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Nassar-Sheikh Rashid A, Hooijberg F, Bergkamp SC, Gruppen MP, Kuijpers TW, Nurmohamed M, Rispens T, Wolbink G, van den Berg JM, Schonenberg-Meinema D, Mathôt RAA. Population Pharmacokinetics of Adalimumab in Juvenile Idiopathic Arthritis Patients: A Retrospective Cohort Study Using Clinical Care Data. Paediatr Drugs 2024; 26:441-450. [PMID: 38630199 PMCID: PMC11192828 DOI: 10.1007/s40272-024-00629-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND AND OBJECTIVE Juvenile idiopathic arthritis (JIA) is a chronic autoimmune disorder that primarily affects the joints in children. Notably, it is known to co-occur with uveitis. Adalimumab, a monoclonal anti-TNF antibody, is effective in treating both conditions. A deeper understanding of the pharmacokinetics (PK) of adalimumab in JIA is crucial to advance in more personalized treatment approaches. The objective of this study is to evaluate the population PK profile of adalimumab in JIA and to explain causes for its variability. MATERIALS AND METHODS Adalimumab and antidrug antibody concentrations were retrospectively retrieved from the charts of patients with JIA. Initially, five literature-based population PK models of adalimumab were evaluated to assess their ability to describe the observed concentration-time profiles in the JIA cohort. These models included one specifically for the pediatric Crohn's disease population and four derived from studies in adult populations in healthy subjects and rheumatoid arthritis patients. Subsequently, a novel population PK model tailored to the JIA population was developed using NONMEM software. Monte Carlo simulations were then conducted utilizing the final PK model to visualize the concentration-time profile of adalimumab in patients with JIA and the impact of covariates. RESULTS A cohort of 50 patients with JIA with 78 available adalimumab samples was assessed. The mean age was 11.8 ± 3.9 years, with a median body weight of 49 kg (interquartile range 29.4-59.8 kg). All literature models adequately described the concentration-time profiles in JIA. The best model, which was developed in patients with rheumatoid arthritis during the maintenance phase of treatment, served as a basis for estimating clearance in JIA, resulting in a value of 0.37 L per day per 70 kg. Patient body weight, antidrug antibodies, methotrexate use, CRP level, and comorbidity of uveitis were found to have a significant impact on adalimumab clearance, and these reduced the inter-patient variability from 58.6 to 28.0%. On steady state in the simulated patient population, the mean trough level was 7.4 ± 5.5 mg/L. The two dosing regimens of 20 and 40 mg every other week, based on patients' body weight, resulted in comparable simulated overall drug exposure. CONCLUSIONS Five literature models effectively described adalimumab PK in this pediatric cohort, highlighting the potential for extrapolating existing models to the pediatric population. The new JIA model confirmed the effect of several known covariates and found a novel association for drug clearance with methotrexate use (lower) and uveitis (higher), which might have clinical relevance for personalized dosing in JIA.
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Affiliation(s)
- Amara Nassar-Sheikh Rashid
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Department of Pediatrics, Zaans Medical Center, Zaandam, The Netherlands.
| | - Femke Hooijberg
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands
- Department of Rheumatology, Amsterdam UMC, Location VUmc, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Sandy C Bergkamp
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mariken P Gruppen
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Mike Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands
- Department of Rheumatology, Amsterdam UMC, Location VUmc, De Boelelaan 1118, 1081 HZ, Amsterdam, The Netherlands
| | - Theo Rispens
- Department of Immunopathology, Sanquin Research and Landsteiner Laboratory Academic Medical Center, Plesmanlaan 125, 1066 CX, Amsterdam, The Netherlands
| | - Gertjan Wolbink
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Location Reade, Dr. Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Ron A A Mathôt
- Hospital Pharmacy, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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Codes-Méndez H, Magallares-López B, Park HS, Mariscal A, Juárez C, Boronat S, Martínez-Martínez L, Corominas H. Diagnostic accuracy of serum calprotectin measured by CLIA and EIA in juvenile idiopathic arthritis: a proof-of-concept study. Front Pediatr 2024; 12:1422916. [PMID: 38962573 PMCID: PMC11219821 DOI: 10.3389/fped.2024.1422916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 06/07/2024] [Indexed: 07/05/2024] Open
Abstract
Objective C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are used to assess disease activity in juvenile idiopathic arthritis (JIA). However, because these biomarkers do not always differentiate between active and inactive disease, there is a need for alternative markers such as serum calprotectin (sCal). The main aim of this proof-of-concept study was to assess the diagnostic accuracy of sCal in patients with JIA. Secondary aims were to identify the optimal sCal cut-off levels to define active disease and evaluate the association between these biomarkers and disease activity status. Methods Serum samples were obtained from 25 pediatric patients with JIA. Serum calprotectin levels were determined by two different assays, the QUANTA FLASH chemiluminescence immunoassay (CLIA) from Inova Diagnostics and the solid-phase enzyme immunoassay (EIA) from Bühlmann Laboratories. Diagnostic accuracy was assessed for sCal CLIA, sCal EIA, CRP, and ESR. The results obtained by the CLIA and EIA methodologies were compared. We also evaluated the association between the individual each biomarkers (sCal CLIA, sCal EIA, CRP, and ESR) and disease activity (according to JADAS-27 criteria and the ACR criteria modified by Anink and colleagues). Results For both sCal assays (CLIA and EIA), the optimal cut-off level (ROC analysis) was the same (2.3 µg/ml). Serum calprotectin levels measured by CLIA and EIA were strongly correlated with each other (Kendall's tau-b, 0.71; p < 0.001). Compared to ESR and CRP, sCal CLIA and EIA were both more accurate (i.e., greater sensitivity) in identifying patients with active disease. By contrast, ESR and CRP were more effective in identifying patients in remission (i.e., better specificity). Conclusion This proof-of-concept study shows that determination of serum calprotectin levels with CLIA or EIA can accurately identify the presence of active disease in patients with JIA.
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Affiliation(s)
- Helena Codes-Méndez
- Rheumatology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Berta Magallares-López
- Rheumatology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Department of Medicine, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Hye-Sang Park
- Rheumatology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Department of Medicine, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Anaís Mariscal
- Department of Medicine, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Immunology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Cándido Juárez
- Department of Medicine, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Immunology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Susana Boronat
- Department of Medicine, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Pediatric Department, Hospital de de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Laura Martínez-Martínez
- Department of Medicine, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Immunology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Hector Corominas
- Rheumatology Department, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
- Department of Medicine, Institut de Recerca Sant Pau (IR SANT PAU), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
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Zeller L, Tyrrell PN, Wang S, Fischer N, Haas JP, Hügle B. α2-fraction and haptoglobin as biomarkers for disease activity in oligo- and polyarticular juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2022; 20:66. [PMID: 35964131 PMCID: PMC9375368 DOI: 10.1186/s12969-022-00721-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/19/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Unlike in adult rheumatology, for most forms of juvenile idiopathic arthritis (JIA) no reliable biomarkers currently exist to assess joint and disease activity. However, electrophoresis is frequently found changed in active juvenile arthritis. The objective of this study was to evaluate the α2-fraction of serum electrophoresis and its main components as biomarkers for JIA, categories extended/persistent oligoarthritis and seronegative polyarthritis, in comparison with the conventionally used erythrocyte sedimentation rate and C-reactive protein. METHODS Serum samples and clinical data from 181 patients with JIA were collected. Serum electrophoresis and α2-fraction and its components were determined using standard methods. Relationship between calculated α2-fraction of serum electrophoresis (CA2F) and its components, acute-phase parameters and cJADAS27 was assessed using Pearson's correlation coefficient and linear regression modelling, adjusting for confounding effects. Results were confirmed in a second cohort with 223 serum samples from 37 patients, using a mixed model to account for repeated measures. RESULTS Compared to ESR and CRP, CA2F showed higher correlation to cJADAS27, in particular for persistent oligoarthritis. Of the three components of the α2-fraction, haptoglobin showed the highest correlation to cJADAS27. Regression analysis demonstrated higher ability to predict cJADAS27 for CA2F, and especially for haptoglobin as a component thereof, than for CRP and ESR. CONCLUSION Compared to conventional methods, α2-fraction of serum electrophoresis and specifically, haptoglobin show higher correlations with disease activity in common subtypes of JIA, representing excellent candidates as biomarkers for disease activity. Further studies are necessary to determine diagnostic value and correlations in other subtypes.
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Affiliation(s)
- Ludwig Zeller
- German Centre for Pediatric and Adolescent Rheumatology (GCPAR), Gehfeldstrasse 24, 82467 Garmisch-Partenkirchen, Germany
| | - Pascal N. Tyrrell
- grid.17063.330000 0001 2157 2938Department of Medical Imaging, University of Toronto, Toronto, Canada ,grid.17063.330000 0001 2157 2938Department of Statistical Sciences, Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Stella Wang
- grid.17063.330000 0001 2157 2938Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Nadine Fischer
- German Centre for Pediatric and Adolescent Rheumatology (GCPAR), Gehfeldstrasse 24, 82467 Garmisch-Partenkirchen, Germany
| | - Johannes-Peter Haas
- German Centre for Pediatric and Adolescent Rheumatology (GCPAR), Gehfeldstrasse 24, 82467 Garmisch-Partenkirchen, Germany
| | - Boris Hügle
- German Centre for Pediatric and Adolescent Rheumatology (GCPAR), Gehfeldstrasse 24, 82467, Garmisch-Partenkirchen, Germany.
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Keskitalo PL, Kangas SM, Sard S, Pokka T, Glumoff V, Kulmala P, Vähäsalo P. Myeloid-related protein 8/14 in plasma and serum in patients with new-onset juvenile idiopathic arthritis in real-world setting in a single center. Pediatr Rheumatol Online J 2022; 20:42. [PMID: 35710418 PMCID: PMC9204870 DOI: 10.1186/s12969-022-00701-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/30/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The aim of this study was to analyze the usefulness of myeloid-related protein 8/14 (MRP8/14) in the prediction of disease course in a real-world setting for patients with new-onset juvenile idiopathic arthritis (JIA), to identify the relationship between MRP8/14 and disease activity using the physician's global assessment of disease activity (PGA), and determine whether the MRP8/14 levels measured in serum and plasma are equally useful. METHODS In this prospective follow-up study, 87 new-onset non-systemic JIA patients were studied. Blood and synovial fluid samples were collected prior to any antirheumatic medication use. MRP8/14 was measured from serum (S-MRP8/14), plasma (P-MRP8/14), and synovial fluid samples using ELISA. RESULTS The baseline MRP8/14 blood levels were significantly higher in patients using synthetic antirheumatic drugs than in patients with no systemic medications at 1 year after diagnosis in serum (mean 298 vs. 198 ng/ml, P < 0.001) and in plasma (mean 291 vs. 137 ng/ml, P = 0.001). MRP8/14 levels at the time of JIA diagnosis were higher in patients who started methotrexate during 1.5-year follow-up compared to those who achieved long-lasting inactive disease status without systemic medications (serum: mean 298 vs. 219 ng/ml, P = 0.006 and plasma: 296 vs. 141 ng/ml, P = 0.001). P-MRP8/14 was the most effective predictive variable for disease activity (by PGA) in linear multivariate regression model (combined to ESR, CRP, leukocytes, and neutrophils), whereas S-MRP8/14 was not significant. CONCLUSION Blood MRP8/14 levels at baseline seem to predict disease course in new-onset JIA patients. P-MRP8/14 might be better than S-MRP8/14 when assessing disease activity at the time of JIA diagnosis.
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Affiliation(s)
- Paula L. Keskitalo
- grid.10858.340000 0001 0941 4873PEDEGO Research Unit, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Department of Pediatrics, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland ,grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Salla M. Kangas
- grid.10858.340000 0001 0941 4873PEDEGO Research Unit, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Sirja Sard
- grid.10858.340000 0001 0941 4873PEDEGO Research Unit, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Department of Pediatrics, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland ,grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tytti Pokka
- grid.10858.340000 0001 0941 4873PEDEGO Research Unit, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Virpi Glumoff
- grid.10858.340000 0001 0941 4873Research Unit of Biomedicine, University of Oulu, Oulu, Finland
| | - Petri Kulmala
- grid.10858.340000 0001 0941 4873PEDEGO Research Unit, University of Oulu, Oulu, Finland ,grid.412326.00000 0004 4685 4917Department of Pediatrics, Oulu University Hospital, Kajaanintie 50, 90220 Oulu, Finland ,grid.412326.00000 0004 4685 4917Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Paula Vähäsalo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland. .,Department of Pediatrics, Oulu University Hospital, Kajaanintie 50, 90220, Oulu, Finland. .,Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland.
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Jensen GL, Naziri J, Hammonds KP, Jhavar SG, Swanson G. C-Reactive Protein Is a Poor Marker of Baseline Inflammation in Prostate Cancer and Response to Radiotherapy or Androgen Ablation. Cureus 2021; 13:e19639. [PMID: 34926085 PMCID: PMC8673689 DOI: 10.7759/cureus.19639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/09/2022] Open
Abstract
Introduction C-reactive protein (CRP) is an acute-phase reactant used as a general marker for inflammation. Isolated levels have been associated with prostate cancer development, prostate-specific antigen (PSA), Gleason score, and treatment response. We seek to establish whether CRP levels reflect inflammation caused by prostate cancer by comparing levels at various points of time before, during, and after therapy. Materials and methods A total of 209 patients had a complete blood count (CBC), PSA, and CRP taken at up to four different time points. Labs were performed up to one week prior to androgen ablation via leuprolide injection (pre-AA), up to one week prior to radiotherapy (RT) (pre-RT), within one week of RT completion (post-RT), and three months following RT completion (FU [follow-up]). Results Significant relationships were found between CRP and WBC pre-AA (p-value=0.0050), pre-RT (p-value=0.0170), and post-RT (p-value=0.0113), but not at FU (p=.096). CRP had no significant relationship with PSA or lymphocytes at any time points. PSA was significantly affected by androgen ablation but lymphocytes, WBCs, and CRP were not. No CRP levels were associated with risk groups or FU-PSA. Lymphatic radiation fields significantly decreased WBCs and lymphocytes but not CRP. PSA, WBC, and lymphocytes all significantly decreased from pre-RT to post-RT, followed by a significant recovery. CRP did not significantly change during any of these periods and was not significantly related to changes in PSA, WBCs, or lymphocytes. Conclusion CRP is not a sensitive marker of the acute inflammatory effects of non-metastatic prostate cancer and treatment response with androgen ablation or radiation therapy.
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Affiliation(s)
- Garrett L Jensen
- Radiation Oncology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Jason Naziri
- Radiation Oncology, Baylor Scott & White Health, Temple, USA
| | | | - Sameer G Jhavar
- Radiation Oncology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Gregory Swanson
- Radiation Oncology, Baylor Scott & White Health, Temple, USA
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Kotecki M, Gietka P, Posadzy M, Sudoł-Szopińska I. Radiographs and MRI of the Cervical Spine in Juvenile Idiopathic Arthritis: A Cross-Sectional Retrospective Study. J Clin Med 2021; 10:5798. [PMID: 34945094 PMCID: PMC8704570 DOI: 10.3390/jcm10245798] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease among children. In some patients, cervical spine arthritis remains a serious and chronic manifestation of JIA. The aim of this study was to assess the frequency of cervical spine lesions on radiographs and MRI in JIA patients with clinical signs of cervical spine involvement and to verify if with the addition of MRI, the use of radiographs could be abandoned. METHODS This retrospective study evaluated consecutive 34 children (25 girls; aged 6-18 years, median 15.5 years) with JIA and with clinical involvement of cervical spine. In each patient, both radiographs and MRI of the cervical spine were performed. Imaging findings were correlated with clinical and laboratory data. RESULTS The cervical spine was affected in 35% of patients. The most frequent lesions were subaxial subluxations (SAS; 24%), apophyseal joint ankylosis (9%), and C1/C2 joint lesions (9%). Anterior atlanto-axial subluxation (AAS) was diagnosed only by radiography, and most of the SAS were seen on radiography, whereas only a few on MRI. Reversely, C1/C2 soft tissue involvement were seen on MRI only. Cervical spine involvement was associated with raised ESR (p = 0.012) and CRP (p = 0.014). CONCLUSIONS The cervical spine lesions are still frequent complication of JIA affecting up to 35% of JIA patients. Most of them develop serious complications, such as AAS and ankylosis. Despite advantages of MRI in terms of the imaging of the atlanto-axial region radiography shows superiority in diagnosis of AAS and SAS.
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Affiliation(s)
- Mateusz Kotecki
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Piotr Gietka
- Department of Pediatric Rheumatology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
| | - Magdalena Posadzy
- Individual Private Practice Magdalena Posadzy, 61-426 Poznan, Poland;
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
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Gruszewska E, Sienkiewicz M, Abramowicz P, Konstantynowicz J, Gudowska-Sawczuk M, Chrostek L, Cylwik B. Serum profile of transferrin isoforms in juvenile idiopathic arthritis: a preliminary study. Rheumatol Int 2018; 38:1235-1240. [PMID: 29761223 PMCID: PMC6006233 DOI: 10.1007/s00296-018-4051-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 05/11/2018] [Indexed: 12/16/2022]
Abstract
It is reported that alterations in protein glycosylation are present in adult rheumatic diseases; however, the data related to pediatric rheumatic conditions are very scarce. The aim of this study was to assess the effect of juvenile idiopathic arthritis (JIA) on the serum glycosylation profile of transferrin isoforms. Twenty-five patients with different clinical forms of an active JIA and 22 healthy controls were studied. Serum samples were analyzed by capillary electrophoresis on MINICAP electrophoretic system (Sebia, France) to determine the levels of transferrin isoforms. In patients with JIA, tetrasialotransferrin (median 82.6%; range 68.8–99.5) concentration was lower (P = 0.032), and pentasialotransferrin (median 14%; range 0.5–31.2) was higher (P = 0.020) in comparison to controls (median 84.45; range 79.8–87.4; median 11.55; range 9.7–16.1, respectively). No significant correlations between concentration of transferrin isoforms and disease activity score (JADAS 27) or the degree of disability (VAS and CHAQ) were found. Erythrocyte sedimentation rate and CRP levels correlated positively with disialotransferrin (R = 0.493, P = 0.017; R = 0.850, P < 0.001, respectively) and pentasialotransferrin (R = 0.533, P = 0.006; R = 0.491, P = 0.045, respectively), and negatively with trisialotransferrin (R = − 0.546, P = 0.007; R = − 0.515, P = 0.049, respectively) and tetrasialotransferrin (R = − 0.436, P = 0.029; R = − 0.504, P = 0.039, respectively). This preliminary study shows the shifts in transferrin isoforms profile among patients with JIA. Our data indicate a potential clinical utility of the transferrin isoforms measurement, especially tetrasialotransferrin and pentasialotransferrin. Further prospective studies on larger groups of patients should be conducted to validate the results.
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Affiliation(s)
- Ewa Gruszewska
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Białystok, Poland
| | - Magdalena Sienkiewicz
- Department of Pediatric Laboratory Diagnostics, Medical University of Bialystok, Waszyngtona 17 Street, 15-274 Białystok, Poland
| | - Paweł Abramowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Waszyngtona 17 Street, 15-274 Białystok, Poland
| | - Jerzy Konstantynowicz
- Department of Pediatrics, Rheumatology, Immunology and Metabolic Bone Diseases, Medical University of Bialystok, Waszyngtona 17 Street, 15-274 Białystok, Poland
| | - Monika Gudowska-Sawczuk
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Białystok, Poland
| | - Lech Chrostek
- Department of Biochemical Diagnostics, Medical University of Bialystok, Waszyngtona 15A Street, 15-269 Białystok, Poland
| | - Bogdan Cylwik
- Department of Pediatric Laboratory Diagnostics, Medical University of Bialystok, Waszyngtona 17 Street, 15-274 Białystok, Poland
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Rypdal V, Arnstad ED, Aalto K, Berntson L, Ekelund M, Fasth A, Glerup M, Herlin T, Nielsen S, Peltoniemi S, Zak M, Rygg M, Rypdal M, Nordal E. Predicting unfavorable long-term outcome in juvenile idiopathic arthritis: results from the Nordic cohort study. Arthritis Res Ther 2018; 20:91. [PMID: 29724248 PMCID: PMC5934822 DOI: 10.1186/s13075-018-1571-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 03/16/2018] [Indexed: 01/06/2023] Open
Abstract
Background The aim was to develop prediction rules that may guide early treatment decisions based on baseline clinical predictors of long-term unfavorable outcome in juvenile idiopathic arthritis (JIA). Methods In the Nordic JIA cohort, we assessed baseline disease characteristics as predictors of the following outcomes 8 years after disease onset. Non-achievement of remission off medication according to the preliminary Wallace criteria, functional disability assessed by Childhood Health Assessment Questionnaire (CHAQ) and Physical Summary Score (PhS) of the Child Health Questionnaire, and articular damage assessed by the Juvenile Arthritis Damage Index-Articular (JADI-A). Multivariable models were constructed, and cross-validations were performed by repeated partitioning of the cohort into training sets for developing prediction models and validation sets to test predictive ability. Results The total cohort constituted 423 children. Remission status was available in 410 children: 244 (59.5%) of these did not achieve remission off medication at the final study visit. Functional disability was present in 111/340 (32.7%) children assessed by CHAQ and 40/199 (20.1%) by PhS, and joint damage was found in 29/216 (13.4%). Model performance was acceptable for making predictions of long-term outcome. In validation sets, the area under the curves (AUCs) in the receiver operating characteristic (ROC) curves were 0.78 (IQR 0.72–0.82) for non-achievement of remission off medication, 0.73 (IQR 0.67–0.76) for functional disability assessed by CHAQ, 0.74 (IQR 0.65–0.80) for functional disability assessed by PhS, and 0.73 (IQR 0.63–0.76) for joint damage using JADI-A. Conclusion The feasibility of making long-term predictions of JIA outcome based on early clinical assessment is demonstrated. The prediction models have acceptable precision and require only readily available baseline variables. Further testing in other cohorts is warranted. Electronic supplementary material The online version of this article (10.1186/s13075-018-1571-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Veronika Rypdal
- Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway. .,Department of Clinical Medicine, UIT the Arctic University of Norway, Tromsø, Norway.
| | - Ellen Dalen Arnstad
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Kristiina Aalto
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Lillemor Berntson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Ekelund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Department of Pediatrics, Ryhov County Hospital, Jonkoping, Sweden
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mia Glerup
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Nielsen
- Department of Pediatrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Suvi Peltoniemi
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Marek Zak
- Department of Pediatrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - Martin Rypdal
- Department of Mathematics and Statistics, UIT the Arctic University of Norway, Tromsø, Norway
| | - Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway, Tromsø, Norway.,Department of Clinical Medicine, UIT the Arctic University of Norway, Tromsø, Norway
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