1
|
Padem N, Wright H, Fuleihan R, Garabedian E, Suez D, Cunningham-Rundles C, Marsh RA, Khojah A. Rheumatologic diseases in patients with inborn errors of immunity in the USIDNET registry. Clin Rheumatol 2022; 41:2197-2203. [PMID: 35099673 DOI: 10.1007/s10067-021-06044-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/10/2021] [Accepted: 12/28/2021] [Indexed: 02/08/2023]
Abstract
There is a gap in clinical knowledge regarding associations between specific inborn errors of immunity (IEIs) and rheumatologic diseases. This study reports the frequency of rheumatologic conditions in a large cohort of patients with IEI using the USIDNET (United States Immunodeficiency Network) registry. We used the USIDNET registry to conduct the analysis. We included all IEI patients within the registry for whom a diagnosed rheumatologic disease was reported. The total number of patients with IEI in our query was 5058. Among those, 278 (5.49%) patients had a diagnosis of rheumatologic disease. This cohort included 172 (61.8%) female and 106 (38.2%) male patients. Rheumatologic complications were highest in the interferonopathies (66.6%), autoimmune lymphoproliferative syndrome (ALPS) (13.7%), and immunoglobulin G subclass deficiency (IgGSD) (11.11%). Additionally, disease patterns were noted to be different in various IEI disease groups. Inflammatory myopathies were the most common rheumatologic condition in patients with X-linked agammaglobulinemia (1.65%), Sjogren's syndrome was the most common rheumatologic disease reported in ALPS patients (6.85%), and systemic lupus erythematosus was the most common rheumatologic disease in patients with chronic mucocutaneous candidiasis (CMC) (7.41%). Rheumatoid arthritis (RA) report rate was highest in patients with IgGSD (3.70%), specific antibody deficiency (SAD) (3.66%), and ALPS (2.74%). This study reports that rheumatologic diseases are frequently observed in patients with IEI. The frequency of different rheumatologic conditions was variable based on the underlying diagnosis. Clinicians caring for patients with IEI should be vigilant to monitor for rheumatologic complications. Key Points • The rates of reported rheumatologic diseases in the USIDNET registry are different in individual IEIs. • Further studies are needed to guide clinicians for detecting rheumatologic conditions earlier in patients with IEI.
Collapse
Affiliation(s)
- N Padem
- Division of Pediatric Pulmonology, Allergy and Sleep Medicine, Riley Hospital for Children, 705 Riley Hospital Dr, ROC 4270, Indianapolis, IN, 46202, USA.
| | - H Wright
- United States Immunodeficiency Network, Towson, MD, USA
| | - R Fuleihan
- Division of Allergy, Immunology and Rheumatology, Columbia University Irving Medical Center, New York, NY, USA
| | - E Garabedian
- Division of Intramural Research, National Human Genome Research Institute, NIH, Bethesda, MD, USA
| | - D Suez
- Allergy, Asthma & Immunology Clinic, PA, Irving, TX, USA
| | - C Cunningham-Rundles
- Division of Clinical Immunology, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - R A Marsh
- Department of Pediatrics, University of Cincinnati, Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - A Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Mecca, Saudi Arabia
| |
Collapse
|
2
|
Cardoso I, Frederiksen P, Specht IO, Händel MN, Thorsteinsdottir F, Heitmann BL, Kristensen LE. Age and Sex Specific Trends in Incidence of Juvenile Idiopathic Arthritis in Danish Birth Cohorts from 1992 to 2002: A Nationwide Register Linkage Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168331. [PMID: 34444082 PMCID: PMC8394352 DOI: 10.3390/ijerph18168331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/16/2021] [Accepted: 08/02/2021] [Indexed: 12/23/2022]
Abstract
This study reports age- and sex-specific incidence rates of juvenile idiopathic arthritis (JIA) in complete Danish birth cohorts from 1992 through 2002. Data were obtained from the Danish registries. All persons born in Denmark, from 1992–2002, were followed from birth and until either the date of first diagnosis recording, death, emigration, 16th birthday or administrative censoring (17 May 2017), whichever came first. The number of incident JIA cases and its incidence rate (per 100,000 person-years) were calculated within sex and age group for each of the birth cohorts. A multiplicative Poisson regression model was used to analyze the variation in the incidence rates by age and year of birth for boys and girls separately. The overall incidence of JIA was 24.1 (23.6–24.5) per 100,000 person-years. The rate per 100,000 person-years was higher among girls (29.9 (29.2–30.7)) than among boys (18.5 (18.0–19.1)). There were no evident peaks for any age group at diagnosis for boys but for girls two small peaks appeared at ages 0–5 years and 12–15 years. This study showed that the incidence rates of JIA in Denmark were higher for girls than for boys and remained stable over the observed period for both sexes.
Collapse
Affiliation(s)
- Isabel Cardoso
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (I.C.); (P.F.); (I.O.S.); (M.N.H.); (F.T.); (L.E.K.)
| | - Peder Frederiksen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (I.C.); (P.F.); (I.O.S.); (M.N.H.); (F.T.); (L.E.K.)
| | - Ina Olmer Specht
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (I.C.); (P.F.); (I.O.S.); (M.N.H.); (F.T.); (L.E.K.)
| | - Mina Nicole Händel
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (I.C.); (P.F.); (I.O.S.); (M.N.H.); (F.T.); (L.E.K.)
| | - Fanney Thorsteinsdottir
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (I.C.); (P.F.); (I.O.S.); (M.N.H.); (F.T.); (L.E.K.)
| | - Berit Lilienthal Heitmann
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (I.C.); (P.F.); (I.O.S.); (M.N.H.); (F.T.); (L.E.K.)
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, NSW 2006, Australia
- The Department of Public Health, Section for General Medicine, University of Copenhagen, 1014 Copenhagen, Denmark
- Correspondence: ; Tel.: +45-3816-3070
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, 2000 Frederiksberg, Denmark; (I.C.); (P.F.); (I.O.S.); (M.N.H.); (F.T.); (L.E.K.)
| |
Collapse
|
3
|
Klinkhardt C, Tanaka P, Adriano A. Anesthesia for Patients with Juvenile Idiopathic Arthritis Current Practice: A Review. Open Orthop J 2020. [DOI: 10.2174/1874325002014010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Juvenile Idiopathic Arthritis is one of the most common chronic diseases in children. The disease affects one or multiple joints. Additionally, systemic involvement can be present either due to the condition itself or due to pharmacologic side effects resulting from treatment. This article reviews different aspects of perioperative management of patients with Juvenile Idiopathic Arthritis. It outlines the risks and difficulties secondary to articular damage, and also pharmacologic treatment strategies interfering with the anesthetic plan.
Collapse
|
4
|
von Schuckmann L, Klotsche J, Suling A, Kahl-Nieke B, Foeldvari I. Temporomandibular joint involvement in patients with juvenile idiopathic arthritis: a retrospective chart review. Scand J Rheumatol 2020; 49:271-280. [PMID: 32757729 DOI: 10.1080/03009742.2020.1720282] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To study the proportion of patients with temporomandibular joint (TMJ) involvement among patients with juvenile idiopathic arthritis (JIA), as well as associated clinical characteristics and signs/symptoms. METHOD We performed a retrospective chart review on consecutive patients followed in the Hamburg Centre for Paediatric and Adolescent Rheumatology Eilbek between January 2010 and July 2012. TMJ involvement was diagnosed based on clinical examination; a subgroup of patients was also assessed by magnetic resonance imaging (MRI). RESULTS The study included 2413 patients with JIA (52.1% girls, mean age at JIA onset 9.5 years). The most frequent JIA category was oligoarthritis (46.6%), followed by enthesitis-related arthritis (ERA; 38.1%). TMJ involvement was diagnosed in 843/2413 patients (34.9%) (677 MRI-confirmed, four not MRI-confirmed, no MRI examination in 162). Female gender (p = 0.017), higher number of additional joints with active arthritis (p < 0.001), anti-nuclear antibody (ANA) positivity (p = 0.005), higher age (p = 0.020), and oligoarthritis (persistent and extended; p = 0.043) were significantly associated with TMJ involvement. Human leucocyte antigen-B27-positive patients were less likely to have TMJ involvement (p = 0.023). Pain on palpation and pain while chewing were statistically significantly associated with TMJ involvement (p = 0.008 and p = 0.020, respectively). CONCLUSIONS Based on our findings, to identify TMJ involvement special attention should be paid to JIA patients with female gender, ANA positivity, and oligoarthritis, as well as those with a higher number of additional joints with active arthritis; and regular examinations of the TMJ should be performed.
Collapse
Affiliation(s)
- L von Schuckmann
- Centre for Paediatric and Adolescent Rheumatology, Schöen Klinik Eilbek , Hamburg, Germany
| | - J Klotsche
- German Rheumatism Research Centre Berlin, A Leibniz Institute , Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine , Berlin, Germany
| | - A Suling
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - B Kahl-Nieke
- Department of Orthodontics, University Medical Centre Hamburg-Eppendorf , Hamburg, Germany
| | - I Foeldvari
- Centre for Paediatric and Adolescent Rheumatology, Schöen Klinik Eilbek , Hamburg, Germany
| |
Collapse
|
5
|
Furutani E, Shah AS, Zhao Y, Andorsky D, Dedeoglu F, Geddis A, Zhou Y, Libermann TA, Myers KC, Shimamura A. Inflammatory manifestations in patients with Shwachman-Diamond syndrome: A novel phenotype. Am J Med Genet A 2020; 182:1754-1760. [PMID: 32293785 DOI: 10.1002/ajmg.a.61593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/20/2020] [Accepted: 03/24/2020] [Indexed: 12/27/2022]
Abstract
Shwachman-Diamond syndrome (SDS) is an autosomal recessive multisystem disorder characterized by exocrine pancreatic dysfunction, bone marrow failure, and leukemia predisposition. Approximately 90% of cases are due to biallelic mutations in the Shwachman-Bodian-Diamond (SBDS) gene. Additional phenotypic features variably associated with SDS include skeletal, neurologic, hepatic, cardiac, endocrine, and dental abnormalities. We report five subjects with SDS who developed a range of inflammatory manifestations. Three patients developed inflammatory eye conditions. Single cases of juvenile idiopathic arthritis, chronic recurrent multifocal osteomyelitis, and scleroderma were also noted. Clinical presentation and treatment responses are described. Proteomic analysis revealed increased inflammatory signatures in SDS subjects as compared to controls. Treatment of inflammatory manifestations in patients with SDS may be complicated by potential myelosuppressive toxicities of anti-rheumatic medications. Further research is needed to better understand the potential link between inflammatory disorders and SDS to inform effective treatment strategies.
Collapse
Affiliation(s)
- Elissa Furutani
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Yongdong Zhao
- Pediatric Rheumatology, Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | | | - Fatma Dedeoglu
- Department of Medicine, Division of Immunology, Rheumatology Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amy Geddis
- Department of Pediatric Hematology, Seattle Children's Hospital, Cancer and Blood Disorders Clinic, Seattle, Washington, USA
| | - Yu Zhou
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| | - Towia A Libermann
- Beth Israel Deaconess Medical Center (BIDMC) Genomics and Proteomics Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Kasiani C Myers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Akiko Shimamura
- Dana-Farber and Boston Children's Cancer and Blood Disorders Center, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Stoll ML, Mellins ED. Psoriatic arthritis in childhood: A commentary on the controversy. Clin Immunol 2020; 214:108396. [PMID: 32229291 DOI: 10.1016/j.clim.2020.108396] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 12/28/2022]
Abstract
Approximately 5% of children with juvenile idiopathic arthritis (JIA) are diagnosed with the psoriatic form of the disease. In recent years, there has been substantial scholarship demonstrating both heterogeneity within the disease as well as similarities with other forms of JIA, culminating in a recent proposal for the categorization of JIA that excluded the psoriatic form altogether. The purpose of the review is to summarize the clinical, epidemiologic, and genetic features of psoriatic JIA (PsJIA), comparing it with other categories of JIA including spondyloarthritis. We conclude that there are sufficient unique clinical and genetic features within PsJIA as well as similarities with its adult counterpart that warrant including it within the JIA paradigm.
Collapse
Affiliation(s)
- Matthew L Stoll
- Department of Pediatrics, University of Alabama at Birmingham, 1600 7(th) Avenue South, Children's Park Place North Suite G10, Birmingham, AL 35233, USA.
| | - Elizabeth D Mellins
- Department of Pediatrics, Program in Immunology, Stanford University, 269 Campus Drive, CCSR Rm 2105c, Stanford, CA 94305-5164, USA.
| |
Collapse
|
7
|
Kısaarslan AP, Sözeri B, Gündüz Z, Zararsız G, Poyrazoğlu H, Düşünsel R. Evaluation of factors affecting the duration of disease-modifying anti-rheumatic drugs application in patients with enthesitis-related arthritis. Eur J Rheumatol 2019; 6:130-135. [PMID: 31070580 DOI: 10.5152/eurjrheum.2019.18180] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/05/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Treatments for enthesitis-related arthritis (ERA) consist of a mono- or combination therapy with non-steroidal anti-inflammatory drugs, disease-modifying anti-rheumatic drugs (DMARDs), and biological agents, and they are primarily based on adult studies and studies on other forms of juvenile idiopathic arthritis, depending on whether there is axial or peripheral involvement. We use DMARDs frequently in our daily practice, even in patients with axial involvement. The main reason for this is that the health insurance system in Turkey does not allow the use of Tumor Negrosis Factor (TNF) blockers as the first line of treatment. The aim of this study is to evaluate the factors affecting the duration of DMARDs application in patients with ERA. METHODS Fifty-two patients with ERA were accepted in this retrospective cohort study. These patients did not have an inflammatory bowel disease, reactive arthritis or undifferentiated arthritis, psoriasis, and familial Mediterranean fever. Demographic characteristics, medical history, the initial and follow-up physical examination, initial Juvenile Spondyloarthritis Disease Activity Index (JSpADA), initial laboratory tests, radiographic tests, Juvenile Arthritis Damage Index-articulary (JADI-A) and extra-articulary (JADI-E) on the last admission, and data on medical treatments were recorded from the registered data. The univariate Cox proportional hazards regression analyses was used to determine factors affecting the non-response time of ERA patients to DMARDs before the biological treatment was started. RESULTS Twenty-seven patients (52%) achieved remission with DMARDs, while 25 (48%) patients did not. The age at diagnosis (HR=1.12; p=0.247); gender (HR=2.53; p=0.210); family history of ankylosing spondylitis (HR=1.17; p=0.730); inflammatory back pain (HR=0.57; p=0.175); the shoulder (HR=0.75 p=0.706), hip (HR=0.45; p=0.129), and small-joint involvement (HR=1.53; p=0.439); sacroiliitis with physical examination (HR=0.90; p=0.814) and magnetic resonance imaging (MRI) (HR=2.84; p=0.110); enthesitis (HR=0.83; p=0.670); presence of uveitis (HR=2.04; p=0.342); presence of HLA-B27 (HR=1.39; p=0.524); initial high acute phase reactants levels(HR=1.89; p=0.183); initial JSpADA score (HR=0.98; p=0.944); and last JADI-A (HR=1.41; p=0.060) score did not affect the duration of DMARDs treatment before switching to biological treatments. CONCLUSION In our study, the absence of factors affecting the duration of DMARDs application in patients with ERA showed that DMARDs may still be applied as the first line of treatment.
Collapse
Affiliation(s)
- Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Zübeyde Gündüz
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Gökmen Zararsız
- Department of Biostatistics, Erciyes University School of Medicine, Kayseri, Turkey
| | - Hakan Poyrazoğlu
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| | - Ruhan Düşünsel
- Department of Pediatric Rheumatology, Erciyes University School of Medicine, Kayseri, Turkey
| |
Collapse
|
8
|
Bang MH, Kim KN. Long Term Safety and Efficacy of Etanercept in Juvenile Idiopathic Arthritis in a Single Center. JOURNAL OF RHEUMATIC DISEASES 2019. [DOI: 10.4078/jrd.2019.26.3.200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Myung Hoon Bang
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Nam Kim
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Anyang, Korea
| |
Collapse
|
9
|
Throm AA, Moncrieffe H, Orandi AB, Pingel JT, Geurs TL, Miller HL, Daugherty AL, Malkova ON, Lovell DJ, Thompson SD, Grom AA, Cooper MA, Oh ST, French AR. Identification of enhanced IFN-γ signaling in polyarticular juvenile idiopathic arthritis with mass cytometry. JCI Insight 2018; 3:121544. [PMID: 30089725 PMCID: PMC6129135 DOI: 10.1172/jci.insight.121544] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/28/2018] [Indexed: 12/26/2022] Open
Abstract
Polyarticular juvenile idiopathic arthritis (JIA) is among the most challenging of the JIA subtypes to treat. Even with current biologic therapies, the disease remains difficult to control in a substantial subset of patients, highlighting the need for new therapies. The aim of this study was to use the high dimensionality afforded by mass cytometry with phospho-specific antibodies to delineate signaling abnormalities in immune cells from treatment-naive polyarticular JIA patients. Peripheral blood mononuclear cells were isolated from 17 treatment-naive polyarticular JIA patients, 10 of the patients after achieving clinical remission, and 19 healthy controls. Samples were stimulated for 15 minutes with IL-6 or IFN-γ and analyzed by mass cytometry. Following IFN-γ stimulation, increased STAT1 and/or STAT3 phosphorylation was observed in subsets of CD4 T cells and classical monocytes from treatment-naive patients. The enhanced IFN-γ signaling was associated with increased expression of JAK1 and SOCS1 in CD4 T cells. Furthermore, substantial heterogeneity in surface marker expression was observed among the subsets of CD4 T cells and classical monocytes with increased IFN-γ responsiveness. The identification of enhanced IFN-γ signaling in CD4 T cells and classical monocytes from treatment-naive polyarticular JIA patients provides mechanistic support for investigations into therapies that attenuate IFN-γ signaling in this disease.
Collapse
Affiliation(s)
- Allison A. Throm
- Division of Pediatric Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Halima Moncrieffe
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
- Department of Pediatrics, University of Cincinnati, College of Medicine, Cincinnati, Ohio
| | - Amir B. Orandi
- Division of Pediatric Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jeanette T. Pingel
- Division of Pediatric Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Theresa L. Geurs
- Division of Pediatric Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Allyssa L. Daugherty
- Division of Pediatric Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Olga N. Malkova
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Daniel J. Lovell
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Susan D. Thompson
- Center for Autoimmune Genomics and Etiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexei A. Grom
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | - Megan A. Cooper
- Division of Pediatric Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen T. Oh
- The Andrew M. and Jane M. Bursky Center for Human Immunology and Immunotherapy Programs, Washington University School of Medicine, St. Louis, Missouri, USA
- Division of Hematology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anthony R. French
- Division of Pediatric Rheumatology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Pathology and Immunology and
| |
Collapse
|
10
|
Zhao Q, Jung LK. Frequency of CD19 +CD24 hiCD38 hi regulatory B cells is decreased in peripheral blood and synovial fluid of patients with juvenile idiopathic arthritis: a preliminary study. Pediatr Rheumatol Online J 2018; 16:44. [PMID: 29973221 PMCID: PMC6033228 DOI: 10.1186/s12969-018-0262-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/20/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND To understand the relationship between regulatory B cells (Bregs) and juvenile idiopathic arthritis (JIA), we analyzed the percentages of Bregs and their function in peripheral blood (PB) and synovial fluid (SF) of JIA patients. METHODS Twenty-one JIA patients and 11 children with growing pain but without known rheumatic diseases as controls were included. The B cell phenotype and intracellular production of IL-10 of Bregs were assessed by flow cytometry. Mononuclear cells from PB and SF were stimulated to produce IL-10 in vitro for the identification of IL-10- producing regulatory B cells. RESULTS The percentage of CD24hiCD38hi Bregs in the PB of JIA patients was significantly decreased compared to that in controls, and it was even lower in the SF of JIA patients compared to that in the PB. CD24hiCD38hi Bregs frequency was significantly lower in the PB of RF-positive patients than in RF-negative patients. Frequency of IL-10-producing regulatory B cells (B10 cells) was significantly lower in active JIA patients than that in inactive patients. CONCLUSIONS The inability of the host to produce enough regulatory B cells in PB and especially in SF of JIA patients may contribute to the disease, especially the local inflammation.
Collapse
Affiliation(s)
- Qianzi Zhao
- grid.239560.bDivision of Rheumatology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| | - Lawrence K. Jung
- grid.239560.bDivision of Rheumatology, Children’s National Medical Center, 111 Michigan Ave, NW, Washington, DC 20010 USA
| |
Collapse
|
11
|
Malattia C, Tzaribachev N, van den Berg JM, Magni-Manzoni S. Juvenile idiopathic arthritis - the role of imaging from a rheumatologist's perspective. Pediatr Radiol 2018; 48:785-791. [PMID: 29766250 DOI: 10.1007/s00247-017-4014-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/11/2017] [Indexed: 10/17/2022]
Abstract
Alongside recent advances in treatment strategies for juvenile idiopathic arthritis (JIA), paediatric rheumatologists have taken increasing interest in the use of imaging. Magnetic resonance imaging (MRI) and musculoskeletal ultrasound, by providing more detailed information on disease activity than clinical examination and conventional radiography (CR), have become helpful diagnostic and managerial tools. The growing skeleton, however, with changing appearances over time, is still challenging in the establishment of valid scoring systems for pathological changes. Defining child- and age-specific reference standards is therefore a highly prioritized issue. The aim of this article is to raise awareness among radiologists of the substantial role that imaging can play to optimize the management of JIA patients and to describe the state-of-the-art validation process of imaging as an outcome measure. A closer collaboration between radiologists and pediatric rheumatologists is crucial to define a scheduled workflow for imaging in JIA.
Collapse
Affiliation(s)
- Clara Malattia
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Largo Gaslini, 5, 16147, Genoa, Italy.
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University of Genova, Genoa, Italy.
| | | | - J Merlijn van den Berg
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital AMC University of Amsterdam, Amsterdam, The Netherlands
| | | |
Collapse
|
12
|
Ruperto N, Brunner HI, Zuber Z, Tzaribachev N, Kingsbury DJ, Foeldvari I, Horneff G, Smolewska E, Vehe RK, Hazra A, Wang R, Mebus CA, Alvey C, Lamba M, Krishnaswami S, Stock TC, Wang M, Suehiro R, Martini A, Lovell DJ. Pharmacokinetic and safety profile of tofacitinib in children with polyarticular course juvenile idiopathic arthritis: results of a phase 1, open-label, multicenter study. Pediatr Rheumatol Online J 2017; 15:86. [PMID: 29282090 PMCID: PMC5745974 DOI: 10.1186/s12969-017-0212-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/12/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease and a leading cause of childhood disability. The objective of this study was to characterize the PK, safety, and taste acceptability of tofacitinib in patients with JIA. METHODS This Phase 1, open-label, multiple-dose (twice daily [BID] for 5 days) study of tofacitinib in patients with active (≥ 5 joints) polyarticular course JIA was conducted from March 2013-December 2015. Patients were allocated to one of three age-based cohorts: Cohort 1, 12 to < 18 years; Cohort 2, 6 to < 12 years; and Cohort 3, 2 to < 6 years. Tofacitinib was administered according to age and body weight as tablets or oral solution (grape flavor). PK were assessed on Day 5; safety was assessed at screening, Day 1, and Day 5. Taste acceptability of the oral solution was evaluated. RESULTS Twenty-six patients (age range 2-17 years) were enrolled: Cohort 1, N = 8; Cohort 2, N = 9; Cohort 3, N = 9; median tofacitinib doses were 5.0, 2.5, and 3.0 mg BID, respectively. The higher median tofacitinib dose in Cohort 3 versus Cohort 2 reflected implementation of an amended dosing scheme following an interim PK analysis after Cohort 2 recruitment. Geometric mean AUC at steady state (AUCtau) was 156.6 ng•h/mL in Cohort 1, 118.8 ng•h/mL in Cohort 2, and 142.5 ng•h/mL in Cohort 3; Cmax (ng/mL) was 47.0, 41.7, and 66.2, respectively. Ctrough, Cmin, and t1/2 were similar in Cohorts 2 and 3, but higher in Cohort 1. Median time to Cmax (Tmax) was similar between cohorts. Apparent clearance and volume of distribution decreased with decreasing age. Tofacitinib was well tolerated, with no serious adverse events or discontinuations due to adverse events reported. Taste acceptability was confirmed. CONCLUSIONS PK findings from this study in children with polyarticular course JIA established dosing regimens and acceptable taste for use in subsequent studies within the tofacitinib pediatric development program. TRIAL REGISTRATION ClinicalTrials.gov: NCT01513902 .
Collapse
Affiliation(s)
- Nicolino Ruperto
- Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy.
| | - Hermine I. Brunner
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, PRCSG, Cincinnati, OH USA
| | - Zbigniew Zuber
- St Louis Children’s Hospital ODS Rheumatology and Neurology, Krakow, Poland
| | | | | | - Ivan Foeldvari
- Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Gerd Horneff
- Centre of General Pediatrics and Neonatology, Asklepios Klinik, Sankt Augustin, Germany
| | - Elzbieta Smolewska
- 0000 0001 2165 3025grid.8267.bDepartment of Pediatric Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Richard K. Vehe
- 0000000419368657grid.17635.36University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Anasuya Hazra
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Collegeville, PA USA
| | - Rong Wang
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Groton, CT USA
| | | | | | - Manisha Lamba
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Groton, CT USA
| | | | - Thomas C. Stock
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Collegeville, PA USA
| | - Min Wang
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Collegeville, PA USA
| | - Ricardo Suehiro
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Collegeville, PA USA
| | - Alberto Martini
- 0000 0004 1760 0109grid.419504.dIstituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | - Daniel J. Lovell
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, PRCSG, Cincinnati, OH USA
| | | | | |
Collapse
|
13
|
Kobus A, Kierklo A, Zalewska A, Kuźmiuk A, Szajda SD, Ławicki S, Bagińska J. Unstimulated salivary flow, pH, proteins and oral health in patients with Juvenile Idiopathic Arthritis. BMC Oral Health 2017; 17:94. [PMID: 28577525 PMCID: PMC5457734 DOI: 10.1186/s12903-017-0386-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/25/2017] [Indexed: 02/07/2023] Open
Abstract
Background There have been inconsistent conclusions regarding salivary abnormalities and their effect on oral health of Juvenile Idiopathic Arthritis (JIA) patients. The purpose of the study was to evaluate the flow rate and selected biochemical parameters of unstimulated whole saliva in correlation to oral health in JIA children. Methods Thirty-four JIA patients and 34 age- and sex-matched controls not affected by JIA (C) were divided into two groups: with mixed and permanent dentition. DMFT/dmft, gingival and simplified oral hygiene indices were evaluated. Salivary flow rate, pH, lysozyme, lactoferrin, salivary protein concentrations and peroxidase activity were assessed. Results The salivary flow rate was significantly lower in the total JIA group (0.41 ml/min) as compared with the C (0.51 ml/min) and in the permanent dentition of JIA children (0.43 ml/min) as compared with the C (0.61 ml/min). A significantly lower pH was observed in total (6.74), mixed (6.7) and permanent (6.76) dentition of JIA groups in comparison to the C (7.25, 7.21, 7.28 respectively). The specific activity of peroxidase was significantly higher in JIA patients (total 112.72 IU/l, mixed dentition 112.98 IU/l, permanent dentition 112.5 IU/l) than in the C group (total 70.03 IU/l, mixed dentition 71.83 IU/l, permanent dentition 68.61 IU/l). The lysozyme concentration in JIA patients (total and permanent dentition groups) was significantly higher than in the C group. There were no significant differences in lactoferrin and salivary protein concentrations. There were no statistically significant differences in oral status between JIA patients and C, respectively: DMFT = 5.71, dmft = 3.73, OHI-S = 0.95, GI = 0.25 and DMFT 5.71, dmft = 3.73, OHI-S = 0.85, GI = 0.24. The specific activity of peroxidase in the unstimulated whole saliva was inversely correlated with the GI index, whereas the salivary lysozyme concentration was inversely correlated with the dmft index in JIA patients. Conclusion In the course of JIA occur a reduction of the resting salivary flow rate and a decrease of saliva pH. In spite of this, no differences in the clinical oral status between the JIA children population and the control group were found. The mobilisation of salivary peroxidase and lysozyme contributes to the maintenance of healthy oral tissues.
Collapse
Affiliation(s)
- Agnieszka Kobus
- Department of Dentistry Propaedeutics, Medical University of Bialystok, ul. Waszyngtona 15A, 15-274, Bialystok, Poland.
| | - Anna Kierklo
- Department of Dentistry Propaedeutics, Medical University of Bialystok, ul. Waszyngtona 15A, 15-274, Bialystok, Poland
| | - Anna Zalewska
- Department of Conservative Dentistry, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24A, 15-274, Bialystok, Poland
| | - Anna Kuźmiuk
- Department of Pediatric Dentistry, Medical University of Bialystok, ul. Waszyngtona 15A, 15-274, Bialystok, Poland
| | - Sławomir Dariusz Szajda
- Department of Psychiatry, Medical University of Bialystok, Plac Brodowicza 1, 16-070, Choroszcz, Poland
| | - Sławomir Ławicki
- Department of Biochemical Diagnostics, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24A, 15-274, Bialystok, Poland
| | - Joanna Bagińska
- Department of Dentistry Propaedeutics, Medical University of Bialystok, ul. Waszyngtona 15A, 15-274, Bialystok, Poland
| |
Collapse
|
14
|
Zisman D, Gladman DD, Stoll ML, Strand V, Lavi I, Hsu JJ, Mellins ED. The Juvenile Psoriatic Arthritis Cohort in the CARRA Registry: Clinical Characteristics, Classification, and Outcomes. J Rheumatol 2017; 44:342-351. [DOI: 10.3899/jrheum.160717] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 02/08/2023]
Abstract
Objective.Children with clinically diagnosed juvenile psoriatic arthritis (JPsA) who were enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry (CARRA-JPsA) were classified according to pediatric International League of Associations for Rheumatology (ILAR) and adult criteria [Classification criteria for Psoriatic Arthritis (CASPAR)]. Data on demographic and clinical features at baseline and 1-year followup were analyzed and compared.Methods.Cross-sectional analysis was performed of CARRA-JPsA patients enrolled between May 2010 and December 2013 and stratified according to age at disease onset (≤ or > 4 yrs). Features of patients fulfilling ILAR and CASPAR criteria were compared at baseline and followup using chi square, Fisher’s exact, Mann-Whitney-McNemar, Wilcoxon signed rank, and t tests, as appropriate.Results.Among 361 children enrolled as CARRA-JPsA, 72.02% had symptom onset at > 4 years of age, with a male predominance and high prevalence of enthesitis. At followup, statistically significant improvements were reported in arthritis, dactylitis, enthesitis, psoriasis, sacroiliitis, and nail pitting, but not in health questionnaire (HQ) scores. Of the patients, 80.5% fulfilled ILAR criteria for JPsA. Fifty-two patients, whose disease fulfilled CASPAR criteria but had not been included in the JPsA cohort, manifested more enthesitis, sacroiliitis, inflammatory bowel disease and uveitis and less psoriasis.Conclusion.The data support division of patients with JPsA into 2 clinical subgroups, according to age at disease onset. Improvement in objective findings did not correlate with changes in HQ scores. Pediatric rheumatologists currently do not diagnose JPsA in all children whose disease manifestations meet CASPAR criteria. Unification of adult and pediatric PsA classification criteria warrants consideration.
Collapse
|
15
|
Lee WJ, Briars L, Lee TA, Calip GS, Suda KJ, Schumock GT. Use of Tumor Necrosis Factor-Alpha Inhibitors in Children and Young Adults With Juvenile Idiopathic Arthritis or Rheumatoid Arthritis. Pharmacotherapy 2016; 36:1201-1209. [DOI: 10.1002/phar.1856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Wan-Ju Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Leslie Briars
- Department of Pharmacy Practice; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Gregory S. Calip
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Katie J. Suda
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center of Innovation for Complex Chronic Healthcare; Hines VA Hospital; Hines Illinois
| | - Glen T. Schumock
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| |
Collapse
|
16
|
Krause ML, Crowson CS, Michet CJ, Mason T, Muskardin TW, Matteson EL. Juvenile Idiopathic Arthritis in Olmsted County, Minnesota, 1960-2013. Arthritis Rheumatol 2016; 68:247-54. [PMID: 26316119 DOI: 10.1002/art.39323] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/06/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the incidence and prevalence of juvenile idiopathic arthritis (JIA) in Olmsted County, Minnesota in 1994-2013 and trends in juvenile rheumatoid arthritis (JRA) in 1960-2013. METHODS Cases of arthritis in 1994-2013 were identified by diagnosis code with medical chart review to confirm diagnosis separately for JIA and JRA. Overall incidence rates with 95% confidence intervals (95% CIs) were age and sex adjusted to the 2010 US white population. Comparisons were made with an earlier (1960-1993) cohort from this same population. RESULTS Seventy-one incident cases of JIA in 1994-2013 were identified, with an overall age- and sex-adjusted incidence rate of 10.3 per 100,000 (95% CI 7.9-12.7). Forty-two (59%) were female, with an incidence of 12.4 per 100,000 (95% CI 8.6-16.2), as compared to 8.3 per 100,000 (95% CI 5.2-11.3) in males. The most common subtype was oligoarthritis (63%). The mean ± SD age at diagnosis was 8.2 ± 5.3 years. The prevalence of JIA on January 1, 2000 and January 1, 2010 was 51.0 per 100,000 (95% CI 25.2-76.8) and 57.6 per 100,000 (95% CI 31.0-94.5), respectively. When the annual incidence of JRA was compared over time from 1960 to 2013, there was no significant change in incidence overall; however, the incidence decreased among females (P = 0.003). A cyclic pattern of incidence was observed, with peaks approximately every 10 years. Similar to the findings with regard to incidence, prevalence did not change overall, but decreased among females (P = 0.048). There were 4 deaths in the cohort of JRA patients diagnosed in 1960-2013; the standardized mortality ratio was 1.50 (95% CI 0.41-3.83). CONCLUSION Incidence of juvenile arthritis overall in Olmsted County, Minnesota has not changed significantly in the past 53 years. A consistent cyclic pattern was noted.
Collapse
Affiliation(s)
| | | | - C John Michet
- Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Thomas Mason
- Mayo Clinic College of Medicine, Rochester, Minnesota
| | | | | |
Collapse
|
17
|
Horneff G. Safety of biologic therapies for the treatment of juvenile idiopathic arthritis. Expert Opin Drug Saf 2016; 14:1111-26. [PMID: 26084637 DOI: 10.1517/14740338.2015.1042453] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The introduction of biological therapies opened a new era of treatment of juvenile idiopathic arthritis. After 15 years of experience with the first biologics for treatment of pediatric rheumatic disease, long-term safety effects are of great interest. AREAS COVERED This review summarizes published knowledge about safety aspects from clinical trials as well as from biologic registries in juvenile idiopathic arthritis patients. Beside infusion and injection reactions, the occurrence and aggravation of infections, the occurrence of a second autoimmune diseases, including uveitis, psoriasis, chronic inflammatory bowel disease, multiple sclerosis, diabetes mellitus, as well as cytopenias and the development of malignancies are major concerns regarding treatment with biologics. EXPERT OPINION The safety profiles of approved biologics, the TNF-α inhibitors etanercept and adalimumab, and the IL-6-inhibitor tocilizumab are highly acceptable. This conclusion is not easily expandable to the IL-1 inhibitor canakinumab as well as the T-cell-activation-inhibitor abatacept due to lack of experience; however, both have showed an excellent safety profile so far. An increase in knowledge about risk profiles in national and international collaborations, with national as well as international registries, is necessary.
Collapse
Affiliation(s)
- Gerd Horneff
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin , Arnold-Janssen-Str. 29, 53757 Sankt Augustin , Germany +0049 2241 249 201 ; +0049 2241 249 203 ;
| |
Collapse
|
18
|
Constantin T, Foeldvari I, Vojinovic J, Horneff G, Burgos-Vargas R, Nikishina I, Akikusa JD, Avcin T, Chaitow J, Koskova E, Lauwerys BR, Calvo Penades I, Flato B, Gamir ML, Huppertz HI, Raad JJJ, Jarosova K, Anton J, Macku M, Otero Escalante WJ, Rutkowska-Sak L, Trauzeddel R, Velez-Sanchez PJ, Wouters C, Wajdula J, Zang C, Bukowski J, Woodworth D, Vlahos B, Martini A, Ruperto N. Two-year Efficacy and Safety of Etanercept in Pediatric Patients with Extended Oligoarthritis, Enthesitis-related Arthritis, or Psoriatic Arthritis. J Rheumatol 2016; 43:816-24. [DOI: 10.3899/jrheum.150430] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2015] [Indexed: 02/05/2023]
Abstract
Objective.The main objective was to determine the 2-year clinical benefit and safety of etanercept (ETN) in children with the juvenile idiopathic arthritis (JIA) categories of extended oligoarthritis (eoJIA), enthesitis-related arthritis (ERA), or psoriatic arthritis (PsA).Methods.CLIPPER was a 96-week, phase IIIb, open-label, multicenter study. Patients with eoJIA, ERA, or PsA received ETN 0.8 mg/kg once weekly (50 mg max) for up to 96 weeks. The proportions of patients reaching the JIA American College of Rheumatology (ACR) 30/50/70/90/100 and inactive disease responses at Week 96 were calculated. Adverse events (AE) were collected throughout the study (intention-to-treat sample).Results.There were 127 patients (eoJIA n = 60, ERA n = 38, PsA n = 29) who received ≥ 1 dose of ETN. The mean disease duration was 31.6 (eoJIA), 23.0 (ERA), and 21.8 (PsA) months. At Week 96, JIA ACR 30/50/70/90/100/inactive disease responses (95% CI) were achieved by 84.3% (76.7, 90.1), 83.5% (75.8, 89.5), 78.7% (70.6, 85.5), 55.1% (46.0, 63.9), 45.7% (36.8, 54.7), and 27.6% (20.0, 36.2) of patients, respectively. The most common AE (no. events, events per 100 patient-yrs) overall were headache (23, 10.7), pyrexia (12, 5.6), and diarrhea (10, 4.6). The most common infections were upper respiratory tract infection (83, 38.6), pharyngitis (50, 23.2), gastroenteritis (22, 10.2), bronchitis (19, 8.8), and rhinitis (17, 7.9). No cases of malignancy, active tuberculosis, demyelinating disorders, or death were reported.Conclusion.Over 96 weeks of therapy, ETN demonstrated sustained efficacy at treating the clinical symptoms of all 3 JIA categories, with no major safety issues.
Collapse
|
19
|
Anderson JH, Anderson KR, Aulie HA, Crowson CS, Mason TG, Ardoin SP, Reed AM, Flatø B. Juvenile idiopathic arthritis and future risk for cardiovascular disease: a multicenter study. Scand J Rheumatol 2016; 45:299-303. [PMID: 26854592 DOI: 10.3109/03009742.2015.1126345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the frequency of cardiovascular disease (CVD) and CVD risk factor development in adult patients previously diagnosed with juvenile idiopathic arthritis (JIA). METHOD A cohort study was conducted utilizing patients at two academic institutions (cohorts 1 and 2). Each institution evaluated the common endpoint of CVD outcomes and CVD risk factor development in adults aged ≥ 30 years and at the 29-year follow-up from disease onset in cohorts 1 and 2, respectively, with comparison to control groups of similar age and sex. RESULTS Cohort 1 included 41 patients with JIA and follow-up ≥ 30 years of age with comparison to 41 controls. Three patients (7%) had CVD, compared to one control (2%; p = 0.31). Cohort 2 included 170 patients with JIA and a median of 29 years of follow-up from disease onset with comparison to 91 controls. Two patients (2%) had CVD, compared to none of the controls (p = 0.29). The presence of CVD risk factors was found to be increased in the JIA group compared to the controls in three categories: family history of CVD (cohort 1), hypertension (cohort 2), and ever smokers (cohorts 2). CONCLUSIONS There is no increase in CVD events in patients with JIA 29 years following disease onset when compared to the general population. As these cohorts age, it will be informative to evaluate whether this baseline risk remains present or a trend towards increasing CVD emerges. Continued longitudinal follow-up of these cohorts and larger population-based studies are needed to establish a definitive relationship between JIA and CVD.
Collapse
Affiliation(s)
- J H Anderson
- a Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology , Mayo Clinic , Rochester , MN , USA
| | - K R Anderson
- b Department of Dermatology/Division of Pediatric Dermatology , Mayo Clinic , Rochester , MN , USA
| | - H A Aulie
- c Department of Rheumatology , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - C S Crowson
- d Department of Biomedical Statistics and Informatics , Mayo Clinic , Rochester , MN , USA.,e Department of Internal Medicine/Division of Rheumatology , Mayo Clinic , Rochester , MN , USA
| | - T G Mason
- e Department of Internal Medicine/Division of Rheumatology , Mayo Clinic , Rochester , MN , USA.,f Department of Pediatric and Adolescent Medicine/Division of Pediatric Rheumatology , Mayo Clinic , Rochester , MN , USA
| | - S P Ardoin
- g Department of Internal Medicine/Division of Rheumatology and Immunology , Ohio State University , Columbus , OH , USA
| | - A M Reed
- f Department of Pediatric and Adolescent Medicine/Division of Pediatric Rheumatology , Mayo Clinic , Rochester , MN , USA
| | - B Flatø
- c Department of Rheumatology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,h Medical Faculty , Institute of Clinical Medicine, University of Oslo , Oslo , Norway
| |
Collapse
|
20
|
Ehrmann Feldman D, Vinet É, Bernatsky S, Duffy C, Hazel B, Meshefedjian G, Sylvestre MP, Bérard A. Birth Outcomes in Women with a History of Juvenile Idiopathic Arthritis. J Rheumatol 2016; 43:804-9. [PMID: 26834215 DOI: 10.3899/jrheum.150592] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether children born to women who had juvenile idiopathic arthritis (JIA) had more adverse birth outcomes than children born to mothers who never had JIA. METHODS Our cohort study used data from physician billing and hospitalizations covering the province of Quebec, Canada. We identified all women with JIA with a first-time birth between January 1, 1983, and December 31, 2010, and assembled a control cohort of first-time mothers without JIA from the same administrative data, matching 4:1 for date of first birth, maternal age, and area of residence. We compared outcomes (stillbirth, prematurity, small for gestational age, and major congenital anomalies) in the JIA versus non-JIA groups using logistic regression. RESULTS Mean age at delivery was 24.7 years in the JIA group (n = 1681) and 25.0 years for the non-JIA group (n = 6724). Women who had JIA were at higher risk for a premature baby [adjusted relative risk (RR) 1.20, 95% CI 1.01-1.42], a baby small for gestational age (adjusted RR 1.19, 95% CI 1.04-1.37), and a child with a congenital malformation (adjusted RR 6.51, 95% CI 5.05-8.39). Neural tube defects were higher in the JIA offspring: 1.61% (95% CI 1.11-2.33) versus 0.03% (95% CI 0.01-0.11) in the non-JIA group, as were congenital heart defects: 1.07% (95% CI 0.68-1.69) versus 0.58% (95% CI 0.42-0.79). CONCLUSION Most women with JIA will deliver a normal baby, even though they are at higher risk for having a child with adverse birth outcomes. Research is needed to understand pathophysiologic mechanisms and to investigate the effects of medications during childhood and youth on future birth outcomes.
Collapse
Affiliation(s)
- Debbie Ehrmann Feldman
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine.
| | - Évelyne Vinet
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Sasha Bernatsky
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Ciarán Duffy
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Beth Hazel
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Garbis Meshefedjian
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Marie-Pierre Sylvestre
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| | - Anick Bérard
- From the École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada.D. Ehrmann Feldman, PhD, École de réadaptation, Université de Montréal, and Direction de Santé Publique de Montréal, and Centre de recherche interdisciplinaire de réadaptation de Montréal, and Institut de recherche en santé publique de l'université de Montréal; É. Vinet, MD, McGill University Health Centre; S. Bernatsky, MD, PhD, McGill University Health Centre, Division of Clinical Epidemiology; C. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, and Faculty of Medicine, University of Ottawa; B. Hazel, MD, McGill University Health Centre; G. Meshefedjian, PhD, Direction de Santé Publique de Montréal; M.P. Sylvestre, PhD, Département de médecine sociale et préventive, Université de Montréal; A. Bérard, PhD, Faculté de pharmacie, Université de Montréal et Centre de recherche CHU Ste-Justine
| |
Collapse
|
21
|
Abu Samra K, Maghsoudlou A, Roohipoor R, Valdes-Navarro M, Lee S, Foster CS. Current Treatment Modalities of JIA-associated Uveitis and its Complications: Literature Review. Ocul Immunol Inflamm 2016; 24:431-9. [PMID: 26765345 DOI: 10.3109/09273948.2015.1115878] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Uveitis is a common and serious complication of juvenile idiopathic arthritis. Up to 75% of all cases of anterior uveitis in childhood are associated with juvenile idiopathic arthritis. Despite the remarkable progress in early detection and treatment of inflammation, vision-threatening complications of uveitis still occur in almost 60% of patients. Structural complications include band keratopathy, maculopathy (macular edema, macular cysts, and epiretinal membrane), glaucomatous optic neuropathy, and cataracts. The management of complications in juvenile idiopathic arthritis is usually complex and requires early surgical intervention. In this paper, we review the general concepts of common ocular complications seen in patients with JIA-associated uveitis, with special attention to the recent diagnostic and preferred treatment approaches at the Massachusetts Eye Research and Surgery Institution. Received 9 March 2015; revised 30 September 2015; accepted 30 October 2015; published online 14 January 2016.
Collapse
Affiliation(s)
- Khawla Abu Samra
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA
| | - Armin Maghsoudlou
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA.,c Department of Ophthalmology , Scheie Eye Institute, University of Pennsylvania School of Medicine , Philadelphia , Pennsylvania , USA.,d Harvard Medical School , Cambridge , Massachusetts , USA
| | - Ramak Roohipoor
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA.,e Department of Ophthalmology , Farabi Eye Hospital , Tehran , Iran.,f Eye Research Centre , Tehran University of Medical Sciences , Tehran , Iran.,g Massachusetts Eye and Ear Infirmary , Cambridge , Massachusetts , USA
| | - Manuel Valdes-Navarro
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA
| | - Stacey Lee
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA
| | - C Stephen Foster
- a Massachusetts Eye Research and Surgery Institution (MERSI) , Waltham , Massachusetts , USA.,b Ocular Immunology and Uveitis Foundation (OIUF) , Waltham , Massachusetts , USA.,d Harvard Medical School , Cambridge , Massachusetts , USA.,g Massachusetts Eye and Ear Infirmary , Cambridge , Massachusetts , USA
| |
Collapse
|
22
|
Ringold S, Hendrickson A, Abramson L, Beukelman T, Blier PR, Bohnsack J, Chalom EC, Gewanter HL, Gottlieb B, Hollister R, Hsu J, Hudgins A, Ilowite NT, Klein-Gitelman M, Lindsley C, Lopez Benitez JM, Lovell DJ, Mason T, Milojevic D, Moorthy LN, Nanda K, Onel K, Prahalad S, Rabinovich CE, Ray L, Rouster-Stevens K, Ruth N, Shishov M, Spalding S, Syed R, Stoll M, Vehe RK, Weiss JE, White AJ, Wallace CA, Sobel RE. Novel Method to Collect Medication Adverse Events in Juvenile Arthritis: Results From the Childhood Arthritis and Rheumatology Research Alliance Enhanced Drug Safety Surveillance Project. Arthritis Care Res (Hoboken) 2015; 67:529-37. [DOI: 10.1002/acr.22487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 09/23/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Sarah Ringold
- Seattle Children's Hospital and Research Institute; Seattle Washington
| | | | | | | | - Peter R. Blier
- Baystate Children's Hospital, Springfield, and Tufts University School of Medicine; Boston Massachusetts
| | | | | | | | - Beth Gottlieb
- Cohen Children's Medical Center of New York; New Hyde Park
| | | | - Joyce Hsu
- Stanford University Medical Center; Stanford California
| | | | | | | | | | | | | | | | - Diana Milojevic
- Floating Hospital for Children, Tufts Medical Center; Boston Massachusetts
| | - Lakshmi N. Moorthy
- Robert Wood Johnson Medical School, Rutgers University; New Brunswick New Jersey
| | - Kabita Nanda
- Comer Children's Hospital, University of Chicago; Chicago Illinois
| | - Karen Onel
- Emory University School of Medicine and Children's Healthcare of Atlanta; Atlanta Georgia
| | - Sampath Prahalad
- Emory University School of Medicine and Children's Healthcare of Atlanta; Atlanta Georgia
| | | | | | - Kelly Rouster-Stevens
- Emory University School of Medicine and Children's Healthcare of Atlanta; Atlanta Georgia
| | - Natasha Ruth
- The Medical University of South Carolina; Charleston
| | | | | | - Reema Syed
- Saint Louis University; St. Louis Missouri
| | | | | | | | | | - Carol A. Wallace
- Seattle Children's Hospital and Research Institute; Seattle Washington
| | | |
Collapse
|
23
|
Autmizguine J, Cohen-Wolkowiez M, Ilowite N. Rilonacept pharmacokinetics in children with systemic juvenile idiopathic arthritis. J Clin Pharmacol 2015; 55:39-44. [PMID: 25079592 PMCID: PMC4276471 DOI: 10.1002/jcph.372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/24/2014] [Indexed: 01/26/2023]
Affiliation(s)
- Julie Autmizguine
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | | |
Collapse
|
24
|
|
25
|
Tarkiainen M, Tynjälä P, Vähäsalo P, Lahdenne P. Occurrence of adverse events in patients with JIA receiving biologic agents: long-term follow-up in a real-life setting. Rheumatology (Oxford) 2014; 54:1170-6. [DOI: 10.1093/rheumatology/keu457] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Indexed: 11/14/2022] Open
|
26
|
Oberle EJ, Harris JG, Verbsky JW. Polyarticular juvenile idiopathic arthritis - epidemiology and management approaches. Clin Epidemiol 2014; 6:379-93. [PMID: 25368531 PMCID: PMC4216020 DOI: 10.2147/clep.s53168] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a group of disorders characterized by arthritis persisting for at least 6 weeks with onset before the age of 16 years. Within this cluster of conditions, the polyarticular form (involving more than four joints within the first 6 months) is further divided based on the presence of rheumatoid factor. Children with polyarticular JIA pose unique diagnostic and therapeutic challenges compared to children with involvement of fewer joints. Polyarticular JIA patients tend to have a more refractory course and therefore are at increased risk for joint damage, resulting in poorer functional outcomes and decreased quality of life. Although the ability to treat this disorder continues to improve, especially with the advent of biologic agents, there is still much about the epidemiology and pathogenesis of polyarticular JIA that is unknown. The epidemiology of polyarticular JIA varies worldwide with a vast difference in reported cases between different global regions as well as within individual countries. Several genetic risk loci have been identified conferring increased susceptibility to JIA, many within the human leukocyte antigen region. Beyond the genome, environmental factors also seem to contribute to the etiology of polyarticular JIA. This review article will focus on the epidemiology and current treatments of polyarticular JIA and briefly discuss genetic and environmental influences on the pathogenesis of JIA as well as new and emerging therapies.
Collapse
Affiliation(s)
- Edward J Oberle
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julia G Harris
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James W Verbsky
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| |
Collapse
|
27
|
Dore RK. Clinical utility of etanercept in the treatment of arthritides in children and adolescents. Adolesc Health Med Ther 2014; 5:35-48. [PMID: 24729739 PMCID: PMC3970916 DOI: 10.2147/ahmt.s38909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a group of chronic inflammatory diseases affecting approximately 300,000 children and adolescents in the United States of unknown cause. It can affect children from the age of 0 years up to the age of 16 years. The International League of Associations of Rheumatology has defined seven subsets of JIA based on several factors including the number of affected joints and the involvement of other tissues; the prognosis for each affected child also depends on multiple factors including age of onset, number of joints involved, and systemic features. As with rheumatoid arthritis in adults, the goal of therapy is remission and resolution of disease activity; however, as a cure does not seem attainable in the near future, a reasonable goal of therapy is prevention of joint damage, inhibition of inflammation, and a high level of quality of life. Even with available therapies, many children with JIA enter adulthood with persistently active disease, suboptimal function, and impaired quality of life. Methotrexate remains the standard of care for children with JIA; etanercept was approved in 2000 in the United States for the treatment of JIA resistant to methotrexate. The efficacy and safety of etanercept therapy in children with JIA is reviewed and its place in the therapeutic regimen is discussed; the available long term data is also presented. The data presented was obtained from a PubMed search as well as a review of the references presented in the 2011 American College of Rheumatology Recommendations for the Treatment of Juvenile Idiopathic Arthritis and the 2013 Update. It is hoped that treatment with etanercept and other biologic therapies will lead to improved outcomes for children with JIA in the future.
Collapse
Affiliation(s)
- Robin K Dore
- David Geffen School of Medicine, Division of Rheumatology, UCLA, Los Angeles, CA, USA
| |
Collapse
|
28
|
Otten MH, Anink J, Prince FHM, Twilt M, Vastert SJ, ten Cate R, Hoppenreijs EPAH, Armbrust W, Gorter SL, van Pelt PA, Kamphuis SSM, Dolman KM, Swart JF, van den Berg JM, Koopman-Keemink Y, van Rossum MAJ, Wulffraat NM, van Suijlekom-Smit LWA. Trends in prescription of biological agents and outcomes of juvenile idiopathic arthritis: results of the Dutch national Arthritis and Biologics in Children Register. Ann Rheum Dis 2014; 74:1379-86. [DOI: 10.1136/annrheumdis-2013-204641] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 03/01/2014] [Indexed: 11/04/2022]
Abstract
BackgroundTreatment of juvenile idiopathic arthritis (JIA) has changed dramatically since the introduction of biological agents in 1999.ObjectiveTo evaluate trends in prescription patterns of biological agents and the subsequent outcome of JIA.MethodsThe Arthritis and Biologics in Children register (multicentre prospective observational study) aimed to include all consecutive patients with JIA in the Netherlands who had started biological agents since 1999. Patients were divided according to year of introduction of first biological agent. Patient characteristics at introduction of the first biological agent and its effectiveness were analysed over 12 years.Results335 patients with non-systemic JIA and 86 patients with systemic JIA started a biological agent between 1999 and 2010. Etanercept remained the most often prescribed biological agent for non-systemic JIA; anakinra became first choice for systemic JIA. The use of systemic glucocorticoids and synthetic disease-modifying antirheumatic drugs before biological agents decreased. During these 12 years of observation, biological agents were prescribed earlier in the disease course and to patients with lower baseline JADAS (Juvenile Arthritis Disease Activity Score) disease activity. All baseline disease activity parameters were lowered in patients with non-systemic JIA. In systemic JIA, prescription patterns changed towards very early introduction of biological agents (median 0.4 years of disease duration) in patients with a low number of joints with active arthritis and high erythrocyte sedimentation rates. These changes for both systemic and non-systemic JIA resulted in more patients with inactive disease after 3 and 15 months of treatment.ConclusionsBiological agents are increasingly prescribed, earlier in the disease and in patients with JIA with lower disease activity. These changes are accompanied by better short-term disease outcomes.
Collapse
|
29
|
Eisenstein EM, Berkun Y. Diagnosis and classification of juvenile idiopathic arthritis. J Autoimmun 2014; 48-49:31-3. [PMID: 24461383 DOI: 10.1016/j.jaut.2014.01.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 11/13/2013] [Indexed: 01/18/2023]
Abstract
In recent years, it has become increasingly clear that the term Juvenile Idiopathic Arthritis (JIA) comprises not one disease but several. Moreover, recent studies strongly suggest that some of these clinico-pathophysiologic entities appear to cross current diagnostic categories. The ultimate goal of the JIA classification is to facilitate development of better, more specific therapy for different forms of disease though improved understanding of pathophysiology. The past two decades have witnessed significant advances in treatment and improved outcomes for many children with chronic arthritis. However, understanding of the basic biologic processes underlying these diseases remains far from complete. As a result, even the best biologic agents of today represent "halfway technologies". Because they do not treat fundamental biologic processes, they are inherently expensive, need to be given for a long time in order to ameliorate the adverse effects of chronic inflammation, and do not cure the disease. Pediatric rheumatology is now entering an era in which diagnostic categories may need to change to keep up with discovery. A more precise, biologically based classification is likely to contribute to development of more specific and improved treatments for the various forms of childhood arthritis. In this review, we discuss how genetic, gene expression, and immunologic findings have begun to influence how these diseases are understood and classified.
Collapse
Affiliation(s)
- Eli M Eisenstein
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, Jerusalem il-91240, Israel.
| | - Yackov Berkun
- Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, POB 24035, Jerusalem il-91240, Israel
| |
Collapse
|
30
|
Zhang X, Morcos PN, Saito T, Terao K. Clinical pharmacology of tocilizumab for the treatment of systemic juvenile idiopathic arthritis. Expert Rev Clin Pharmacol 2014; 6:123-37. [DOI: 10.1586/ecp.13.1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
31
|
Adams TL, Marchiori DM. Arthritides. Clin Imaging 2014. [DOI: 10.1016/b978-0-323-08495-6.00009-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
32
|
Thierry S, Fautrel B, Lemelle I, Guillemin F. Prevalence and incidence of juvenile idiopathic arthritis: a systematic review. Joint Bone Spine 2013; 81:112-7. [PMID: 24210707 DOI: 10.1016/j.jbspin.2013.09.003] [Citation(s) in RCA: 264] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 09/03/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To conduct a systematic literature review on incidence and prevalence of juvenile idiopathic arthritis and to estimate these figures in Europe for 2010. METHODS Articles on incidence or prevalence of juvenile idiopathic arthritis were searched in Medline. Pooled incidence and prevalence were calculated overall, by gender, age, classification and arthritis categories. We used the available age and gender pooled rates to standardize the incidence and prevalence on the 2010 European population and estimate the number of cases in Europe in 2010. RESULTS Forty-three articles (33 on incidence, 29 on prevalence) were included. Incidence rates varied from 1.6 to 23 and prevalence from 3.8 to 400/100,000. Pooled incidence and prevalence were higher for girls (10.0 [9.4-10.7] and 19.4 [18.3-20.6]/100,000) than boys (5.7 [5.3-6.2] and 11.0 [10.2-11.9]/100,000). Oligoarthritis was the most frequent form (pooled incidence rate 3.7 [3.5-3.9] and prevalence 16.8 [15.9-17.7]/100,000). The direct standardized incidence rate was 8.2 [7.5-9.0] and prevalence 70.2 [62.9-78.1]/100,000. In Europe in 2010, the estimated number of incident cases was 6896 [5481-8578] and 59,175 [44,256-76,983] prevalent cases. CONCLUSIONS Incidence and prevalence varied greatly among published reports of juvenile idiopathic arthritis, which may be explained by methodological issues, classification used, and time. Estimating the number of affected children can be useful, especially with the new treatment possibilities.
Collapse
Affiliation(s)
- Sigrid Thierry
- Université de Lorraine, Université Paris-Descartes, EA 4360 Apemac, 54500 Nancy, France
| | - Bruno Fautrel
- AP-HP, Groupe hospitalier Pitié-Salpêtrière, Service de Rhumatologie, 75013 Paris, France; Université Pierre-et-Marie-Curie-Paris VI, GRC 08, 75013 Paris, France
| | - Irène Lemelle
- Nancy University Hospital, Department of Pediatry, 54500 Nancy, France
| | - Francis Guillemin
- Université de Lorraine, Université Paris-Descartes, EA 4360 Apemac, 54500 Nancy, France.
| |
Collapse
|
33
|
Harrold LR, Salman C, Shoor S, Curtis JR, Asgari MM, Gelfand JM, Wu JJ, Herrinton LJ. Incidence and prevalence of juvenile idiopathic arthritis among children in a managed care population, 1996-2009. J Rheumatol 2013; 40:1218-25. [PMID: 23588938 DOI: 10.3899/jrheum.120661] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Few studies based in well-defined North American populations have examined the occurrence of juvenile idiopathic arthritis (JIA), and none has been based in an ethnically diverse population. We used computerized healthcare information from the Kaiser Permanente Northern California membership to validate JIA diagnoses and estimate the incidence and prevalence of the disease in this well-characterized population. METHODS We identified children aged ≤ 15 years with ≥ 1 relevant International Classification of Diseases, 9th edition, diagnosis code of 696.0, 714, or 720 in computerized clinical encounter data during 1996-2009. In a random sample, we then reviewed the medical records to confirm the diagnosis and diagnosis date and to identify the best-performing case-finding algorithms. Finally, we used the case-finding algorithms to estimate the incidence rate and point prevalence of JIA. RESULTS A diagnosis of JIA was confirmed in 69% of individuals with at least 1 relevant code. Forty-five percent were newly diagnosed during the study period. The age- and sex-standardized incidence rate of JIA per 100,000 person-years was 11.9 (95% CI 10.9-12.9). It was 16.4 (95% CI 14.6-18.1) in girls and 7.7 (95% CI 6.5-8.9) in boys. The peak incidence rate occurred in children aged 11-15 years. The prevalence of JIA per 100,000 persons was 44.7 (95% CI 39.1-50.2) on December 31, 2009. CONCLUSION The incidence rate of JIA observed in the Kaiser Permanente population, 1996-2009, was similar to that reported in Rochester, Minnesota, USA, but 2 to 3 times higher than Canadian estimates.
Collapse
Affiliation(s)
- Leslie R Harrold
- Department of Medicine, University of Massachusetts Medical School, Meyers Primary Care Institute and Fallon Clinic, Worcester, Massachusetts 01605, USA.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Yim DS, Zhou H, Buckwalter M, Nestorov I, Peck CC, Lee H. Population Pharmacokinetic Analysis and Simulation of the Time-Concentration Profile of Etanercept in Pediatric Patients With Juvenile Rheumatoid Arthritis. J Clin Pharmacol 2013; 45:246-56. [PMID: 15703360 DOI: 10.1177/0091270004271945] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was performed to estimate the population pharmacokinetic (PK) parameters of etanercept in pediatric juvenile rheumatoid arthritis (JRA) patients and to compare the steady-state time-concentration profiles between etanercept 0.8-mg/kg once-weekly and 0.4-mg/kg twice-weekly subcutaneous (SC) regimens by clinical trial simulation. To this end, mixed-effect analysis (NONMEM, Version 5.1) was performed using the etanercept PK database consisting of 69 JRA patients (4-17 years). Based on the population PK parameters obtained herein, a Monte Carlo clinical trial simulation experiment was conducted to compare the PK profiles in 200 virtual JRA patients who randomly received either etanercept 0.4 mg/kg SC twice weekly or 0.8 mg/kg once weekly for 12 weeks. The following population PK model could adequately describe etanercept PK profiles for twice-weekly SC dosing of 0.4 mg/kg: CL/F (L/h)=0.0576 (female) or 0.0772 (male) x (body surface area in m2/1.071)1.41, V/F(L)=7.88 x (body weight in kg/30.8). The means +/- standard deviations of simulated trough concentrations for 0.8-mg/kg once-weekly and 0.4-mg/kg twice-weekly dosing regimens were 1.58 +/- 1.07 mg/L and 1.92 +/- 1.09 mg/L, respectively. Peaks during 0.8-mg/kg once-weekly dosing (2.92 +/- 1.41 mg/L) were only 11% higher than during 0.4 mg/kg twice-weekly dosing (2.62 +/- 1.23 mg/L). In conclusion, the clinical trial simulation confirmed that 0.8-mg/kg once-weekly and 0.4-mg/kg twice-weekly SC regimens of etanercept are expected to yield overlapping steady-state time-concentration profiles, leading to equivalent clinical outcomes. This has been the basis of the recent Food and Drug Administration approval of the 0.8-mg/kg once-weekly regimen in pediatric patients with JRA.
Collapse
Affiliation(s)
- Dong-Seok Yim
- Center for Drug Development Science, Department of Pharmacology, Box 571441, Georgetown University School of Medicine, Washington, DC 20057-1441, USA
| | | | | | | | | | | |
Collapse
|
35
|
Singh JA, Jensen MR, Harmsen WS, Gabriel SE, Lewallen DG. Cardiac and thromboembolic complications and mortality in patients undergoing total hip and total knee arthroplasty. Ann Rheum Dis 2011; 70:2082-8. [PMID: 22021865 PMCID: PMC3315837 DOI: 10.1136/ard.2010.148726] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To study 90-day complications following total hip arthroplasty (THA) or total knee arthroplasty (TKA). METHOD In a population-based cohort of all Olmsted County residents who underwent a THA or TKA (1994-2008), we assessed 90-day occurrence and predictors of cardiac complications (myocardial infarction, cardiac arrhythmia or congestive heart failure), thromboembolic complications (deep venous thrombosis or pulmonary embolism) and mortality. RESULTS 90-day complication rates after THA and TKA were: cardiac, 6.9% and 6.7%; thromboembolic, 4.0% and 4.9%; and mortality, 0.7% and 0.4%, respectively. In multivariable-adjusted logistic regression analyses, ASA class III-IV (OR 6.1, 95% CI:1.6-22.8) and higher Deyo-Charlson comorbidity score (OR 1.2, 95% CI:1.0-1.4) were significantly associated with odds of 90-day cardiac event post-THA in patients with no known previous cardiac event. In those with known previous cardiac disease, ASA class III-IV (OR 4.4, 95% CI:2.0-9.9), male gender (OR 0.5, 95% CI:0.3-0.9) and history of thromboembolic disease (OR 3.2; 95% CI:1.4-7.0) were significantly associated with odds of cardiac complication 90 days post-THA. No significant predictors of thromboembolism were found in THA patients. In TKA patients with no previous cardiac history, age >65 years (OR 4.1, 95% CI:1.2-14.0) and in TKA patients with known cardiac disease, ASA class III-IV (OR 3.2, 95% CI:1.8-5.7) was significantly associated with odds of 90-day cardiac events. In TKA patients with no previous thromboembolic disease, male gender (OR 0.5, 95% CI:0.2-0.9) and higher Charlson index (OR 1.2, 95% CI:1.1-1.3) and in patients with known thromboembolic disease, higher Charlson index score (OR 1.2, 95% CI:1.1-1.4) was associated with odds of 90-day thromboembolic events. CONCLUSION Older age, higher comorbidity, higher ASA class and previous history of cardiac/thromboembolic disease were associated with an increased risk.
Collapse
Affiliation(s)
- Jasvinder A Singh
- Department of Health Sciences Research, Mayo Clinic School of Medicine, Rochester, Minnesota, USA.
| | | | | | | | | |
Collapse
|
36
|
Minden K. Classification and epidemiology of juvenile idiopathic arthritis. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00097-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
|
37
|
Kremers HM, Myasoedova E, Crowson CS, Savova G, Gabriel SE, Matteson EL. The Rochester Epidemiology Project: exploiting the capabilities for population-based research in rheumatic diseases. Rheumatology (Oxford) 2011; 50:6-15. [PMID: 20627969 PMCID: PMC3716332 DOI: 10.1093/rheumatology/keq199] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 05/27/2010] [Indexed: 12/14/2022] Open
Abstract
The Rochester Epidemiology Project (REP) is a patient record-based database based upon a medical records-linkage system for all residents of the Olmsted County, MN, USA. This comprehensive system includes all health-care providers of patients resident in this geographically defined region. It uniquely enables long-term population-based studies of all medical conditions occurring in this population; their incidence and prevalence; permits examination of disease risk and protective factors, health resource utilization and cost as well as translational studies in rheumatic diseases.
Collapse
Affiliation(s)
- Hilal Maradit Kremers
- Department of Health Sciences Research, Division of Epidemiology, Division of Biomedical Statistics and Informatics and Department of Internal Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Elena Myasoedova
- Department of Health Sciences Research, Division of Epidemiology, Division of Biomedical Statistics and Informatics and Department of Internal Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Cynthia S. Crowson
- Department of Health Sciences Research, Division of Epidemiology, Division of Biomedical Statistics and Informatics and Department of Internal Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Guergana Savova
- Department of Health Sciences Research, Division of Epidemiology, Division of Biomedical Statistics and Informatics and Department of Internal Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Sherine E. Gabriel
- Department of Health Sciences Research, Division of Epidemiology, Division of Biomedical Statistics and Informatics and Department of Internal Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eric L. Matteson
- Department of Health Sciences Research, Division of Epidemiology, Division of Biomedical Statistics and Informatics and Department of Internal Medicine, Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| |
Collapse
|
38
|
Modesto C, Antón J, Rodriguez B, Bou R, Arnal C, Ros J, Tena X, Rodrigo C, Rotés I, Hermosilla E, Barceló P. Incidence and prevalence of juvenile idiopathic arthritis in Catalonia (Spain). Scand J Rheumatol 2010; 39:472-9. [PMID: 20858139 DOI: 10.3109/03009741003742722] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To ascertain the incidence and prevalence of juvenile idiopathic arthritis (JIA) in Catalonia (autonomous region in northeast Spain), examined according to the currently established disease subtypes. METHODS Before initiating the study, we conducted an educational programme on paediatric rheumatology, addressed to all general paediatricians in Catalonia. A 2-year (2004-2006), prospective, population-based study was then carried out to determine the incidence of JIA. Prospective and retrospective data retrieval was performed to calculate prevalence. The International League of Associations for Rheumatology (ILAR, Edmonton revision) classification criteria were applied. RESULTS Over the study period, 145 new cases of JIA were diagnosed. The mean annual incidence was 6.9/10⁵ children aged less than 16 years (range 5.8-8.1 years; 9.0 years for girls and 4.8 years for boys). On separate analysis of patients ≤ 6 and > 6 years, the distribution in younger children was found to be similar for both girls and boys, whereas in older children, most girls belonged to the oligoarthritis and polyarthritis subgroups, and boys to the enthesitis-related arthritis and undifferentiated subgroups. The calculated prevalence of JIA (31 October 2006) was 39.7 (36.1-43.7)/10⁵ children younger than 16. The relative risk of girls having JIA was 2.1 [95% confidence interval (CI) 1.7-2.7, p < 0.001]. In 70% of patients, the diagnosis was established before the age of 7. Subgroup distribution of prevalent cases mirrored that of incident cases. CONCLUSION This is the first population-based study on the epidemiology of JIA in Catalonia. Incidence and prevalence rates are lower than those reported for several areas in Nordic countries of Europe. Oligoarthritis was the most common subtype.
Collapse
Affiliation(s)
- C Modesto
- Department of Rheumatology, University Hospital Vall d'Hebron, Barcelona, Spain.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Visvanathan S, Wagner C, Marini JC, Lovell DJ, Martini A, Petty R, Cuttica R, Woo P, Espada G, Gattorno M, Apaz MT, Baildam E, Fasth A, Gerloni V, Lahdenne P, Quartier P, Saurenmann R, Travers S, Mendelsohn A, Xu S, Giannini EH, Ruperto N. The effect of infliximab plus methotrexate on the modulation of inflammatory disease markers in juvenile idiopathic arthritis: analyses from a randomized, placebo-controlled trial. Pediatr Rheumatol Online J 2010; 8:24. [PMID: 20822542 PMCID: PMC2949752 DOI: 10.1186/1546-0096-8-24] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/07/2010] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND We evaluated the effect of infliximab on markers of inflammation in patients with juvenile idiopathic arthritis (JIA). METHODS In this randomized, placebo-controlled substudy, 122 patients with JIA received infliximab 3 mg/kg + methotrexate (MTX)(n = 60) or placebo + MTX (n = 62) at weeks 0, 2, and 6. At week 14, patients receiving placebo + MTX crossed over to infliximab 6 mg/kg + MTX; patients receiving infliximab 3 mg/kg + MTX continued treatment through week 44. Sera and plasma from eligible patients receiving infliximab 3 mg/kg + MTX (n = 34) and receiving placebo→infliximab 6 mg/kg +MTX (n = 38) were collected at weeks 0, 2, 14, 16, 28, and 52 and analyzed for inflammatory markers (IL-6, IL-12p40, ICAM-1, MMP-3, VEGF, TNF-α, and CRP). RESULTS At week 2, decreases from baseline in IL-6, ICAM-1, MMP-3, TNF-α, and CRP were greater with infliximab versus placebo treatment, and with the exception of CRP, these differences were generally maintained through week 14. The decreases from baseline to week 52 in IL-6, ICAM-1, VEGF, MMP-3, and CRP and increases in IL-12p40 levels were larger in patients receiving placebo→infliximab 6 mg/kg +MTX versus infliximab 3 mg/kg + MTX treatment. Patients receiving infliximab 3 mg/kg+MTX who achieved an American College of Rheumatology Pediatric 30 (ACR-Pedi-30) response had significantly larger decreases from baseline in ICAM-1 (p = 0.0105) and MMP-3 (p = 0.0253) at week 2 and in ICAM-1 (p = 0.0304), MMP-3 (p = 0.0091), and CRP (p = 0.0011) at week 14 versus ACR-Pedi-30 nonresponders. CONCLUSION Infliximab + MTX attenuated several inflammatory markers in patients with JIA; larger decreases in ICAM-1, MMP-3, and CRP levels were observed in ACR-Pedi-30 responders versus nonresponders. TRIAL REGISTRATION NCT00036374.
Collapse
Affiliation(s)
| | - Carrie Wagner
- Centocor Research & Development, Inc., Malvern, PA, USA
| | | | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Ross Petty
- British Columbia's Children's Hospital and the University of British Columbia, British Columbia, Canada
| | - Ruben Cuttica
- Hospital General de Niños Pedro de Elizalde, Buenos Aires, Argentina
| | - Patricia Woo
- Great Ormond St Hospital for Children, London, UK
| | - Graciela Espada
- Hospital de Ninos Ricardo Gutierrez, Buenos Aires, Argentina
| | | | | | | | - Anders Fasth
- University of Gothenberg and The Queen Silvia Children's Hospital, Götenborg, Sweden
| | | | - Pekka Lahdenne
- Hospital for Children and Adolescents, Helsinki, Finland
| | - Pierre Quartier
- Hopital Necker Enfants Malades, Assistance Publique Hopitaux de Paris and Universite Paris-Descartes, Paris, France
| | | | | | | | - Stephen Xu
- Centocor Research & Development, Inc., Malvern, PA, USA
| | - Edward H Giannini
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | |
Collapse
|
40
|
Shapira Y, Agmon-Levin N, Shoenfeld Y. Geoepidemiology of autoimmune rheumatic diseases. Nat Rev Rheumatol 2010; 6:468-76. [PMID: 20567251 DOI: 10.1038/nrrheum.2010.86] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The accumulative global burden of autoimmune and inflammatory rheumatic diseases is substantial. Studying the distribution of these conditions across various global regions and ethnic groups by means of geoepidemiology might readily provide epidemiological data and also advance our understanding of their genetic and environmental underpinnings. In order to depict the geoepidemiology of autoimmune and inflammatory rheumatic diseases, namely rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, ankylosing spondylitis and Sjögren's syndrome, we present a comprehensive collection of epidemiological reports from various world regions, including the prevalence of each of these conditions. The accumulated data show that the reviewed rheumatic diseases are global phenomena, and, with some variance, seem to be relatively evenly distributed. This finding is in contrast with the obviously uneven distribution of some major nonrheumatic autoimmune conditions. In addition, geoepidemiology demonstrates that ethnogenetic susceptibility interacts with lifestyle and environmental factors, which include socioeconomic status, infectious agents (triggering or protective agents), environmental pollutants, and vitamin D (dependent on sunlight exposure), in determining the risk of developing rheumatic autoimmunity.
Collapse
Affiliation(s)
- Yinon Shapira
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer 52621, Israel.
| | | | | |
Collapse
|
41
|
Ayaz NA, Demirkaya E, Bilginer Y, Ozçelik U, Cobanoğlu N, Kiper N, Besbas N, Bakkaloğlu A, Ozen S. Preventing tuberculosis in children receiving anti-TNF treatment. Clin Rheumatol 2010; 29:389-92. [PMID: 20084445 DOI: 10.1007/s10067-009-1334-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 10/29/2009] [Accepted: 12/07/2009] [Indexed: 12/19/2022]
Abstract
Anti-tumor necrosis factor (TNF) treatment has been a breakthrough in the management of juvenile idiopathic arthritis (JIA). However, they are associated with a significant risk of tuberculosis. We evaluated JIA patients who received etanercept treatment from an eastern Mediterranean country with moderate tuberculosis frequency. JIA patients under anti-TNF treatment, etanercept, were enrolled to the study. Chest X-rays, Tuberculin Skin Test (TST), clinical histories, family screening, and physical examinations were reviewed retrospectively. If TST was above 10 mm in a patient with one Bacillus Calmette-Guerin, cultures and, if needed, thorax computerized tomography were obtained. These patients received 1-2 months of isoniazid (INH) treatment which was followed by an INH prophylaxis for a period of 9 months while etanercept treatment was started. All were re-evaluated within 3 months intervals. A total of 36 patients under etanercept treatment were enrolled to the study. Mean age of the patients was 14.00 years (range 4-22 years). Median duration of disease was 36.00 months (range 4-216 months). Median duration of etanercept therapy was 11.5 months (3-48 months) at final evaluation. Seven patients had an initial TST score above 10 mm. All received INH treatment as outlined above. They had normal examinations and X-rays during followup. With proper initial evaluation, anti-TNF treatment is safe even in countries where tuberculosis is moderately frequent. An initial 1-2 months of INH treatment followed by chemoprophylaxis for 9 months is suggested for children with a TST of >10 mm.
Collapse
Affiliation(s)
- Nuray Aktay Ayaz
- Medical Faculty, Pediatric Rheumatology Unit, Acibadem University, Ankara, Turkey.
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Solau-Gervais E, Robin C, Gambert C, Troller S, Danner S, Gombert B, Debiais F, Hankard R. Prevalence and distribution of juvenile idiopathic arthritis in a region of Western France. Joint Bone Spine 2010; 77:47-9. [PMID: 20034832 DOI: 10.1016/j.jbspin.2009.11.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2009] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To determine the prevalence and distribution of the various forms of juvenile idiopathic arthritis (JIA) in the Poitou-Charentes region of Western France. METHODS We surveyed all the practicing rheumatologists and pediatricians in the study region for cases of JIA meeting ILAR criteria seen in 2006 among the population of 305,198 children younger than 16 years of age who resided in the study region. The survey was conducted by means of a questionnaire followed by a phone call. Cases of JIA identified by the survey were reviewed retrospectively. RESULTS We identified 48 children with JIA, which yielded a prevalence of 15.7/100,000. Mean age at diagnosis was 6.6 years (range, 1-15 years). Oligoarticular disease was the most common pattern, with 20 (41.6%) patients, a mean age of 4.9 years at diagnosis, and 80% of females. Oligoarticular disease was associated with the best outcomes, and only two (2/20, 10%) patients in this subgroup required disease-modifying therapy. Enthesitis-related arthritis contributed eight (16.6%) patients, with a mean age at diagnosis of 10.7 years and 75% of males. There were nine patients with polyarticular disease and seven with systemic disease; disease severity was greatest in these 16 patients, of whom only two were not taking disease-modifying drugs or glucocorticoids. CONCLUSION The prevalence of JIA in Poitou-Charentes was similar to the prevalences reported in other regions of France.
Collapse
|
43
|
Vora SS, Bengtson CE, Syverson GD, Nocton JJ. An evaluation of the utility of routine laboratory monitoring of juvenile idiopathic arthritis (JIA) patients using non-steroidal anti-inflammatory drugs (NSAIDs): a retrospective review. Pediatr Rheumatol Online J 2010; 8:11. [PMID: 20398286 PMCID: PMC2860356 DOI: 10.1186/1546-0096-8-11] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 04/14/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No consensus evidence-based guidelines for the routine laboratory monitoring of children with JIA receiving non-steroidal anti-inflammatory drugs (NSAIDs) exist. The purpose of this study is to evaluate the clinical utility of routine laboratory monitoring of hemoglobin, transaminases, blood urea nitrogen, serum creatinine, and urinalysis in patients with juvenile idiopathic arthritis (JIA) receiving NSAIDs. METHODS The medical records of 91 children with JIA followed between 1996 and 2006 were retrospectively reviewed for laboratory results and clinically significant adverse effects attributed to NSAID use. Laboratory abnormalities were documented, with potential adverse clinical sequelae, including if NSAID use was discontinued. RESULTS Abnormal laboratory results were recorded for 24 of 91 patients. Nearly all abnormalities were mild and not associated with adverse clinical sequelae. All patients but one continued to receive NSAID therapy after the abnormality was detected. CONCLUSIONS Although detection of abnormal laboratory values occurred while on NSAIDs, these abnormalities did not correlate with adverse clinical signs and symptoms. The routine monitoring of laboratory tests in asymptomatic children treated with NSAIDs is of questionable utility.
Collapse
Affiliation(s)
- Sheetal S Vora
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Children's Research Institute, Milwaukee, WI, USA.
| | - Christine E Bengtson
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Children's Research Institute, Milwaukee, WI, USA
| | - Grant D Syverson
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Children's Research Institute, Milwaukee, WI, USA
| | - James J Nocton
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Children's Research Institute, Milwaukee, WI, USA
| |
Collapse
|
44
|
Berkun Y, Padeh S. Environmental factors and the geoepidemiology of juvenile idiopathic arthritis. Autoimmun Rev 2010; 9:A319-24. [DOI: 10.1016/j.autrev.2009.11.018] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
45
|
Rates of autoimmune diseases in Kaiser Permanente for use in vaccine adverse event safety studies. Vaccine 2010; 28:1062-8. [DOI: 10.1016/j.vaccine.2009.10.115] [Citation(s) in RCA: 99] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 10/14/2009] [Accepted: 10/19/2009] [Indexed: 11/24/2022]
|
46
|
Abstract
Juvenile idiopathic arthritis (JIA) refers to a group of chronic childhood arthropathies of unknown etiology, currently classified into subtypes primarily on the basis of clinical features. Research has focused on the hypothesis that these subtypes arise through distinct etiologic pathways. In this Review, we discuss four subtypes of JIA: persistent oligoarticular, extended oligoarticular, rheumatoid-factor-positive polyarticular and rheumatoid-factor-negative polyarticular. These subtypes differ in prevalence between ethnic groups and are associated with different HLA alleles. Non-HLA genetic risk factors have also been identified, some of which reveal further molecular differences between these subtypes, while others suggest mechanistic overlap. Investigations of immunophenotypes also provide insights into subtype differences: adaptive immunity seems to have a prominent role in both polyarticular and oligoarticular JIA, and the more-limited arthritis observed in persistent oligoarticular JIA as compared with extended oligoarticular JIA may reflect more-potent immunoregulatory T-cell activity in the former. Tumor necrosis factor seems to be a key mediator of both polyarticular and oligoarticular JIA, especially in the extended oligoarticular subtype, although elevated levels of other cytokines are also observed. Limited data on monocytes, dendritic cells, B cells, natural killer T cells and neutrophils suggest that the contributions of these cells differ across subtypes of JIA. Within each subtype, however, common pathways seem to drive joint damage.
Collapse
|
47
|
Gabriel SE, Michaud K. Epidemiological studies in incidence, prevalence, mortality, and comorbidity of the rheumatic diseases. Arthritis Res Ther 2009; 11:229. [PMID: 19519924 PMCID: PMC2714099 DOI: 10.1186/ar2669] [Citation(s) in RCA: 550] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Epidemiology is the study of the distribution and determinants of disease in human populations. Over the past decade there has been considerable progress in our understanding of the fundamental descriptive epidemiology (levels of disease frequency: incidence and prevalence, comorbidity, mortality, trends over time, geographic distributions, and clinical characteristics) of the rheumatic diseases. This progress is reviewed for the following major rheumatic diseases: rheumatoid arthritis (RA), juvenile rheumatoid arthritis, psoriatic arthritis, osteoarthritis, systemic lupus erythematosus, giant cell arteritis, polymyalgia rheumatica, gout, Sjögren's syndrome, and ankylosing spondylitis. These findings demonstrate the dynamic nature of the incidence and prevalence of these conditions--a reflection of the impact of genetic and environmental factors. The past decade has also brought new insights regarding the comorbidity associated with rheumatic diseases. Strong evidence now shows that persons with RA are at a high risk for developing several comorbid disorders, that these conditions may have atypical features and thus may be difficult to diagnose, and that persons with RA experience poorer outcomes after comorbidity compared with the general population. Taken together, these findings underscore the complexity of the rheumatic diseases and highlight the key role of epidemiological research in understanding these intriguing conditions.
Collapse
Affiliation(s)
- Sherine E Gabriel
- Department of Health Sciences Research, Mayo Foundation, First St. SW, Rochester, MN 55905, USA
| | - Kaleb Michaud
- Nebraska Arthritis Outcomes Research Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
- National Data Bank for Rheumatic Diseases, N Emporia, Wichita, KS 67214, USA
| |
Collapse
|
48
|
|
49
|
Silman AJ. Forty-six million Americans have arthritis: True or false? ACTA ACUST UNITED AC 2008; 58:1220-5. [DOI: 10.1002/art.23472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
50
|
Quality of life after TKA for patients with juvenile rheumatoid arthritis. Clin Orthop Relat Res 2008; 466:167-78. [PMID: 18196390 PMCID: PMC2505301 DOI: 10.1007/s11999-007-0010-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2006] [Accepted: 10/08/2007] [Indexed: 01/31/2023]
Abstract
UNLABELLED Total knee arthroplasty frequently is required during early adulthood in patients with advanced juvenile rheumatoid arthritis. We queried patients on issues of importance to them, asked whether they were satisfied with surgical outcomes, and ascertained their postoperative status. We retrospectively reviewed 14 adult patients (22 knees) with severe juvenile rheumatoid arthritis who were treated with primary total knee arthroplasty between 1989 and 2001. All patients were evaluated by pain and stiffness visual analog scales, range of motion, the Patient-Specific Index, Hospital for Special Surgery knee score, WOMAC Osteoarthritis Index, EuroQuol in five dimensions, and SF-36 Health Survey. Preoperative scores were assessed by recall. Patients had a minimum followup of 2 years (mean, 8 years; range, 2-13 years). Quality of life improved after TKA as measured by the Patient-Specific Index. Eighteen of 22 patients rated themselves satisfied with the functional outcome of their surgery; all patients were satisfied with pain relief. Final SF-36, EuroQuol in five dimensions, and WOMAC scores were low compared with age-matched population norms. A mean postoperative flexion arc of 77 degrees (range, 30 degrees -130 degrees ) was observed. Total knee arthroplasty had a major positive impact on quality of life as reported by patients. LEVEL OF EVIDENCE Level IV, therapeutic study.
Collapse
|