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Lim LSH, Ekuma O, Marrie RA, Brownell M, Peschken CA, Hitchon CA, Gerhold K, Lix LM. Do Patterns of Early Disease Severity Predict Grade 12 Academic Achievement in Youths With Childhood-Onset Chronic Rheumatic Diseases? J Rheumatol 2023; 50:1165-1172. [PMID: 36725055 DOI: 10.3899/jrheum.220656] [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] [Accepted: 01/06/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test the association of early disease severity with grade 12 standards test performance in individuals with childhood-onset chronic rheumatic diseases (ChildCRDs), including juvenile arthritis and systemic autoimmune rheumatic diseases. METHODS We used linked provincial administrative data to identify patients with ChildCRDs born between 1979 and 1998 in Manitoba, Canada. Primary outcomes were Language and Arts Achievement Index (LAI) scores and Math Achievement Index (MAI) scores from grade 12 standards test results as well as enrollment data. The secondary outcome was enrollment in grade 12 by 17 years of age. Latent class trajectory analysis identified disease severity groups using physician visits following diagnosis. Multivariable linear regression tested the association of disease severity groups with LAI and MAI scores, and logistic regression tested the association of disease severity with age-appropriate enrollment, after adjusting for sociodemographic factors and psychiatric morbidities. RESULTS The study cohort included 541 patients, 70.1% of whom were female. A 3-class trajectory model provided the best fit; it classified 9.7% of patients as having severe disease, 54.5% as having moderate disease, and 35.8% as having mild disease. After covariate adjustment, severe disease was associated with poorer LAI and MAI scores but not with age-appropriate enrollment. CONCLUSION Among patients with ChildCRDs, those with severe disease performed more poorly on grade 12 standards tests, independent of sociodemographic and psychiatric risk factors. Clinicians should work with educators and policy makers to advocate for supports to improve educational outcomes of patients with ChildCRDs.
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Affiliation(s)
- Lily S H Lim
- L.S.H. Lim, MBBS, PhD, K. Gerhold, Dr med habil, MSc, Department of Pediatrics, Rady Faculty of Health Sciences, University of Manitoba;
| | - Okechukwu Ekuma
- O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba
| | - Ruth A Marrie
- R.A. Marrie, MD, PhD, C. A. Peschken, MD, MSc, C.A. Hitchon, MD, MSc, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Marni Brownell
- O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy, Rady Faculty of Health Sciences, University of Manitoba
| | - Christine A Peschken
- R.A. Marrie, MD, PhD, C. A. Peschken, MD, MSc, C.A. Hitchon, MD, MSc, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Carol A Hitchon
- R.A. Marrie, MD, PhD, C. A. Peschken, MD, MSc, C.A. Hitchon, MD, MSc, Department of Medicine, Rady Faculty of Health Sciences, University of Manitoba
| | - Kerstin Gerhold
- L.S.H. Lim, MBBS, PhD, K. Gerhold, Dr med habil, MSc, Department of Pediatrics, Rady Faculty of Health Sciences, University of Manitoba
| | - Lisa M Lix
- L.M. Lix, PhD, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Kirwin E, MacDonald S, Simmonds K. Profiles in Epidemiology: Dr. Larry Svenson. Am J Epidemiol 2022. [PMID: 34850825 DOI: 10.1093/aje/kwab282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Krzemień P, Kasperczyk S, Banach M, Kasperczyk A, Dobrakowski M, Tomasik T, Windak A, Mastej M, Catapano A, Ray KK, Mikhailidis DP, Toth PP, Howard G, Lip GYH, Tomaszewski M, Charchar FJ, Sattar N, Williams B, MacDonald TM, Penson PE, Jóźwiak JJ. Analysis of the impact of sex and age on the variation in the prevalence of antinuclear autoantibodies in Polish population: a nationwide observational, cross-sectional study. Rheumatol Int 2022; 42:261-271. [PMID: 34755204 PMCID: PMC8800880 DOI: 10.1007/s00296-021-05033-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/13/2021] [Indexed: 11/05/2022]
Abstract
The detection of antinuclear autoantibody (ANA) is dependent on many factors and varies between the populations. The aim of the study was first to assess the prevalence of ANA in the Polish adult population depending on age, sex and the cutoff threshold used for the results obtained. Second, we estimated the occurrence of individual types of ANA-staining patterns. We tested 1731 patient samples using commercially available IIFA using two cutoff thresholds of 1:100 and 1:160. We found ANA in 260 participants (15.0%), but the percentage of positive results strongly depended on the cutoff level. For a cutoff threshold 1:100, the positive population was 19.5% and for the 1:160 cutoff threshold, it was 11.7%. The most prevalent ANA-staining pattern was AC-2 Dense Fine speckled (50%), followed by AC-21 Reticular/AMA (14.38%) ANA more common in women (72%); 64% of ANA-positive patients were over 50 years of age. ANA prevalence in the Polish population is at a level observed in other highly developed countries and is more prevalent in women and elderly individuals. To reduce the number of positive results released, we suggest that Polish laboratories should set 1:160 as the cutoff threshold.
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Affiliation(s)
- Paweł Krzemień
- Euroimmun Polska Sp. z o.o., 2a Widna St., 50-543 Wrocław, Poland
| | - Sławomir Kasperczyk
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Łódź, Poland
| | - Aleksandra Kasperczyk
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Michał Dobrakowski
- Department of Biochemistry, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Tomasik
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, Kraków, Poland
| | | | - Alberico Catapano
- Department of Pharmacological Sciences, University of Milano and Multimedica IRCCS, Milan, Italy
| | - Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College, Kensington, London, UK
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital, University College London, London, UK
| | - Peter P. Toth
- Cicarrone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore, MD USA
- CGH Medical Center, Sterling, IL USA
| | - George Howard
- Department of Biostatistics, School of Public Health of Alabama, Birmingham, AL USA
| | - Gregory Y. H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Fadi J. Charchar
- School of Health and Life Sciences, Federation University Australia, Ballarat, VIC Australia
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Bryan Williams
- NIHR University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK
| | - Thomas M. MacDonald
- MEMO Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY UK
| | - Peter E. Penson
- School of Pharmacy and Biomolecular Sciences, Liverpool John Moores University, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Jacek J. Jóźwiak
- Department of Family Medicine and Public Health, Faculty of Medicine, University of Opole, Opole, Poland
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Lim LSH, Ekuma O, Marrie RA, Brownell M, Peschken CA, Hitchon CA, Gerhold K, Lix LM. A Population-based Study of Grade 12 Academic Performance in Adolescents With Childhood-onset Chronic Rheumatic Diseases. J Rheumatol 2021; 49:299-306. [PMID: 34725181 DOI: 10.3899/jrheum.201514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The aims of this study were (1) to compare grade 12 standardized test results of patients diagnosed with childhood-onset chronic rheumatic diseases (ChildCRD) and unaffected peers; and (2) to identify factors associated with test results of patients with ChildCRD and unaffected peers. METHODS This was a population-based retrospective cohort study. All patients with ChildCRD (juvenile arthritis and systemic autoimmune rheumatic diseases) from the only pediatric rheumatology center in Manitoba for birth cohorts January 1979 to December 1998 were linked to the provincial administrative databases containing records of healthcare use and education outcomes. Patients were matched by age, sex, and postal codes to their peers who did not have ChildCRD. The primary outcomes were the grade 12 Language Arts Achievement Index (LAI) and the Math Achievement Index (MAI) scores. ChildCRD, sociodemographic, and mental health factors were tested for their associations with LAI and MAI scores using multivariable linear regression. RESULTS Five hundred and forty-one patients with ChildCRD were matched to 2713 unaffected peers. Patients with ChildCRD had lower LAI and MAI scores compared to their peers. More patients with ChildCRD failed or did not take the language arts (51% vs 41%, P < 0.001) and math (61% vs 55%, P = 0.02) tests. On multivariable analysis, ChildCRD, lower socioeconomic status, younger maternal age at first childbirth, family income assistance, involvement with child welfare services, and mental health morbidities (between ChildCRD diagnosis and standardized testing), were associated with worse LAI and MAI results. CONCLUSION This population-based study showed that patients with ChildCRD performed less well than their peers on grade 12 standardized testing, independent of sociodemographic and mental health comorbidities.
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Affiliation(s)
- Lily S H Lim
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Okekchukwu Ekuma
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Ruth Ann Marrie
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Marni Brownell
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Christine A Peschken
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Carol A Hitchon
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Kerstin Gerhold
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
| | - Lisa Marie Lix
- This study is supported by funds from The Arthritis Society (Canada) Young Investigator Operating Grant. L.S.H. Lim, MBBS, PhD, K. Gerhold, MSc, Department of Paediatrics; O. Ekuma, MSc, M. Brownell, PhD, Manitoba Centre for Health Policy; R.A. Marrie, MD, PhD, FRCPC, C. Peschken, MD, FRCPC, MSc, C. Hitchon, MD, FRCPC, MSc, Department of Medicine; L.M. Lix, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. L.S.H. Lim, 501F-715 McDermott Ave, Winnipeg, MB R3P 3E4, Canada. . Accepted for publication October 13, 2021
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Mitratza M, Klijs B, Hak AE, Kardaun JWPF, Kunst AE. Systemic autoimmune disease as a cause of death: mortality burden and comorbidities. Rheumatology (Oxford) 2021; 60:1321-1330. [PMID: 32944773 PMCID: PMC7937014 DOI: 10.1093/rheumatology/keaa537] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/29/2020] [Indexed: 11/17/2022] Open
Abstract
Objectives Systemic autoimmune diseases (SAIDs) have chronic trajectories and share characteristics of self-directed inflammation, as well as aspects of clinical expression. Nonetheless, burden-of-disease studies rarely investigate them as a distinct category. This study aims to assess the mortality rate of SAIDs as a group and to evaluate co-occurring causes of death. Methods We used death certificate data in the Netherlands, 2013–2017 (N = 711 247), and constructed a SAIDs list at the fourth-position ICD-10 level. The mortality rate of SAIDs as underlying cause of death (CoD), non-underlying CoD, and any-mention CoD was calculated. We estimated age-sex-standardized observed/expected (O/E) ratios to assess comorbidities in deaths with SAID relative to the general deceased population. Results We observed 3335 deaths with SAID on their death certificate (0.47% of all deaths). The mortality rate of SAID was 14.6 per million population as underlying CoD, 28.0 as non-underlying CoD, and 39.7 as any-mention CoD. The mortality rate was higher for females and increased exponentially with age. SAID-related deaths were positively associated with all comorbidities except for solid neoplasms and mental conditions. Particularly strong was the association with diseases of the musculoskeletal system (O/E = 3.38; 95% CI: 2.98, 3.82), other diseases of the genitourinary system (O/E = 2.73; 95% CI: 2.18, 3.38), influenza (O/E = 2.71; 95% CI: 1.74, 4.03), blood diseases (O/E = 2.02; 95% CI: 1.70, 2.39), skin and subcutaneous tissue diseases (O/E = 1.95; 95% CI: 1.54, 2.45), and infectious diseases (O/E = 1.85; 95% CI: 1.70, 2.01). Conclusion Systemic autoimmune diseases constitute a rare group of causes of death, but contribute to mortality through multiple comorbidities. Classification systems could be adapted to better encompass these diseases as a category.
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Affiliation(s)
- Marianna Mitratza
- Department of Public and Occupational Health, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart Klijs
- Department of Public and Occupational Health, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands
| | - A Elisabeth Hak
- Department of Rheumatology and Clinical Immunology, Academic Medical Center, Amsterdam UMC, Amsterdam Rheumatology and Immunology Center, Amsterdam, the Netherlands
| | - Jan W P F Kardaun
- Department of Public and Occupational Health, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Department of Health and Care, Statistics Netherlands, The Hague, the Netherlands
| | - Anton E Kunst
- Department of Public and Occupational Health, Academic Medical Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Chédeville G, McGuire K, Cabral DA, Shiff NJ, Rumsey DG, Proulx-Gauthier JP, Schmeling H, Berard RA, Batthish M, Soon G, Gerhold K, Gerschman T, Bruns A, Duffy CM, Tucker LB, Guzman J. Parent-Reported Medication Side-Effects and Their Impact on Health-Related Quality of Life in Children with Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2021; 74:1567-1574. [PMID: 33787074 DOI: 10.1002/acr.24610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/16/2021] [Accepted: 03/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe frequency and severity of parent-reported medication side effects (SE) in children with Juvenile Idiopathic Arthritis (JIA), relative to physician-reported actionable adverse events (AAE); and to assess their impact on health-related quality of life (HRQoL). METHODS Newly diagnosed JIA patients recruited between 2017 and 2019 to the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry were included. Parents reported presence and severity (0=no problem, 10=very severe) of medication SE at every clinic visit. Physicians were asked to report any AAE. HRQoL was assessed using the Quality of My Life (QoML) questionnaire (0=the worst, 10=the best) and parent's global assessment (0=very well, 10=very poor). Analyses included proportion of visits with SE or AAE, cumulative incidence by Kaplan-Meier methods, and HRQoL impact measured with longitudinal mixed effects models. RESULTS SE were reported at 371/884 (42%) visits (95% CI 39-45%) in 249 patients with a median of 2 SE per visit (IQR 1,3), and median severity of 3 (IQR 1.5,5). Most SE were gastrointestinal (32.5% of visits) or behavioral/psychiatric (22.4%). SE frequency was lowest with NSAID alone (34.7%) and highest with prednisone and methotrexate combinations (66%). SE cumulative incidence was 67% (95% CI 59-75) within 1y of diagnosis, and 36% (95% CI 28-44) for AAE. Parent global and QoML scores were worse with SE present, the impact persisted after adjusting for pain and number of active joints. CONCLUSION Parents report 2/3 children with JIA experience SE impacting their HRQoL within 1y of diagnosis. SE mitigation strategies are needed in managing JIA.
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Affiliation(s)
- Gaëlle Chédeville
- Division of Pediatric Rheumatology. Department of Pediatrics. McGill
| | | | - David A Cabral
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
| | - Natalie J Shiff
- University of Saskatchewan, Department of Community Health and Epidemiology, Saskatoon, SK, Canada
| | - Dax G Rumsey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | | | - Roberta A Berard
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre and Western University, London, ON, Canada
| | | | - Gordon Soon
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Kerstin Gerhold
- Department of Pediatrics and Child Health, University of Manitoba, Manitoba, MB, Canada
| | - Tommy Gerschman
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
| | - Alessandra Bruns
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Ciaran M Duffy
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Lori B Tucker
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
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Real-world incidence and prevalence of systemic lupus erythematosus in Alberta, Canada. Rheumatol Int 2018; 38:1721-1726. [PMID: 29987494 PMCID: PMC6105153 DOI: 10.1007/s00296-018-4091-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 06/19/2018] [Indexed: 11/14/2022]
Abstract
Systemic lupus erythematosus (SLE) is rather uncommon than rare. The purpose of this study was to estimate the incidence and prevalence of SLE in the population of Alberta, Canada, using administrative health data. Multiple population-based data sources, including the Alberta Health Care Insurance Plan Central Stakeholder Registry (AHCIP CSR), Fee-For-Service, and Hospital Discharge Abstract Database were used. Age- and sex-specific incidence and prevalence rates, and 95% confidence intervals (CI), were computed using the AHCIP CSR mid-year population estimates as the denominator, for the period of 2000–2015. The overall incidence of SLE for all age groups was 4.43 (95% CI 3.65, 5.04) per 100,000 population. The overall incidence in male and female of all age groups was 1.26 (95% CI 0.72, 1.76) and 7.69 (95% CI 6.22, 8.81) per 100,000 population, respectively. A prevalence of 47.99 per 100,000 (male = 13.5, female = 83.2) of SLE was observed for the year 2000 and has increased to 90 (male = 25.5, female = 156.7) per 100,000 population in 2015. Over the 16-year period, the incidence of SLE in women was approximately six times higher than in men (odds ratio = 6.16). The highest and lowest incidence was recorded in 2001 and 2015, respectively. Despite the stable incidence of SLE, the findings of the study confirms that the prevalence of SLE has increased over the 16-year period. The increase in prevalence of SLE in Alberta will have an impact on health service utilizations. This finding can be used for planning and evaluating health services for this group of patients. Further studies are required to determine the economic burden of the condition.
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Olaosebikan BH, Adelowo OO, Animashaun BA, Akintayo RO. Spectrum of paediatric rheumatic diseases in Nigeria. Pediatr Rheumatol Online J 2017; 15:7. [PMID: 28143550 PMCID: PMC5282742 DOI: 10.1186/s12969-017-0139-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/23/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Paediatric rheumatology service in Sub-Sahara African is virtually not available as there is a shortage of paediatric rheumatologists and other rheumatology health professionals. We aim to describe the clinical spectrum and the frequencies of paediatric rheumatic diseases (PRDs) in Lagos State University Teaching Hospital (LASUTH), Lagos, Nigeria. METHODS This is a retrospective review of patients with PRDs seen over a five year period (March 2010 to February 2016) at the rheumatology clinic and children ward of LASUTH. We reviewed the folders of 57 patients from our records. The demographics, baseline laboratory features, clinical diagnosis, treatment patterns and patient outcomes were extracted and analyzed. Clinical and laboratory characteristics between patients with Juvenile idiopathic arthritis (JIA) and patients with juvenile connective tissue diseases (JCTD) were compared using Fisher's exact test. RESULTS Fifty seven patients were studied with a female to male ratio of 3 to 1 (Female: 43; M: 14). The mean age at presentation in years was 14 ± 4.4 years (range: 1.5-22 years). The mean duration of symptoms before diagnosis was 18.4 ± .9 months (range: 2-60 months). The diagnostic types of PRDs included 28(49.1%) cases of JIA. These were made up of 14 cases of polyarticular JIA, nine cases of oligoarticular JIA and 5 cases of systemic onset JIA. Others were 18 (24.6%) cases of juvenile systemic lupus erythematosus (JSLE), 3 (5.3%) cases of joint hypermobility syndrome, 2 (3.5%) cases of juvenile systemic sclerosis, 2 (3.5%) cases of fibromyalgia, 2 (3.5%) cases of plantar fasciitis, 1 (1.6%) case of juvenile dermatomyositis (JDM), 1 (1.6%) case of juvenile polymyositis-systemic lupus erythematosus (PM-SLE) overlap, 1 (1.6%) case of secondary bilateral knee osteoarthritis from Blount disease, 1 (1.6%) case of secondary osteoporosis from childhood leukemia and 1 (1.6%) case of Osgood-Schlatter's disease. Constitutional symptoms and extra-articular diseases were significantly more frequent among JCTD cases than among the JIA cases (Constitutional symptoms: 100% vs 83.3%, p = 0.003; extra-articular disease: 100% vs 10.7%, p = 0.001). The percentage mortality in this study was 10.5% while 20 (35.1%) of the patients were lost to clinic follow up. CONCLUSION The pattern of PRDs observed in this study is similar to that described in South African and North American series but it differs from patterns reported in Asian series. Although hitherto largely unrecognized, PRDs may constitute a substantial cause of morbidity and mortality in black Africans.
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Affiliation(s)
- Babatunde Hakeem Olaosebikan
- 0000 0004 0481 2583grid.411278.9Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos State Nigeria
| | - Olufemi Oladipo Adelowo
- 0000 0004 0481 2583grid.411278.9Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos State Nigeria
| | - Barakat Adeola Animashaun
- 0000 0004 0481 2583grid.411278.9Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos State Nigeria
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Dahman HAB. Challenges in the diagnosis and management of Pediatric Rheumatology in the developing world: Lessons from a newly established clinic in Yemen. Sudan J Paediatr 2017; 17:21-29. [PMID: 29545661 DOI: 10.24911/sjp.2017.2.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Pediatric rheumatology is still considered a mysterious branch of pediatric medicine, especially among developing countries. Long-term consequences usually follow delayed diagnosis, referral, and management of rheumatic disorders. We aim to describe the clinical spectrum and the frequency of pediatric rheumatic diseases (PRDs) in AL-Mukalla hospital in Hadhramout province/Yemen. A case record retrospective study was conducted among all patients who attended the pediatric rheumatology clinic in Al-Mukalla hospital (from January 2010 to December 2016) with a musculoskeletal complaint or systemic symptoms suggestive of rheumatic disease. Data collected included: gender, address, age at the onset of symptoms, initial manifestations, the presence of complications, referral diagnosis, final diagnosis and the lag period before attending the rheumatology clinic. PRDs were present in 86% (37/43) of cases, 83.8% (31/37) were from Hadhramout province. Male to female ratio was 0.9:1 (Male: 18; Female: 19) and the commonest age group affected was (>9-12) years. The mean age at first presentation was 8.859 ± 4.11 years (four months-14 years). One year (0.13-98.4 months) was the median time before referral to the rheumatologist. About 70.3% of cases were referred from other specialists or peripheral hospitals. Joint swelling (54.1%) was the most common presentation and juvenile idiopathic arthritis (24.3%) was the commonest diagnosis. The discrepancy between the referral and the final diagnosis was noticed in 21(48.8%) cases. Only eight cases (18.6%) matched the final diagnosis. Two patients died with a mortality rate of 5.4%. Knowledge of the spectrum and incidence of PRDs will increase the awareness of specialists and general practitioners for early referral and diagnosis to avoid long-term sequels.
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Affiliation(s)
- Haifa A Bin Dahman
- Pediatric Department, Hadharmout University College of Medicine (HUCOM), Hadhramout Province, Yemen
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10
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Selmi C, Ceribelli A, Generali E, Scirè CA, Alborghetti F, Colloredo G, Porrati L, Achenza MIS, De Santis M, Cavaciocchi F, Massarotti M, Isailovic N, Paleari V, Invernizzi P, Matthias T, Zucchi A, Meroni PL. Serum antinuclear and extractable nuclear antigen antibody prevalence and associated morbidity and mortality in the general population over 15 years. Autoimmun Rev 2015; 15:162-6. [PMID: 26524640 DOI: 10.1016/j.autrev.2015.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 10/25/2015] [Indexed: 11/28/2022]
Abstract
The prevalence of ANA and anti-ENA in the general population is not well established, especially their clinical significance in healthy subjects. We herein determined the prevalence and predictive value of serum ANA and anti-ENA for connective tissue diseases (CTD), cancer, and mortality. We took advantage of a randomly selected sample of the 1998 general population (Isola I) consisting of 2828 subjects (53% women, age 43±13 years) from a well-defined Northern Italian area. Serum ANA and anti-ENA were tested on the 2690 samples available in 2012 (Isola II, 50% women, age 58±13 years). Administrative databases were searched for CTD, cancer diagnosis, and death cases occurring between enrollment and December 31, 2013. The hazard ratio (HR) was calculated for incident cases. Serum ANA is positive in 18.1% for any titer and 6.1% for titers ≥1:160, 23% in subjects over 50 years and 13.1% and 6.1% for any titer and titers ≥1:160, respectively, in women. The HR for CTD development was significantly high for all ANA titers, with the highest for ANA ≥1:160 (HR 14.19, 95% CI 3.07-65.68). ANA positivity was not associated with cancer (HR 1.03; 95% CI 0.75-1.43), or with mortality (HR adjusted for age and sex 1.40; 95% CI 0.94-2.09). Serum anti-ENA is positive in a minority of subjects with highest figures for anti-nucleosome (1.9%), -histone (1.6%) and -PM/Scl (1.5%). In conclusion, serum ANA prevalence in the general population is highest in senior subjects and in women, while the female predominance is significantly lower compared to overt CTD. Serum ANA is associated with an increased probability of CTD development over time, but does not influence survival or cancer risk.
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Affiliation(s)
- Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; University of Milan, Milan, Italy.
| | - Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy; University of Milan, Milan, Italy
| | - Elena Generali
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Carlo A Scirè
- Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
| | | | - Guido Colloredo
- Division of Internal Medicine, San Pietro Hospital, Ponte San Pietro, Italy
| | - Luisa Porrati
- Bergamo local health authority (ASL), Bergamo, Italy
| | - Maria I S Achenza
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Francesca Cavaciocchi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Marco Massarotti
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Valentina Paleari
- Clinical Research Unit, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | - Pietro Invernizzi
- Center of Autoimmune Liver Disease, Humanitas Clinical and Research Center, Rozzano, Milan, Italy
| | | | | | - Pier Luigi Meroni
- University of Milan, Milan, Italy; Istituto Auxologico Italiano, Milan, Italy
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