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Rosina S, Consolaro A, Pistorio A, Rebollo-Giménez A, Bracaglia C, Dolezalova P, Guilaisne Bernard-Medina A, Herlin T, Trachana M, Vargová V, Wouters C, Carenini L, Ruperto N, Ravelli A. Defining criteria for disease activity states in juvenile dermatomyositis based on the Juvenile Dermatomyositis Activity Index. RMD Open 2024; 10:e003093. [PMID: 38307698 PMCID: PMC10840041 DOI: 10.1136/rmdopen-2023-003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/22/2023] [Indexed: 02/04/2024] Open
Abstract
OBJECTIVES To develop and validate the cut-offs in the Juvenile DermatoMyositis Activity Index (JDMAI) to distinguish the states of inactive disease (ID), low disease activity (LDA), moderate disease activity (MDA) and high disease activity (HDA) in children with juvenile dermatomyositis (JDM). METHODS For cut-off definition, data from 139 patients included in a randomised clinical trial were used. Among the six versions of the JDMAI, JDMA1 (score range 0-40) and JDMAI2 (score range 0-39) were selected. Optimal cut-offs were determined against external criteria by calculating different percentiles of score distribution and through receiver operating characteristic curve analysis. External criteria included the modified Pediatric Rheumatology International Trials Organization (PRINTO) criteria for clinically ID in JDM (for ID) and PRINTO levels of improvement in the clinical trial (for LDA and HDA). MDA cut-offs were set at the score interval between LDA and HDA cut-offs. Cut-off validation was conducted by assessing construct and discriminative ability in two cohorts including a total of 488 JDM patients. RESULTS The calculated JDMAI1 cut-offs were ≤2.4 for ID, ≤6.6 for LDA, 6.7-11 for MDA and >11 for HDA. The calculated JDMAI2 cut-offs were ≤5.2 for ID, ≤8.5 for LDA, 8.6-11.3 for MDA and >11.3 for HDA. The cut-offs discriminated strongly among disease activity states defined subjectively by caring physicians and parents, parents' satisfaction or non-satisfaction with illness outcome, levels of pain, fatigue, physical functional impairment and physical well-being. CONCLUSIONS Both JDMAI1 and JDMAI2 cut-offs revealed good metrologic properties in validation analyses and are, therefore, suited for application in clinical practice and research.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Alessandro Consolaro
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DiNOGMI), University of Genoa, Genova, Italy
| | - Angela Pistorio
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ana Rebollo-Giménez
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, Ospedale Pediatrico Bambino Gesu, Rome, Italy
| | - Pavla Dolezalova
- 1st Faculty of Medicine, Charles University, General University Hospital in Prague, Prague, Czech Republic
| | - Ana Guilaisne Bernard-Medina
- Servicio de Reumatología, Hospital Civil de Guadalajara Unidad Hospitalaria Fray Antonio Alcalde, Guadalajara, Mexico
| | - Troels Herlin
- Pediatric Rheumatology Unit, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Trachana
- Thessaloniki University School of Medicine, First Department of Pediatrics, Pediatric Immunology and Rheumatology Referral Center, Hippokration General Hospital, Thessaloniki, Greece
| | - Veronika Vargová
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Kosice, Slovakia
| | - Carine Wouters
- Pediatric Rheumatology and Immune-inflammatory diseases, and KU Leuven - University of Leuven, Department of Microbiology and Immunology, Laboratory Immunobiology, UZ Leuven - Universitair ziekenhuis, Leuven, Belgium
| | - Laura Carenini
- UOC Servizio Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nicolino Ruperto
- UOC Servizio Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angelo Ravelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal-Infantile Sciences (DiNOGMI), University of Genoa, Genova, Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Rosina S, Rebollo-Giménez AI, Consolaro A, Ravelli A. Treat-to-Target in Pediatric Rheumatic Diseases. Curr Rheumatol Rep 2023; 25:226-235. [PMID: 37584859 DOI: 10.1007/s11926-023-01112-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE OF REVIEW To summarize the current evidence on the adoption of the treat-to-target (T2T) strategy in pediatric rheumatic diseases (PRD). RECENT FINDINGS The recent advances in the management of PRD have markedly increased the ability to achieve disease remission. Complete disease quiescence is regarded as the ideal therapeutic goal because its attainment leads to lesser long-term damage and physical disability, and to optimization of quality of life. Studies in adult rheumatic diseases have shown that patient outcomes are improved if complete suppression of the inflammatory process is aimed for by frequent adjustments of therapy according to quantitative indices. This approach, which underlies the T2T concept, has been applied in strategic trials in rheumatoid arthritis (RA). Furthermore, recommendations for the T2T have been issued for RA and other adult rheumatic diseases. There is currently a growing interest for the introduction of T2T in PRD, and recommendations for treating juvenile idiopathic arthritis (JIA) to target were promulgated. A similar initiative has been undertaken for childhood-onset systemic lupus erythematosus. Preliminary therapeutic studies have explored the T2T design in JIA. The T2T strategy is a modern therapeutic approach that holds the promise of improving the outcomes in patients with PRD.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia E Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | | | - Alessandro Consolaro
- UOC Reumatologia E Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento Di Neuroscienze, Scienze Materno-Infantili, Università Degli Studi Di Genova, RiabilitazioneGenoa, Oftalmologia, Geneticae , Italy
| | - Angelo Ravelli
- Dipartimento Di Neuroscienze, Scienze Materno-Infantili, Università Degli Studi Di Genova, RiabilitazioneGenoa, Oftalmologia, Geneticae , Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Giancane G, Rosina S, Consolaro A, Ruperto N. Outcome Scores in Pediatric Rheumatology. Curr Rheumatol Rep 2021; 23:23. [PMID: 33683471 DOI: 10.1007/s11926-021-00988-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Providing a summary of the latest research on outcome measures in juvenile idiopathic arthritis, childhood -onset systemic lupus erythematosus, and juvenile dermatomyositis. RECENT FINDINGS A rational management of patients with pediatric rheumatic diseases requires the regular assessment of the level of disease activity and damage, as well as the evaluation of therapeutic response through validated and standardized outcome measures. Ideally, such tools should be simple, feasible, and easily applicable in routine care. Recently, there has been a great deal of effort to refine existing tools and devise novel outcome measures, aiming to address the various aspects of disease impact and to improve the reliability of research studies and clinical trials. The newest outcome tools in pediatric rheumatology have markedly enlarged the spectrum of health domains assessable in a standardized way, thus increasing the reliability of evaluation of clinical response and fostering future clinical trials.
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Affiliation(s)
- Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Silvia Rosina
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
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Identification of Potential Biomarkers and Biological Pathways in Juvenile Dermatomyositis Based on miRNA-mRNA Network. BIOMED RESEARCH INTERNATIONAL 2019; 2019:7814287. [PMID: 31886250 PMCID: PMC6925816 DOI: 10.1155/2019/7814287] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/14/2019] [Accepted: 11/08/2019] [Indexed: 01/09/2023]
Abstract
Objective The aim of this study is to explore the potential pathogenesis of juvenile dermatomyositis by bioinformatics analysis of gene chips, which would screen the hub genes, identify potential biomarkers, and reveal the development mechanism of juvenile dermatomyositis. Material and Methods We retrieved juvenile dermatomyositis's original expression microarray data of message RNAs (mRNAs) and microRNAs (miRNAs) from NCBI's Gene Expression Omnibus database (GEO, http://www.ncbi.nlm.nih.gov/geo/); through the R package of limma in Bioconductor, we can screen the differentially expressed miRNAs and mRNAs, and then we further analyzed the predicted target genes by the methods such as Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis and miRNA-mRNA regulatory network construction and protein-protein interaction (PPI) network using Cytoscape 3.6.1. Results Compared with normal juvenile skin tissues, 6 upregulated microRNAs and 5 downregulated microRNAs were identified from 166 downregulated microRNAs and 58 upregulated microRNAs in juvenile dermatomyositis tissues. The enrichment pathways of differentially expressed microRNAs include cell adhesion molecules (CAMs), autoimmune thyroid disease, Type I diabetes mellitus, antigen and presentation, viral myocardium, graft-versus-host disease, and Kaposi sarcoma-associated herpes virus infection. By screening of microRNA-messenger RNA regulatory network and construction of PPI network map, three target miRNAs were identified, namely, miR-193b, miR-199b-5p, and miR-665. Conclusion We identified mir-193b, mir-199b-5p, and mir-6653 target miRNAs by exploring the miRNA-mRNA regulation network mechanism related to the pathogenesis of juvenile dermatomyositis, which will be of great significance for further study on the pathogenesis and targeted therapy of juvenile dermatomyositis.
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Wakiguchi H. Multispecialty approach for improving outcomes in juvenile dermatomyositis. J Multidiscip Healthc 2019; 12:387-394. [PMID: 31213823 PMCID: PMC6549682 DOI: 10.2147/jmdh.s171095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 04/11/2019] [Indexed: 11/23/2022] Open
Abstract
Juvenile dermatomyositis (JDM) is a pediatric rheumatic disease characterized by inflammation of the muscle and skin. Prognosis of JDM in children has improved in general owing to medical progress; however, pathogenesis and management of JDM in children and prognosis in refractory JDM remain challenging. For elucidation of JDM pathophysiology and establishment of appropriate treatment for JDM, pediatric rheumatologists need to adopt a multispecialty approach that involves experts in genetics, immunology, pathology, musculoskeletal medicine, dermatology, pulmonology, cardiology, hematology, gastroenterology, endocrinology, ophthalmology, psychology, radiology, pharmacology, physiotherapy, surgery, preventive medicine, and adult rheumatology. Such collaborations will potentially lead to improved outcomes in children with JDM.
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Affiliation(s)
- Hiroyuki Wakiguchi
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan
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Rosina S, Consolaro A, van Dijkhuizen P, Pistorio A, Varnier GC, Bovis F, Nistala K, Maillard S, Civino A, Tsitsami E, de Inocencio J, Jelusic M, Vojinovic J, Espada G, Makay B, Katsicas MM, Pratsidou-Gertsi P, Lazarevic D, Rao AP, Pires Marafon D, Martini A, Pilkington C, Ruperto N, Ravelli A. Development and validation of a composite disease activity score for measurement of muscle and skin involvement in juvenile dermatomyositis. Rheumatology (Oxford) 2019; 58:1196-1205. [DOI: 10.1093/rheumatology/key421] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 11/01/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Silvia Rosina
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Alessandro Consolaro
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Angela Pistorio
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Giulia Camilla Varnier
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Francesca Bovis
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
| | - Kiran Nistala
- Paediatric Rheumatology Department, Great Ormond Street Hospital, London, UK
| | - Susan Maillard
- Paediatric Rheumatology Department, Great Ormond Street Hospital, London, UK
| | - Adele Civino
- Oncoematologia Pediatrica, Ospedale Vito Fazzi, Lecce, Italy
| | - Elena Tsitsami
- First Department of Pediatrics, Children’s Hospital Agia Sofia, Athens, Greece
| | - Jaime de Inocencio
- Unidad de Reumatología Pediátrica, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Marija Jelusic
- Department of Pediatrics, University of Zagreb, Zagreb, Croatia
| | | | - Graciela Espada
- Pediatric Rheumatology Unit, Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina
| | - Balahan Makay
- Division of Pediatric Rheumatology, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Maria Martha Katsicas
- Servicio de Inmunologia/Reumatologia, Hospital de Pediatría Juan P.Garrahan, Buenos Aires, Argentina
| | | | | | | | - Denise Pires Marafon
- Clinica Pediatrica De Marchi, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Martini
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Clarissa Pilkington
- Paediatric Rheumatology Department, Great Ormond Street Hospital, London, UK
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze Riabilitazione Oftalmologia Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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