondrocytes. Pediatr Rheumatol Online J 2021; 19:72. [PMID: 33980237 PMCID: PMC8117630 DOI: 10.1186/s12969-021-00556-8] [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: 11/05/2020] [Accepted: 04/16/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We examined influences of conditioned media from chondrocytes (Ch) on juvenile idiopathic arthritis synovial fibroblasts (JFLS) and potential for JFLS to undergo endochondral bone formation (EBF). METHODS Primary cells from three control fibroblast-like synoviocytes (CFLS) and three JFLS were cultured in Ch-conditioned media and compared with untreated fibroblast-like synoviocytes (FLS). RNA was analyzed by ClariomS microarray. FLS cells cultured in conditioned media were exposed to either TGFBR1 inhibitor LY3200882 or exogenous BMP4 and compared with FLS cultured in conditioned media from Ch (JFLS-Ch). Media supernatants were analyzed by ELISA. RESULTS In culture, JFLS downregulate BMP2 and its receptor BMPR1a while upregulating BMP antagonists (NOG and CHRD) and express genes (MMP9, PCNA, MMP12) and proteins (COL2, COLX, COMP) associated with chondrocytes. Important TGFβ superfamily member gene expression (TGFBI, MMP9, COL1A1, SOX6, and MMP2) is downregulated when JFLS are cultured in Ch-conditioned media. COL2, COLX and COMP protein expression decreases in JFLS-Ch. BMP antagonist protein (NOG, CHRD, GREM, and FST) secretion is significantly increased in JFLS-Ch. Protein phosphorylation increases in JFLS-Ch exposed to exogenous BMP4, and chondrocyte-like phenotype is restored in BMP4 presence, evidenced by increased secretion of COL2 and COLX. Inhibition of TGFBR1 in JFLS-Ch results in overexpression of COL2. CONCLUSIONS JFLS are chondrocyte-like, and Ch-conditioned media can abrogate this phenotype. The addition of exogenous BMP4 causes JFLS-Ch to restore this chondrocyte-like phenotype, suggesting that JFLS create a microenvironment favorable for endochondral bone formation, thereby contributing to joint growth disturbances in juvenile idiopathic arthritis.
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Affiliation(s)
- Megan M. Simonds
- grid.239281.30000 0004 0458 9676Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, 1701 Rockland Rd, Wilmington, DE 19803 USA
| | - Amanda R. Schlefman
- grid.413611.00000 0004 0467 2330Rheumatology, Johns Hopkins All Children’s Hospital, St. Petersburg, FL USA
| | - Suzanne M. McCahan
- grid.239281.30000 0004 0458 9676Nemours Biomedical Research, Nemours/Alfred I. duPont Hospital for Children, 1701 Rockland Rd, Wilmington, DE 19803 USA
| | - Kathleen E. Sullivan
- grid.239552.a0000 0001 0680 8770Allergy and Immunology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Carlos D. Rose
- grid.239281.30000 0004 0458 9676Division of Rheumatology, Nemours/Alfred I. duPont Hospital for Children, 1701 Rockland Rd, Wilmington, DE 19803 USA
| | - Anne Marie C. Brescia
- grid.239281.30000 0004 0458 9676Division of Rheumatology, Nemours/Alfred I. duPont Hospital for Children, 1701 Rockland Rd, Wilmington, DE 19803 USA
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12
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Biological classification of childhood arthritis: roadmap to a molecular nomenclature. Nat Rev Rheumatol 2021; 17:257-269. [PMID: 33731872 DOI: 10.1038/s41584-021-00590-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
Chronic inflammatory arthritis in childhood is heterogeneous in presentation and course. Most forms exhibit clinical and genetic similarity to arthritis of adult onset, although at least one phenotype might be restricted to children. Nevertheless, paediatric and adult rheumatologists have historically addressed disease classification separately, yielding a juvenile idiopathic arthritis (JIA) nomenclature that exhibits no terminological overlap with adult-onset arthritis. Accumulating clinical, genetic and mechanistic data reveal the critical limitations of this strategy, necessitating a new approach to defining biological categories within JIA. In this Review, we provide an overview of the current evidence for biological subgroups of arthritis in children, delineate forms that seem contiguous with adult-onset arthritis, and consider integrative genetic and bioinformatic strategies to identify discrete entities within inflammatory arthritis across all ages.
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13
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Chhabra A, Robinson C, Houghton K, Cabral DA, Morishita K, Tucker LB, Petty RE, Larché M, Batthish M, Guzman J. Long-term outcomes and disease course of children with juvenile idiopathic arthritis in the ReACCh-Out cohort: a two-centre experience. Rheumatology (Oxford) 2021; 59:3727-3730. [PMID: 32402087 DOI: 10.1093/rheumatology/keaa118] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/20/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess long-term outcomes of children with JIA diagnosed in the biologic era. METHODS Chart review of patients prospectively enrolled in the Research in Arthritis in Canadian Children Emphasizing Outcomes inception cohort at two Canadian centres. Inactive disease and remission were defined according to Wallace criteria. RESULTS We included 247 of 254 (97%) eligible patients diagnosed 2005-10. At the last follow-up visit at a median age of 16.9 years, 47% were in remission off medications, 25% in remission on medications and 27% had active disease; 51% were on at least one anti-rheumatic medication (22% on biologics). Patients with systemic JIA had the highest frequency of remission off medications (70%) and patients with RF-positive polyarthritis had the lowest (18%) (P <0.05 by Fisher's exact test). Among 99 patients with oligoarthritis at enrolment, 14 (14%) had an oligoarthritis extended course. Forty-five patients (18%) had at least one erosion or joint space narrowing in X-rays or MRI, and two (0.8%) required joint replacement. CONCLUSION Relative to historical cohorts, this study suggests a reduction in JIA permanent damage, a more favourable prognosis for systemic JIA and a lower progression to oligoarthritis extended category. However, in an era of biologic therapy, one in four patients with JIA still enter adulthood with active disease and one in two still on treatment.
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Affiliation(s)
- Amieleena Chhabra
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - Cal Robinson
- McMaster University, Hamilton, Ontario, Canada.,McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Kristin Houghton
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - David A Cabral
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - Kimberly Morishita
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - Lori B Tucker
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - Ross E Petty
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | | | - Michelle Batthish
- McMaster University, Hamilton, Ontario, Canada.,McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
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14
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Rezaei E, Hogan D, Trost B, Kusalik AJ, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Watanabe Duffy K, Gordon J, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Morishita K, Oen KG, Petty RE, Ramsey SE, Scuccimarri R, Spiegel L, Stringer E, Taylor-Gjevre RM, Tse SML, Tucker LB, Turvey SE, Tupper S, Yeung RSM, Benseler S, Ellsworth J, Guillet C, Karananayake C, Muhajarine N, Roth J, Schneider R, Rosenberg AM. Clinical and associated inflammatory biomarker features predictive of short-term outcomes in non-systemic juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 59:2402-2411. [PMID: 31919503 DOI: 10.1093/rheumatology/kez615] [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: 08/26/2019] [Revised: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To identify early predictors of disease activity at 18 months in JIA using clinical and biomarker profiling. METHODS Clinical and biomarker data were collected at JIA diagnosis in a prospective longitudinal inception cohort of 82 children with non-systemic JIA, and their ability to predict an active joint count of 0, a physician global assessment of disease activity of ≤1 cm, and inactive disease by Wallace 2004 criteria 18 months later was assessed. Correlation-based feature selection and ReliefF were used to shortlist predictors and random forest models were trained to predict outcomes. RESULTS From the original 112 features, 13 effectively predicted 18-month outcomes. They included age, number of active/effused joints, wrist, ankle and/or knee involvement, ESR, ANA positivity and plasma levels of five inflammatory biomarkers (IL-10, IL-17, IL-12p70, soluble low-density lipoprotein receptor-related protein 1 and vitamin D), at enrolment. The clinical plus biomarker panel predicted active joint count = 0, physician global assessment ≤ 1, and inactive disease after 18 months with 0.79, 0.80 and 0.83 accuracy and 0.84, 0.83, 0.88 area under the curve, respectively. Using clinical features alone resulted in 0.75, 0.72 and 0.80 accuracy, and area under the curve values of 0.81, 0.78 and 0.83, respectively. CONCLUSION A panel of five plasma biomarkers combined with clinical features at the time of diagnosis more accurately predicted short-term disease activity in JIA than clinical characteristics alone. If validated in external cohorts, such a panel may guide more rationally conceived, biologically based, personalized treatment strategies in early JIA.
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Affiliation(s)
- Elham Rezaei
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
| | - Daniel Hogan
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Brett Trost
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Anthony J Kusalik
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Gilles Boire
- Département de Médecine, Université de Sherbrooke, Sherbrooke, QCCanada
| | - David A Cabral
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Sarah Campillo
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Gaëlle Chédeville
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Anne-Laure Chetaille
- Département de Médecine le, Centre Hospitalier Universitaire de Quebec, Quebec, QCCanada
| | - Paul Dancey
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St John's, NLCanada
| | - Ciaran Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Karen Watanabe Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - John Gordon
- Department of Medicine, University of Saskatchewan, Saskatoon, SKCanada
| | - Jaime Guzman
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Kristin Houghton
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Adam M Huber
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Roman Jurencak
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Bianca Lang
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Kimberly Morishita
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Kiem G Oen
- Department of Pediatrics, University of Manitoba, Winnipeg, MBCanada
| | - Ross E Petty
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Suzanne E Ramsey
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Rosie Scuccimarri
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Lynn Spiegel
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Elizabeth Stringer
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | | | - Shirley M L Tse
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Lori B Tucker
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Stuart E Turvey
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Susan Tupper
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
| | - Rae S M Yeung
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Susanne Benseler
- Department of Pediatrics, University of Calgary, Calgary, ABCanada
| | - Janet Ellsworth
- Department of Pediatrics, University of Alberta, Edmonton, ABCanada
| | - Chantal Guillet
- Department of Pediatrics, Hôpital Fleurimont (CHUS), Quebec, QCCanada
| | | | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Johannes Roth
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Rayfel Schneider
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Alan M Rosenberg
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
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15
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Moadab F, Khorramdelazad H, Abbasifard M. Role of CCL2/CCR2 axis in the immunopathogenesis of rheumatoid arthritis: Latest evidence and therapeutic approaches. Life Sci 2021; 269:119034. [PMID: 33453247 DOI: 10.1016/j.lfs.2021.119034] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 12/18/2022]
Abstract
Evidence suggests that uncontrolled immune system responses and their components play a significant role in developing rheumatoid arthritis (RA), which is considered an autoimmune disease (AD). Among immune system mediators, cytokines and chemokines are involved in numerous physiological and pathological processes. CCL2 or monocyte chemoattractant protein-1 (MCP-1) is known as a CC chemokine that can induce the locomotion and recruitment of monocytes and macrophages to the site of injury. When CCL2 binds to its receptors, the most important of which is CCR2, various signaling pathways are triggered, eventually leading to various immunological events such as inflammation. This chemokine also participates in several events involved in RA pathogenesis, such as osteoclastogenesis, migration of effector T cells to the RA synovium tissue, and angiogenesis. In this review article, the role of the CCL2/CCR2 axis in RA pathogenesis and the immunotherapy opportunities based on CCL2/CCR2 axis targeting has been discussed based on existing investigations.
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Affiliation(s)
- Fatemeh Moadab
- Student Research Committee, Rafsanjan University of Medical Sciences, Rafsanjan, Iran; Department of Immunology, School of Medicine; Molecular Medicine Research Center, Institute of Basic Medical Sciences Research, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Hossein Khorramdelazad
- Department of Immunology, School of Medicine; Molecular Medicine Research Center, Institute of Basic Medical Sciences Research, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Mitra Abbasifard
- Department of Internal Medicine, Ali-Ibn Abi-Talib Hospital, School of Medicine; Molecular Medicine Research Center, Institute of Basic Medical Sciences Research, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
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16
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Doya LJ, Bijow FW, Dayoub A. Juvenile idiopathic arthritis in a premature baby: rare case report. Oxf Med Case Reports 2020; 2020:omaa100. [PMID: 33269084 PMCID: PMC7685014 DOI: 10.1093/omcr/omaa100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/23/2020] [Accepted: 09/08/2020] [Indexed: 11/14/2022] Open
Abstract
ABSTRACTJuvenile idiopathic arthritis (JIA) is chronic arthritis in children and adolescents. It is clinically diagnosed, which includes children under the age of 16 with arthritis for at least six weeks. Cases younger than six months of age are extremely rare. Here we report a rare case in the literature about Juvenile idiopathic arthritis in a premature baby, presenting at 21 days of age. The diagnosis was made according to clinical symptoms, laboratory analyses and duration of disease.
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Affiliation(s)
- Leen Jamel Doya
- Department of Pediatrics, Tishreen University Hospital, Lattakia, Syria
| | | | - Adnan Dayoub
- Department of Pediatrics, Tishreen University Hospital, Lattakia, Syria
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17
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Sezer M, Aydın F, Kurt T, Tekgöz N, Tekin ZE, Karagöl C, Çakar N, Acar B. Prediction of inactive disease and relapse in oligoarticular juvenile idiopathic arthritis. Mod Rheumatol 2020; 31:1025-1030. [PMID: 33050742 DOI: 10.1080/14397595.2020.1836788] [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: 10/23/2022]
Abstract
OBJECTIVE The aim of this study is to describe clinical features of patients with oligoarticular juvenile idiopathic arthritis (JIA) who achieved inactive disease at 3rd month and also to determine the predictors of relapse and extended course. METHODS In the cohort study, 88 patients with oligoarticular JIA were retrospectively analyzed. The demographic data, clinical features, medications, relapse rates were recorded. Juvenile Arthritis Disease Activity Score (JADAS) and American College of Rheumatology Pediatric criteria were used to measure disease activity and treatment response at 3, 6 and 12 months. RESULTS Fifty-nine (67%) patients were females and the mean age at diagnosis was 7.9 ± 4.3 years. The odds of achieving inactive disease (JADAS ≤1) at 3rd month were increased by a lower JADAS27 score at admission. Forty-one (48.8%) of 84 patients relapsed. Ankle involvement at onset, high JADAS27 score at admission, increased ESR at admission and presence of synovial hypertrophy in imaging were risk factors for occurrence of relapse. CONCLUSION Our results show that a significant proportion of oligoarticular JIA patients relapse after inactive period. JADAS is a useful tool to guide the treatment decisions of patients who may be at risk of high disease activity and relapse.
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Affiliation(s)
- Müge Sezer
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Fatma Aydın
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Tuba Kurt
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nilüfer Tekgöz
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Zahide Ekici Tekin
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Cüneyt Karagöl
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nilgün Çakar
- Department of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Banu Acar
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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18
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Shoop-Worrall SJW, Hyrich KL, Verstappen SMM, Sergeant JC, Baildam E, Chieng A, Davidson J, Foster H, Ioannou Y, McErlane F, Wedderburn LR, Thomson W, McDonagh JE. Comparing Proxy, Adolescent, and Adult Assessments of Functional Ability in Adolescents With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 72:517-524. [PMID: 30875458 PMCID: PMC7154708 DOI: 10.1002/acr.23877] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/05/2019] [Indexed: 12/24/2022]
Abstract
Objective In pediatric research, investigators rely on proxy reports of outcome, such as the proxy‐completed Childhood Health Assessment Questionnaire (C‐HAQ), to assess function in juvenile idiopathic arthritis (JIA). As children mature, they may self‐complete the adult HAQ or the unvalidated adolescent‐specific C‐HAQ. It is unclear how these measures compare and whether they are directly interchangeable. The present study was undertaken to compare agreement between the proxy‐completed C‐HAQ, adolescent‐specific C‐HAQ, and the HAQ at initial presentation to pediatric rheumatologic care and 1 year following the first presentation in adolescents with JIA. Methods Adolescents ages 11–17 years participating in the Childhood Arthritis Prospective Study (CAPS), a UK multicenter inception cohort, were included. In a CAPS substudy, adolescents self‐completed the adolescent‐specific C‐HAQ and the HAQ, and proxies simultaneously completed the proxy‐completed C‐HAQ at baseline and 1 year. Correlation and agreement between scores were assessed at baseline. Agreement and ability to similarly classify clinically important changes over time were assessed at 1 year following initial presentation to rheumatologic care. Results A total of 107 adolescents (adolescent‐specific C‐HAQ and HAQ) or their proxies (proxy‐completed C‐HAQ) had completed all 3 measures at baseline. Median age at diagnosis was 13 years, and 61% were female. Although the 3 scores demonstrated strong correlations (r > 0.8), they were not completely interchangeable, with agreement ranging between 70% and 80%. There was similar agreement between the changes in scores between baseline and 1 year. Using proxy‐completed C‐HAQ minimum clinically important cutoffs, the adolescent‐specific C‐HAQ and the HAQ similarly classified 80% to 90% of adolescents as having improved or worsened. Conclusion While there is relatively high agreement and similar classification of change between HAQ and the 2 C‐HAQ scores, these are not completely interchangeable. This impacts the comparison of function when measured in different ways over the lifespan.
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Affiliation(s)
| | - Kimme L Hyrich
- University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Suzanne M M Verstappen
- University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Eileen Baildam
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Alice Chieng
- Royal Manchester Children's Hospital, Manchester, UK
| | - Joyce Davidson
- Royal Hospital for Children, Glasgow, UK, and Royal Hospital for Sick Children, Edinburgh, UK
| | - Helen Foster
- Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, and Newcastle University, Newcastle upon Tyne, UK
| | | | - Flora McErlane
- Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lucy R Wedderburn
- University College London, Great Ormond Street Hospital NHS Foundation Trust, and NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Wendy Thomson
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
| | - Janet E McDonagh
- Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, and University of Manchester, Manchester, UK
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19
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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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20
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Tumefactive synovial thickening mimicking synovial chondromatosis in the setting of oligoarticular juvenile idiopathic arthritis in a toddler. Radiol Case Rep 2020; 15:218-221. [PMID: 31890072 PMCID: PMC6931215 DOI: 10.1016/j.radcr.2019.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 11/26/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common cause of arthritis in children. It is characterized by inflammatory cell infiltration of synovial membranes leading to synovitis and synovial membrane thickening. Synovial chondromatosis is rare sequela of synovitis in which foci of cartilage develop within the synovial membrane of a joint capsule. We report a case of a 35-month old boy who developed tumefactive synovial hypertrophy and hyperplasia that mimicked synovial chondromatosis on MRI. The reactive synovium was arthroscopically excised and the patient's arthritis improved. Tumefactive synovial hypertrophy and hyperplasia mimicking synovial chondromatosis on MRI in the setting of JIA, has not been reported in this young of a patient in the literature to date. A discussion on imaging in oligoarticular JIA and synovial chondromatosis is presented herein.
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Rosenberg AM. Do we need a new classification of juvenile idiopathic arthritis? Clin Immunol 2019; 211:108298. [PMID: 31706029 DOI: 10.1016/j.clim.2019.108298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/28/2019] [Accepted: 11/05/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Alan M Rosenberg
- Department of Pediatrics, Division of Rheumatology, University of Saskatchewan, 103 Hospital Drive, Saskatoon, Saskatchewan S7N 0W8, Canada.
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Cleary G, Pain C, McCann L, Mahmood K, Brookes-Fazakerley S, Robinson S, Walton R, Highcock A, Landes C, Barnes N, Roberts I, James L. Short-term outcome of surgical arthrodiastasis of the ankle with Ilizarov frame in a cohort of children and young people with juvenile idiopathic arthritis. Rheumatol Adv Pract 2019; 3:rkz031. [PMID: 31559381 PMCID: PMC6755489 DOI: 10.1093/rap/rkz031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 08/05/2019] [Indexed: 01/15/2023] Open
Abstract
Objectives Despite medical advances, life-changing articular damage may still occur in patients with JIA. We report a cohort with destructive arthropathy of the ankle treated by surgical arthrodiastasis. Methods Eight patients (nine ankles) received arthrodiastasis by means of an Ilizarov frame between 2009 and 2013. Patient- and clinician-reported outcome measures were collated prospectively, with retrospective analysis of demographics, disease and pre-surgical treatment. Results Pre-surgery, all patients received IA CS (mean 0.8 injections/year) and MTX (mean diagnosis to treatment 3.8 years; two of eight started within 3 months). Seven of eight patients received biologic drugs. Pain scores improved by 56 and 29% (P < 0.005) at 6 and 12 months post-frame removal. American Academy Orthopaedic Foot and Ankle Society ankle–hindfoot scale, Oxford Ankle Foot Questionnaire-Child and Oxford Ankle Foot Questionnaire-Parent scores improved by 171, 62 and 80%, respectively (P < 0.005) at 12 months post-frame removal. Patients remained satisfied with surgical treatment for a mean of 13.3 months. There was transient pin site infection in three patients, and all patients had radiological improvement in joint space. Conclusion Arthrodiastasis with an Ilizarov frame is a safe, well-tolerated technique that should be considered as a short-term joint-preserving procedure to improve pain and function when damage has occurred. Delays to systemic medical treatment in this cohort would be considered out-with standard modern practice but, although less prevalent, destructive ankle arthropathy continues to occur in JIA, and we believe this study to be relevant. The ankle is particularly susceptible to damage and, even if localized, should be treated early and aggressively with DMARDs and rapid progression to biologic therapies. Levelof evidence Level IV.
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Affiliation(s)
- Gavin Cleary
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
| | - Clare Pain
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
| | - Liza McCann
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
| | - Kamran Mahmood
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
| | | | | | - Roger Walton
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
| | | | - Caren Landes
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
| | - Nik Barnes
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
| | - Ian Roberts
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
| | - Leroy James
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool
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Kindgren E, Guerrero-Bosagna C, Ludvigsson J. Heavy metals in fish and its association with autoimmunity in the development of juvenile idiopathic arthritis: a prospective birth cohort study. Pediatr Rheumatol Online J 2019; 17:33. [PMID: 31266504 PMCID: PMC6604193 DOI: 10.1186/s12969-019-0344-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 06/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The etiology of Juvenile Idiopathic Arthritis (JIA) is poorly understood. The purpose of this study was to examine the possible influence of early nutrition on later development of JIA. METHODS In a population-based prospective birth cohort of 15,740 children we collected nutritional data, including fish consumption, and biological samples during pregnancy, at birth and at different ages. 16 years after study inclusion we identified 42 children with JIA, of whom 11 were positive for Antinuclear Antibodies (ANA). Heavy metals were analysed in cord blood of all 42 JIA patients and 40 age and sex-matched controls. A multivariable logistic regression model, adjusted for relevant factors, was used as well as Mann-Whitney U-test. RESULTS Fish consumption more than once a week during pregnancy as well as during the child's first year of life was associated with an increased risk of JIA (aOR 4.5 (1.95-10.4); p < 0.001 and aOR 5.1 (2.1-12.4) p < 0.001) and of ANA-positivity (aOR 2.2 (1.4-3.6); p = 0.002 and p < 0.001). Concentrations of Al, Cd, Hg and Li in cord blood were significantly higher in the JIA-group than in controls. The ANA-positive, all of whom had consumed fish >once/week their first year, had significantly higher concentrations of Al (p < 0.001), Cd (p = 0.003), and Li (p < 0.001) in cord blood than controls. Frequency of fish consumption correlated with concentrations of Cd (p = 0.003), Li (p = 0.015) and Hg (p = 0.011). CONCLUSIONS Moderate exposure to heavy metals, associated with fish consumption, during pregnancy and early childhood may cause effects on the immune system of the offspring, resulting in ANA positivity and JIA.
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Affiliation(s)
- Erik Kindgren
- Department of Pediatrics, Västervik Hospital, Västervik, Sweden. .,Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. .,Department of Pediatrics, Skaraborg Hospital, SE-541 85 Skövde, Skövde, Sweden.
| | - Carlos Guerrero-Bosagna
- 0000 0001 2162 9922grid.5640.7Avian Behavioural Genomics and Physiology Group, IFM Biology, Linköping University, Linköping, Sweden
| | - Johnny Ludvigsson
- 0000 0001 2162 9922grid.5640.7Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden ,Crown Princess Victoria Children’s Hospital, Region Östergötland, Linköping, Sweden
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Consider the wrist: a retrospective study on pediatric connective tissue disease with MRI. Rheumatol Int 2019; 39:2095-2101. [PMID: 31222439 DOI: 10.1007/s00296-019-04353-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 06/17/2019] [Indexed: 10/26/2022]
Abstract
The aim of this study is to describe the clinical characteristics and MRI findings of the wrist in a cohort of children suffering from connective tissue disease with musculoskeletal involvement. Ten patients with pediatric connective tissue disease [median age 14.7 years (IQR 12.7-16.6 years), 70% female] were identified from a large MRI database. Clinical findings during the disease course were retrospectively obtained from patient charts and findings at the time of MRI were prospectively registered in the MRI database. MRI wrist datasets were evaluated by three readers in consensus for synovitis, tenosynovitis, bone marrow changes, bone erosions and myositis. Patients suffered from connective tissue disease with clinical overlap of subtypes systemic lupus erythematosus, Sjögren syndrome and dermatomyositis. Median onset of disease was at 12.3 years (IQR 7.8-14.8 years). Clinical arthritis activity was scored low (median visual analogue scale physician 19, IQR 7-31). Notwithstanding, extensive inflammatory abnormalities such as synovitis and tenosynovitis were found in the wrist of 7/10 patients. Osteochondral involvement was detected in 3/10 patients. In a small cohort of children with connective tissue disease and musculoskeletal symptoms, severe inflammatory abnormalities of the involved wrist were present in the MRI, while clinical disease scores suggested mild disease activity. Therefore, clinicians should consider the wrist as vulnerable for joint damage and can add MRI as a helpful tool in the management of patients with pediatric connective tissue disease and musculoskeletal involvement.
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Abstract
Juvenile idiopathic arthritis is the most common chronic rheumatic disease of unknown aetiology in childhood and predominantly presents with peripheral arthritis. The disease is divided into several subgroups, according to demographic characteristics, clinical features, treatment modalities and disease prognosis. Systemic juvenile idiopathic arthritis, which is one of the most frequent disease subtypes, is characterized by recurrent fever and rash. Oligoarticular juvenile idiopathic arthritis, common among young female patients, is usually accompanied by anti-nuclear antibodie positivity and anterior uveitis. Seropositive polyarticular juvenile idiopathic arthritis, an analogue of adult rheumatoid arthritis, is seen in less than 10% of paediatric patients. Seronegative polyarticular juvenile idiopathic arthritis, an entity more specific for childhood, appears with widespread large- and small-joint involvement. Enthesitis-related arthritis is a separate disease subtype, characterized by enthesitis and asymmetric lower-extremity arthritis. This disease subtype represents the childhood form of adult spondyloarthropathies, with human leukocyte antigen-B27 positivity and uveitis but commonly without axial skeleton involvement. Juvenile psoriatic arthritis is characterized by a psoriatic rash, accompanied by arthritis, nail pitting and dactylitis. Disease complications can vary from growth retardation and osteoporosis secondary to treatment and disease activity, to life-threatening macrophage activation syndrome with multi-organ insufficiency. With the advent of new therapeutics over the past 15 years, there has been a marked improvement in juvenile idiopathic arthritis treatment and long-term outcome, without any sequelae. The treatment of juvenile idiopathic arthritis patients involves teamwork, including an experienced paediatric rheumatologist, an ophthalmologist, an orthopaedist, a paediatric psychiatrist and a physiotherapist. The primary goals of treatment are to eliminate active disease, to normalize joint function, to preserve normal growth and to prevent long-term joint damage. Timely and aggressive treatment is important to provide early disease control. The first-line treatment includes disease-modifying anti-rheumatic drugs (methotrexate, sulphasalazine, leflunomide) in combination with corticosteroids, used in different dosages and routes (oral, intravenous, intra-articular). Intra-articular application of steroids seems to be an effective treatment modality, especially in monoarthritis. Biological agents should be added in the treatment of unresponsive patients. Anti-tumour necrosis factor agents (etanercept, infliximab, adalimumab), anti-interleukin-1 agents (anakinra, canakinumab), anti- interleukin-6 agents (tocilizumab) and T-cell regulatory agents (abatacept) have been shown to be safe and effective in childhood patients. Recent studies reported sustained reduction in joint damage with even complete clinical improvement in paediatric patients, compared to previous data.
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Affiliation(s)
- Kenan Barut
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Sezgin Şahin
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
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Avenarius DFM, Nusman C, Malattia C, de Horatio LT, Rosendahl K, Maas M, Müller LSO. Current status of wrist imaging in juvenile idiopathic arthritis. Pediatr Radiol 2018; 48:801-810. [PMID: 29766247 DOI: 10.1007/s00247-017-4063-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 11/19/2017] [Accepted: 12/18/2017] [Indexed: 10/17/2022]
Abstract
Wrist involvement occurs in about one-quarter of patients diagnosed with juvenile idiopathic arthritis (JIA), increasing to 40% 5 years after diagnosis. The imaging appearances, both for active inflammation and permanent change, differ from those seen in adult rheumatoid arthritis; therefore, a child-specific approach is crucial for correct assessment. In this review article, we provide an update on the current status for imaging wrist JIA, with a focus on evidence-based practice.
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Affiliation(s)
| | - Charlotte Nusman
- Department of Paediatric Haematology, Rheumatology, Immunology, and Infectious Disease, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands.,Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Clara Malattia
- Department of Paediatrics, University of Genoa, Genova, Italy
| | | | - Karen Rosendahl
- Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, K1, University of Bergen, Bergen, Norway
| | - Mario Maas
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Lil-Sofie Ording Müller
- Department of Radiology and Intervention Unit for Paediatric Radiology, Oslo University, Oslo, Norway
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Nalbanti P, Kanakoudi-Tsakalidou F, Trachana M, Pratsidou-Gertsi P, Farmaki E, Bamidis P, Papachristou F. Juvenile idiopathic arthritis in the biologic era: predictors of the disease progression and need for early introduction of biologic treatment. Rheumatol Int 2018; 38:1241-1250. [PMID: 29845429 DOI: 10.1007/s00296-018-4062-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 05/23/2018] [Indexed: 12/21/2022]
Abstract
To assess longitudinally the course and outcome of juvenile idiopathic arthritis (JIA) in patients diagnosed and followed-up exclusively in the biologic era; also, to define possible predictors of the disease progression and need for early implementation of biologicals. Prospective and retrospective, monocentric cohort study of 120 JIA patients, diagnosed between 2001 and 2010, and followed-up for ≥ 4 years (median 8.04). Disease activity, cumulative articular/extra-articular damage and quality of life were evaluated by the assessment tools Juvenile Arthritis Disease Activity Score (JADAS71), Juvenile Arthritis Damage Index (JADI) and Childhood Health Assessment Questionnaire (CHAQ), respectively. Moreover, potential predictors of the disease progression and their relation to biologic therapy were investigated. High JADAS71 score (> 9) at diagnosis was indicative of progression to polyarticular course and the need for early introduction of biologic treatment. Other independent predictors of progression to polyarthritis, were: involvement of upper limb, hip and ankle within 6 months following JIA diagnosis and percentage of cumulative time with active disease > 35% within the first year. At the end of the study, both the median JADAS71 score and the Disability Index were significantly lower than the initial (p < 0.001) and remission off medication was achieved in 25% of the patients. Articular and extra-articular (only ocular) cumulative damage was demonstrated only in 5 and 7.5% of patients, respectively. Physical functional ability was found normal/mildly restricted in 93.3% and moderately restricted in 6.7% of the patients. We believe that these findings, fit in with a picture of JIA course and outcome under current conditions of objective "disease status" evaluation and of tightly controlled follow-up. Predictors emerged from our study could contribute to the identification of patients who will need early implementation of biologic treatment.
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Affiliation(s)
- Panayiota Nalbanti
- First Department of Pediatrics, School of Medicine, Pediatric Immunology and Rheumatology Referral Center, Ippokration General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos St, 54642, Thessaloniki, Greece.
| | - Florentia Kanakoudi-Tsakalidou
- First Department of Pediatrics, School of Medicine, Pediatric Immunology and Rheumatology Referral Center, Ippokration General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos St, 54642, Thessaloniki, Greece
| | - Maria Trachana
- First Department of Pediatrics, School of Medicine, Pediatric Immunology and Rheumatology Referral Center, Ippokration General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos St, 54642, Thessaloniki, Greece
| | - Polyxeni Pratsidou-Gertsi
- First Department of Pediatrics, School of Medicine, Pediatric Immunology and Rheumatology Referral Center, Ippokration General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos St, 54642, Thessaloniki, Greece
| | - Evangelia Farmaki
- First Department of Pediatrics, School of Medicine, Pediatric Immunology and Rheumatology Referral Center, Ippokration General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos St, 54642, Thessaloniki, Greece
| | - Panagiotis Bamidis
- Medical Education Informatics, Lab of Medical Physics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotios Papachristou
- First Department of Pediatrics, School of Medicine, Pediatric Immunology and Rheumatology Referral Center, Ippokration General Hospital, Aristotle University of Thessaloniki, 49 Konstantinoupoleos St, 54642, Thessaloniki, Greece
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Conventional radiography in juvenile idiopathic arthritis: Joint recommendations from the French societies for rheumatology, radiology and paediatric rheumatology. Eur Radiol 2018; 28:3963-3976. [PMID: 29582130 PMCID: PMC6096609 DOI: 10.1007/s00330-018-5304-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Revised: 12/03/2017] [Accepted: 01/02/2018] [Indexed: 10/29/2022]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) can cause structural damage. However, data on conventional radiography (CR) in JIA are scant. OBJECTIVE To provide pragmatic guidelines on CR in each non-systemic JIA subtype. METHODS A multidisciplinary task force of 16 French experts (rheumatologists, paediatricians, radiologists and one patient representative) formulated research questions on CR assessments in each non-systemic JIA subtype. A systematic literature review was conducted to identify studies providing detailed information on structural joint damage. Recommendations, based on the evidence found, were evaluated using two Delphi rounds and a review by an independent committee. RESULTS 74 original articles were included. The task force developed four principles and 31 recommendations with grades ranging from B to D. The experts felt strongly that patients should be selected for CR based on the risk of structural damage, with routine CR of the hands and feet in rheumatoid factor-positive polyarticular JIA but not in oligoarticular non-extensive JIA. CONCLUSION These first pragmatic recommendations on CR in JIA rely chiefly on expert opinion, given the dearth of scientific evidence. CR deserves to be viewed as a valuable tool in many situations in patients with JIA. KEY POINTS • CR is a valuable imaging technique in selected indications. • CR is routinely recommended for peripheral joints, when damage risk is high. • CR is recommended according to the damage risk, depending on JIA subtype. • CR is not the first-line technique for imaging of the axial skeleton.
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Nigrovic PA, Raychaudhuri S, Thompson SD. Review: Genetics and the Classification of Arthritis in Adults and Children. Arthritis Rheumatol 2017; 70:7-17. [PMID: 29024575 DOI: 10.1002/art.40350] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 10/05/2017] [Indexed: 12/16/2022]
Abstract
Current classification of primary inflammatory arthritis begins from the assumption that adults and children are different. No form of juvenile idiopathic arthritis bears the same name as an adult arthritis, a nomenclature gap with implications for both clinical care and research. Recent genetic data have raised questions regarding this adult/pediatric divide, revealing instead broad patterns that span the age spectrum. Combining these genetic patterns with demographic and clinical data, we propose that inflammatory arthritis can be segregated into 4 main clusters, largely irrespective of pediatric or adult onset: seropositive, seronegative (likely including a distinct group that usually begins in early childhood), spondyloarthritis, and systemic. Each of these broad clusters is internally heterogeneous, highlighting the need for further study to resolve etiologically discrete entities. Eliminating divisions based on arbitrary age cutoffs will enhance opportunities for collaboration between adult and pediatric rheumatologists, thereby helping to promote the understanding and treatment of arthritis.
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Affiliation(s)
- Peter A Nigrovic
- Brigham and Women's Hospital and Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Soumya Raychaudhuri
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, and Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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Glerup M, Herlin T, Twilt M. Remission rate is not dependent on the presence of antinuclear antibodies in juvenile idiopathic arthritis. Clin Rheumatol 2017; 36:671-676. [PMID: 28097448 DOI: 10.1007/s10067-017-3540-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 01/17/2023]
Abstract
Recently, it has been hypothesized that the subcategories of the ILAR classification of juvenile idiopathic arthritis (JIA) are not homogeneous, and that the presence of antinuclear antibodies (ANA) should lead to a separate entity. Therefore, the aim of this study was to evaluate ANA positivity as a predictor of achieving remission. A retrospective single-center cohort study including all JIA patients diagnosed between January 2000 and May 2014. A minimum follow-up of 1 year was required plus the ANA status. ANA positivity was defined as at least two positive results with a titer ≥1:160. Demographic and clinical features were collected. Remission at last follow-up was defined by the Wallace criteria. A total of 625 patients met the inclusion criteria and 230 (37%) were found ANA positive. Analysis showed no difference in remission rate between ANA-positive and ANA-negative patients. Additionally, joint count at diagnosis and at last follow-up were comparable in both groups. ANA positivity was correlated to a female predominance and young age at diagnosis (p < 0.001). Remission rates are not different in ANA-positive patients than in ANA-negative patients. This does not support the hypothesis to possibly divide JIA patients based on their ANA status.
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Affiliation(s)
- M Glerup
- Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - T Herlin
- Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - M Twilt
- Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
- Department of Paediatrics, division of Rheumatology, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
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Lepore N, Cashin M, Bartley D, Ardelean DS. Atypical monoarthritis presentation in children with oligoarticular juvenile idiopathic arthritis: a case series. Pediatr Rheumatol Online J 2017; 15:2. [PMID: 28086918 PMCID: PMC5237193 DOI: 10.1186/s12969-016-0129-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Oligoarticular juvenile idiopathic arthritis (oligoJIA), the most common chronic inflammatory arthritis of childhood, usually involves the knees and ankles. Severe oligoJIA monoarthritis presenting in a joint other than knees and ankles, is rare. FINDINGS We report four children who presented with severe isolated arthritis of the hip, wrist or elbow and were diagnosed with oligoJIA. All four were girls with a median age of 11.5 years. Those with hip arthritis also met the classification criteria for juvenile-onset spondylarthopathy. Median duration of symptoms prior to diagnosis was 9.5 months. Three children had already cartilage loss or erosive disease at diagnosis. CONCLUSIONS Children diagnosed with oligoJIA that present with monoarthritis of the hip, wrist and elbow can have aggressive disease. Girls with positive HLA-B27 presenting with isolated hip arthritis could meet the classification criteria for both oligoJIA and juvenile-onset SpA. Early referral to specialized care may improve their diagnosis, treatment and outcome.
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Affiliation(s)
- Natasha Lepore
- Department of Pediatrics, University of Western Ontario, London, ON Canada ,Lawson Health Research Institute, London, ON Canada ,University College Cork, Cork, Ireland ,Western Bone & Joint Institute, London, ON Canada
| | - Megan Cashin
- Lawson Health Research Institute, London, ON Canada ,Department of Surgery, Division of Orthopedic Surgery, London, ON Canada
| | - Debra Bartley
- Lawson Health Research Institute, London, ON Canada ,Department of Surgery, Division of Orthopedic Surgery, London, ON Canada
| | - Daniela Simona Ardelean
- Department of Pediatrics, University of Western Ontario, London, ON, Canada. .,Lawson Health Research Institute, London, ON, Canada. .,Western Bone & Joint Institute, London, ON, Canada. .,Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.
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Kim YD, Job AV, Cho W. Differential Diagnosis of Juvenile Idiopathic Arthritis. JOURNAL OF RHEUMATIC DISEASES 2017. [DOI: 10.4078/jrd.2017.24.3.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Young Dae Kim
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Alan V Job
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, USA
| | - Woojin Cho
- Department of Orthopaedic Surgery, Albert Einstein College of Medicine, New York, USA
- Department of Orthopaedic Surgery, Montefiore Medical Center, New York, USA
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Sudoł-Szopińska I, Grochowska E, Gietka P, Płaza M, Pracoń G, Saied F, Walentowska-Janowicz M. Imaging of juvenile idiopathic arthritis. Part II: Ultrasonography and MRI. J Ultrason 2016; 16:237-51. [PMID: 27679727 PMCID: PMC5034018 DOI: 10.15557/jou.2016.0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 03/12/2016] [Accepted: 03/16/2016] [Indexed: 11/22/2022] Open
Abstract
Juvenile idiopathic arthritis is the most common autoimmune systemic disease of the connective tissue affecting individuals in the developmental age. Radiography, which was described in the first part of this publication, is the standard modality in the assessment of this condition. Ultrasound and magnetic resonance imaging enable early detection of the disease which affects soft tissues, as well as bones. Ultrasound assessment involves: joint cavities, tendon sheaths and bursae for the presence of synovitis, intraand extraarticular fat tissue to visualize signs of inflammation, hyaline cartilage, cartilaginous epiphysis and subchondral bone to detect cysts and erosions, and ligaments, tendons and their entheses for signs of enthesopathies and tendinopathies. Magnetic resonance imaging is indicated in children with juvenile idiopathic arthritis for assessment of inflammation in peripheral joints, tendon sheaths and bursae, bone marrow involvement and identification of inflammatory lesions in whole-body MRI, particularly when the clinical picture is unclear. Also, MRI of the spine and spinal cord is used in order to diagnose synovial joint inflammation, bone marrow edema and spondylodiscitis as well as to assess their activity, location, and complications (spinal canal stenosis, subluxation, e.g. in the atlantoaxial region). This article discusses typical pathological changes seen on ultrasound and magnetic resonance imaging. The role of these two methods for disease monitoring, its identification in the pre-clinical stage and establishing its remission are also highlighted.
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Affiliation(s)
- Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland; Department of Medical Imaging, Second Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Elżbieta Grochowska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Piotr Gietka
- Department of Pediatrics, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Mateusz Płaza
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Grzegorz Pracoń
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Fadhil Saied
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Marta Walentowska-Janowicz
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
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Giancane G, Consolaro A, Lanni S, Davì S, Schiappapietra B, Ravelli A. Juvenile Idiopathic Arthritis: Diagnosis and Treatment. Rheumatol Ther 2016; 3:187-207. [PMID: 27747582 PMCID: PMC5127964 DOI: 10.1007/s40744-016-0040-4] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Indexed: 12/20/2022] Open
Abstract
Juvenile idiopathic arthritis is a broad term that describes a clinically heterogeneous group of arthritides of unknown cause, which begin before 16 years of age. This term encompasses several disease categories, each of which has distinct presentation, clinical manifestations, and, presumably, genetic background and etiopathogenesis. Although none of the available drugs has curative potential, prognosis has greatly improved as a result of substantial progresses in disease management. The most important new development has been the introduction of the biologic medications, which constitute a valuable treatment option for patients who are resistant to conventional antirheumatic agents. Further insights into the disease pathogenesis and treatment will be provided by the continuous advances in understanding of the mechanisms related to the immune response and inflammatory process, and by the development of new drugs that are capable of selectively inhibiting single molecules or pathways.
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Affiliation(s)
- Gabriella Giancane
- Istituto Giannina Gaslini, Genoa, Italy.,Università degli Studi di Genova, Genoa, Italy
| | - Alessandro Consolaro
- Istituto Giannina Gaslini, Genoa, Italy.,Università degli Studi di Genova, Genoa, Italy
| | | | | | | | - Angelo Ravelli
- Istituto Giannina Gaslini, Genoa, Italy. .,Università degli Studi di Genova, Genoa, Italy.
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Esbjörnsson AC, Iversen MD, André M, Hagelberg S, Schwartz MH, Broström EW. Effect of Intraarticular Corticosteroid Foot Injections on Walking Function in Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2016; 67:1693-701. [PMID: 26017638 DOI: 10.1002/acr.22624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 04/23/2015] [Accepted: 05/19/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate gait dynamics and self-reported foot-related disability before and after treatment with intraarticular corticosteroid injections (IACI) in children with juvenile idiopathic arthritis (JIA) and foot involvement, and determined whether children with polyarticular and oligoarticular disease responded similarly to IACI treatment. METHODS Forty-three children (35 girls and 8 boys) with JIA were consecutively recruited (mean ± SD age 11.1 ± 4.2 years, mean disease duration 4.5 ± 3.6 years). Sixty-five percent were diagnosed with polyarthritis. All children received IACI treatment for ankle and/or foot joint synovitis. Fifty-eight percent received additional injections in the knee and/or hip joint. Forty healthy children, matched by age and sex, comprised the control group. Gait dynamics and foot-related disability were assessed before IACI treatment and at 3 weeks and 3 months following the injections. RESULTS Foot-related disability and inflammatory joint symptoms improved following treatment. Gait dynamics were compromised before treatment and did not improve following treatment (mean ± SD nondimensional walking speed 0.49 ± 0.05 in the control group; 0.44 ± 0.07 in the JIA group pretreatment; 0.43 ± 0.10 in the JIA group 3 weeks following treatment; and 0.43 ± 0.07 in the JIA group 3 months following treatment) (P = 0.001 in controls versus pretreatment JIA group, P = 0.45 JIA over time). Mean ± SD ankle power was 3.81 ± 0.67 in the control group; 3.01 ± 1.19 in the JIA group pretreatment; 3.19 ± 1.30 in the JIA group 3 weeks after treatment; and 3.22 ± 1.03 in the JIA group 3 months after treatment (P < 0.001 in controls versus pretreatment JIA group, P = 0.51 JIA over time). The ankle power to hip power ratio was reduced (P = 0.01 in controls versus pretreatment JIA group), indicating a power shift from the ankles to the hips, which was more prominent in children with polyarthritis. CONCLUSION As a result of IACI treatment, improvements were found in self-reported foot-related disability and inflammatory joint symptoms, but gait dynamics were unchanged. Children with polyarticular disease and those with greater self-reported walking difficulties prior to IACI treatment demonstrated worse outcomes, and children in these groups should be monitored carefully after treatment.
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Affiliation(s)
| | - Maura D Iversen
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden, and Brigham and Women's Hospital, Harvard Medical School, and Northeastern University, Boston, Massachusetts
| | - Marie André
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Stefan Hagelberg
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Michael H Schwartz
- Gillette Children's Specialty Healthcare and the University of Minnesota, St. Paul
| | - Eva W Broström
- Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Ilisson J, Zagura M, Zilmer K, Salum E, Heilman K, Piir A, Tillmann V, Kals J, Zilmer M, Pruunsild C. Increased carotid artery intima-media thickness and myeloperoxidase level in children with newly diagnosed juvenile idiopathic arthritis. Arthritis Res Ther 2015; 17:180. [PMID: 26179062 PMCID: PMC4504074 DOI: 10.1186/s13075-015-0699-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 06/26/2015] [Indexed: 12/19/2022] Open
Abstract
Introduction Juvenile idiopathic arthritis (JIA) is a frequent childhood rheumatic disease characterized by chronic inflammation. The latter has been related to impairment of arterial functional-structural properties, atherogenesis and later cardiovascular events. The objective of this study was to examine intima-media thickness (IMT) and the parameters of arterial stiffness in children with JIA at diagnosis and their correlation with JIA subtype and markers of inflammation and atherosclerosis. Methods Thirty-nine newly diagnosed patients with JIA (26 girls; mean age, 13.2 ± 2.6 years) and 27 healthy controls (9 girls; mean age, 13.6 ± 3.4 years) were included in the study. Twelve patients had oligoarthritis, fifteen had extended oligoarthritis and twelve had rheumatoid factor–negative polyarthritis. IMT of the common carotid artery was determined by ultrasonography, carotid-femoral pulse wave velocity (cfPWV) and augmentation index adjusted to a heart rate of 75 beats/min (AIx@75) were determined by applanation tonometry. The serum levels of atherosclerosis-related biomarkers, such as asymmetric dimethylarginine (ADMA), myeloperoxidase (MPO) and adiponectin, were measured by enzyme-linked immunosorbent assay. Results Mean IMT (0.46 ± 0.04 vs. 0.42 ± 0.04 mm; p = 0.0003) and MPO concentration (115.2 [95 % confidence interval {95 % CI}, 97.4–136.3] vs. 57.6 [95 % CI, 47.1–70.3] ng/ml; p < 0.0001) were higher in the patients with JIA than in the control subjects. The cfPWV, AIx@75 and serum ADMA and adiponectin levels did not significantly differ between the groups and JIA subtypes. Serum adiponectin level correlated negatively with AIx@75 in patients with JIA (r = −0.38; p < 0.05). Conclusions Patients with JIA have increased mean IMT and elevated MPO levels at early stages of the disease. AIx@75 was inversely independently associated with adiponectin level in the patients, suggesting that lower adiponectin levels might influence arterial subclinical stiffening in patients with newly diagnosed JIA.
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Affiliation(s)
- Jaanika Ilisson
- Department of Paediatrics, Faculty of Medicine, University of Tartu, Lunini 6, Tartu, 51014, Estonia. .,Children's Clinic, Tartu University Hospital, Tartu, Estonia.
| | - Maksim Zagura
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia. .,Department of Cardiology, Faculty of Medicine, University of Tartu, Tartu, Estonia.
| | - Kersti Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia.
| | - Erik Salum
- Department of Cardiology, Faculty of Medicine, University of Tartu, Tartu, Estonia.
| | - Kaire Heilman
- Department of Paediatrics, Faculty of Medicine, University of Tartu, Lunini 6, Tartu, 51014, Estonia. .,Tallinn Children's Hospital, Tallinn, Estonia.
| | - Anneli Piir
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia.
| | - Vallo Tillmann
- Department of Paediatrics, Faculty of Medicine, University of Tartu, Lunini 6, Tartu, 51014, Estonia. .,Children's Clinic, Tartu University Hospital, Tartu, Estonia.
| | - Jaak Kals
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia. .,Department of Vascular Surgery, Tartu University Hospital, Tartu, Estonia.
| | - Mihkel Zilmer
- Department of Biochemistry, Institute of Biomedicine and Translational Medicine, The Centre of Excellence for Translational Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia.
| | - Chris Pruunsild
- Department of Paediatrics, Faculty of Medicine, University of Tartu, Lunini 6, Tartu, 51014, Estonia. .,Children's Clinic, Tartu University Hospital, Tartu, Estonia.
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Frequency of joint involvement in juvenile idiopathic arthritis during a 5-year follow-up of newly diagnosed patients: implications for MR imaging as outcome measure. Rheumatol Int 2014; 35:351-7. [DOI: 10.1007/s00296-014-3108-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/30/2014] [Indexed: 10/24/2022]
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Coulson EJ, Hanson HJM, Foster HE. What does an adult rheumatologist need to know about juvenile idiopathic arthritis? Rheumatology (Oxford) 2014; 53:2155-66. [PMID: 24987157 DOI: 10.1093/rheumatology/keu257] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
JIA is the most common chronic inflammatory arthritis in children and young people and an estimated one-third of individuals will have persistent active disease into adulthood. There are a number of key differences in the clinical manifestations, assessment and management of JIA compared with adult-onset arthritis. Transition and transfer to adult services present significant challenges for many patients, their families and health care professionals. We describe key clinical issues relevant to adult rheumatology health care teams responsible for ongoing care of these young people.
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Affiliation(s)
- Elizabeth J Coulson
- Rheumatology Department, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust and Musculoskeletal Research Group, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Helen J M Hanson
- Rheumatology Department, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust and Musculoskeletal Research Group, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Helen E Foster
- Rheumatology Department, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust and Musculoskeletal Research Group, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK. Rheumatology Department, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust and Musculoskeletal Research Group, Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
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40
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van Dijkhuizen EHP, Wulffraat NM. Early predictors of prognosis in juvenile idiopathic arthritis: a systematic literature review. Ann Rheum Dis 2014; 74:1996-2005. [DOI: 10.1136/annrheumdis-2014-205265] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 05/25/2014] [Indexed: 11/04/2022]
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Distribution pattern of MRI abnormalities within the knee and wrist of juvenile idiopathic arthritis patients: signature of disease activity. AJR Am J Roentgenol 2014; 202:W439-46. [PMID: 24758678 DOI: 10.2214/ajr.13.11314] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of this study in clinically active juvenile idiopathic arthritis (JIA) was to assess the frequency and distribution pattern of synovitis as hallmark of disease and additional soft-tissue and bony abnormalities on MRI in the knee and wrist as two target joints. MATERIALS AND METHODS MRI datasets of 153 clinically active JIA patients (110 with knee and 43 with wrist involvement) were evaluated independently by two readers for the presence of literature-based imaging features: "synovial hypertrophy," "bone marrow changes," "bone erosions," "tenosynovitis" (only in the wrist), and "cartilage lesions" (only in the knee) in accordance with validated definitions and scoring locations. RESULTS Synovial hypertrophy was most frequently observed--both in the knee and in the wrist (61.8-65.1% of cases). For the knee, the most frequently involved locations were the cruciate ligaments (46/183 locations [25.1%] affected with synovial hypertrophy) and medial patella (18/62 locations [29.0%] with bone marrow changes). Cartilage lesions and bone erosions were rare (5.5-7.3% of cases). For the wrist, most frequently involved were the radiocarpal joint (21/64 locations [32.8%] with synovial hypertrophy), lunate (7/46 locations [15.2%] with bone marrow changes), and capitate or triquetrum (6/28 locations [21.4%] with bone erosions). Tenosynovitis was a common wrist-specific feature (46.5% of cases). MRI showed no abnormalities in a subgroup of patients with clinically active knee (23.6%) and wrist (16.3%) involvement. CONCLUSION The distribution pattern of MRI abnormalities in the knee and wrist of active JIA patients provides a practical tool to detect a signature of JIA disease activity in target joints.
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Giancane G, Pederzoli S, Norambuena X, Ioseliani M, Sato J, Gallo MC, Negro G, Pistorio A, Ruperto N, Martini A, Ravelli A. Frequency of radiographic damage and progression in individual joints in children with juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2014; 66:27-33. [PMID: 23983211 DOI: 10.1002/acr.22123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Accepted: 08/09/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To evaluate the presence and progression of radiographic joint damage, as assessed with the adapted Sharp/van der Heijde score (SHS), in individual joints in the hand and wrist in patients with juvenile idiopathic arthritis (JIA) and to compare progression of damage among different JIA categories. METHODS A total of 372 radiographs of both wrists and hands obtained at first observation and at last followup visit (after 1-10 years) in 186 children with polyarticular-course JIA were evaluated. All radiographs were scored using the adapted SHS by 2 independent readers. Radiographic assessment included evaluation of joint space narrowing (JSN) and erosions on baseline and last followup radiographs and of progression of radiographic changes from baseline to last followup radiographs. RESULTS Both JSN and erosions occurred in all adapted SHS areas. Overall, radiographic damage and progression were more common in the wrist and less common in metacarpophalangeal (MCP) joints. The hamate and capitate areas appeared particularly vulnerable to cartilage loss. Erosions were identified most frequently in the hamate and capitate bones as well as in the second and third metacarpal bases. Patients with extended oligoarthritis were distinctly less susceptible to JSN in hand joints, whereas patients with polyarthritis showed a greater tendency to developing erosions in hand joints. CONCLUSION Radiographic joint damage and progression in our patients with JIA were seen most commonly in the wrist and less commonly in MCP joints. The frequency and localization of structural abnormalities differed markedly across disease categories.
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SOLARI NICOLETTA, PALMISANI ELENA, CONSOLARO ALESSANDRO, PISTORIO ANGELA, VIOLA STEFANIA, BUONCOMPAGNI ANTONELLA, GATTORNO MARCO, PICCO PAOLO, RUPERTO NICOLINO, MALATTIA CLARA, MARTINI ALBERTO, RAVELLI ANGELO. Factors Associated with Achievement of Inactive Disease in Children with Juvenile Idiopathic Arthritis Treated with Etanercept. J Rheumatol 2012. [DOI: 10.3899/jrheum.120842] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the rate of inactive disease in children with juvenile idiopathic arthritis (JIA) treated with etanercept, and to identify clinical characteristics associated with attainment of inactive disease.Methods.Clinical charts of patients who were given etanercept between January 2002 and January 2011 were evaluated retrospectively. For each patient, all visits from initiation of etanercept to the last followup evaluation in which the patient was still receiving etanercept were examined to establish whether the patient had reached the state of inactive disease and to identify the first visit in which inactive disease was documented. Clinical characteristics associated with achievement of inactive disease were determined through univariate analyses and Cox regression procedures.Results.A total of 173 patients who received etanercept for a median of 2.2 years (range 0.5–10.5 yrs) were studied. Eighty-seven patients (50.3%) achieved inactive disease after a median of 0.6 years (range 0.1–2.5 yrs) of therapy. At last followup evaluation, 85 patients (49.1%) still had inactive disease and 70 (40.5%) were in clinical remission on medication. The probability of achievement of inactive disease after 6, 12, and 24 months of therapy was 24%, 46% and 57%, respectively. On Cox regression analysis, the attainment of inactive disease was associated with lack of wrist involvement and an age at disease onset < 3.6 years.Conclusion.Around half of our patients with JIA treated with etanercept achieved a state of inactive disease. Children who lacked wrist involvement and were younger at disease onset had a greater likelihood of achieving inactive disease.
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Abstract
In children, laboratory evaluations can assist in the screening of patients for inflammatory disorders, confirm diagnoses, allow for monitoring of disease activity and response to therapy, and suggest prognoses and risk of morbidities associated with rheumatic diseases. This review provides an overview of the usefulness and interpretation of both the commonly ordered tests ordered by the general pediatrician as well as those frequently used in the pediatric rheumatology clinic for diagnosis and disease monitoring. Studies discussed include the complete blood count, acute phase reactants, autoantibodies, serum complement, urinalysis, streptococcal antibody tests, and commonly used genetic studies.
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Affiliation(s)
- Jay Mehta
- Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore, Bronx, NY 10467, USA.
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Breton S, Jousse-Joulin S, Finel E, Marhadour T, Colin D, de Parscau L, Devauchelle-Pensec V. Imaging Approaches for Evaluating Peripheral Joint Abnormalities in Juvenile Idiopathic Arthritis. Semin Arthritis Rheum 2012; 41:698-711. [DOI: 10.1016/j.semarthrit.2011.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 08/16/2011] [Accepted: 08/23/2011] [Indexed: 12/14/2022]
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Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldingsnes W, Mikkelsen K, Kaufmann C, Kvien TK. Parity in patients with chronic inflammatory arthritides childless at time of diagnosis. Scand J Rheumatol 2012; 41:202-7. [DOI: 10.3109/03009742.2011.641582] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM, Ilowite NT, Kimura Y, Laxer RM, Lovell DJ, Martini A, Rabinovich CE, Ruperto N. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken) 2011; 63:465-82. [PMID: 21452260 PMCID: PMC3222233 DOI: 10.1002/acr.20460] [Citation(s) in RCA: 525] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to these guidelines and recommendations to be voluntary, with the ultimate determination regarding their application to be made by the physician in light of each patient’s individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed or endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice.
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Affiliation(s)
- Timothy Beukelman
- University of Alabama at Birmingham, Birmingham, AL 35233-1711, USA.
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Abstract
Juvenile idiopathic arthritis, formerly known as juvenile rheumatoid arthritis, is a heterogeneous group of diseases characterized by onset of chronic arthritis in childhood. Diagnosis requires onset of disease by age 16 years, persistent arthritis in any joint for ≥ 6 weeks, and exclusion of other conditions that cause arthritis (eg, infection, malignancy, acute rheumatic fever, inflammatory bowel disease). Most patients with juvenile idiopathic arthritis present with subacute arthritis with minimal pain and few constitutional symptoms. Laboratory evaluation and imaging are useful to exclude other diagnoses and establish the presence of systemic inflammation. However, these modalities are of limited value in screening for rheumatic diseases, and they may be misleading because of the high rate of false-positive results. Most rheumatologic conditions are diagnosed based on pattern recognition, which is established with a thorough history and physical examination.
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Wallenius M, Skomsvoll JF, Irgens LM, Salvesen KÅ, Nordvåg BY, Koldingsnes W, Mikkelsen K, Kaufmann C, Kvien TK. Fertility in women with chronic inflammatory arthritides. Rheumatology (Oxford) 2011; 50:1162-7. [PMID: 21292737 DOI: 10.1093/rheumatology/keq458] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare fertility rates in women with RA, other chronic arthritides (OCAs) and JIA with reference women from the general population. METHODS Each woman from a Norwegian patient registry was matched by year of birth with 100 reference women randomly selected from the National Population Registry. Data linkage of patients and references with the Medical Birth Registry of Norway (MBRN) identified all offspring in patients and references until October 2007, and indirectly also nulliparous (childless) women. Groups were compared with Mann-Whitney U-test for continuous variables and chi-squared tests for categorical variables. Poisson regression analysis was applied to calculate relative fertility rates in the diagnostic groups vs references. RESULTS Among 631 patients 849 children were registered in MBRN. Of these, 289 children (34.0%) were born after time of diagnosis vs 44.3% in references. Altogether, 206 of 631 patients (32.6%) were nulliparous vs 26.4% in references (P < 0.001). Among RA patients, 28.4% (96 of 338) were nulliparous vs 24.5% in references (P = 0.09), 30.7% (67 of 218) in OCA patients vs 24.5% in references (P = 0.03) and 57.3% (43 of 75) in JIA patients vs 40.9% in references (P = 0.004). Adjusted relative fertility rates in RA, OCA and JIA after diagnosis were 0.88, 0.84 and 0.84, respectively, compared with references. CONCLUSION A higher proportion of women with chronic inflammatory arthritides were nulliparous compared with references, and relative fertility rates were reduced in all patient groups.
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Affiliation(s)
- Marianne Wallenius
- Department of Rheumatology, St Olav's Hospital, Trondheim University Hospital, Bevegelsessenteret, N-7006 Trondheim, Norway.
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