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Elnaggar RK, Mahmoud WS, Abdelbasset WK, Alqahtani BA, Alrawaili SM, Elfakharany MS. Low-energy laser therapy application on knee joints as an auxiliary treatment in patients with polyarticular juvenile idiopathic arthritis: a dual-arm randomized clinical trial. Lasers Med Sci 2021; 37:1737-1746. [PMID: 34599401 DOI: 10.1007/s10103-021-03427-6] [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] [Received: 05/20/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
Patients with juvenile idiopathic arthritis (JIA) always experience persistent pain and stiffness which induces muscle weakness, fatigue, and functional limitations. This study evaluated whether applying low-energy laser therapy (LLT) on the knee joint could be an effective adjuvant intervention for patients with JIA. Sixty children with polyarticular JIA participated and were randomly allocated to receive either LLT (wavelength λ = 903 nm; power output of 50 mW; and energy of 1.5 J) plus exercises (LLT group) or exercises alone (control group). Pain, peak concentric torque of quadriceps muscles, fatigue, and functional status were measured by the visual analogue scale, isokinetic testing system, Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, and Childhood Health Assessment Questionnaire, respectively pre- and post-intervention, and at 6-month follow-up. Per the mixed-model analysis of variance, the LLT group showed a statistically more favorable improvement in pain (P = .003, ηp2 = .014), fatigue perception (P = .004, ηp2 = .015), and functional status (P = .022, ηp2 = .09) across the three assessment occasions, as compared to the control group. However, no significant difference was demonstrated between both groups concerning peak concentric torque (all P > .05). Incorporation of LLT into the standard physical rehabilitation program for patients with JIA has the potential to induce more conducive improvements in pain, fatigue, and functional performance, but is not effective for improving muscle performance.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia. .,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
| | - Waleed S Mahmoud
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia.,Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walid K Abdelbasset
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia.,Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Bader A Alqahtani
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia
| | - Saud M Alrawaili
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia
| | - Mahmoud S Elfakharany
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Leblebici G, Ovacik U, Gungor F, Davids JR, Tarakci E, Kasapcopur O. Validity and reliability of "Shriners Hospital for Children Upper Extremity Evaluation" in children with rheumatic diseases. Clin Rheumatol 2021; 40:5033-5040. [PMID: 34350521 DOI: 10.1007/s10067-021-05866-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 06/26/2021] [Accepted: 07/19/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION/OBJECTIVES The aim of this study was to investigate the validity and reliability of "Shriners Hospital for Children Upper Extremity Evaluation (SHUEE)" for children with rheumatic diseases. METHODS The study was carried out after obtaining the necessary permissions and retrospectively registered. The psychometric properties evaluated were reliability and concurrent validity. Reliability was determined by intra- and inter-observer agreement. Concurrent validity was performed using the Jebsen Taylor Hand Function Test (JTHFT), Abilhand-Rheumatoid Arthritis (Abilhand-RA), and Children Health Assessment Questionnaire (CHAQ). The validity and reliability of the evaluation were determined after the retest 1 week later. RESULTS Twenty children with rheumatic diseases were participated in to study. Intraclass coefficients ranged from 0.82 to 0.97 and the intraobserver reliability for SHUEE total and subscales were considered "excellent." Interobserver reliability was considered "excellent" for the SHUUE total score, spontaneous functional analysis and dynamic positional analysis, and "moderate" for grasp-release. A moderate negative correlation was determined between Spontaneous Functional Analysis and JTHFT (r = - 0.63; p = 0.003). CONCLUSION SHUEE is a valid and reliable evaluation for children with rheumatic diseases. ClinicalTrials.org NCT04685434/21.12.2020 Key Points • SHUEE tends to be appropriate and acceptable to children with rheumatic diseases. • SHUEE can be used safely in the pediatric rheumatology group and it is beneficial in the clinical decision-making process. • SHUEE is a pioneering performance test that evaluates the quality of movement in pediatric rheumatology on a joint basis.
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Affiliation(s)
- Gokce Leblebici
- Division of Physiotherapy and Rehabilitation, Faculty of Health Science, Istanbul Medeniyet University, Dumlupınar, D100 No:98, Kadıköy, 34000, Istanbul, Turkey. .,Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey.
| | - Ugur Ovacik
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Physiotherapy Program, Department of Medical Services and Techniques, Vocational School of Health Services, Istanbul Aydin University, Istanbul, Turkey
| | - Feray Gungor
- Department of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Jon Robert Davids
- Pediatric Orthopedic Surgery, Motion Analysis Laboratory, Shriners Hospitals for Children-Northern California, Sacramento, CA, USA
| | - Ela Tarakci
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Cerrahpasa Medical School, Department of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul, Turkey
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3
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Shoop-Worrall SJW, Oude Voshaar MAH, McDonagh JE, Van de Laar MAFJ, Wulffraat N, Thomson W, Hyrich KL, Verstappen SMM. Common Functional Ability Score for Young People With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2021; 73:947-954. [PMID: 32286729 DOI: 10.1002/acr.24204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/31/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE As young people enter adulthood, the interchangeable use of child and adult outcome measures may inaccurately capture changes over time. This study aimed to use item response theory (IRT) to model a continuous score for functional ability that can be used no matter which questionnaire is completed. METHODS Adolescents (ages 11-17 years) in the UK Childhood Arthritis Prospective Study (CAPS) self-completed an adolescent Childhood Health Assessment Questionnaire (CHAQ) and a Health Assessment Questionnaire (HAQ). Their parents answered the proxy-completed CHAQ. Those children with at least 2 simultaneously completed questionnaires at initial presentation or 1 year were included. Psychometric properties of item responses within each questionnaire were tested using Mokken analyses to assess the applicability of IRT modeling. A previously developed IRT model from the Pharmachild-NL registry from The Netherlands was validated in CAPS participants. Agreement and correlations between IRT-scaled functional ability scores were tested using intraclass correlations and Wilcoxon's signed rank tests. RESULTS In 303 adolescents, the median age at diagnosis was 13 years, and 61% were female. CHAQ scores consistently exceeded HAQ scores. Mokken analyses demonstrated high scalability, monotonicity, and the fact that each questionnaire yielded reliable scores. There was little difference in item response characteristics between adolescents enrolled in CAPS and Pharmachild-NL (maximum item residual 0.08). Significant differences were no longer evident between IRT-scaled HAQ and CHAQ scores. CONCLUSION IRT modeling allows the direct comparison of function scores regardless of different questionnaires being completed by different people over time. IRT modeling facilitates the ongoing assessment of function as adolescents transfer from pediatric clinics to adult services.
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Affiliation(s)
| | | | - Janet E McDonagh
- University of Manchester and Manchester Academic Health Sciences Centre, NIHR Manchester Biomedical Research Centre, and Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | | | - Nico Wulffraat
- University Medical Center Utrecht and European Reference Network-RITA, Utrecht, The Netherlands
| | - Wendy Thomson
- University of Manchester and Manchester Academic Health Sciences Centre, NIHR Manchester Biomedical Research Centre, and Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Kimme L Hyrich
- University of Manchester and Manchester Academic Health Sciences Centre, NIHR Manchester Biomedical Research Centre, and Manchester University Hospital NHS Foundation Trust, Manchester, UK
| | - Suzanne M M Verstappen
- University of Manchester and Manchester Academic Health Sciences Centre, NIHR Manchester Biomedical Research Centre, and Manchester University Hospital NHS Foundation Trust, Manchester, UK
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Ouyang H, Gao X, Zhang J. Symptom measures in pediatric narcolepsy patients: a review. Ital J Pediatr 2021; 47:124. [PMID: 34078436 PMCID: PMC8173823 DOI: 10.1186/s13052-021-01068-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/13/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose This study aimed to provide a summary of the measures to assess narcoleptic symptoms or complications in pediatric narcolepsy patients. Methods We searched in the National Center for Biotechnology Information (NCBI) for measures of narcoleptic symptoms for pediatric patients. Further review was conducted if relevant questionnaires or information were mentioned. Results There were only two narcolepsy-specific questionnaires, the narcolepsy severity scale and Ullanlinna Narcolepsy Scale, neither of them was developed or validated in the pediatric population. For cataplexy, all the measures were study-specific diaries and were not validated questionnaires. For excessive daytime sleepiness, the Epworth Sleepiness Scale was most frequently used to measure excessive daytime sleepiness in children. For nighttime sleep, the Children’s Sleep Habits Questionnaire was most frequently used. For depression, the Children Depression Inventory was the most frequently used. For attention-deficit/hyperactivity disorder, the Child Behavior Checklist was the most frequently used. For quality of life, KIDSCREEN was most frequently used. Conclusions At present, there is a lack of disease-specific and validated questionnaires for pediatric narcoleptic patients. This need can be met by modifying and adjusting the existing adult questionnaires and developing new questionnaires for pediatric narcoleptic patients.
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Affiliation(s)
- Hui Ouyang
- Department of Neuromedicine, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Xuguang Gao
- Department of Neuromedicine, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China
| | - Jun Zhang
- Department of Neuromedicine, Peking University People's Hospital, 11 Xizhimen South Street, Beijing, China.
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5
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Trachtman R, Wang CM, Murray E, Szymonifka J, Pan N, Adams AB, Taber SF, Onel KB, Mandl LA. PROMIS Computer Adaptive Tests and Their Correlation With Disease Activity in Juvenile Idiopathic Arthritis. J Clin Rheumatol 2021; 27:131-135. [PMID: 31743268 PMCID: PMC10364139 DOI: 10.1097/rhu.0000000000001171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND/OBJECTIVE The importance of patient-reported outcomes, like the Patient-Reported Outcomes Measurement Information System (PROMIS) measures, is increasingly recognized both in clinical care and in research. While "short forms" have been studied in juvenile idiopathic arthritis (JIA), study of PROMIS computer adaptive tests (CATs) in JIA is limited. This cross-sectional study evaluates whether PROMIS CATs correlate with disease activity in patients with JIA. METHODS A convenience sample of patients with JIA (N = 44) was recruited from a single center. Patients and parents completed pediatric and parent proxy PROMIS CATs. Disease activity was evaluated using the Juvenile Arthritis Disease Activity Score in 71 joints (JADAS-71) and the Childhood Health Assessment Questionnaire (CHAQ). Correlation of the CAT T scores with disease activity was assessed using Spearman correlation coefficients. RESULTS Forty-four of 80 eligible subjects (29 patients and 15 parents) completed all or some PROMIS CATs. Pain interference and mobility CATs correlated moderately with JADAS-71. Nearly all correlations with the JADAS-71 were weakened when the patient global was removed. Pain interference, mobility, and fatigue were strongly correlated with the CHAQ. Among parent proxy CATs, only mobility and depressive symptoms correlated strongly with the CHAQ. CONCLUSIONS Only pain interference and mobility PROMIS CATs showed strong correlation with standard disease activity measures in JIA, and nearly all correlations were weakened when the patient global was removed. Correlations of the CATs with the CHAQ were stronger than correlations with the JADAS-71, indicating that although the CHAQ is no longer routinely used it may be a better measure of health-related quality of life in routine clinical care.
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Affiliation(s)
| | | | | | | | - Nancy Pan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Alexa B. Adams
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Sarah F. Taber
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Karen B. Onel
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Lisa A. Mandl
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
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6
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Trachtman R, Murray E, Wang CM, Szymonifka J, Toussi SS, Walters H, Nellis ME, Onel KB, Mandl LA. Procalcitonin Differs in Children With Infection and Children With Disease Flares in Juvenile Idiopathic Arthritis. J Clin Rheumatol 2021; 27:87-91. [PMID: 31693652 PMCID: PMC10364140 DOI: 10.1097/rhu.0000000000001170] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVE Patients with juvenile idiopathic arthritis (JIA) often present with signs and symptoms suggestive of serious bacterial infection (SBI). Procalcitonin (PCT) is a biomarker that is elevated in SBI. We conducted a comparative cohort study to test the hypothesis that PCT levels will differ between active JIA, quiescent JIA, and bacteremic patients and healthy controls. METHODS From October 2016 to May2018, consecutive children 6 months to 18 years of age with (a) active untreated JIA, (b) quiescent JIA, and (c) healthy elective presurgical candidates were recruited from clinics at a musculoskeletal specialty hospital. Juvenile idiopathic arthritis was defined according to the International League of Associations for Rheumatology criteria. Clinical data and serum samples meeting the same criteria were included from a prior study. Consecutive bacteremic patients were identified over the same period. Procalcitonin and other common measures of inflammation were measured. Descriptive statistics and univariate logistic analyses were performed. RESULTS Ninety-two study subjects were recruited. Erythrocyte sedimentation rate, C-reactive protein (CRP), and PCT levels were all elevated in bacteremic patients in comparison to the other groups. Erythrocyte sedimentation rate and CRP both had wide ranges that overlapped between groups; however, the PCT concentration was 0.15 μg/mL or greater in 1 of 59 patients with JIA, whereas it was 0.15 μg/mL or less in only 1 bacteremic patient. CONCLUSIONS Our study indicates that serum erythrocyte sedimentation rate, CRP, and PCT levels are all biomarkers that can be used to distinguish SBI versus active JIA at presentation. However, PCT is the most accurate, with the least overlap between patients with infection and noninfectious inflammatory arthritis. This finding can help clinicians direct therapy.
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Affiliation(s)
| | | | | | | | | | | | | | - Karen B. Onel
- Hospital for Special Surgery
- Weill Cornell Medicine, New York
| | - Lisa A. Mandl
- Hospital for Special Surgery
- Northwell Health, Lake Success, NY
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7
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Lohse A, Lemelle I, Pillet P, Duquesne A, Ballot C, Tran TA, Sparsa L, Goumy L, Reumaux H, Rossi L, Solau-Gervais E, Arbault A, Alleyrat C, Guillemin F, Devauchelle-Pensec V. Therapeutic alliance is associated to treatment adherence in children with juvenile idiopathic arthritis. Joint Bone Spine 2021; 88:105151. [PMID: 33561531 DOI: 10.1016/j.jbspin.2021.105151] [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] [Received: 07/21/2020] [Accepted: 01/25/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Therapeutic alliance (TA) is the agreement between caregiver and patient during the care process. Therapeutic adherence is a major issue for the management of Juvenile Idiopathic Arthritis (JIA) requiring child's strong ability to follow treatments. The aim of this study was to evaluate the relationship between TA and adherence in patients with JIA. METHODS Observational, cross-sectional, multicenter study. Children, with JIA, aged 8-16, were included. Children, parents and physicians completed the Helping Alliance Questionnaire (HAQ-CP) for assessing TA. Adherence was measured using the Child/Parent Adherence Report Questionnaire (CARQ & PARQ). Demographic data, disease characteristics, current treatments and social environment were collected. The univariate relationship between TA and adherence, was studied by Pearson correlation coefficient. The multivariate analysis used a multiple linear regression model. RESULTS A total of 119 patients were included: 68.9% girls, mean age (SD) 12.4 (2.9) years, disease duration 73.1 (48.2) months. JIA was in remission (52%), in low activity (32%) and active (16%). TA scores were high (≥80/100) for children, parents and physicians. HAQCP was highly correlated with CARQ (r=0.31; P<0.001) PARQ (r=0.37; P<0.001). In univariate analysis, disease activity (P<0.05), place of residence (P<0.01) and family status (P<0.01) were associated with child's TA. In multivariate analysis, only the place of residence (P<0.001) and the family status (P<0.05) remained associated with TA. CONCLUSION TA strongly influences therapeutic adherence and therefore may be important for treatment effectiveness.
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Affiliation(s)
- Anne Lohse
- Rheumatology, Nord Franche-Comté Hospital, 100, route de Moval, CS10499, 90015 Belfort, France.
| | - Irène Lemelle
- Paediatric onco-haematology, University Hospital of Nancy - Brabois Hospital, Vandoeuvre-Lès-Nancy, France
| | - Pascal Pillet
- Paediatrics, Rheumatology and Paediatric Internal Medicine, Children's Hospital, Bordeaux, France
| | - Agnès Duquesne
- Nephrology-rheumatology-paediatric dermatology-Rheumatology, Mother and Child Hospital, University Hospital of Lyon, Bron, France
| | - Claire Ballot
- Paediatric haematology, Jean-Minjoz Hospital, Besançon, France
| | - Tu-Anh Tran
- Paediatric haematology, CHU of Nîmes, Nîmes, France
| | | | | | - Héloïse Reumaux
- Paediatric Rheumatology, Lille University Hospital, Lille, France
| | - Linda Rossi
- Paediatric Rheumatology Service, Reference Centre for Auto-inflammatory Diseases and Amylosis, Bicêtre Hospital, Kremlin-Bicêtre, France
| | | | - Anais Arbault
- Rheumatology Department, Dijon University Hospital, Dijon, France
| | - Camille Alleyrat
- Inserm CIC-1433 Clinical Epidemiology, CHRU of Nancy, University of Lorraine, Nancy, France
| | - Francis Guillemin
- Inserm CIC-1433 Clinical Epidemiology, CHRU of Nancy, University of Lorraine, Nancy, France
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Greer AE, Iversen MD. Measures of Pediatric Function and Physical Activity in Arthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:499-521. [PMID: 33091268 DOI: 10.1002/acr.24239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Maura D Iversen
- Sacred Heart University, Fairfield, Connecticut, Karolinska Instituet, Stockholm, Sweden, and Brigham& Women's Hospital, Boston, Massachusetts
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9
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Taha R, Papadopoulou M, Zetterberg M, Oskarsdottir S, Grönlund MA. Visual Function And Quality Of Life In A Cohort Of Swedish Children With Juvenile Idiopathic Arthritis. Clin Ophthalmol 2019; 13:2081-2091. [PMID: 31749605 PMCID: PMC6818101 DOI: 10.2147/opth.s202486] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 08/06/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate quality of life (QoL) in children with juvenile idiopathic arthritis (JIA). Methods Forty children with a mean age of 7.9 years were included. The children underwent an ophthalmological examination and completed questionnaires on physical function (CHAQ) and vision-related (VR) QoL (EYE-Q). Results No differences regarding visual acuity (VA), refraction, intraocular pressure or physical or VRQoL were found between those with JIA without (n=33) and those with JIA-associated uveitis (n=7). When comparing physical function measured by CHAQ disability index and JIA subtype, a difference was found; children with polyarthritis scored the worst (p=0.0098). Children with subnormal VA scored worse on EYE-Q compared with those with normal VA (p=0.013). We found correlations between duration of JIA and CHAQ disability index (r=-0.42, p=0.0007) and CHAQ well-being (r=-0.34, p=0.022). Conclusion This study indicates the importance of measuring not only physical function but also VRQoL in children with JIA and JIA-associated uveitis.
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Affiliation(s)
- Rezhna Taha
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Maria Papadopoulou
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Madeleine Zetterberg
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Solveig Oskarsdottir
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Marita Andersson Grönlund
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Sweden
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Role of musculoskeletal ultrasonography in the detection of subclinical synovitis in oligo and polyarticular juvenile idiopathic arthritis children. THE EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.05.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Sarkar S, Alam MM, Das G, Datta S. Inflammatory Markers and Disease Activity in Juvenile Idiopathic Arthritis. Indian J Pediatr 2017; 84:349-356. [PMID: 28176230 DOI: 10.1007/s12098-017-2292-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 01/04/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the post treatment changes in disease activity and inflammatory markers over time in longitudinal follow-up involving different subtypes of juvenile idiopathic arthritis (JIA) patients. METHODS This prospective longitudinal study, carried out over a period of 2 y, included JIA patients, both old and new, with high disease activity. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin, CHAQ (Childhood Health Assessment Questionnaire) score and JADAS27 (Juvenile Arthritis Disease Activity score with 27 active joint counts) were estimated at the initial visit, 6 mo, 12 mo and 18 mo of follow-up. RESULTS Out of 40 patients, 10 had persistent oligoarthritis, 11 had rheumatoid factor (RF) positive polyarthritis, 8 had RF negative polyarthritis and 11 had systemic JIA. Twenty-one of them were females. Serum ferritin was highly elevated in systemic JIA patients with a range of 750-7712 ng/ml at the initial visit. All three inflammatory markers with disease activity score decreased significantly over 18-mo-period in all four subtypes. At any visit, all these parameters had largest value in systemic arthritis and least in oligoarthritis variety. At 18 mo, all oligoarthritis and polyarthritis cases had low or inactive disease while none of the systemic JIA patients achieved inactive disease. Elevated ESR and serum ferritin was found in all at 18 mo. CRP normalized in some with low or moderate disease activity. CONCLUSIONS Inflammatory markers and disease activity decreased in all subtypes of JIA with treatment without biologics. Acute phase markers often remain elevated in inactive disease state. Similarly, normal level of an inflammatory marker does not necessarily indicate absence of active disease.
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Affiliation(s)
- Sumantra Sarkar
- Department of Pediatrics, Institute of Postgraduate Medical Education & Research (I.P.G.M.E.& R.), 244, AJC Bose Road, Kolkata, 700020, India. .,, Flat B1, Jibantaru Appartment, Maheshtala, Kolkata, 700141, India.
| | - Md Mahboob Alam
- Department of Physiology, Institute of Postgraduate Medical Education & Research (I.P.G.M.E.& R.), Kolkata, India
| | - Gargi Das
- Department of Pediatrics, Institute of Postgraduate Medical Education & Research (I.P.G.M.E.& R.), 244, AJC Bose Road, Kolkata, 700020, India
| | - Supratim Datta
- Department of Pediatrics, Institute of Postgraduate Medical Education & Research (I.P.G.M.E.& R.), 244, AJC Bose Road, Kolkata, 700020, India
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Hersh AO, Salimian PK, Weitzman ER. Using Patient-Reported Outcome Measures to Capture the Patient's Voice in Research and Care of Juvenile Idiopathic Arthritis. Rheum Dis Clin North Am 2016; 42:333-46. [PMID: 27133493 PMCID: PMC4853816 DOI: 10.1016/j.rdc.2016.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient-reported outcome (PRO) measures provide a valuable window into how patients with juvenile idiopathic arthritis and their parents perceive their functioning, quality of life, and medication side effects in the context of their disease and treatment. Momentum behind adoption of PRO measures is increasing as these patient-relevant tools capture information pertinent to taking a patient-centered approach to health care and research. This article reviews the clinical and research utility of obtaining PROs across domains applicable to the experience of juvenile idiopathic arthritis and summarizes available self-report and parent-proxy PRO measures. Current challenges and limitations of PRO usage are discussed.
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Affiliation(s)
- Aimee O Hersh
- Pediatric Rheumatology, University of Utah, 81 Mario Capecchi Way, 4th Floor, Salt Lake City, UT 84113, USA.
| | - Parissa K Salimian
- Division of Developmental Medicine, Boston Children's Hospital, 300 Longwood Avenue BCH3185, Boston, MA 02115, USA
| | - Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue BCH3187, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue BCH3187, Boston, MA 02115, USA; Computational Health Informatics Program, Boston Children's Hospital, 300 Longwood Avenue BCH3187, Boston, MA 02115, USA
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Düzçeker Y, Kanbur NÖ, Demirkaya E, Derman O, Moorthy LN, Ozen S. Quality of life measures and psychiatric symptoms in adolescents with systemic lupus erythematosus and familial Mediterranean fever. Int J Adolesc Med Health 2014; 26:541-549. [PMID: 24486727 DOI: 10.1515/ijamh-2013-0332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/04/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To describe the relation between global Quality of Life (QL) and psychiatric symptoms in adolescents with systemic lupus erythematosus (SLE) and familial Mediterranean fever (FMF), and to analyze the perceptions of parents and adolescents. METHODS This study included 51 adolescents diagnosed with SLE (n=25) and FMF (n=26), and 51 healthy adolescents. The Health Related QL (HRQL) of SLE patients was rated by parents and adolescents using the Simple Measurement of Impact of Lupus Erythematosus in Youngsters© (SMILEY©). The global QL of FMF patients and healthy adolescents was rated by the response given to the first question of the SMILEY© by each parent and adolescent. All participants completed the Brief Symptom Inventory (BSI), which measures psychiatric symptoms. RESULTS In total, 92.3% with FMF, 56% with SLE and 76.5% of healthy adolescents reported their global QL as good and very good using the first question of the SMILEY©. The global QL perceptions of adolescents and their parents did not correlate (FMF, p=0.94; SLE, p=0.16). SLE patients had the highest rate of depression (54.2%), whereas hostility was detected among 54.9% of healthy adolescents. Significant relations were detected between BSI and SMILEY© scores. CONCLUSION The global QL perceptions of adolescents with FMF were better than those of healthy adolescents, which may be explained by their perceived relief of anguish they suffer during their short-lived attacks. The global QL perceptions of adolescents with SLE were the worst, most probably due to the chronic course resulting in an awareness of limitations and intense treatment. Adolescents with SLE had similar psychopathological symptom scores when compared with FMF patients and healthy adolescents. This could be explained by developing resilience. Differences in the perception of adolescents versus their parents regarding global QL emphasized the importance of adolescent-specific interviews for chronic illnesses and multidisciplinary follow-up with adolescent medicine.
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Hamilton TW, Hutchings L, Alsousou J, Tutton E, Hodson E, Smith CH, Wakefield J, Gray B, Symonds S, Willett K. The treatment of stable paediatric forearm fractures using a cast that may be removed at home. Bone Joint J 2013; 95-B:1714-20. [DOI: 10.1302/0301-620x.95b12.31299] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We investigated whether, in the management of stable paediatric fractures of the forearm, flexible casts that can be removed at home are as clinically effective, cost-effective and acceptable to both patient and parent as management using a cast conventionally removed in hospital. A single-centre randomised controlled trial was performed on 317 children with a mean age of 9.3 years (2 to 16). No significant differences were seen in the change in Childhood Health Assessment Questionnaire index score (p = 0.10) or EuroQol 5-Dimensions domain scores between the two groups one week after removal of the cast or the absolute scores at six months. There was a significantly lower overall median treatment cost in the group whose casts were removed at home (£150.88 (sem 1.90) vs £251.62 (sem 2.68); p < 0.001). No difference was seen in satisfaction between the two groups (p = 0.48). Cite this article: Bone Joint J 2013;95-B:1714–20.
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Affiliation(s)
- T. W. Hamilton
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - L. Hutchings
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Alsousou
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - E. Tutton
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - E. Hodson
- Wellcome Trust Centre for Human Genetics, Roosevelt
Drive, Oxford, UK
| | - C. H. Smith
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J. Wakefield
- The Royal Marsden Hospital NHS Trust, Department
of Radiology, Downs Road, Sutton, Surrey
SM2 5PT, UK
| | - B. Gray
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - S. Symonds
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - K. Willett
- Kadoorie Centre, Nuffield
Department of Orthopaedics, Rheumatology and
Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Weiss PF, Beukelman T, Schanberg LE, Kimura Y, Colbert RA. Enthesitis-related arthritis is associated with higher pain intensity and poorer health status in comparison with other categories of juvenile idiopathic arthritis: the Childhood Arthritis and Rheumatology Research Alliance Registry. J Rheumatol 2012; 39:2341-51. [PMID: 23070991 DOI: 10.3899/jrheum.120642] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the relative effect of clinical factors and medications on pain intensity, physical function, and health status in juvenile idiopathic arthritis (JIA). METHODS We conducted a retrospective cross-sectional study of data from children with JIA enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. We tested whether clinical characteristics of JIA were associated with pain intensity, physical function, and health status using multivariable linear and ordinal logistic regression. RESULTS During the study period, 2571 subjects with JIA enrolled in the CARRA Registry. Ratings of pain intensity, physical function, and health status differed significantly between JIA categories. In comparison to other categories of JIA, subjects with enthesitis-related arthritis (ERA) reported worse pain and function. In multivariable analyses, higher active joint count and current use of nonsteroidal antiinflammatory drugs (NSAID), biologics, or corticosteroids were associated with worse scores on all patient-reported measures. ERA and older age were significantly associated with higher pain intensity and poorer health status. Systemic JIA and uveitis were significantly associated with worse health status. Enthesitis, sacroiliac tenderness, and NSAID use were independently associated with increased pain intensity in ERA. The correlation was low between physician global assessment of disease activity and patient-reported pain intensity, physical function, and health status. CONCLUSION Significant differences in pain intensity, physical function, and health status exist among JIA categories. These results suggest that current treatments may not be equally effective for particular disease characteristics more common in specific JIA categories, such as enthesitis or sacroiliac tenderness in ERA.
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Affiliation(s)
- Pamela F Weiss
- Department of Pediatrics, University of Pennsylvania, Philadelphia, PA, USA.
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van Mater HA, Williams JW, Coeytaux RR, Sanders GD, Kemper AR. Psychometric characteristics of outcome measures in juvenile idiopathic arthritis: a systematic review. Arthritis Care Res (Hoboken) 2012; 64:554-62. [PMID: 22006870 DOI: 10.1002/acr.20667] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To review the performance characteristics of the instruments most commonly used to measure clinical outcomes in juvenile idiopathic arthritis (JIA), including global assessments, articular indices, functional/disability assessments, and quality of life measures. METHODS As part of an Agency for Healthcare Research and Quality comparative effectiveness review of antirheumatic drugs, we explored the characteristics of commonly used outcome measures for JIA. English-language studies of children with JIA were identified from Medline and Embase. Two independent reviewers screened titles and abstracts, with subsequent full-text review of studies selected based on predetermined criteria. RESULTS We included 35 publications describing 34 unique studies and involving 14,831 patients. The Childhood Health Assessment Questionnaire (C-HAQ) was the most extensively studied instrument and had high reliability, but only moderate correlations with other indices of disease activity and poor responsiveness to change in disease status. The physician global assessment of disease activity (PGA) and articular indices had the strongest association with disease activity and were the most responsive to change. Measures of psychosocial function and quality of life were moderately associated with measures of disease activity, but were less responsive to changes in disease status. CONCLUSION In children with JIA, no single instrument was superior in reliability or validity or in describing the impact of JIA. Although the C-HAQ has been extensively evaluated, the PGA and articular indices appear to have the highest responsiveness to change and, therefore, the highest potential for detecting important differences in treatment response.
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Affiliation(s)
- Heather A van Mater
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
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18
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Halbig M, Horneff G. Improvement of functional ability in children with juvenile idiopathic arthritis by treatment with etanercept. Rheumatol Int 2009; 30:229-38. [DOI: 10.1007/s00296-009-0942-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 04/28/2009] [Indexed: 11/24/2022]
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ten Klooster PM, Taal E, van de Laar MAFJ. Rasch analysis of the Dutch health assessment questionnaire disability index and the health assessment questionnaire II in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2008; 59:1721-8. [PMID: 19035413 DOI: 10.1002/art.24065] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Peter M ten Klooster
- Faculty of Behavioral Sciences, University of Twente, Enschede, The Netherlands.
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Moorthy LN, Peterson MGE, Harrison MJ, Onel KB, Lehman TJA. Physical function assessment tools in pediatric rheumatology. Pediatr Rheumatol Online J 2008; 6:9. [PMID: 18533038 PMCID: PMC2440744 DOI: 10.1186/1546-0096-6-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 06/04/2008] [Indexed: 11/24/2022] Open
Abstract
Pediatric rheumatic diseases with predominant musculoskeletal involvement such as juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis(JDM) can cause considerable physical functional impairment and significantly affect the children's quality of life (QOL). Physical function, QOL, health-related QOL (HRQOL) and health status are personal constructs used as outcomes to estimate the impact of these diseases and often used as proxies for each other. The chronic, fluctuating nature of these diseases differs within and between patients, and complicates the measurement of these outcomes. In children, their growing needs and expectations, limited use of age-specific questionnaires, and the use of proxy respondents further influences this evaluation. This article will briefly review the different constructs inclusive of and related to physical function, and the scales used for measuring them. An understanding of these instruments will enable assessment of functional outcome in clinical studies of children with rheumatic diseases, measure the impact of the disease and treatments on their lives, and guide us in formulating appropriate interventions.
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Affiliation(s)
- Lakshmi Nandini Moorthy
- Robert Wood Johnson Medical School-UMDNJ, Dept, of Pediatrics, Division of Rheumatology, New Brunswick, NJ 08903, USA.
| | | | | | - Karen B Onel
- Pediatric Rheumatology, The Univeristy of Chicago Medical Center, MC5044, 5841 South Maryland Avenue, Chicago, IL 60637, USA
| | - Thomas JA Lehman
- Pediatric Rheumatology, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
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Takken T, van den Eijkhof F, Hoijtink H, Helders PJM, van der Net J. Examining the psychometric characteristics of the Dutch childhood health assessment questionnaire: room for improvement? Rheumatol Int 2006; 26:979-83. [PMID: 16468046 DOI: 10.1007/s00296-006-0108-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Accepted: 12/25/2005] [Indexed: 10/25/2022]
Abstract
The aim of this study was to examine the psychometric characteristics of the childhood health assessment questionnaire-disability index (CHAQ-DI). Seventy-six patients with juvenile idiopathic arthritis (JIA), age range 4.8-15.8 years, completed a CHAQ questionnaire one or more times. In total, 321 CHAQ questionnaires were available for analysis. Factor analysis and correlation were used to analyse the data. The analysis indicated that 12 items could be removed from the original 30 items of the CHAQ-DI. Also the addition of "aids and assistance" to the overall scoring method of the CHAQ-DI did not contribute to the overall measuring concept of the CHAQ-DI. The psychometric characteristics of the CHAQ-DI could be improved by removing 12 items from the original 30 items. Moreover, a simple scoring method, without the addition of aids and assistance to the total CHAQ-DI improves sensitivity to change of the CHAQ-DI.
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Affiliation(s)
- T Takken
- Department of Pediatric Physical Therapy & Exercise Physiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KB2.056.0, PO Box 85090, 3508, AB Utrecht, The Netherlands.
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