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Yazici H, Yazici Y. Are Disease Classification Criteria for Diagnosis or for Research? In Fact, for Neither. J Rheumatol 2024; 51:114-116. [PMID: 37914213 DOI: 10.3899/jrheum.2023-0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Affiliation(s)
- Hasan Yazici
- H. Yazici, MD, Professor, Academic Hospital, Internal Medicine (Rheumatology), Istanbul, Turkey;
| | - Yusuf Yazici
- Y. Yazici MD, Clinical Associate Professor, Division of Rheumatology, NYU Grossman School of Medicine, New York, New York, USA
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Lerkvaleekul B, Chobchai P, Rattanasiri S, Vilaiyuk S. Evaluating performance of the 2019 EULAR/ACR, 2012 SLICC, and 1997 ACR criteria for classifying adult-onset and childhood-onset systemic lupus erythematosus: A systematic review and meta-analysis. Front Med (Lausanne) 2022; 9:1093213. [PMID: 36619627 PMCID: PMC9813386 DOI: 10.3389/fmed.2022.1093213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction The American College of Rheumatology (ACR) 1997, Systemic Lupus International Collaborating Clinics (SLICC) 2012, and European League Against Rheumatism (EULAR)/ACR 2019 SLE criteria are often used to classify patients with adult-onset and childhood-onset systemic lupus erythematosus (SLE) in clinical practice because there are currently no diagnostic criteria for SLE. However, there is scarce evidence regarding which criteria are best for diagnosing patients with adult-onset and childhood-onset SLE. Methods We searched Medline and Scopus databases for English-language articles from inception through October 2021. Data were extracted from the included publications by two independent reviewers. We performed bivariate meta-analysis with a random-effects model to pool diagnostic parameters. Meta-regression and subgroup analyses were performed to explore heterogeneity sources. We used network meta-analysis to compare diagnosis performance among the three criteria and ranked them in descending order. Publication bias was assessed using Deeks' funnel plot. Results We included 29 studies for systematic review and meta-analysis. Of these, 18 studies involved adult-onset SLE and 11 studies involved childhood-onset SLE. The pooled sensitivities of the three criteria for diagnosis of adult-onset SLE were comparable between SLICC 2012 and EULAR/ACR 2019 [95.86, 95% confidence interval (CI) 92.28-97.81 vs. 94.79, 95% CI 92.03-96.63]; pooled specificity was highest in ACR 1997 (92.24, 95% CI 87.06-95.46). In childhood-onset SLE, pooled sensitivity was highest in SLICC 2012 (93.76, 95% CI 89.45-96.39), and pooled specificity was highest in ACR 1997 (95.89, 95% CI 91.73-98.00). In network meta-analysis, the pooled diagnostic odds ratio ranked highest for EULAR/ACR 2019 (131.570, 95% CI 61.50-281.47) in adult-onset SLE and ranked highest for SLICC 2012 (191.07, 95% CI 76.06-480.01) in childhood-onset SLE. Deeks' funnel plot showed no publication bias. Conclusion We found that the diagnostic performance of the ACR 1997, SLICC 2012, and EULAR/ACR 2019 criteria differed between adult-onset and childhood-onset SLE. EULAR/ACR 2019 performed best for adult-onset SLE and SLICC 2012 was best for childhood-onset SLE in classifying patients with SLE. Systematic review registration [www.ClinicalTrials.gov], identifier [CRD420 21281586].
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Affiliation(s)
- Butsabong Lerkvaleekul
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pantira Chobchai
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Sasivimol Rattanasiri
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Soamarat Vilaiyuk
- Rheumatology Division, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand,*Correspondence: Soamarat Vilaiyuk,
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Nascimento DDQ, da Silva IIFG, Lima CAD, Cavalcanti ADS, Roberti LR, Queiroz RGDP, Ferriani VPL, Crovella S, Carvalho LMD, Sandrin-Garcia P. Expression of the miR-9-5p, miR-125b-5p and its target gene NFKB1 and TRAF6 in childhood-onset systemic lupus erythematosus (cSLE). Autoimmunity 2022; 55:515-519. [PMID: 36177494 DOI: 10.1080/08916934.2022.2128781] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Childhood- onset systemic lupus erythematosus (cSLE) is a multisystem inflammatory disease that can lead to severe clinical conditions resulting in early comorbidities. Several genetic, environmental, and immunological factors are known to influence the onset of the disease. MiRNAs have been already considered as potential actors involved in the development and activity of the SLE. Thus, understanding the behavior of these regulators can contribute to clarify the inflammatory process affecting SLE patients. Among miRNAs, miR-125b-5p and miR-9-5p targeting NFKB1 and TRAF6 genes can be involved in the etio-pathogenesis of the disease by modulating inflammation. In this study we evaluated miR-9-5p and miR-125b-5p expression and its target genes NFKB1 and TRAF6 in peripheral blood samples (PBMC) from the 35 cSLE patients and 35 healthy controls. MiRNAs and gene target expression have been evaluated by using RT-PCR with specific TaqMan® probes. Both miR-9-5p [Fold Change (FC) = -2.21; p = 0.002] and miR-125b-5p (FC= -3.30; p < 0.0001) and NFKB1 (FC = -1.84; p < 0.001) were downregulated in cSLE patients, while TRAF6 was upregulated (FC = 1.80; p = 0.006) in cSLE patients when compared to controls. A significant correlation was found between miR-125b-5p and its target gene NFKB1 [Spearman (r) = 0.47; p = 0.023]. Our results showed miR-125b-5p and miR-9-5p differential expression in cSLE patients, possibly contributing to better understanding the role of these regulators in cSLE development and disease pathogenesis.
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Affiliation(s)
- Denise de Queiroga Nascimento
- Department of genetics, PostGraduate Program in Genetics, Federal University of Pernambuco, Recife, Pernambuco, Brazil.,Laboratory of Immunopathology Keizo Asami, Recife, Pernambuco, Brazil
| | - Isaura Isabelle Fonseca Gomes da Silva
- Department of genetics, PostGraduate Program in Genetics, Federal University of Pernambuco, Recife, Pernambuco, Brazil.,Laboratory of Immunopathology Keizo Asami, Recife, Pernambuco, Brazil
| | - Camilla Albertina Dantas Lima
- Laboratory of Immunopathology Keizo Asami, Recife, Pernambuco, Brazil.,Department of Oceanography, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - André de Souza Cavalcanti
- Division of Pediatric Rheumatology, Clinical Hospital of Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | - Luciana Rodrigues Roberti
- Division of Pediatric Rheumatology, Clinic Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Rosane Gomes de Paula Queiroz
- Division of Pediatric Rheumatology, Clinic Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Virginia Paes Leme Ferriani
- Division of Pediatric Rheumatology, Clinic Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Sergio Crovella
- Department of Biological and Environmental Sciences, Biological Sciences Program, College of Arts and Sciences, Qatar University, Doha, State of Qatar
| | - Luciana Martins de Carvalho
- Division of Pediatric Rheumatology, Clinic Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Paula Sandrin-Garcia
- Department of genetics, PostGraduate Program in Genetics, Federal University of Pernambuco, Recife, Pernambuco, Brazil.,Laboratory of Immunopathology Keizo Asami, Recife, Pernambuco, Brazil
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Siegel CH, Kleinman J, Barbhaiya M, Sevim E, Vega J, Mancuso CA, Lockshin MD, Sammaritano LR. The Psychosocial Impact of Undifferentiated Connective Tissue Disease on Patient Health and Well-Being: A Qualitative Study. J Clin Rheumatol 2022; 28:e340-e347. [PMID: 33657588 DOI: 10.1097/rhu.0000000000001714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
METHODS We identified 20 adult patients with UCTD enrolled in the UCTD and Overlap Registry at our tertiary care level hospital. A licensed clinical social worker administered a 30-minute semistructured interview by telephone. The standardized questionnaire consisted of 14 open-ended questions on UCTD. A team of physicians, research coordinators, and a social worker used grounded theory to analyze the qualitative data and identify themes. RESULTS Among 14/20 study participants (100% female; mean age, 53.6 ± 13.2 years [range, 27-74 years]), all had at least an associate's/bachelor's degree; 9 (64%) were White. The mean disease duration was 14.5 ± 13.5 years (range, 0.5-44 years). Nine study participants (64%) were engaged in counseling or mindfulness training. Ten specific psychosocial themes and categories emerged, including the need for professional guidance and peer and family support to increase awareness, reduce isolation, and promote self-efficacy. CONCLUSIONS Emerging themes from semistructured interviews of women with UCTD at a major academic center suggest the need for psychosocial interventions (e.g., patient support groups, educational materials, peer counselors) to help UCTD patients manage and cope with their illness. Future studies evaluating the psychosocial impact of UCTD diagnosis on diverse cohorts are needed.
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Affiliation(s)
| | | | | | - Ecem Sevim
- Department of Medicine, Montefiore Medical Center, Wakefield Campus, Albert Einstein College of Medicine, Bronx
| | - JoAnn Vega
- Barbara Volcker Center for Women and Rheumatic Diseases, Hospital for Special Surgery, New York
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Lockshin MD, Crow MK, Barbhaiya M. When a Diagnosis Has No Name: Uncertainty and Opportunity. ACR Open Rheumatol 2021; 4:197-201. [PMID: 34806330 PMCID: PMC8916551 DOI: 10.1002/acr2.11368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Diagnostic uncertainty, commonly encountered in rheumatology and other fields of medicine, is an opportunity: Stakeholders who understand uncertainty's causes and quantitate its effects can reduce uncertainty and can use uncertainty to improve medical practice, science, and administration. To articulate, bring attention to, and offer recommendations for diagnostic uncertainty, the Barbara Volcker Center at the Hospital for Special Surgery sponsored, in April 2021, a virtual international workshop, “When a Diagnosis Has No Name.” This paper summarizes the opinions of 72 stakeholders from the fields of medical research, industry, federal regulatory agencies, insurers, hospital management, medical philosophy, public media, health care law, clinical rheumatology, other specialty areas of medicine, and patients. Speakers addressed the effects of diagnostic uncertainty in their fields. The workshop addressed the following six questions: What is a diagnosis? What are the purposes of diagnoses? How do doctors assign diagnoses? What is uncertainty? What are its causes? How does understanding uncertainty offer opportunities to improve all fields of medicine? The workshop's conveners systematically reviewed video recordings of formal presentations, video recordings of open discussion periods, manuscripts, and slide files submitted by the speakers to develop consensus take‐home messages, which were as follows: Diagnostic uncertainty causes harm when patients lack access to laboratory test and treatments, do not participate in research studies, are not counted in administrative and public health documents, and suffer humiliation in their interactions with others. Uncertainty offers opportunities, such as quantifying uncertainty, using statistical technologies and automated intelligence to stratify patient groups by level of uncertainty, using a common vocabulary, and considering the effects of time.
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Affiliation(s)
- Michael D Lockshin
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Mary K Crow
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Medha Barbhaiya
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
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Lockshin MD, Barbhaiya M, Izmirly P, Buyon JP, Crow MK. SLE: reconciling heterogeneity. Lupus Sci Med 2019; 6:e000280. [PMID: 31080630 PMCID: PMC6485210 DOI: 10.1136/lupus-2018-000280] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 11/14/2018] [Accepted: 11/18/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Michael D Lockshin
- Barbara Volcker Center, Hospital for Special Surgery, New York City, New York, USA
| | - Medha Barbhaiya
- Barbara Volcker Center, Hospital for Special Surgery, New York City, New York, USA
| | - Peter Izmirly
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Jill P Buyon
- Division of Rheumatology, Department of Medicine, New York University School of Medicine, New York City, New York, USA
| | - Mary K Crow
- Mary Kirkland Center for Lupus Research, Hospital for Special Surgery, New York City, New York, USA
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