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Chhabra A, Oen K, Huber AM, Shiff NJ, Boire G, Benseler SM, Berard RA, Scuccimarri R, Feldman BM, Lim LSH, Barsalou J, Bruns A, Cabral DA, Chédeville G, Ellsworth J, Houghton K, Lang B, Morishita K, Rumsey DG, Rosenberg AM, Tse SM, Watanabe Duffy K, Duffy CM, Guzman J, Bolaria R, Gross K, Turvey SE, Chan M, Tucker LB, Petty R, Johnson N, Luca N, Miettunen P, Schmeling H, Gerhold K, Larché M, Levy DM, Laxer RM, Feldman D, Spiegel L, Schneider R, Silverman E, Cameron B, Yeung RSM, Roth J, Jurencak R, Gibbon M, Chetaille A, Dorval J, Campillo S, LeBlanc C, Chédeville G, Haddad E, Cyr CS, Ramsey SE, Stringer E, Dancey P. Real‐World Effectiveness of Common Treatment Strategies for Juvenile Idiopathic Arthritis: Results From a Canadian Cohort. Arthritis Care Res (Hoboken) 2020; 72:897-906. [DOI: 10.1002/acr.23922] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/26/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Amieleena Chhabra
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Kiem Oen
- University of Manitoba Winnipeg Manitoba Canada
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University Halifax Nova Scotia Canada
| | - Natalie J. Shiff
- Shands Children's Hospital and University of Florida Gainesville
| | - Gilles Boire
- Centre intégré universitaire de santé et de services sociaux de l'EstrieCentre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke Sherbrooke Quebec Canada
| | - Susanne M. Benseler
- Alberta Children's Hospital and University of Calgary Calgary Alberta Canada
| | - Roberta A. Berard
- London Health Sciences Centre and Western University London Ontario Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University Montreal Quebec Canada
| | - Brian M. Feldman
- Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | | | - Julie Barsalou
- Centre hospitalier universitaire Sainte‐Justine and Université de Montréal Montreal Quebec Canada
| | - Alessandra Bruns
- Centre intégré universitaire de santé et de services sociaux de l'EstrieCentre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke Sherbrooke Quebec Canada
| | - David A. Cabral
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University Montreal Quebec Canada
| | - Janet Ellsworth
- Stollery Children's Hospital and University of Alberta Edmonton Alberta Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University Halifax Nova Scotia Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Dax G. Rumsey
- Stollery Children's Hospital and University of Alberta Edmonton Alberta Canada
| | - Alan M. Rosenberg
- Royal University Hospital and University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Shirley M. Tse
- Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa Ottawa Ontario Canada
| | - Ciaran M. Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa Ottawa Ontario Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
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Smits RM, Veldhuijzen DS, van Middendorp H, Hissink Muller PCE, Armbrust W, Legger E, Wulffraat NM, Evers AWM. Pharmacological conditioning for juvenile idiopathic arthritis: a potential solution to reduce methotrexate intolerance. Pediatr Rheumatol Online J 2020; 18:12. [PMID: 32033577 PMCID: PMC7006148 DOI: 10.1186/s12969-020-0407-5] [Citation(s) in RCA: 2] [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: 10/16/2019] [Accepted: 02/03/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Methotrexate (MTX) therapy has proven to be a successful and safe treatment for Juvenile Idiopathic Arthritis (JIA). Despite the high efficacy rates of MTX, treatment outcomes are often complicated by burdensome gastro-intestinal side effects. Intolerance rates for MTX in children are high (approximately 50%) and thus far no conclusive effective treatment strategies to control for side effects have been found. To address this need, this article proposes an innovative research approach based on pharmacological conditioning, to reduce MTX intolerance. PRESENTATION OF THE HYPOTHESIS A collaboration between medical psychologists, pediatric rheumatologists, pharmacologists and patient groups was set up to develop an innovative research design that may be implemented to study potential improved control of side effects in JIA, by making use of the psychobiological principles of pharmacological conditioning. In pharmacological conditioning designs, learned positive associations from drug therapies (conditioning effects) are integrated in regular treatment regimens to maximize treatment outcomes. Medication regimens with immunosuppressant drugs that made use of pharmacological conditioning principles have been shown to lead to optimized therapeutic effects with reduced drug dosing, which might ultimately cause a reduction in side effects. TESTING THE HYPOTHESIS This research design is tailored to serve the needs of the JIA patient group. We developed a research design in collaboration with an interdisciplinary research group consisting of patient representatives, pediatric rheumatologists, pharmacologists, and medical psychologists. IMPLICATIONS OF THE HYPOTHESIS Based on previous experimental and clinical findings of pharmacological conditioning with immune responses, we propose that the JIA patient group is particularly suited to benefit from a pharmacological conditioning design. Moreover, findings from this study may potentially also be promising for other patient groups that endure long-lasting drug therapies.
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Affiliation(s)
- Rosanne M. Smits
- 0000 0001 2312 1970grid.5132.5Health, Medical and Neuropsychology unit, Leiden University, Leiden, P.O. Box 9500, The Netherlands ,Leiden Institute for Brain and Cognition, Leiden, P.O. Box 9600, The Netherlands ,0000000090126352grid.7692.aDepartment Pediatric Rheumatology and Immunology, University Medical Center Utrecht, Utrecht, P.O. Box 85090, The Netherlands
| | - Dieuwke S. Veldhuijzen
- 0000 0001 2312 1970grid.5132.5Health, Medical and Neuropsychology unit, Leiden University, Leiden, P.O. Box 9500, The Netherlands ,Leiden Institute for Brain and Cognition, Leiden, P.O. Box 9600, The Netherlands ,0000000090126352grid.7692.aDepartment Pediatric Rheumatology and Immunology, University Medical Center Utrecht, Utrecht, P.O. Box 85090, The Netherlands
| | - Henriet van Middendorp
- 0000 0001 2312 1970grid.5132.5Health, Medical and Neuropsychology unit, Leiden University, Leiden, P.O. Box 9500, The Netherlands ,Leiden Institute for Brain and Cognition, Leiden, P.O. Box 9600, The Netherlands
| | - Petra C. E. Hissink Muller
- 0000000089452978grid.10419.3dDepartment Pediatric Rheumatology and Immunology, Leiden University Medical Center, Leiden, P.O. Box 9600, The Netherlands
| | - Wineke Armbrust
- 0000 0000 9558 4598grid.4494.dDepartment Pediatric Rheumatology and Immunology, University Medical Centre Groningen, Groningen, P.O. Box 30.001, The Netherlands
| | - Elizabeth Legger
- 0000 0000 9558 4598grid.4494.dDepartment Pediatric Rheumatology and Immunology, University Medical Centre Groningen, Groningen, P.O. Box 30.001, The Netherlands
| | - Nico M. Wulffraat
- 0000000090126352grid.7692.aDepartment Pediatric Rheumatology and Immunology, University Medical Center Utrecht, Utrecht, P.O. Box 85090, The Netherlands
| | - Andrea W. M. Evers
- 0000 0001 2312 1970grid.5132.5Health, Medical and Neuropsychology unit, Leiden University, Leiden, P.O. Box 9500, The Netherlands ,Leiden Institute for Brain and Cognition, Leiden, P.O. Box 9600, The Netherlands ,0000000089452978grid.10419.3dDepartment of Psychiatry, Leiden University Medical Center, Leiden, P.O. Box 9600, The Netherlands
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Giancane G, Muratore V, Marzetti V, Quilis N, Benavente BS, Bagnasco F, Alongi A, Civino A, Quartulli L, Consolaro A, Ravelli A. Disease activity and damage in juvenile idiopathic arthritis: methotrexate era versus biologic era. Arthritis Res Ther 2019; 21:168. [PMID: 31287015 PMCID: PMC6615271 DOI: 10.1186/s13075-019-1950-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 06/24/2019] [Indexed: 11/25/2022] Open
Abstract
Objective To compare the long-term disease state, in terms of activity and damage, of children with juvenile idiopathic arthritis (JIA) who had their disease onset in methotrexate (MTX) or biologic eras. Methods Patients were included in MTX or biologic era cohort depending on whether their disease presentation occurred before or after January 2000. All patients had disease duration ≥ 5 years and underwent a prospective cross-sectional assessment, which included measurement of disease activity and damage. Inactive disease (ID) and low disease activity (LDA) states were defined according to Wallace, JADAS10, and cJADAS10 criteria. Articular and extraarticular damage was assessed with the Juvenile Arthritis Damage Index (JADI). Results MTX and biologic era cohorts included 239 and 269 patients, respectively. Patients were divided in the “functional phenotypes” of oligoarthritis and polyarthritis. At cross-sectional visit, patients in the biologic era cohort with either oligoarthritis or polyarthritis had consistently higher frequencies of ID and LDA by all criteria. The measurement of disease damage at cross-sectional visit revealed that the frequency of impairment of > 1 JADI-Articular items was higher in MTX than in biologic era cohort (17.6% versus 11% in oligoarthritis and 52.6% versus 21.8% in polyarthritis). Likewise, frequency of involvement of > 1 JADI-Extraarticular items was higher in the MTX than in the biologic era cohort (26.5% versus 16.2% in oligoarthritis and 31.4% versus 13.5% in polyarthritis). Conclusion Our study provides evidence of the remarkable outcome improvement obtained with the recent therapeutic advance in JIA.
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Affiliation(s)
- Gabriella Giancane
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy. .,Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy.
| | - Valentina Muratore
- Clinica Pediatrica, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Valentina Marzetti
- Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy
| | - Neus Quilis
- Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy
| | | | - Francesca Bagnasco
- Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy
| | - Alessandra Alongi
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università degli Studi di Genova, Genoa, Italy.,Clinica Pediatrica e Reumatologia, IRCCS G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy
| | | | - Lorenzo Quartulli
- UOC Pediatria, Azienda Ospedaliera Cardinale G. Panico, Tricase, 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 G. Gaslini, via G. Gaslini 5, 16147, 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 G. Gaslini, via G. Gaslini 5, 16147, Genoa, Italy.,Sechenov First Moscow State Medical University, Moscow, Russian Federation
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Update on the pathogenesis and treatment of juvenile idiopathic arthritis. Curr Opin Rheumatol 2018; 29:523-529. [PMID: 28538013 DOI: 10.1097/bor.0000000000000417] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of recently published studies on pathogenesis and management of juvenile idiopathic arthritis (JIA). RECENT FINDINGS In the past year, the potential role of network analysis in the understanding of the molecular phenotype of individual JIA subgroups has been highlighted. In addition, potential new targets for pharmacologic interventions have been identified through the elucidation of mechanisms that modulate the function of cells involved in the inflammatory process. There is a growing interest for the role of the gut microbiome in disease pathogenesis, which may open the way to future therapeutic manipulations of fecal microbial population. Recent therapeutic studies have provided important information in large patient samples on the effectiveness and toxicity profile of biologic medications used in JIA. Concomitant administration of methotrexate was found to increase the effectiveness of intra-articular corticosteroid therapy in children with oligoarticular JIA. SUMMARY A great deal of work is being conducted to better define the molecular phenotype of the individual subsets of JIA and to identify potential new targets for therapeutic interventions. The results of the ongoing large-scale international data collections will help establish the long-term safety profiles of biologic medications, in particular the risk of malignancy.
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