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Satirer Ö, Henes JC, Döring M, Lesk T, Benseler S, Kuemmerle-Deschner JB. Autologous haematopoiesis stem cell transplantation (AHSCT) for treatment-refractory autoimmune diseases in children. RMD Open 2024; 10:e004381. [PMID: 39004431 PMCID: PMC11253738 DOI: 10.1136/rmdopen-2024-004381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/27/2024] [Indexed: 07/16/2024] Open
Abstract
OBJECTIVES To evaluate the long-term effectiveness and safety of autologous haematopoiesis stem cell transplantation (AHSCT) for severe, refractory autoimmune diseases in paediatric patients. METHODS A single-centre study of consecutive children and adolescents with refractory autoimmune diseases undergoing AHSCT was performed. Demographics, clinical, laboratory features, pre-AHSCT medications, disease activity and functional status were captured. The primary outcome was progression-free survival, secondary outcomes included overall survival, disease-specific treatment responses, disease activity at the last follow-up and AHSCT safety. RESULTS The study included seven patients: two systemic sclerosis, one pansclerotic morphoea, one eosinophilic fasciitis, one juvenile dermatomyositis and two patients with systemic juvenile idiopathic arthritis; four women, three men median age at AHSCT of 10 years (7-19), median follow-up post-AHSCT of 17 years. Median progression-free survival and overall survival was 4.2 years (95% CI: 0.98 to 8.3) and 17 years (95% CI: 11.8 to 22.1), respectively. Progression-free survival rates at 1 and 2 years post-AHSCT were 100% and 77%, respectively. All children survived. All patients are in clinical remission, only four require ongoing immunotherapy. SAFETY Three experienced infections, including HHV6, Candida and Ralstonia sepsis; one developed a systemic inflammatory response syndrome; two new onset secondary autoimmune diseases including autoimmune haemolytic anaemia, Graves' disease and one was found to have a breast fibroadenoma. Treatment toxicity: one cyclophosphamide-associated transient renal failure and pericardial effusion, one patient with amenorrhoea/infertility. CONCLUSIONS AHSCT was an effective and safe approach for children and adolescents with treatment-refractory autoimmune diseases. The indication and timing of transplantation requires a careful consideration and a multidisciplinary approach.
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Affiliation(s)
- Özlem Satirer
- Department of Paediatrics and Autoinflammation reference Center Tuebingen (arcT), Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany
| | - Joerg C Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Oncology, Haematology, Immunology and Rheumatology), Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany
| | - Michaela Döring
- Pediatric Hematology &Oncology, University of Tübingen, Tubingen, Baden-Württemberg, Germany
| | - Till Lesk
- Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany
| | - Susanne Benseler
- Rheumatology, Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
- Children's Health Ireland, Dublin, Dublin, Ireland
| | - Jasmin Beate Kuemmerle-Deschner
- Department of Paediatrics and Autoinflammation reference Center Tuebingen (arcT), Universitatsklinikum Tubingen, Tubingen, Baden-Württemberg, Germany
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Marder G, Quach T, Chadha P, Nandkumar P, Tsang J, Levine T, Schiopu E, Furie R, Davidson A, Narain S. Belimumab treatment of adult idiopathic inflammatory myopathy. Rheumatology (Oxford) 2024; 63:742-750. [PMID: 37326854 PMCID: PMC10907809 DOI: 10.1093/rheumatology/kead281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/16/2023] [Accepted: 05/31/2023] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE To evaluate belimumab addition to the standard of care in patents with refractory idiopathic inflammatory myopathy (IIM). METHODS We conducted a 40-week multicentre, randomized, double-blind, placebo-controlled trial with 1:1 IV belimumab 10 mg/kg or placebo randomization and a 24-week open-label extension. Clinical responses were measured by the definition of improvement (DOI) and total improvement score (TIS). Flow cytometry analyses were performed on available samples before randomization, at 24 and 60-64 weeks. Descriptive statistics, t-test, Fisher's exact test and analysis of variance tests were used. RESULTS A total of 17 patients were randomized, 15 received five or more doses of belimumab or placebo and were included in the intention-to-treat analysis. More belimumab patients vs placebo attained a TIS ≥40 [55.5% vs 33.3%; P = non-significant (NS)] and achieved the DOI (33.3% vs 16.7%; P = NS) at weeks 40 and 64; the mean TIS was similar among groups. Two patients achieved major responses (TIS = 72.5) after week 40 in the belimumab arm and none in the placebo arm. No improvement in the placebo arm after switching to the open-label phase was observed. There was no steroid-sparing effect. No new safety signals were detected. Although total B cells were not reduced, belimumab induced naïve B cell depletion while enhancing the number and frequency memory B cells. CONCLUSION The study did not meet the primary endpoint and no statistically significant differences were observed in clinical responses between arms. More patients achieved sustained TIS ≥40 and reached the DOI. Most patients who received belimumab for >40 weeks had clinical improvement. Phenotypic changes in B cell populations were not associated with clinical responses. CLINICAL TRIAL REGISTRATION NUMBER Clinicaltrials.gov (https://clinicaltrials.gov/), NCT02347891.
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Affiliation(s)
- Galina Marder
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Tam Quach
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Priyal Chadha
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Preeya Nandkumar
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Jimmy Tsang
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Todd Levine
- Phoenix Neurological Associates, Phoenix, AZ, USA
| | - Elena Schiopu
- Division of Rheumatology, University of Michigan, Ann Arbor, MI, USA
| | - Richard Furie
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
| | - Anne Davidson
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
- Institute of Molecular Medicine, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Sonali Narain
- Division of Rheumatology, Northwell Health, Donald and Barbara Zucker School of Medicine, Great Neck, NY, USA
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Connolly CM, Gupta L, Fujimoto M, Machado PM, Paik JJ. Idiopathic inflammatory myopathies: current insights and future frontiers. THE LANCET. RHEUMATOLOGY 2024; 6:e115-e127. [PMID: 38267098 DOI: 10.1016/s2665-9913(23)00322-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/24/2023] [Accepted: 11/29/2023] [Indexed: 01/26/2024]
Abstract
Idiopathic inflammatory myopathies are a group of autoimmune diseases with a broad spectrum of clinical presentations, primarily characterised by immune-mediated muscle injury. Until recently, there was little insight into the pathogenesis of idiopathic inflammatory myopathies, which challenged the recognition of the breadth of heterogeneity of this group of diseases as well as the development of new therapeutics. However, the landscape of idiopathic inflammatory myopathies is evolving. In the past decade, advances in diagnostic tools have facilitated an enhanced understanding of the underlying disease mechanisms in idiopathic inflammatory myopathies, enabling the expansion of therapeutic trials. The fields of transcriptomics, prot§eomics, and machine learning offer the potential to gain greater insights into the underlying pathophysiology of idiopathic inflammatory myopathies. Harnessing insights gained from these sophisticated tools could contribute to the identification of differences at a molecular level among patients, accelerating the development of targeted, tailored therapies. Bolstered by the validation and standardisation of robust outcome measures, many promising therapies are in clinical trial development. Although challenges remain, there is great optimism in the field due to the progress in innovative diagnostics, outcome measures, and therapeutic approaches. In this Review, we discuss the expanding landscape of idiopathic inflammatory myopathies as the frontier of precision medicine becomes imminent.
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Affiliation(s)
- Caoilfhionn M Connolly
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Latika Gupta
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK; Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, The University of Manchester, Manchester, UK; Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Manabu Fujimoto
- Department of Dermatology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Pedro M Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, University College London, London, UK; Centre for Rheumatology, University College London, London, UK; National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK; Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Julie J Paik
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Saygin D, Kim H, Douglas C, Erman B, Wilkerson J, McGrath JA, Oddis CV, Lundberg IE, Amato AA, García-De La Torre I, Chinoy H, Fiorentino D, Chung L, Song YW, Miller FW, Ruperto N, Vencovsky J, Aggarwal R, Rider LG. Performance of the 2016 ACR-EULAR Myositis Response Criteria in adult dermatomyositis/polymyositis therapeutic trials and consensus profiles. Rheumatology (Oxford) 2023; 62:3672-3679. [PMID: 36929923 PMCID: PMC10629785 DOI: 10.1093/rheumatology/kead110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/07/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE The ACR-EULAR Myositis Response Criteria (MRC) were developed as a composite measure using absolute percentage change in six core set measures (CSMs). We aimed to further validate the MRC by assessing the contribution of each CSM, frequency of strength vs extramuscular activity improvement, representation of patient-reported outcome measures (PROM), and frequency of CSM worsening. METHODS Data from adult dermatomyositis/polymyositis patients in the rituximab (n = 147), etanercept (n = 14), and abatacept (n = 19) trials, and consensus patient profiles (n = 232) were evaluated. The Total Improvement Score (TIS), number of improving vs worsening CSMs, frequency of improvement with and without muscle-related CSMs, and contribution of PROM were evaluated by MRC category. Regression analysis was performed to assess contribution of each CSM to the MRC. RESULTS Of 412 adults with dermatomyositis/polymyositis, there were 37%, 24%, 25%, and 14% with no, minimal, moderate, and major MRC improvement, respectively. The number of improving CSMs and absolute percentage change in all CSMs increased by improvement category. In minimal-moderate improvement, only physician-reported disease activity contributed significantly more than expected by MRC. Of patients with at least minimal improvement, 95% had improvement in muscle-related measures and a majority (84%) had improvement in PROM. Patients with minimal improvement had worsening in a median of 1 CSM, and most patients with moderate-major improvement had no worsening CSMs. Physician assessment of change generally agreed with MRC improvement categories. CONCLUSION The ACR-EULAR MRC performs consistently across multiple studies, further supporting its use as an efficacy end point in future myositis therapeutic trials.
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Affiliation(s)
- Didem Saygin
- Section of Rheumatology at University of Chicago and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Hanna Kim
- Juvenile Myositis Pathogenesis and Therapeutics Unit, National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | | | - Brian Erman
- Social & Scientific Systems, Inc, Durham, NC, USA
| | | | | | - Chester V Oddis
- Section of Rheumatology at University of Chicago and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anthony A Amato
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Ignacio García-De La Torre
- Hospital General de Occidente de la Secretaría de Salud and Universidad de Guadalajara, Department of Immunology and Rheumatology, Mexico
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Division of Musculoskeletal and Dermatological Sciences, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
| | - David Fiorentino
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Lorinda Chung
- Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA
| | - Yeong-Wook Song
- Medical Research Center, Institute of Human-Environment Interface Biology, Department of Internal Medicine, Seoul National University
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOSID Centro Trial, Reumatologia, Pediatria II, PRINTO, Genoa, Italy
| | - Jiri Vencovsky
- Department of Rheumatology, 1st Medical Faculty, Institute of Rheumatology; Charles University, Prague, Czech Republic
| | - Rohit Aggarwal
- Section of Rheumatology at University of Chicago and Division of Rheumatology and Clinical Immunology, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
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Kim H, Saygin D, Douglas C, Wilkerson J, Erman B, Pistorio A, McGrath JA, Reed AM, Oddis CV, Bracaglia C, van Royen-Kerkhof A, Bica B, Dolezalova P, Ferriani VPL, Flato B, Bernard-Medina AG, Herlin T, Miller FW, Vencovsky J, Ruperto N, Aggarwal R, Rider LG. Performance of the 2016 ACR-EULAR myositis response criteria in juvenile dermatomyositis therapeutic trials and consensus profiles. Rheumatology (Oxford) 2023; 62:3680-3689. [PMID: 36929918 PMCID: PMC10629769 DOI: 10.1093/rheumatology/kead111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES The 2016 ACR-EULAR Response Criteria for JDM was developed as a composite measure with differential weights of six core set measures (CSMs) to calculate a Total Improvement Score (TIS). We assessed the contribution of each CSM, representation of muscle-related and patient-reported CSMs towards improvement, and frequency of CSM worsening across myositis response criteria (MRC) categories in validation of MRC. METHODS Data from JDM patients in the Rituximab in Myositis trial (n = 48), PRINTO JDM trial (n = 139), and consensus patient profiles (n = 273) were included. Observed vs expected CSM contributions were compared using Sign test. Characteristics of MRC categories were compared by Wilcoxon tests with Bonferroni adjustment. Spearman correlation of changes in TIS and individual CSMs were examined. Agreement between physician-assessed change and MRC categories was evaluated by weighted Cohen's kappa. RESULTS Of 457 JDM patients with IMACS CSMs and 380 with PRINTO CSMs, 9-13% had minimal, 19-23% had moderate and 41-50% had major improvement. The number of improved and absolute percentage change of CSMs increased by MRC improvement level. Patients with minimal improvement by MRC had a median of 0-1 CSM worsened, and those with moderate/major improvement had a median of zero worsening CSMs. Of patients improved by MRC, 94-95% had improvement in muscle strength and 93-95% had improvement in ≥1 patient-reported CSM. IMACS and PRINTO CSMs performed similarly. Physician-rated change and MRC improvement categories had moderate-to-substantial agreement (Kappa 0.5-0.7). CONCLUSION The ACR-EULAR MRC perform consistently across multiple studies, supporting its further use as an efficacy end point in JDM trials.
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Affiliation(s)
- Hanna Kim
- Juvenile Myositis Pathogenesis and Therapeutics Unit, National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Didem Saygin
- Section of Rheumatology, Department of Medicine, University of Chicago, Chicago, IL, USA
- School of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Brian Erman
- Social & Scientific Systems, Inc, Durham, NC, USA
| | - Angela Pistorio
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | | | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Chester V Oddis
- School of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Claudia Bracaglia
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Annet van Royen-Kerkhof
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Blanca Bica
- Section of Rheumatology, Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pavla Dolezalova
- General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Virginia P L Ferriani
- Department of Pediatrics; Division of Rheumatology, Ribeirao Preto Medical School- Sao Paulo University, Ribeirao Preto, Brazil
| | - Berit Flato
- Department of Rheumatology, Oslo University Hospital, Norway and Institute of clinical medicine, University of Oslo, Oslo, Norway
| | | | - Troels Herlin
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
| | - Jiri Vencovsky
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Nicolino Ruperto
- UOSID Centro Trial, PRINTO, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Rohit Aggarwal
- School of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
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Machado LSG, Oliveira ACD, Mancuso FJN, Sato EI. First study demonstrating speckle tracking echocardiography has prognostic value in patients with idiopathic inflammatory myopathies. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2163-2171. [PMID: 37592086 DOI: 10.1007/s10554-023-02925-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 07/31/2023] [Indexed: 08/19/2023]
Abstract
To measure left ventricular (LV) global longitudinal strain (GLS) using speckle tracking echocardiography in idiopathic inflammatory myopathy (IIM) patients and to determine whether the LV GLS predicts outcomes in those patients. Prospective study consisted of a cross-sectional phase with 61 IIM patients and 32 individuals without IIM and longitudinal phase, in which patients were divided into two subgroups: 26 with reduced LV GLS and 35 with normal LV GLS; patients were followed for a mean of 25 months, and the occurrence of cardiovascular events and criteria for IIM activity were compared. The mean LV GLS (18.5 ± 2.9% vs. 21.6 ± 2.5%; p < 0.001) and right ventricle free wall strain (21.9 ± 6.1% vs. 27.5 ± 4.7%; p < 0.001) were lower in patients than in controls. The mean N-terminal pro B-type natriuretic peptide level was higher in patients than in controls. There were no differences regarding other cardiac involvement. Anti-Jo1 antibody was associated with general electrocardiographic abnormality and LV diastolic dysfunction. The subgroup with reduced GLS progressed with higher mean creatine phosphokinase, myositis disease activity assessment visual analogue scales, the physician's and patient's visual analogue scales, the health assessment questionnaire, and a higher proportion of relapses than the subgroup with normal GLS. There was no difference between the subgroups regarding cardiovascular events. The LV GLS appears to be useful for evaluating patients with IIM. Abnormal values are associated with more frequent relapses and increased disease activity during follow-up.
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Affiliation(s)
- Luiz S G Machado
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, São Paulo, CEP 04023 900, Brazil
| | - Ana C D Oliveira
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, São Paulo, CEP 04023 900, Brazil
| | - Frederico J N Mancuso
- Cardiology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Emilia I Sato
- Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Botucatu, 740, São Paulo, São Paulo, CEP 04023 900, Brazil.
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Pijnenburg L, Giannini M, Bouchard-Marmen M, Arnaud L, Barsotti S, Bellando-Randone S, Bernardi L, Bini P, Blagojevic J, Codullo V, Couderc M, De Moreuil C, Dernis E, Diamanti L, Dubost JJ, Duval F, Emmi G, Galempoix JM, Geny B, Gottenberg JE, Groza M, Guffroy A, Guichard I, Guilpain P, Hervier B, Hudson M, Iaccarino L, Iannone F, Lebrun D, Marchioni E, Mariampillai K, Maurier F, Mosca M, Nadaj-Pakleza A, Nannini C, Piot JM, Prieto-González S, Poursac N, Rouanet E, Sellam J, Selva-O'Callaghan A, Séverac F, Sibilia J, Sole G, Soulages A, Terrier B, Tournadre A, Troyanov Y, Vernier N, Vesperini V, Viallard JF, Ziane R, Cavagna L, Meyer A. In inflammatory myopathies, dropped head/bent spine syndrome is associated with scleromyositis: an international case-control study. RMD Open 2023; 9:e003081. [PMID: 37666644 PMCID: PMC10481849 DOI: 10.1136/rmdopen-2023-003081] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 06/22/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Some myopathies can lead to dropped head or bent spine syndrome (DH/BS). The significance of this symptom has not been studied in inflammatory myopathies (IM). OBJECTIVES To assess the significance of DH/BS in patients with IM. METHODS Practitioners from five IM networks were invited to report patients with IM suffering from DH/BS (without other known cause than IM). IM patients without DH/BS, randomly selected in each participating centre, were included as controls at a ratio of 2 to 1. RESULTS 49 DH/BS-IM patients (DH: 57.1%, BS: 42.9%) were compared with 98 control-IM patients. DH/BS-IM patients were older (65 years vs 53 years, p<0.0001) and the diagnosis of IM was delayed (6 months vs 3 months, p=0.009). Weakness prevailing in the upper limbs (42.9% vs 15.3%), dysphagia (57.1% vs 25.5%), muscle atrophy (65.3% vs 34.7%), weight loss (61.2% vs 23.5%) and loss of the ability to walk (24.5% vs 5.1%) were hallmarks of DH/BS-IM (p≤0.0005), for which the patients more frequently received intravenous immunoglobulins (65.3% vs 34.7%, p=0.0004). Moreover, DH/BS-IM patients frequently featured signs and/or complications of systemic sclerosis (SSc), fulfilling the American College of Rheumatology/European Alliance of Associations for Rheumatology criteria for this disease in 40.8% of the cases (vs 5.1%, p<0.0001). Distribution of the myopathy, its severity and its association with SSc were independently associated with DH/BS (p<0.05). Mortality was higher in the DH/BS-IM patients and loss of walking ability was independently associated with survival (p<0.05). CONCLUSION In IM patients, DH/BS is a marker of severity and is associated with SSc (scleromyositis).
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Affiliation(s)
- Luc Pijnenburg
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Margherita Giannini
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
- Exploration fonctionnelle musculaire, Service de Physiologie Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | | | - Laurent Arnaud
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Simone Barsotti
- Department of Rheumatology and Clinical Immunology Unit, University of Pisa, Pisa, Italy
| | - Silvia Bellando-Randone
- Department of Experimental and Clinical Medicine, Universitaria Careggi, Azienda Ospedaliera, Florence, Italy
| | - Livio Bernardi
- Departement of rheumatology, University of Padova, Padova, Italy
| | - Paola Bini
- Department of neurology, Neurological Institute Mondino, University of Pavia, Pavia, Italy
| | - Jelena Blagojevic
- Department of Experimental and Clinical Medicine, Universitaria Careggi, Azienda Ospedaliera, Florence, Italy
| | - Veronica Codullo
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation Pavia, Pavia, Italy
| | - Marion Couderc
- Service de rhumatologie, Hôpitaux Universitaires de Clermont-Ferrand, Clermont-Ferrand, France
| | - Claire De Moreuil
- Service de médecine interne, Hôpitaux Universitaires de Brest, Brest, France
| | - Emanuelle Dernis
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
| | - Luca Diamanti
- Department of neurology, Neurological Institute Mondino, University of Pavia, Pavia, Italy
| | - Jean Jacques Dubost
- Service de médecine interne, Hôpitaux Universitaires de Clermont-Ferrand, Clermont-Ferrand, France
| | - Fanny Duval
- Service de neurologie, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, Universitaria Careggi, Azienda Ospedaliera, Florence, Italy
| | - Jean-Marc Galempoix
- Service de Médecine Interne, Centre Hospitalier de Charleville-Mézières, Charleville-Mézières, France
| | - Bernard Geny
- Exploration fonctionnelle musculaire, Service de Physiologie Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jacques-Eric Gottenberg
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Monica Groza
- Service de médecine interne, Centre hospitalier Colmar, Colmar, France
| | - Aurelien Guffroy
- Service d'immunologie clinique, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Isabelle Guichard
- Service de médecine interne, Hôpitaux Universitaires de Saint Etienne, Saint Etienne, France
| | - Philippe Guilpain
- Service de médecine interne, Hôpitaux Universitaires de Montpellierr, Montpellier, France
| | - Baptiste Hervier
- Service de médecine interne, Assistance publique - Hôpitaux de Paris, Saint Louis, Paris, France
| | - Marie Hudson
- Department of medicine, Division of Rheumatology, Jewish General Hospital, McGill University, Montreal, Québec, Canada
| | - Luca Iaccarino
- Departement of rheumatology, University of Padova, Padova, Italy
| | | | - Delphine Lebrun
- Service de Médecine Interne, Centre Hospitalier de Charleville-Mézières, Charleville-Mézières, France
| | - Enrico Marchioni
- Department of neurology, Neurological Institute Mondino, University of Pavia, Pavia, Italy
| | - Kuberaka Mariampillai
- Service de médecine interne, Assistance publique - Hôpitaux de Paris, Saint Louis, Paris, France
| | - Francois Maurier
- Service de médecine interne, Hôpitaux privés de Metz, Metz, France
| | - Marta Mosca
- Department of Rheumatology and Clinical Immunology Unit, University of Pisa, Pisa, Italy
| | - Aleksandra Nadaj-Pakleza
- Service de neurologie, Centre de référence des maladies neuromusculaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | - Jean-Maxime Piot
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
| | | | - Nicolas Poursac
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Eglantine Rouanet
- Service de rhumatologie, Centre hospitalier Le Mans, Le Mans, France
| | - Jérémie Sellam
- Service de rhumatologie, Hôpital Saint Antoine, Assistance publique - Hôpitaux de Paris, Paris, France
| | | | - François Séverac
- Service de Santé Publique, GMRC; ICube, UMR 7357, Hôpitaux universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Jean Sibilia
- Service de rhumatologie, Centre de Référence des Maladies Auto-immunes Systémiques Rares Est Sud-Ouest Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
| | - Guilhem Sole
- Service de neurologie, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Antoine Soulages
- Service de neurologie, Hôpitaux Universitaires de Bordeaux, Bordeaux, France
| | - Benjamin Terrier
- Service de médecine interne, Hôpital Cochin Assistance publique - Hôpitaux de Paris Cochin, Paris, France
| | - Anne Tournadre
- Service de rhumatologie, Hôpitaux Universitaires de Clermont-Ferrand, Clermont-Ferrand, France
| | - Yves Troyanov
- Department of rheumatology, Hôpital Sacre Cœur Montréal, Université de Montréal, Montreal, Québec, Canada
| | - Nathalie Vernier
- Service de médecine interne, Hôpitaux Universitaires de Dijon, Dijon, France
| | | | | | - Rahima Ziane
- Service de médecine interne, Hôpitaux Universitaires de Montpellierr, Montpellier, France
| | - Lorenzo Cavagna
- Rheumatology Division, University and IRCCS Policlinico S. Matteo Foundation Pavia, Pavia, Italy
| | - Alain Meyer
- Exploration fonctionnelle musculaire, Service de Physiologie Explorations Fonctionnelles Musculaires, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France
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8
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Curiel RV, Nguyen W, Mamyrova G, Jones D, Ehrlich A, Brindle KA, Haji-Momenian S, Sheets R, Kim H, Jones OY, Rider LG. Improvement in Disease Activity in Refractory Juvenile Dermatomyositis Following Abatacept Therapy. Arthritis Rheumatol 2023; 75:1229-1237. [PMID: 36657109 PMCID: PMC10339445 DOI: 10.1002/art.42450] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/29/2022] [Accepted: 01/17/2023] [Indexed: 01/21/2023]
Abstract
OBJECTIVE This open-label, 24-week study was conducted to evaluate the safety and efficacy of abatacept in patients with refractory juvenile dermatomyositis (DM). METHODS Ten patients ≥7 years of age with moderate disease activity were enrolled in a 24-week study to examine the safety of subcutaneous abatacept and patient responses to the treatment. The primary endpoint was the International Myositis Assessment and Clinical Studies (IMACS) group Definition Of Improvement (DOI). Secondary endpoints included safety, changes in the core set activity measures (CSMs) of the IMACS group and the Pediatric Rheumatology International Trials Organization, and improvements in disease activity based on the American College of Rheumatology (ACR)/EULAR response criteria for juvenile DM. Radiologists blinded with regard to participant data assessed magnetic resonance images (MRIs) of patient thigh muscles. Interferon (IFN)-regulated gene score was performed on whole-blood RNA samples using a NanoString assay, and cytokines were assessed using a Luminex assay. RESULTS Five patients achieved DOI at week 12, and 9 patients achieved DOI at week 24, including 2 patients with minimal, 4 patients with moderate, and 3 patients with major improvement by the 2016 ACR/EULAR response criteria for juvenile DM when patients were assessed using the CSMs of the IMACS Group. Improvements from baseline were seen in all CSMs at weeks 12 and 24, except in muscle enzymes. Daily glucocorticoid doses decreased from a mean of 16.7 mg at baseline to 10.2 mg at week 24 (P = 0.002). Average MRI muscle edema scores decreased from a mean baseline score of 5.3 to 2.3 at week 24 (P = 0.01). Six patients had down-trending IFN-regulated gene scores and galectin-9 expression at week 24. Decreases in IFN-regulated gene scores and in levels of interferon-γ-inducible protein 10kDa, galectin-9, and interleukin-2 correlated with improvements in disease activity and in muscle edema shown on MRI. Eleven grade 2 or 3 treatment-emergent adverse events were observed. CONCLUSION This open-label study demonstrated that abatacept may be beneficial for patients with treatment-refractory juvenile DM.
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Affiliation(s)
- Rodolfo V. Curiel
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - William Nguyen
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Gulnara Mamyrova
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Derek Jones
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Alison Ehrlich
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kathleen A. Brindle
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Shahriar Haji-Momenian
- Department of Radiology, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Robert Sheets
- Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, University of California San-Diego, Rady Children’s Hospital, San Diego, CA
| | - Hanna Kim
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
- Juvenile Myositis Therapeutic and Translation Studies Unit (JMPTU), Pediatric Translation Research Branch (PTRB), National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health (NIH), Bethesda, MD
| | - Olcay Y. Jones
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
- Division of Pediatric Rheumatology, Walter Reed National Military Medical Center, Bethesda, MD
| | - Lisa G. Rider
- Division of Rheumatology, Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences (NIEHS), NIH, Bethesda, MD
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9
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Mishra B, Sudheer P, Agarwal A, Srivastava MVP, Nilima, Vishnu VY. Minimal Clinically Important Difference (MCID) in Patient-Reported Outcome Measures for Neurological Conditions: Review of Concept and Methods. Ann Indian Acad Neurol 2023; 26:334-343. [PMID: 37970301 PMCID: PMC10645230 DOI: 10.4103/aian.aian_207_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 11/17/2023] Open
Abstract
The concept of the minimal clinically important difference (MCID) emerged from the recognition that statistical significance alone is not enough to determine the clinical relevance of treatment effects in clinical research. In many cases, statistically significant changes in outcomes may not be meaningful to patients or may not result in any tangible improvements in their health. This has led to a growing emphasis on the importance of measuring patient-reported outcome measures (PROMs) in clinical trials and other research studies, in order to capture the patient perspective on treatment effectiveness. MCID is defined as the smallest change in scores that is considered meaningful or important to patients. MCID is particularly important in fields such as neurology, where many of the outcomes of interest are subjective or based on patient-reported symptoms. This review discusses the challenges associated with interpreting outcomes of clinical trials based solely on statistical significance, highlighting the importance of considering clinical relevance and patient perception of change. There are two main approaches to estimating MCID: anchor-based and distribution-based. Anchor-based approaches compare change scores using an external anchor, while distribution-based approaches estimate MCID values based on statistical characteristics of scores within a sample. MCID is dynamic and context-specific, and there is no single 'gold standard' method for estimating it. A range of MCID thresholds should be defined using multiple methods for a disease under targeted intervention, rather than relying on a single absolute value. The use of MCID thresholds can be an important tool for researchers, neurophysicians and patients in evaluating the effectiveness of treatments and interventions, and in making informed decisions about care.
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Affiliation(s)
- Biswamohan Mishra
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pachipala Sudheer
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ayush Agarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Nilima
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
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10
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Raaphorst J, Gullick NJ, Pipitone N, Shokraneh F, Brassington R, Ali SS, Gordon PA. Immunosuppressive and immunomodulatory therapies for idiopathic inflammatory myopathies. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2023; 2023:CD014510. [PMCID: PMC9885519 DOI: 10.1002/14651858.cd014510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: This protocol is for two separate reviews to assess the effects (benefits and harms) of immunosuppressant and immunomodulatory treatments for the idiopathic inflammatory myopathies.
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Affiliation(s)
| | - Joost Raaphorst
- Department of NeurologyAmsterdam UMC, University of Amsterdam, Amsterdam NeuroscienceAmsterdamNetherlands
| | - Nicola J Gullick
- Department of RheumatologyUniversity Hospitals Coventry and Warwickshire NHS TrustCoventryUK,Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Nicolo Pipitone
- Rheumatology Unit, Department of Internal MedicineAzienda USL-IRCCS di Reggio EmiliaReggio EmiliaItaly
| | - Farhad Shokraneh
- Cochrane Neuromuscular GroupUniversity College London Hospitals TrustLondonUK
| | - Ruth Brassington
- Queen Square Centre for Neuromuscular DiseasesNational Hospital for Neurology and NeurosurgeryLondonUK
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11
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Parkes JE, Boehler JF, Li N, Kendra RM, O'Hanlon TP, Hoffman EP, Peterson JM, Miller FW, Rider LG, Nagaraju K. A novel estrogen receptor 1-sphingomyelin phosphodiesterase acid like 3B pathway mediates rituximab response in myositis patients. Rheumatology (Oxford) 2022:6883897. [PMID: 36478205 PMCID: PMC10393434 DOI: 10.1093/rheumatology/keac687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/19/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The B cell depleting biologic, rituximab, is used to treat refractory autoimmune myositis. However, the beneficial effects of rituximab appear to outweigh the known contribution of B-cells in myositis. We aimed to elucidate how myositis patients respond differently to rituximab and possible alternative mechanisms of action. METHODS Here we have: a) comprehensively investigated concurrent mRNA and microRNA expression in muscle biopsies taken at baseline and 16 weeks post treatment in ten patients who were part of the rituximab in myositis (RIM) trial; and b) investigated the beneficial effect of rituximab on myositis muscle cells. RESULTS Our analyses identified an increased number of changes in gene expression in biopsies from patients who had a clinical response to rituximab (n = 5) compared with non-responders (n = 5). The two groups had completely different changes in microRNA and mRNA expression following rituximab therapy, with the exception of one mRNA, BHMT2. Networks of mRNA and microRNA with opposite direction of expression changes highlighted ESR1 as upregulated in responders. We confirmed ESR1 upregulation upon rituximab treatment of immortalized myotubes and primary human dermatomyositis muscle cells in vitro, demonstrating a direct effect of rituximab on muscle cells. Notably, despite showing a response to rituximab, human dermatomyositis primary muscle cells did not express the rituximab target, CD20. However, these cells expressed a possible alternative target of rituximab, sphingomyelinase-like phosphodiesterase 3 b (SMPDL3B). CONCLUSION In addition to B cell depletion, rituximab may be beneficial in myositis due to increased ESR1 signalling mediated by rituximab binding to SMPDL3B on skeletal muscle cells.
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Affiliation(s)
- Joanna E Parkes
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY, USA
| | | | - Ning Li
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY, USA
| | - Ryan M Kendra
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY, USA
| | - Terrance P O'Hanlon
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Eric P Hoffman
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY, USA
| | - Jennifer M Peterson
- School of Exercise & Rehabilitative Sciences, The University of Toledo, OH, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Kanneboyina Nagaraju
- School of Pharmacy and Pharmaceutical Sciences, Binghamton University, Binghamton, NY, USA
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12
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Aggarwal R, Charles-Schoeman C, Schessl J, Bata-Csörgő Z, Dimachkie MM, Griger Z, Moiseev S, Oddis C, Schiopu E, Vencovský J, Beckmann I, Clodi E, Bugrova O, Dankó K, Ernste F, Goyal NA, Heuer M, Hudson M, Hussain YM, Karam C, Magnolo N, Nelson R, Pozur N, Prystupa L, Sárdy M, Valenzuela G, van der Kooi AJ, Vu T, Worm M, Levine T. Trial of Intravenous Immune Globulin in Dermatomyositis. N Engl J Med 2022; 387:1264-1278. [PMID: 36198179 DOI: 10.1056/nejmoa2117912] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Intravenous immune globulin (IVIG) for the treatment of dermatomyositis has not been extensively evaluated. METHODS We conducted a randomized, placebo-controlled trial involving patients with active dermatomyositis. The patients were assigned in a 1:1 ratio to receive IVIG at a dose of 2.0 g per kilogram of body weight or placebo every 4 weeks for 16 weeks. The patients who received placebo and those without confirmed clinical deterioration while receiving IVIG could enter an open-label extension phase for another 24 weeks. The primary end point was a response, defined as a Total Improvement Score (TIS) of at least 20 (indicating at least minimal improvement) at week 16 and no confirmed deterioration up to week 16. The TIS is a weighted composite score reflecting the change in a core set of six measures of myositis activity over time; scores range from 0 to 100, with higher scores indicating greater improvement. Key secondary end points included at least moderate improvement (TIS ≥40) and major improvement (TIS ≥60), and change in score on the Cutaneous Dermatomyositis Disease Area and Severity Index. RESULTS A total of 95 patients underwent randomization: 47 patients were assigned to the IVIG group, and 48 to the placebo group. At 16 weeks, 79% of the patients in the IVIG group (37 of 47) and 44% of those in the placebo group (21 of 48) had a TIS of at least 20 (difference, 35 percentage points; 95% confidence interval, 17 to 53; P<0.001). The results with respect to the secondary end points, including at least moderate improvement and major improvement, were generally in the same direction as the results of the primary end-point analysis, except for the change in creatine kinase level (an individual core measure of the TIS), which did not differ meaningfully between the two groups. Over 40 weeks, 282 treatment-related adverse events occurred in the IVIG group, including headache (in 42% of patients), pyrexia (in 19%), and nausea (in 16%). A total of 9 serious adverse events that were considered to be related to IVIG occurred, including 6 thromboembolic events. CONCLUSIONS In this 16-week trial involving adults with dermatomyositis, the percentage of patients with a response of at least minimal improvement based on a composite score of disease activity was significantly greater among those who received IVIG than among those who received placebo. IVIG was associated with adverse events, including thromboembolism. (Funded by Octapharma Pharmazeutika; ProDERM ClinicalTrials.gov number, NCT02728752.).
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Affiliation(s)
- Rohit Aggarwal
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Christina Charles-Schoeman
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Joachim Schessl
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Zsuzsanna Bata-Csörgő
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Mazen M Dimachkie
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Zoltan Griger
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Sergey Moiseev
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Chester Oddis
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Elena Schiopu
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Jiri Vencovský
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Irene Beckmann
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Elisabeth Clodi
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Olga Bugrova
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Katalin Dankó
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Floranne Ernste
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Namita A Goyal
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Marvin Heuer
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Marie Hudson
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Yessar M Hussain
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Chafic Karam
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Nina Magnolo
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Ronald Nelson
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Nataliia Pozur
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Liudmyla Prystupa
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Miklós Sárdy
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Guillermo Valenzuela
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Anneke J van der Kooi
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Tuan Vu
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Margitta Worm
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
| | - Todd Levine
- From the University of Pittsburgh School of Medicine, Pittsburgh (R.A., C.O.), and Penn Neuroscience Center-Neurology, Hospital of the University of Pennsylvania, Philadelphia (C.K.) - both in Pennsylvania; the University of California, Los Angeles, Los Angeles (C.C.-S.), and the Department of Neurology, University of California, Irvine, Irvine (N.A.G.); the Friedrich-Baur Institute, Department of Neurology (J.S.), and the Department of Dermatology and Allergy, University Hospital (M.S.), Ludwig-Maximilians University of Munich, Munich, the University Hospital of Münster, Münster (N.M.), and the Clinic for Dermatology, Venereology and Allergology, Charité, Universitätsmedizin Berlin, Berlin (M.W.) - all in Germany; the Department of Dermatology and Allergology, University of Szeged, Szeged (Z.B.-C.), the Division of Clinical Immunology, Faculty of Medicine, University of Debrecen, Debrecen (Z.G., K.D.), and the Department of Dermatology, Venereology, and Dermatooncology, Semmelweis University, Budapest (M.S.) - all in Hungary; the University of Kansas Medical Center, Kansas City (M.M.D.); the Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow (S.M.), and Orenburg State Medical University, Orenburg (O.B.) - both in Russia; the Division of Rheumatology, Department of Internal Medicine, Michigan Medicine University Hospitals, Ann Arbor (E.S.); the Institute of Rheumatology and the Department of Rheumatology, Charles University, Prague, Czech Republic (J.V.); Octapharma Pharmazeutika, Vienna (I.B., E.C.); the Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, MN (F.E.); HMD Research, Orlando (M. Heuer), and Integral Rheumatology and Immunology Specialists (IRIS) and IRIS Research and Development, Plantation (G.V.), and the Department of Neurology, University of South Florida, Tampa (T.V.) - all in Florida; the Division of Rheumatology, Department of Medicine, Jewish General Hospital, Lady Davis Institute and McGill University, Montreal (M. Hudson); the University of Texas at Austin Dell Medical School, Austin Neuromuscular Center, Austin (Y.M.H.); Stones River Dermatology, Murfreesboro, TN (R.N.); Ivano-Frankivsk City Clinical Hospital No. 1, Ivano-Frankivsk (N.P.), and the Department of Internal Medicine, Sumy State University, Medical Institute, Sumy (L.P.) - both in Ukraine; the Department of Neurology, Amsterdam University Medical Centers, Amsterdam (A.J.K.); and Phoenix Neurological Associates, Phoenix, AZ (T.L.)
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13
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Oddis CV, Rockette HE, Zhu L, Koontz DC, Lacomis D, Venturupalli S, Moghadam‐Kia S, Ascherman DP, Crofford L, Dimachkie MM, Ernste F, Gazeley D, Marder G, Aggarwal R. Randomized Trial of Tocilizumab in the Treatment of Refractory Adult Polymyositis and Dermatomyositis. ACR Open Rheumatol 2022; 4:983-990. [PMID: 36128663 PMCID: PMC9661830 DOI: 10.1002/acr2.11493] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/10/2022] [Accepted: 07/06/2022] [Indexed: 11/21/2022] Open
Abstract
Objective To assess the efficacy and tolerability of tocilizumab in a multicenter, randomized, double‐blind, placebo‐controlled trial in refractory adult patients with dermatomyositis (DM) and polymyositis (PM). Methods Thirty‐six subjects with probable or definite DM/PM were enrolled in a 6‐month phase 2B clinical trial and randomized 1:1 to receive tocilizumab (8 mg/kg intravenously) or placebo every 4 weeks for 24 weeks. Eligible subjects had either a DM rash, a myositis‐associated autoantibody or an adjudicated PM diagnosis. Active disease was defined by at least three of six abnormal core set measures (CSMs), including a manual muscle testing (MMT)‐8 score of less than 136/150. If the MMT‐8 score was greater than 136, then a cutaneous score of 3 or more (10 cm visual analogue scale) was required along with three additional abnormal CSMs indicating disease activity. The primary endpoint compared the Total Improvement Score (TIS) between both arms from week 4 to 24. Secondary outcomes included time to meeting minimal TIS improvement, changes in CSMs, time to worsening, steroid‐sparing effect, proportion of subjects meeting more stringent improvement criteria, and safety outcomes. Results There was no significant difference (P = 0.86) in the TIS over 24 weeks between tocilizumab and placebo arms. The secondary endpoints of time to improvement (minimal, moderate, or major), time to worsening, CSM changes, safety outcomes, and steroid‐sparing effect were also not significantly different between arms. Conclusion Tocilizumab was safe and well tolerated but did not meet the primary or secondary efficacy outcomes in refractory DM and PM in this 24‐week phase 2B study.
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Affiliation(s)
- Chester V. Oddis
- University of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| | | | - Lei Zhu
- University of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| | - Diane C. Koontz
- University of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| | - David Lacomis
- University of Pittsburgh School of Medicine Pittsburgh Pennsylvania
| | - Swamy Venturupalli
- Cedars Sinai Medical Center and University of California Los Angeles School of Medicine Los Angeles California
| | | | | | | | | | | | | | - Galina Marder
- Hofstra Northwell School of Medicine Uniondale New York
| | - Rohit Aggarwal
- University of Pittsburgh School of Medicine Pittsburgh Pennsylvania
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14
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Abstract
Idiopathic inflammatory myopathies (IIM), also known as myositis, are a heterogeneous group of autoimmune disorders with varying clinical manifestations, treatment responses and prognoses. Muscle weakness is usually the classical clinical manifestation but other organs can be affected, including the skin, joints, lungs, heart and gastrointestinal tract, and they can even result in the predominant manifestations, supporting that IIM are systemic inflammatory disorders. Different myositis-specific auto-antibodies have been identified and, on the basis of clinical, histopathological and serological features, IIM can be classified into several subgroups - dermatomyositis (including amyopathic dermatomyositis), antisynthetase syndrome, immune-mediated necrotizing myopathy, inclusion body myositis, polymyositis and overlap myositis. The prognoses, treatment responses and organ manifestations vary among these groups, implicating different pathophysiological mechanisms in each subtype. A deeper understanding of the molecular pathways underlying the pathogenesis and identifying the auto-antigens of the immune reactions in these subgroups is crucial to improving outcomes. New, more homogeneous subgroups defined by auto-antibodies may help define disease mechanisms and will also be important in future clinical trials for the development of targeted therapies and in identifying biomarkers to guide treatment decisions for the individual patient.
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15
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Ringold S, Consolaro A, Ardoin SP. Outcome Measures in Pediatric Rheumatic Disease. Rheum Dis Clin North Am 2021; 47:655-668. [PMID: 34635297 DOI: 10.1016/j.rdc.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Reliable and responsive outcome measures that accurately detect changes in disease state, activity, and damage are crucial to conducting observational and interventional trials that can directly transform care for children with rheumatic disease. A combination of consensus-based and direct measurement approaches has led to the development of several validated, composite outcome measures in juvenile idiopathic arthritis, juvenile dermatomyositis, childhood-onset systemic lupus erythematosus, and pediatric vasculitis. This review outlines clinician-reported, disease-specific outcome measures developed for these conditions.
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Affiliation(s)
- Sarah Ringold
- Seattle Children's, 4800 Sand Point Way Northeast, Seattle, WA 98115, USA.
| | - Alessandro Consolaro
- Rheumatology Unit, Istituto Giannina Gaslini, University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Stacy P Ardoin
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, 700 Children's Drive, Columbus, OH 43205, USA
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16
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Vanderhout SM, Smith M, Pallone N, Tingley K, Pugliese M, Chakraborty P, Stockler S, Offringa M, Butcher N, Nicholls SG, Potter BK. Patient and family engagement in the development of core outcome sets for two rare chronic diseases in children. RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:66. [PMID: 34521478 PMCID: PMC8439069 DOI: 10.1186/s40900-021-00304-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 08/12/2021] [Indexed: 05/29/2023]
Abstract
BACKGROUND Core outcome sets (COS) are lists of consensus-determined outcomes to be measured and reported in all clinical research studies within a disease area. While including patients and families in COS development to improve their relevance and applicability to patient values is key, there is limited literature documenting practical barriers and facilitators to successful patient engagement in COS development. In this paper, as researchers and patient partners, we provide a resource for COS developers to meaningfully and effectively engage patients and families. MAIN BODY To establish a consensus-based COS for children with two inherited metabolic diseases (medium-chain acyl-CoA dehydrogenase deficiency and phenylketonuria), we conducted an evidence review, Delphi survey, and workshop. Two adult patient partner co-investigators co-developed the study protocol, co-designed strategies to address challenges with incorporating patient perspectives, and led all patient engagement activities, including communication with a group of family advisors. Seven adult family advisors received training about COS development and subsequently contributed to Delphi survey development, outcome definitions, the consensus workshop, and selection of outcome measurement instruments. Patient partner co-investigators and family advisors were essential to the successful design, conduct, and completion of the two COS. Patient partner co-investigators supported the understanding, inclusion and engagement of family advisors, and helped develop accessible tools to determine patient-oriented outcome measurement instruments. Patient partner co-investigators and family advisors collaborated with the study team to co-develop surveys, modify technical language, and recruit participants to the study. Together, we addressed challenges to patient engagement in COS development such as unfamiliarity with study methods, comprehensibility of materials and ongoing engagement, and power imbalances between team members. CONCLUSION Our approach to patient and family engagement in COS development for two rare conditions for children was feasible and considered valuable by all study team members, including patients and family members, in improving the relevance of the deliverable to patients. This approach to patient engagement in developing COS can be applied to other paediatric disease contexts, allowing patient and family perspectives to influence the direction of future studies to develop COS.
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Affiliation(s)
- Shelley M Vanderhout
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada
| | - Maureen Smith
- Patient Partner, Canadian Organization for Rare Disorders, Toronto, ON, Canada
| | - Nicole Pallone
- Patient Partner, Director of CanPKU and Parent of a Child with an Inherited Metabolic Disease, Toronto, ON, Canada
| | - Kylie Tingley
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada
| | - Michael Pugliese
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, 415 Smyth Road, Ottawa, ON, K1H 8M8, Canada
| | - Sylvia Stockler
- Division of Biochemical Genetics, BC Children's Hospital, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Martin Offringa
- The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, South 16, Toronto, ON, M5G 0A4, Canada
| | - Nancy Butcher
- The Hospital for Sick Children Research Institute, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, South 16, Toronto, ON, M5G 0A4, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, 250 College St, 8th Floor, Toronto, ON, M5T 1R8, Canada
| | - Stuart G Nicholls
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 501 Smyth Road, Box 201B, Ottawa, ON, K1H 8L6, Canada
| | - Beth K Potter
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Room 101, Ottawa, ON, K1G 5Z3, Canada.
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17
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Zhang H, Sun Y, Liu H, Cheng X, Ye J, Hu Q, Jia J, Wang M, Liu T, Zhou Z, Yang C, Chi H, Teng J, Su Y. Plasma exchange therapy in refractory inflammatory myopathy with anti-signal recognition particle antibody: a case series. Rheumatology (Oxford) 2021; 61:2625-2630. [PMID: 34508561 DOI: 10.1093/rheumatology/keab629] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/27/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To explore the efficacy of plasma exchange (PE) therapy in refractory idiopathic inflammatory myopathy (IIM) patients with positive anti-signal recognition particle (SRP) antibody. METHODS Nine refractory IIM patients with positive anti-SRP antibody were enrolled, who received PE therapy at Ruijin Hospital from Octobor 2017 to December 2020. The clinical manifestations, laboratory tests, chest CT and lower extremity MRI images before and after PE therapy were compared. The treatment response was evaluated by the 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) myositis response criteria. RESULTS 88.9% (8/9) subjects had achieved improvement by 3 weeks after PE therapy, with 55.6% (5/9) minimal improvement and 33.3% (3/9) moderate improvement. There were statistically significant improvements between baseline and after PE therapy at 3 weeks on the core set measures: physician global activity, patient global activity, Health Assessment Questionnaire (HAQ), manual muscle testing (MMT), extramuscular disease activity, and muscle enzymes activity including creatine kinase (CK), lactate dehydrogenase (LDH), aspartate transaminase (AST), except for alanine transaminase (ALT). Moreover, the chest CT showed regression of ground glass opacities and irregular linear opacities after PE therapy in four patients with interstitial lung disease. The MRI images of lower extremity in four patients showed reduction of muscle oedema after the therapy. CONCLUSION PE therapy is effective for refractory IIM patients with positive anti-SRP antibody. It should be considered as an alternative treatment for those patients who are resistant to the combined therapy of glucocorticoids and immunosuppressive agents.
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Affiliation(s)
- Hao Zhang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yue Sun
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Honglei Liu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaobing Cheng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junna Ye
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiongyi Hu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinchao Jia
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mengyan Wang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tingting Liu
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhuochao Zhou
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chengde Yang
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huihui Chi
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialin Teng
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yutong Su
- Department of Rheumatology and Immunology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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18
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Paik JJ, Shneyderman M, Gutierrez-Alamillo L, Albayda J, Tiniakou E, Perin J, Purwin G, Leung S, Leung D, Casciola-Rosen L, Koenig AS, Christopher-Stine L. Long Term Extension Study of Tofacitinib in Refractory Dermatomyositis. Arthritis Rheumatol 2021; 74:371-372. [PMID: 34369109 DOI: 10.1002/art.41944] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 07/06/2021] [Indexed: 11/12/2022]
Abstract
We previously demonstrated that tofacitinib was effective in treating skin-predominant refractory dermatomyositis (DM) at 12 weeks in a prospective open label clinical trial, Study of Tofacitinib In Refractory dermatomyositis (STIR) (1). Here, we report the long-term extension results of up to 96 weeks to investigate the treatment durability of tofacitinib in refractory DM. Inclusion criteria and outcome measures were the same as the parent study (1). Assessments were conducted at weeks 20, 72, and 96. The baseline demographic features of all 10 trial patients were reported previously (1).
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Affiliation(s)
- Julie J Paik
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Jemima Albayda
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eleni Tiniakou
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jamie Perin
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Grazyna Purwin
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sherry Leung
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Doris Leung
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Livia Casciola-Rosen
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Andrew S Koenig
- Formerly of Pfizer Inflammation and Immunology US Medical Affairs, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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19
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Casal-Dominguez M, Pinal-Fernandez I, Mammen AL. Inhibiting Interferon Pathways in Dermatomyositis: Rationale and Preliminary Evidence. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-021-00182-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Miao M, Li Y, Huang B, Chen J, Jin Y, Shao M, Zhang X, Sun X, He J, Li Z. Treatment of Active Idiopathic Inflammatory Myopathies by Low-Dose Interleukin-2: A Prospective Cohort Pilot Study. Rheumatol Ther 2021; 8:835-847. [PMID: 33852146 PMCID: PMC8217480 DOI: 10.1007/s40744-021-00301-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 03/17/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Treatment of idiopathic inflammatory myopathies (IIMs) is challenging due to a lack of safe and efficacious medication. Low-dose interleukin-2 (IL-2) treatment emerges as a new option in active IIMs. This study aims to explore the clinical and immunological effects of low-dose IL-2 in patients with active IIMs. METHODS Eighteen patients with active IIMs were enrolled and received 1 × 106 IU of IL-2 subcutaneously every other day for 12 weeks on top of standard care. The primary endpoint for the trial was change in percentage of regulatory T (Treg) cells in total CD4+ T cells at week 12. The secondary endpoints included the International Myositis Assessment and Clinical Studies (IMACS) definition of improvement (DOI), the 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) myositis response criteria, safety, and steroid-sparing effect at weeks 12 and 24. RESULTS With low-dose IL-2 treatment, 77.78% (14/18) patients achieved IMACS DOI and 83.33% (15/18) patients met the 2016 ACR/EULAR myositis response criteria at week 12. All individual core set measures (CSMs) including PhGA, PGA and HAQ-DI, muscle enzymes, MMT-8 and extramuscular activity were improved at week 12. The cutaneous dermatomyositis disease area and severity index activity score (CDASI-a) decreased significantly from 7 (4.5, 13) to 2 (0, 7) after IL-2 administration (P < 0.001). Proportion of Treg cells significantly increased with low-dose IL-2 treatment at week 12 (8.97% [5.77, 9.89%] vs. 15.2% [10.4, 17.3%], P = 0.009). There were no serious adverse events. CONCLUSIONS Low-dose IL-2 was effective in active IIMs and well tolerated. The amelioration of disease activity may associate with promotion of Tregs. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT04062019.
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Affiliation(s)
- Miao Miao
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yuhui Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Bo Huang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Jiali Chen
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Yuebo Jin
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Miao Shao
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Xia Zhang
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China
| | - Xiaolin Sun
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China.
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.
| | - Jing He
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China.
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.
| | - Zhanguo Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, 100044, China.
- Beijing Key Laboratory for Rheumatism Mechanism and Immune Diagnosis (BZ0135), Beijing, China.
- Peking-Tsinghua Center for Life Sciences, Beijing, China.
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Clinical Trials in Myositis: Where Do We Stand? CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2021. [DOI: 10.1007/s40674-021-00180-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paik JJ, Casciola-Rosen L, Shin JY, Albayda J, Tiniakou E, Leung DG, Gutierrez-Alamillo L, Perin J, Florea L, Antonescu C, Leung SG, Purwin G, Koenig A, Christopher-Stine L. Study of Tofacitinib in Refractory Dermatomyositis: An Open-Label Pilot Study of Ten Patients. Arthritis Rheumatol 2021; 73:858-865. [PMID: 33258553 DOI: 10.1002/art.41602] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This open-label 12-week study was conducted to evaluate the efficacy and safety of tofacitinib, a JAK inhibitor, in treatment-refractory active dermatomyositis (DM). METHODS Tofacitinib in extended-release doses of 11 mg was administered daily to 10 subjects with DM. Prior to treatment, a complete washout of all steroid-sparing agents was performed. The primary outcome measure was assessment of disease activity improvement based on the International Myositis Assessment and Clinical Studies group definition of improvement. Response rate was measured as the total improvement score according to the 2016 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) myositis response criteria. Secondary outcome measures included Cutaneous Dermatomyositis Disease Area and Severity Index (CDASI) scores, chemokine levels, immunohistochemical analysis of STAT1 expression in the skin, RNA sequencing analysis, and safety. RESULTS At 12 weeks, the primary outcome was met in all 10 subjects. Five (50%) of 10 subjects experienced moderate improvement in disease activity, and the other 50% experienced minimal improvement according to the 2016 ACR/EULAR myositis response criteria. The secondary outcome of the mean change in the CDASI activity score over 12 weeks was statistically significant (mean ± SD 28 ± 15.4 at baseline versus 9.5 ± 8.5 at 12 weeks) (P = 0.0005). Serum chemokine levels of CXCL9/CXCL10 showed a statistically significant change from baseline. A marked decrease in STAT1 signaling in association with suppression of interferon target gene expression was demonstrated in 3 of 9 skin biopsy samples from subjects with dermatomyositis. The mean ± SD level of creatine kinase in the 10 subjects at baseline was 82 ± 34.8 IU/liter, highlighting that disease activity was predominantly located in the skin. CONCLUSION This is the first prospective, open-label clinical trial of tofacitinib in DM that demonstrates strong clinical efficacy of a pan-JAK inhibitor, as measured by validated myositis response criteria. Future randomized controlled trials using JAK inhibitors should be considered for treating DM.
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Affiliation(s)
- Julie J Paik
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | - Jemima Albayda
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eleni Tiniakou
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Doris G Leung
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Jamie Perin
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Liliana Florea
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Corina Antonescu
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sherry G Leung
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Grazyna Purwin
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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Aggarwal R, Charles-Schoeman C, Schessl J, Dimachkie MM, Beckmann I, Levine T. Prospective, double-blind, randomized, placebo-controlled phase III study evaluating efficacy and safety of octagam 10% in patients with dermatomyositis ("ProDERM Study"). Medicine (Baltimore) 2021; 100:e23677. [PMID: 33429735 PMCID: PMC7793357 DOI: 10.1097/md.0000000000023677] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Dermatomyositis (DM) is an inflammatory myopathy characterized by distinct skin manifestations and muscle weakness. Intravenous immunoglobulin (IVIg) has been used off-label as adjuvant therapy in DM, but is not indicated for DM, due to lack of proven efficacy in a large randomized controlled trial. The objective of the ProDERM (Progress in DERMatomyositis) study was to evaluate the efficacy, safety and long-term tolerability of IVIg (Octagam 10%) in patients with DM in a randomized, placebo-controlled, double-blind, Phase III study. METHODS Adult patients with active DM who were continuing standard therapy at a stable dose were eligible for this study. Patients were randomized 1:1 to receive either 2 g/kg of IVIg or placebo, administered every 4 weeks until week 16 (First Period). Patients were switched to the alternate treatment if they showed clinical deterioration in the First Period. After response assessment at week 16, all patients on placebo and those without deterioration on IVIg entered the open-label Extension Period, receiving 2 g/kg IVIg every 4 weeks for 24 weeks. RESULTS The primary efficacy endpoint was the proportion of responders in the IVIg vs placebo arm at week 16, where response was defined per 2016 ACR/EULAR Myositis Response Criteria of at least minimal improvement [Total Improvement Score (TIS) ≥20] and without deterioration at 2 consecutive visits up to week 16. TIS consists of composite response criteria, combining weighted improvement in 6 core set measures (CSMs), Global Disease Activity (Physician and Patient), manual muscle testing-8 (MMT-8), Health Assessment Questionnaire, extra-muscular disease activity, and muscle enzymes. Secondary endpoints included the mean change in individual CSMs, time to improvement in TIS, time to confirmed deterioration in the First Period, and the overall proportion of patients with deteriorations. Adverse events, including infusion reactions and thromboembolic events, were recorded. CONCLUSIONS The ProDERM study was the first to assess the long-term efficacy and safety of IVIg (Octagam 10%) in a placebo-controlled, blinded, randomized trial in DM. The study aimed to inform on the use of IVIg in the treatment of DM, and results are expected in Q3 2020. CLINICALTRIALSGOV IDENTIFIER NCT02728752.
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Affiliation(s)
- Rohit Aggarwal
- University of Pittsburgh School of Medicine, Pittsburgh, PA
| | | | - Joachim Schessl
- Friedrich-Baur-Institute, Department of Neurology, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | - Irene Beckmann
- Octapharma Pharmazeutika Produktionsges.m.b.H., Vienna, Austria
| | - Todd Levine
- Department of Neurology, Phoenix Neurological Associates, Ltd., Phoenix, AZ
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Clairman H, Dover S, Whitney K, Marcuz JA, Bell-Peter A, Feldman BM. Correlation of a Modified Disease Activity Score (DAS) with the Validated Original DAS in Patients with Juvenile Dermatomyositis. J Rheumatol 2021; 48:101-104. [PMID: 32173660 DOI: 10.3899/jrheum.191255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Juvenile dermatomyositis (JDM) is a rare disease in children that is treatable, but patients may suffer from long-term effects. Clinical trials are needed to find better treatments for affected patients. Among validated tools for evaluating disease activity clinically is the Disease Activity Score (DAS), but it is not routinely collected in all clinics. We developed a modified DAS (DASmod), which can be scored using data routinely collected by our clinical staff and has been used in previous studies. The aim of this study was to determine if our DASmod correlates with the validated DAS in patients with JDM. METHODS In this study, we used DASmod (scored 0-12) and DAS (scored 0-20) scores for patients with JDM in our clinic. We analyzed the correlation between the DASmod and the validated DAS. RESULTS For 51 patients seen in our JDM clinic, the median (IQR) DASmod score was 2.0 (0-4.0) and the DAS score was 3.0 (0-5.5). Scores on the 2 tools were highly positively correlated (r = 0.94, P < 0.001, 95% CI 0.89-0.96). The linear regression was significant [R2 = 0.88, F (1, 49) = 357.60, P < 0.001] and in this dataset, the tools can be used interchangeably with the regression equation: DAS score = -0.26 + 1.5*DASmod. CONCLUSION If the regression equation from this dataset is successfully tested against future datasets, then further research collaborations between centers that collect different data related to disease activity in children with JDM will be facilitated.
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Affiliation(s)
- Hayyah Clairman
- H. Clairman, MSc, S. Dover, MSc, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
| | - Saunya Dover
- H. Clairman, MSc, S. Dover, MSc, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
| | - Kristi Whitney
- H. Clairman, MSc, S. Dover, MSc, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
| | - Jo-Anne Marcuz
- H. Clairman, MSc, S. Dover, MSc, Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children
| | - Audrey Bell-Peter
- K. Whitney, PT, MSc, J.A. Marcuz, PT, Division of Rheumatology, Department of Pediatrics, and Department of Rehabilitation, The Hospital for Sick Children
| | - Brian M Feldman
- K. Whitney, PT, MSc, J.A. Marcuz, PT, Division of Rheumatology, Department of Pediatrics, and Department of Rehabilitation, The Hospital for Sick Children;
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Landon-Cardinal O, Bachasson D, Guillaume-Jugnot P, Vautier M, Champtiaux N, Hervier B, Rigolet A, Aggarwal R, Benveniste O, Hogrel JY, Allenbach Y. Relationship between change in physical activity and in clinical status in patients with idiopathic inflammatory myopathy: A prospective cohort study. Semin Arthritis Rheum 2020; 50:1140-1149. [DOI: 10.1016/j.semarthrit.2020.06.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Revised: 05/22/2020] [Accepted: 06/17/2020] [Indexed: 02/01/2023]
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Ahn GY, Suh CH, Kim YG, Park YB, Shim SC, Lee SH, Lee SS, Bae SC, Yoo DH. Efficacy and Safety of Rituximab in Korean Patients with Refractory Inflammatory Myopathies. J Korean Med Sci 2020; 35:e335. [PMID: 32989931 PMCID: PMC7521958 DOI: 10.3346/jkms.2020.35.e335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Rituximab (RTX), a monoclonal antibody that selectively binds to CD20+ B cells, showed favorable outcomes in patients with idiopathic inflammatory myopathies (IIM) in small case series, but the evidence is still not enough. Our goal was to determine the efficacy and safety of RTX for Korean patients with refractory IIM. METHODS We retrospectively analyzed the medical records of 16 patients with refractory IIM treated with RTX in seven tertiary rheumatology clinics in the Korea. The efficacy of RTX was evaluated with the improvement of serum creatine phosphokinase (CPK) level and physician's global assessment (PGA), and daily corticosteroid dose reduction. A > 25% decrease in CPK level, corticosteroid dose, or PGA was considered significant. A complete response (CR) was designated by meeting three efficacy criteria and a partial response (PR) by only two criteria. RESULTS Sixteen patients with IIM were evaluated (13 female; median age, 51.8 years). All patients had received at least one conventional immunosuppressive agent (median, 3.6 [2.0-5.0]) and concomitant corticosteroids. The median CPK level and median dose of prednisolone was 421.0 units/L and 20.0 mg/day respectively. Eleven patients were treated with intravenous immunoglobulin. Seven patients received 2,000 mg of RTX and the others received lower dose. Twenty-four weeks after RTX treatment, 11 patients achieved a > 25% reduction in corticosteroid dose and CPK levels, and nine showed improved PGA. The overall response rate was 68.8% (11 patients). At the end of follow-up (median 24 weeks), 12 (75.0%) patients responded overall: four (25.0%) and eight (50.0%) patients achieved CR and PR, respectively. Baseline muscle enzyme levels were higher in responders than non-responders, but disease duration, RTX dose, ESR and serum CRP were not significantly different between the two groups. The rate of adverse event was 25.4/1,000 person-years. CONCLUSION RTX could be an effective and relatively safe therapeutic option in patients with refractory IIM.
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Affiliation(s)
- Ga Young Ahn
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Chang Hee Suh
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Korea
| | - Yong Gil Kim
- Division of Rheumatology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Beom Park
- Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Cheol Shim
- Division of Rheumatology, Regional Rheumatoid & Degenerative Arthritis Center, Chungnam National University Hospital, Daejeon, Korea
| | - Sang Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Shin Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Sang Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | - Dae Hyun Yoo
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
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Abstract
PURPOSE OF REVIEW To highlight new and emerging treatment targets in myositis. RECENT FINDINGS The landscape of novel therapeutics in myositis has vastly changed in the past 5 years. This is largely due to a greater understanding of the pathogenesis of myositis and validation of more robust outcome measures that standardize the ability to assess treatment response. Clinical trials in dermatomyositis are leading the way with ongoing multicenter, international phase 3 clinical trials. Proof-of-concept studies targeting the JAK/STAT pathway have also showed early promise in treating refractory dermatomyositis in adults and children. This review highlights that the future armamentarium of therapeutic drugs will likely be larger and more selective in treating different subgroups of myositis.
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Affiliation(s)
- Lauren N Smith
- Johns Hopkins University School of Medicine, 5200 Eastern Ave, MFL Building, Center Tower Suite 4100, Baltimore, MD, USA
| | - Julie J Paik
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower Suite 4500, Baltimore, MD, 21224, USA.
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Dover S, Stephens S, Schneiderman JE, Pullenayegum E, Wells GD, Levy DM, Marcuz JA, Whitney K, Schulze A, Tein I, Feldman BM. The Effect of Creatine Supplementation on Muscle Function in Childhood Myositis: A Randomized, Double-blind, Placebo-controlled Feasibility Study. J Rheumatol 2020; 48:434-441. [PMID: 32739897 DOI: 10.3899/jrheum.191375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the feasibility of studying creatine in juvenile dermatomyositis (JDM). Secondary objectives were to determine the effect of creatine on muscle function and metabolism, aerobic capacity, fatigue, physical activity, and quality of life (QOL), as well as its safety. METHODS We conducted a 6-month, double-blind, randomized, multiple-baseline design; patients were assigned to creatine or placebo. Feasibility was assessed using attended study visits, completed study procedures, and adherence. Muscle function, aerobic capacity, and muscle strength were assessed with standardized exercise tests. Muscle metabolism was assessed using a 31-Phosphorus Magnetic Resonance Spectroscopy protocol. Fatigue, physical activity, and QOL were assessed by questionnaires. Statistical significance was estimated using a randomization (permutation) test. Changes in outcome measures taken at baseline and end-of-study were calculated using paired t-tests. RESULTS Median (range) adherence to the study drug was 88.5% (20.5-95.5%) and the proportion of subjects with 80% adherence or higher was 76.9%. There were no missed study visits. There were no statistically significant changes in muscle function, strength, aerobic capacity, disease activity, fatigue, physical activity, or QOL while subjects were receiving creatine compared to placebo. There were statistically significant adaptations in muscle metabolism (e.g., decrease in change in muscle pH following exercise, and decrease in phosphate/phosphocreatine ratio) at the end-of-study compared to baseline. There were no significant adverse effects. CONCLUSION Creatine supplementation in children with JDM is feasible to study, and is safe and well-tolerated; it may lead to improvements in muscle metabolism.
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Affiliation(s)
- Saunya Dover
- S. Dover, MSc, Child Health Evaluative Sciences, The Hospital for Sick Children
| | - Samantha Stephens
- S. Stephens, PhD, Neurosciences and Mental Health, The Hospital for Sick Children
| | - Jane E Schneiderman
- J.E. Schneiderman, PhD, RKin, CEP, Clinical Research Services, Research Institute, The Hospital for Sick Children, and Faculty of Kinesiology and Physical Education, University of Toronto
| | - Eleanor Pullenayegum
- E. Pullenayegum, PhD, Child Health Evaluative Sciences, The Hospital for Sick Children, and Institute of Health Policy, Management and Evaluation, the Dalla Lana School of Public Health, University of Toronto
| | - Greg D Wells
- G.D. Wells, PhD, Translational Medicine, The Hospital for Sick Children
| | - Deborah M Levy
- D.M. Levy, MD, MS, FRCPC, Child Health Evaluative Sciences, The Hospital for Sick Children, and Department of Pediatrics, Faculty of Medicine, University of Toronto, and Division of Rheumatology, The Hospital for Sick Children
| | - Jo-Anne Marcuz
- J.A. Marcuz, MScPT, K. Whitney, MSc, BScPT, Division of Rheumatology, The Hospital for Sick Children, and Department of Rehabilitation, The Hospital for Sick Children
| | - Kristi Whitney
- J.A. Marcuz, MScPT, K. Whitney, MSc, BScPT, Division of Rheumatology, The Hospital for Sick Children, and Department of Rehabilitation, The Hospital for Sick Children
| | - Andreas Schulze
- A. Schulze, MD, PhD, Clinical and Metabolic Genetics, The Hospital for Sick Children
| | - Ingrid Tein
- I. Tein, MD, FRCPC, Division of Neurology, Department of Pediatrics and Genetics and Genome Biology Program, The Hospital for Sick Children, and Department of Laboratory Medicine and Pathobiology, University of Toronto
| | - Brian M Feldman
- B.M. Feldman, MD, MSc, FRCPC, Child Health Evaluative Sciences, The Hospital for Sick Children, and Institute of Health Policy, Management & Evaluation, the Dalla Lana School of Public Health, University of Toronto, and Department of Pediatrics, Faculty of Medicine, University of Toronto, and Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
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Abstract
INTRODUCTION Currently, there are no proven drugs that are FDA approved for the treatment of dermatomyositis (DM), even though multiple clinical trials are ongoing to evaluate safety and efficacy of novel therapeutics in DM. The purpose of this review is to highlight the biological plausibility, existing clinical evidence as well as completed and ongoing clinical trials for various drugs in pipeline for development for use in dermatomyositis. AREAS COVERED The drugs with the strongest evidence have been included in this review with a focus on the mechanism of their action pertaining to the disease process, clinical studies including completed and ongoing trials. With better understanding of the underlying pathophysiologic process, there are new molecular targets that have been identified that can be targeted by these novel drugs, predominantly biologic drugs. EXPERT OPINION There are various drugs being evaluated in phase II/III clinical trials that hold promise in DM. At the forefront of these are immunoglobulin, Lenabasum, and Abatacept for which phase III clinical trials are ongoing. In addition, promising clinical studies are ongoing or reported for KZR-616, anti-B cell therapy, anti-interferon drugs, and Repository Corticotrophin Injection (RCI).
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Affiliation(s)
- Tanya Chandra
- Internal Medicine Residency Program, University of Connecticut , Farmington, CT, USA
| | - Rohit Aggarwal
- Department of Medicine, Rheumatology and Clinical Immunology, University of Pittsburgh , Pittsburgh, PA, USA
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Campanilho-Marques R, Deakin CT, Simou S, Papadopoulou C, Wedderburn LR, Pilkington CA. Retrospective analysis of infliximab and adalimumab treatment in a large cohort of juvenile dermatomyositis patients. Arthritis Res Ther 2020; 22:79. [PMID: 32293539 PMCID: PMC7161150 DOI: 10.1186/s13075-020-02164-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 03/27/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anti-TNF treatment may be useful for the treatment of patients with refractory juvenile dermatomyositis (JDM). The aim of this study was to describe the use of infliximab and adalimumab therapy in juvenile dermatomyositis as an adjunctive treatment. METHODS Sixty children recruited to the UK JDM Cohort and Biomarker Study that had received at least 3 months of anti-TNF treatment (infliximab or adalimumab) were studied. Childhood Myositis Assessment Scale (CMAS), Manual Muscle Testing (MMT8) and physician's global assessment (PGA) were recorded. Skin disease was assessed using the modified skin disease activity score (DAS). Data were analysed using Friedman's test for repeated measures analysis of variance. RESULTS Compared to baseline, there were improvements at 6 and 12 months in skin disease (χ2(2) = 15.52, p = 0.00043), global disease (χ2(2) = 8.14, p = 0.017) and muscle disease (CMAS χ2(2) = 17.02, p = 0.0002 and MMT χ2(2) = 10.56, p = 0.005) in infliximab patients. For patients who switched from infliximab to adalimumab, there was improvement in global disease activity (χ2(2) = 6.73, p = 0.03), and trends towards improvement in CMAS, MMT8 and modified DAS. The median initial prednisolone dose was 6 [0-10] mg, and final was 2.5 [0-7.5] mg (p < 0.0001). Fifty-four per cent of patients had a reduction in the number and/or size of calcinosis lesions. Twenty-five per cent switched their anti-TNF treatment from infliximab to adalimumab. 66.7%of the switches were to improve disease control, 26.7% due to adverse events and 6.6% due to patient preference. A total of 13.9 adverse reactions occurred in 100 patient-years, of which 5.7 were considered serious. CONCLUSION Reductions in muscle and skin disease, including calcinosis, were seen following treatment with infliximab and adalimumab.
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Affiliation(s)
- Raquel Campanilho-Marques
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Serviço de Reumatologia e Doenças Ósseas Metabólicas, Hospital de Santa Maria, CHULN-Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Unidade de Investigação em Reumatologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa-Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Claire T Deakin
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, UK
| | - Stefania Simou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
| | - Charalampia Papadopoulou
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
| | - Lucy R Wedderburn
- Infection, Inflammation and Rheumatology Section, UCL Great Ormond Street Institute for Child Health, London, UK
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London, UK
| | - Clarissa A Pilkington
- Rheumatology Section, Great Ormond Street Hospital for Children NHS Trust, Level 6 Southwood Building, Great Ormond Street, London, WC1N 3JH, UK.
- NIHR Biomedical Research Centre at Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
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Alexanderson H, Boström C. Exercise therapy in patients with idiopathic inflammatory myopathies and systemic lupus erythematosus – A systematic literature review. Best Pract Res Clin Rheumatol 2020; 34:101547. [DOI: 10.1016/j.berh.2020.101547] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Clinical features and outcomes of the patients with anti-glycyl tRNA synthetase syndrome. Clin Rheumatol 2020; 39:2417-2424. [DOI: 10.1007/s10067-020-04979-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/13/2020] [Accepted: 02/07/2020] [Indexed: 12/27/2022]
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Abstract
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of inflammatory myopathies whose common feature is immune-mediated muscle injury. There are distinct subgroups including dermatomyositis (DM), polymyositis (PM), inclusion body myositis, and immune-mediated necrotizing myopathy. Antisynthetase syndrome is also emerging as a distinct subgroup with its unique muscle histopathological characteristic of perifascicular necrosis. While the newly updated EULAR/ACR Classification Criteria for IIM have brought advancements in diagnosis and the exclusion of mimickers, the use of only one autoantibody in the derivation of the schema limits its use. Similarly, while the advent of multiple novel therapeutics in the treatment of myositis has been exciting, it has also highlighted the scarcity of validated outcome measures. The purpose of our review is to highlight the updated classification criteria of myositis, newly reported clinical phenotypes associated with myositis autoantibodies, the measurement of outcomes, and emerging treatments in the field.
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Affiliation(s)
- Sara Baig
- Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, Suite 1B.1, Baltimore, MD 21224 USA
| | - Julie J Paik
- Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower Suite 4500, Baltimore, MD 21224 USA.
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DiRenzo D, Bingham CO, Mecoli CA. Patient-Reported Outcomes in Adult Idiopathic Inflammatory Myopathies. Curr Rheumatol Rep 2019; 21:62. [PMID: 31741079 DOI: 10.1007/s11926-019-0862-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Idiopathic inflammatory myopathies (IIM) have considerable impact on patient symptoms and quality of life. We have reviewed the evolution of patient-centered care and use of patient-reported outcome measures (PROMs) for adults with IIM. RECENT FINDINGS Use of PROMs in myositis care and research is limited, although the importance of incorporation into routine practice and trials has become increasingly recognized. Several key domains/measures have been identified including the patient global assessment of disease activity, physical function as measured by the health assessment questionnaire-disability index (HAQ-DI), Short Form Health Survey-36 (SF-36), or the Patient-Reported Outcome Measurement Information System ® (PROMIS®) in adult IIM. Data are limited for these instruments concerning their reliability, content and construct validity, and responsiveness. Incorporation of the patient perspective into clinical care and research may be used to address the unmet/unaddressed needs of the patient living with myositis. Several ongoing projects aim to bring validated PROMs to the IIM community.
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Affiliation(s)
- Dana DiRenzo
- The Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Clifton O Bingham
- The Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Christopher A Mecoli
- The Johns Hopkins University School of Medicine, 5200 Eastern Avenue, MFL Building, Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
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Vencovský J, Alexanderson H, Lundberg IE. Idiopathic Inflammatory Myopathies. Rheum Dis Clin North Am 2019; 45:569-581. [DOI: 10.1016/j.rdc.2019.07.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mammen AL, Allenbach Y, Stenzel W, Benveniste O. 239th ENMC International Workshop: Classification of dermatomyositis, Amsterdam, the Netherlands, 14-16 December 2018. Neuromuscul Disord 2019; 30:70-92. [PMID: 31791867 DOI: 10.1016/j.nmd.2019.10.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 10/21/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, 50 South Drive, Building 50, Room 1146, MD 20892, United States.
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Pitié Salpetrière Hospital, AP-HP Sorbonne University, Paris, France
| | - Werner Stenzel
- Department of Neuropathology, Charité-Universitatsmedizin, Berlin, Germany
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié Salpetrière Hospital, AP-HP Sorbonne University, Paris, France
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Abstract
OBJECTIVE In therapeutic trials for infant gastroesophageal reflux disease (GERD), ways to define GERD and measure and report study outcomes vary widely. The aim of this study was to develop a core outcome set (COS) for infant GERD. METHODS The COS was developed using the Delphi technique, adhering to the Outcome Measures in Rheumatology Initiative 2.0 recommendations. Healthcare professionals (HCPs) (predominantly pediatric gastroenterologists and general pediatricians) and parents of infants (age 0-12 months) with GERD, listed up to 5 primary goals of therapy from their perspective and up to 5 persistent signs or symptoms that would signify inadequate treatment. Outcomes mentioned by >10% of participants were included in 2 shortlists. Next, HCPs and parents rated and prioritized outcomes on these shortlists. Outcomes with the highest rank formed the draft COS. The final COS was created after 2 consensus meetings between an expert panel and patient representatives. RESULTS In total, 125 of 165 HCPs (76%) and 139 of 143 parents (97%) of infants with GERD completed the first phase. The second phase was completed by 83 of 139 HCPs (60%) and 127 of 142 different parents (89%). Outcomes of these phases were discussed during the consensus meetings and a 9-item COS was formed: "Adequate Growth," "Adequate Relief," "Adverse events,", "Crying," "Evidence of Esophagitis," "Feeding Difficulties," "Hematemesis," "No Escalation of Therapy," and "Sleep Problems." CONCLUSIONS We developed a COS for infant GERD consisting of 9 items that should minimally be measured in future therapeutic trials to decrease study heterogeneity and ease comparability of results.
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Meyer A, Scirè CA, Talarico R, Alexander T, Amoura Z, Avcin T, Barsotti S, Beretta L, Blagojevic J, Burmester G, Cavazzana I, Cherrin P, Damian L, Doria A, Fonseca JE, Furini F, Galetti I, Houssiau F, Krieg T, Larosa M, Launay D, Campanilho-Marques R, Martin T, Matucci-Cerinic M, Moinzadeh P, Montecucco C, Moraes-Fontes MF, Mouthon L, Neri R, Paolino S, Piette Y, Rednic S, Tamirou F, Tincani A, Toplak N, Bombardieri S, Hachulla E, Mueller-Ladner U, Schneider M, Smith V, Vieira A, Cutolo M, Mosca M, Cavagna L. Idiopathic inflammatory myopathies: state of the art on clinical practice guidelines [corrected]. RMD Open 2019; 4:e000784. [PMID: 30886730 PMCID: PMC6397434 DOI: 10.1136/rmdopen-2018-000784] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 12/16/2022] Open
Abstract
Idiopathic inflammatory myopathies (IIMs) encompass a heterogeneous group of rare autoimmune diseases characterised by muscle weakness and inflammation, but in antisynthetase syndrome arthritis and interstitial lung disease are more frequent and often inaugurate the disease. Clinical practice guidelines (CPGs) have been proposed for IIMs, but they are sparse and heterogeneous. This work aimed at identifying: i) current available CPGs for IIMs, ii) patients ' and clinicians' unmet needs not covered by CPGs. It has been performed in the framework of the European Reference Network on rare and complex connective tissue and musculoskeletal diseases (ReCONNET), a network of centre of expertise and patients funded by the European Union's Health Programme. Fourteen original CPGs were identified, notably recommending that: i) extra-muscular involvements should be assessed; ii) corticosteroids and methotrexate or azathioprine are first-line therapies of IIMs. ii) IVIG is a treatment of resistant-DM that may be also used in other resistant-IIMs; iii) physical therapy and sun protection (in DM patients) are part of the treatment; v) tumour screening for patients with DM include imaging of chest, abdomen, pelvis and breast (in woman) along with colonoscopy (in patients over 50 years); vi) disease activity and damages should be monitor using standardised and validated tools. Yet, only half of these CPGs were evidence-based. Crucial unmet needs were identified both by patients and clinicians. In particular, there was a lack of large multidisciplinary working group and of patients ' preferences. The following fields were not or inappropriately targeted: diagnosis; management of extra-muscular involvements other than skin; co-morbidities and severe manifestations.
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Affiliation(s)
- Alain Meyer
- Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Service de humatologie, Service de physiologie, Unité d’explorations fonctionnelles musculaires, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
- EA3072, Fédération de Médecine Translationelle, Université de Strasbourg, Strasbourg, France
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Tobias Alexander
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Zahir Amoura
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Simone Barsotti
- Rheumatology Unit, University of Pisa, Pisa, Italy
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmue Diseases, Referral Center for Systemic Autoimmue DiseasesFondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Jelena Blagojevic
- Department of Clinical and Experimental Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, University of Florence, AOUC, Florence, Italy
| | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital Berlin, Berlin, Germany
| | - Ilaria Cavazzana
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Patrick Cherrin
- Department of Internal Medicine, Hospital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Laura Damian
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Federica Furini
- Section of Rheumatology, Department of Medical Sciences, Sant’Anna University Hospital, Ferrara, Italy
| | - Ilaria Galetti
- FESCA, Federation of European Scleroderma Associations, Milan, Italy
| | - Frederic Houssiau
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Thomas Krieg
- Department of Dermatology, Universitätsklinikum Köln, Cologne, Germany
| | - Maddalena Larosa
- Rheumatology Unit, Department of Medicine, AO Padova and University of Padua, Padua, Italy
| | - David Launay
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), Université de Lille, CHU Lille, LIRIC, INSERM, Lille, France
| | - Raquel Campanilho-Marques
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Thierry Martin
- Departement of Internal Medicine, Centre National de Référence des Maladies Systémiques et Auto-immunes Rares Grand-Est Sud-Ouest (RESO), Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Marco Matucci-Cerinic
- Department of Clinical and Experimental Medicine, Department of Geriatric Medicine, Division of Rheumatology and Scleroderma Unit, University of Florence, AOUC, Florence, Italy
| | - Pia Moinzadeh
- Department of Dermatology, Universitätsklinikum Köln, Cologne, Germany
| | | | - Maria Francisca Moraes-Fontes
- Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, Lisbon, Portugal
| | - Luc Mouthon
- Service de Médecine Interne, Centre de Référence Maladies systémiques Autoimmunes Rares d’Ile de France, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Cochin, Université Paris Descartes, Paris, France
| | | | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Yves Piette
- Department of Rheumatology, Department of Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Simona Rednic
- Department of Rheumatology, Emergency County Teaching Hospital, Cluj-Napoca, Romania
| | - Farah Tamirou
- Department of Rheumatology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Civil Hospital, Brescia, Italy
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Eric Hachulla
- Département de Médecine Interne et Immunologie Clinique, Centre de Référence des Maladies Systémiques et Auto-Immunes Rares du Nord-Ouest (CERAINO), Université de Lille, CHU Lille, LIRIC, INSERM, Lille, France
| | - Ulf Mueller-Ladner
- Department of Rheumatology and Clinical Immunology, Kerckhoff Klinik, Justus-Liebig University of Giessen, Bad Nauheim, Germany
| | - Matthias Schneider
- Department of Rheumatology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Vanessa Smith
- Department of Rheumatology, Department of Internal Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ana Vieira
- Liga Portuguesa Contra as Doenças Reumáticas, Núcleo Síndrome de Sjögren, Lisbon, Portugal
| | - Maurizio Cutolo
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, IRCCS Polyclinic Hospital San Martino, University of Genoa, Genoa, Italy
| | - Marta Mosca
- Rheumatology Unit, AOU Pisana, Pisa, Italy
- Rheumatology Unit, University of Pisa, Pisa, Italy
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
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Leclair V, Galindo-Feria AS, Dastmalchi M, Holmqvist M, Lundberg IE. Efficacy and safety of rituximab in anti-synthetase antibody positive and negative subjects with idiopathic inflammatory myopathy: a registry-based study. Rheumatology (Oxford) 2019; 58:1214-1220. [DOI: 10.1093/rheumatology/key450] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/13/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Valérie Leclair
- Division of Rheumatology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- Division of Rheumatology, Jewish General Hospital, Montreal, Quebec, Canada
| | - Angeles Shunashy Galindo-Feria
- Division of Rheumatology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Maryam Dastmalchi
- Division of Rheumatology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Marie Holmqvist
- Division of Rheumatology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Solna, and Center for Molecular Medicine, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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Rosina S, Consolaro A, van Dijkhuizen P, Pistorio A, Varnier GC, Bovis F, Nistala K, Maillard S, Civino A, Tsitsami E, de Inocencio J, Jelusic M, Vojinovic J, Espada G, Makay B, Katsicas MM, Pratsidou-Gertsi P, Lazarevic D, Rao AP, Pires Marafon D, Martini A, Pilkington C, Ruperto N, Ravelli A. Development and validation of a composite disease activity score for measurement of muscle and skin involvement in juvenile dermatomyositis. Rheumatology (Oxford) 2019; 58:1196-1205. [DOI: 10.1093/rheumatology/key421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/01/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Silvia Rosina
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Alessandro Consolaro
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Angela Pistorio
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Camilla Varnier
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Francesca Bovis
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Kiran Nistala
- Paediatric Rheumatology Department, Great Ormond Street Hospital, London, UK
| | - Susan Maillard
- Paediatric Rheumatology Department, Great Ormond Street Hospital, London, UK
| | - Adele Civino
- Oncoematologia Pediatrica, Ospedale Vito Fazzi, Lecce, Italy
| | - Elena Tsitsami
- First Department of Pediatrics, Children’s Hospital Agia Sofia, Athens, Greece
| | - Jaime de Inocencio
- Unidad de Reumatología Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marija Jelusic
- Department of Pediatrics, University of Zagreb, Zagreb, Croatia
| | | | - Graciela Espada
- Pediatric Rheumatology Unit, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Balahan Makay
- Division of Pediatric Rheumatology, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Maria Martha Katsicas
- Servicio de Inmunologia/Reumatologia, Hospital de Pediatría Juan P.Garrahan, Buenos Aires, Argentina
| | | | | | | | - Denise Pires Marafon
- Clinica Pediatrica De Marchi, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Martini
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Clarissa Pilkington
- Paediatric Rheumatology Department, Great Ormond Street Hospital, London, UK
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Idiopathic inflammatory myopathies with anti-mitochondrial antibodies: Clinical features and treatment outcomes in a Chinese cohort. Neuromuscul Disord 2019; 29:5-13. [DOI: 10.1016/j.nmd.2018.11.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 11/06/2018] [Accepted: 11/11/2018] [Indexed: 12/19/2022]
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Kohsaka H, Mimori T, Kanda T, Shimizu J, Sunada Y, Fujimoto M, Kawaguchi Y, Jinnin M, Muro Y, Ishihara S, Tomimitsu H, Ohta A, Sumida T. Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists. Mod Rheumatol 2018; 29:1-19. [DOI: 10.1080/14397595.2018.1521185] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Sunada
- Department of Neurology, Kawasaki Medical School, Okayama, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Kawaguchi
- Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichiro Ishihara
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroyuki Tomimitsu
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akiko Ohta
- Division of Public Health, Department of Social Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Kohsaka H, Mimori T, Kanda T, Shimizu J, Sunada Y, Fujimoto M, Kawaguchi Y, Jinnin M, Muro Y, Ishihara S, Tomimitsu H, Ohta A, Sumida T. Treatment consensus for management of polymyositis and dermatomyositis among rheumatologists, neurologists and dermatologists. J Dermatol 2018; 46:e1-e18. [PMID: 30562845 DOI: 10.1111/1346-8138.14604] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 12/27/2022]
Abstract
Although rheumatologists, neurologists and dermatologists see patients with polymyositis (PM) and dermatomyositis (DM), their management appears to vary depending on the physician's specialty. The aim of the present study was to establish the treatment consensus among specialists of the three fields to standardize the patient care. We formed a research team supported by a grant from the Ministry of Health, Labor and Welfare, Japan. Clinical questions (CQ) on the management of PM and DM were raised. A published work search on CQ was performed primarily using PubMed. Using the nominal group technique, qualified studies and results in the published work were evaluated and discussed to reach consensus recommendations. They were sent out to the Japan College of Rheumatology, Japanese Society of Neurology and Japanese Dermatological Association for their approval. We reached a consensus in 23 CQ and made recommendations and a decision tree for management was proposed. They were officially approved by the three scientific societies. In conclusion, a multidisciplinary treatment consensus for the management of PM and DM was established for the first time.
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Affiliation(s)
- Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tsuneyo Mimori
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takashi Kanda
- Department of Neurology and Clinical Neuroscience, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Jun Shimizu
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yoshihide Sunada
- Department of Neurology, Kawasaki Medical School, Okayama, Japan
| | - Manabu Fujimoto
- Department of Dermatology, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Yasushi Kawaguchi
- Department of Rheumatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masatoshi Jinnin
- Department of Dermatology, Wakayama Medical University Graduate School of Medicine, Wakayama, Japan
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shoichiro Ishihara
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Hiroyuki Tomimitsu
- Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akiko Ohta
- Division of Public Health, Department of Social Medicine, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Takayuki Sumida
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Abstract
Purpose of the review A growing body of evidence supports exercise as a very important part of the treatment for adult patients with idiopathic inflammatory myopathies (IIM). This review mainly focuses on exercise studies published during the last 2 years in adult myositis. Recent findings During the last couple of years, new publications present further evidence for intensive endurance exercise as an anti-inflammatory treatment inducing muscle growth and improving mitochondrial function compared a non-exercising control group. Further, blood-flow restricted resistance training was effective to maintain muscle strength compared to a non-exercising control group which lost a mean of 9.2% in quadriceps strength over 3 months in inclusion body myositis. Another study evaluates the effects of intra-muscular injections of an isoform of follistatin (FS344) by AAV1 in combination with exercise in a small group of patients with inclusion body myositis. An improvement in physical capacity was associated to higher exercise levels. Less is known about exercise effects in patients with recent onset, active polymyositis, and dermatomyositis. Summary All studies report safety of exercise in all types and stages of myositis and exercise could now be considered as medicine. It is recommended to initiate exercise on a low intensity under supervision of a physical therapist with regular follow-up and progression of intensity over time.
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Affiliation(s)
- Helene Alexanderson
- Department of NVS, Huddinge, Karolinska Institutet and Department of Medicine, Karolinska Institutet, Solna and Function Area Occupational Therapy and Physical Therapy, Karolinska University Hospital, SE-171 76 Stockholm, Sweden
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Tang Q, Ramsköld D, Krystufkova O, Mann HF, Wick C, Dastmalchi M, Lakshmikanth T, Chen Y, Mikes J, Alexanderson H, Achour A, Brodin P, Vencovsky J, Lundberg IE, Malmström V. Effect of CTLA4-Ig (abatacept) treatment on T cells and B cells in peripheral blood of patients with polymyositis and dermatomyositis. Scand J Immunol 2018; 89:e12732. [PMID: 30451307 DOI: 10.1111/sji.12732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 11/29/2022]
Abstract
We aimed to evaluate in vivo effects of abatacept on phenotypes of T and B cells in the circulation of myositis patients in a sub-study of the ARTEMIS trial. Twelve patients with paired frozen PBMCs before and after 6-month abatacept treatment were included in this sub-study where mass cytometry (CyTOF) was chosen as a technology to be tested for its utility in a real-life clinical immune monitoring setting. Using CyTOF, the peripheral T cell phenotypes demonstrated considerable variation over time and between individuals precluding the identification of treatment-specific changes. We therefore conclude that studies of patient cohorts displaying wide clinical heterogeneity using mass cytometry must be relatively large in order to be suited for discovery research and immune monitoring. Still, we did find some correlations with functional muscle outcome, namely positive correlations between the ratio of CD4+ T cells and CD8+ T cells (CD4/CD8) in peripheral blood samples both at baseline and after treatment with muscle endurance improvement as assessed by the functional index-2 (FI-2) test. Our data suggest that the CD4/CD8 ratio in circulation at time of active disease may be a predictor of treatment efficacy in myositis patients.
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Affiliation(s)
- Quan Tang
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Ramsköld
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Herman F Mann
- Institute of Rheumatology Prague, Prague, Czech Republic
| | - Cecilia Wick
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Maryam Dastmalchi
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Tadepally Lakshmikanth
- Science for Life Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Yang Chen
- Science for Life Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Jaromir Mikes
- Science for Life Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helene Alexanderson
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden.,Functional Area Occupational Therapy and Physical Therapy, Karolinska University Hospital, and Division of Physiotherapy, Department of NVS, Karolinska Institutet, Stockholm, Sweden
| | - Adnane Achour
- Science for Life Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Petter Brodin
- Science for Life Laboratory, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Department of Neonatology, Karolinska University Hospital, Stockholm, Sweden
| | - Jiri Vencovsky
- Institute of Rheumatology Prague, Prague, Czech Republic
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Vivianne Malmström
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
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Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, Cuttica R, Ilowite NT, Khubchandani R, Laxer RM, Lovell DJ, Petty RE, Wallace CA, Wulffraat NM, Pistorio A, Ruperto N. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. J Rheumatol 2018; 46:190-197. [PMID: 30275259 DOI: 10.3899/jrheum.180168] [Citation(s) in RCA: 258] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To revise the current juvenile idiopathic arthritis (JIA) International League of Associations for Rheumatology (ILAR) classification criteria with an evidence-based approach, using clinical and routine laboratory measures available worldwide, to identify homogeneous clinical groups and to distinguish those forms of chronic arthritis typically seen only in children from the childhood counterpart of adult diseases. METHODS The overall project consists of 4 steps. This work represents Step 1, a Delphi Web-based consensus and Step 2, an international nominal group technique (NGT) consensus conference for the new provisional Pediatric Rheumatology International Trials Organization JIA classification criteria. A future large data collection of at least 1000 new-onset JIA patients (Step 3) followed by analysis and NGT consensus (Step 4) will provide data for the evidence-based validation of the JIA classification criteria. RESULTS In Step 1, three Delphi rounds of interactions were implemented to revise the 7 ILAR JIA categories. In Step 2, forty-seven questions with electronic voting were implemented to derive the new proposed criteria. Four disorders were proposed: (a) systemic JIA; (b) rheumatoid factor-positive JIA; (c) enthesitis/spondylitis-related JIA; and (d) early-onset antinuclear antibody-positive JIA. The other forms were gathered under the term "others." These will be analyzed during the prospective data collection using a list of descriptors to see whether the clustering of some of them could identify homogeneous entities. CONCLUSION An international consensus was reached to identify different proposed homogeneous chronic disorders that fall under the historical term JIA. These preliminary criteria will be formally validated with a dedicated project.
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Affiliation(s)
- Alberto Martini
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands. .,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO.
| | - Angelo Ravelli
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Tadej Avcin
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Michael W Beresford
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Ruben Burgos-Vargas
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Ruben Cuttica
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Norman T Ilowite
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Raju Khubchandani
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Ronald M Laxer
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Daniel J Lovell
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Ross E Petty
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Carol A Wallace
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Nico M Wulffraat
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Angela Pistorio
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Nicolino Ruperto
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
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Ran J, Ji S, Morelli JN, Wu G, Li X. T2 mapping in dermatomyositis/polymyositis and correlation with clinical parameters. Clin Radiol 2018; 73:1057.e13-1057.e18. [PMID: 30172348 DOI: 10.1016/j.crad.2018.07.106] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 07/24/2018] [Indexed: 12/24/2022]
Abstract
AIM To explore the T2-mapping signal characteristics of the thigh muscles in patients with dermatomyositis/polymyositis (DM/PM) and to investigate the correlation between thigh muscle T2 values, clinical parameters, and serum creatinine kinase (CK). MATERIALS AND METHODS Forty-two patients with DM/PM proven by diagnostic criteria were enrolled in the study along with 13 healthy control subjects. Both T2-mapping and conventional magnetic resonance imaging (MRI) images were obtained in the thigh musculature of all subjects. The T2 values of thigh muscles were compared between the DM/PM patients and control groups. Thirty-one DM/PM patients were evaluated with manual muscle testing (MMT) and serum CK levels. A Spearman correlation coefficient model was used to correlate the mean T2 values and clinical assessments. The Kruskal-Wallis test and receiver operating characteristic (ROC) curves were also utilised. p-Values <0.05 reflected statistical significance. RESULTS The T2 value of all oedematous muscles was greater on average than that of the unaffected muscles of the DM/PM patients (p<0.05) and the muscles of healthy volunteers (p<0.05). The T2 value of unaffected muscles in DM/PM patients was also greater than that of the normal muscles in healthy volunteers (p<0.05). The area under the curves (AUCs) for T2 relaxation time values was 0.72 with respective sensitivity and specificity of 72.6% and 65.4%. The mean T2 relaxation time of the 31 patients group and the MMTs (p<0.05) was correlated without serum CK levels (p>0.05). CONCLUSION T2 mapping is not only quantitatively used for subclinical muscle involvement in DM/PM, but also be used to demonstrate severity of damaged muscles in DM/PM.
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Affiliation(s)
- J Ran
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - S Ji
- Department of Neurology, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - J N Morelli
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - G Wu
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China
| | - X Li
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
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Jørgensen AN, Aagaard P, Frandsen U, Boyle E, Diederichsen LP. Blood-flow restricted resistance training in patients with sporadic inclusion body myositis: a randomized controlled trial. Scand J Rheumatol 2018; 47:400-409. [PMID: 29775118 DOI: 10.1080/03009742.2017.1423109] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the effect of 12 weeks of low-load blood-flow restricted resistance (BFR) training on self-reported and objective physical function, and maximal muscle strength in patients with sporadic inclusion body myositis (sIBM). METHOD Twenty-two patients with sIBM were randomized into a training group (BFR group) or a non-exercising control group, according to CONsolidated Standards Of Reporting Trials (CONSORT) guidelines. The BFR group performed 12 weeks of BFR training twice per week. The primary outcome was the physical function domain of the 36-item Short Form Health Survey (pf-SF-36), which was used to measure self-reported physical function. All patients performed physical function tests (2-Minute Walk Test, Timed Up and Go, and 30-Second Chair Stand), completed the Inclusion Body Myositis Functional Rating Scale (IBMFRS), and were tested for isolated knee extensor muscle strength. RESULTS No effects of the training intervention were observed for pf-SF-36 or the objective physical function tests. Leg muscle strength decreased in controls (-9.2%, p = 0.02), but was unaltered in the BFR group (+0.9%, p = 0.87), resulting in a between-group difference in the per-protocol analysis (p = 0.026). Between-group differences in baseline to follow-up changes emerged for IBMFRS, in favour of the BFR group (p = 0.018). CONCLUSION Twelve weeks of BFR training did not improve self-reported or objective physical function in these sIBM patients. However, the training protocol had a preventive (retaining) effect on the disease-related decline in leg muscle strength, which may aid the long-term preservation of physical function and postpone the need for healthcare assistance.
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Affiliation(s)
- A N Jørgensen
- a Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC) , University of Southern Denmark , Odense , Denmark.,b Department of Clinical Research , University of Southern Denmark , Odense , Denmark
| | - P Aagaard
- a Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC) , University of Southern Denmark , Odense , Denmark
| | - U Frandsen
- a Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC) , University of Southern Denmark , Odense , Denmark
| | - E Boyle
- a Department of Sports Science and Clinical Biomechanics, SDU Muscle Research Cluster (SMRC) , University of Southern Denmark , Odense , Denmark.,c Division of Epidemiology, Dalla Lana School of Public Health , University of Toronto , Toronto , ON , Canada
| | - L P Diederichsen
- b Department of Clinical Research , University of Southern Denmark , Odense , Denmark.,d Department of Rheumatology , Odense University Hospital , Odense , Denmark
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Abstract
Idiopathic inflammatory myopathies (IIMs) are heterogeneous disorders that affect the skeletal muscles. Polymyositis, dermatomyositis, and inclusion body myositis are major IIM subsets. Immune-mediated necrotizing myopathy became recognized as a potentially new IIM subset. Since the new classification criteria published by the International Myositis Classification Criteria Project have higher sensitivity and specificity for IIM classification and subclassification than the previous criteria, they should help precise diagnosis. It should be noted that several tests available in current clinical practice, such as electromyography, magnetic resonance imaging, and other myositis-specific autoantibodies than anti-Jo-1 antibodies, were not included in the new criteria. As for treatment, glucocorticoids are used empirically as the first-line treatment despite their various adverse effects. Concomitant treatment with steroid-sparing immunosuppressive agents, including methotrexate, azathioprine, calcineurin inhibitors, mycophenolate mofetil, and cyclophosphamide, reduces successfully initial glucocorticoid doses for the remission induction, the relapse risk during glucocorticoid tapering, and adverse effects of glucocorticoids. Treatment with biologics, including rituximab and abatacept, seems promising in some IIM patients. Multi-target treatment with glucocorticoids and several steroid-sparing immunosuppressive agents is effective in refractory IIM patients. Considering proven steroid-sparing efficacy and tolerability of multi-target treatment in patients with other autoimmune diseases, it should be a good therapeutic option for IIMs.
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Affiliation(s)
- Hirokazu Sasaki
- a Department of Rheumatology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Hitoshi Kohsaka
- a Department of Rheumatology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
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