1
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Alunno A, Carubbi F, Tan AL, Sen P, Cavagna L, Joshi M, Day J, Saha S, Gutiérrez CET, Caballero-Uribe CV, Distler O, Chinoy H, Aggarwal R, Agarwal V, Gupta L. COVID-19 severity, breakthrough infections and vaccine safety in young individuals with autoimmune diseases: insights from the COVAD study. Rheumatol Int 2024:10.1007/s00296-024-05654-w. [PMID: 39003346 DOI: 10.1007/s00296-024-05654-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/21/2024] [Indexed: 07/15/2024]
Abstract
Notwithstanding the wealth of literature on COVID-19, studies focusing on young adults with autoimmune diseases (AD) are lacking. To determine early (within 7 days) and late (after 7 days) anti-SARS-CoV-2 vaccine-related adverse events (AEs), post-vaccine disease flares, COVID-19 severity and breakthrough infections (B-INFs) in young people with rheumatic diseases (RMDs) and non-rheumatic autoimmune diseases (nr-ADs) compared to healthy controls (HC). Data were captured through the international COVID-19 vaccination in autoimmune diseases (COVAD) 1 and 2 questionnaires. Of 20,685 complete responses, we identified 6010 from patients aged 18-35 years (1692 RMD, 400 nrADs, 3918 HC) who received up to 4 vaccine doses. BNT162b2 was the most frequently administered vaccine and prior to vaccination, 7% of people with nrAD were taking immunosuppressants (IS) versus 80% in RMDs. Early mild AEs were more frequent in RMDs (93%) and nr-ADs (92%) compared to HC (85%). The frequency of late mild AEs was < 20% in all groups. Severe AEs were rare. SARS-CoV-2 infection rates were similar across all groups, however, RMD patients reported a single episode of infection more frequently than nrADs and HC, while nrADs reported multiple infections more frequently than RMD. Self-reported disease flares were reported by 10% or RMD and 7% of nrAD patients. Our study reinforces the safety of anti-SARS-CoV-2 vaccine also in young people with ADs, but it also highlights that among young individuals the number and clinical picture of SARS-CoV-2 infections is affected more by the type of AD rather than by coexisting IS therapy.
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Affiliation(s)
- Alessia Alunno
- Internal Medicine and Nephrology Division, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila and San Salvatore Hospital, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy.
| | - Francesco Carubbi
- Internal Medicine and Nephrology Division, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila and San Salvatore Hospital, Piazzale Salvatore Tommasi 1, 67100, L'Aquila, Italy
| | - Ai Lyn Tan
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, UK
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Parikshit Sen
- Maulana Azad Medical College, 2-Bahadurshah Zafar Marg, New Delhi, Delhi, 110002, India
| | - Lorenzo Cavagna
- Rheumatology Unit, Dipartimento di Medicine Interna e Terapia Medica, Università degli Studi di Pavia, Pavia, Lombardy, Italy
| | - Mrudula Joshi
- Byramjee Jeejeebhoy Government Medical College and Sassoon General Hospitals, Pune, India
| | - Jessica Day
- Department of Rheumatology, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
- Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, 3052, Australia
- Department of Medical Biology, University of Melbourne, Parkville, VIC, 3052, Australia
| | - Sreoshy Saha
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - Carlos Enrique Toro Gutiérrez
- Reference Center for Osteoporosis, Rheumatology and Dermatology, Pontifica Universidad Javeriana Cali, Cali, Colombia
| | | | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hector Chinoy
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK
- Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Latika Gupta
- Division of Musculoskeletal and Dermatological Sciences, Centre for Musculoskeletal Research, School of Biological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Department of Rheumatology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, UK
- Department of Rheumatology, City Hospital, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
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2
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Choukair D, Patry C, Lehmann R, Treiber D, Hoffmann GF, Grasemann C, Bruck N, Berner R, Burgard P, Lorenz HM, Tönshoff B. Resource utilization and costs of transitioning from pediatric to adult care for patients with chronic autoinflammatory and autoimmune disorders. Pediatr Rheumatol Online J 2024; 22:28. [PMID: 38395977 PMCID: PMC10885380 DOI: 10.1186/s12969-024-00963-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND A structured transition of adolescents and young adults with chronic autoinflammatory and autoimmune disorders from the pediatric to the adult health care system is important. To date, data on the time, processes, outcome, resources required for the necessary components of the transition process and the associated costs are lacking. METHODS Evaluation of resource use and costs in a prospective cohort study of 58 adolescents with chronic autoinflammatory and autoimmune disorders, for the key elements of a structured transition pathway including (i) compilation of a summary of patient history, (ii) assessment of patients' disease-related knowledge and needs, (iii) required education and counseling sessions, (iv) and a transfer appointment of the patient with the current pediatric and the future adult rheumatologist. RESULTS Forty-nine of 58 enrolled patients (84.5%) completed the transition pathway and were transferred to adult care. The mean time from the decision to start the transition process to the final transfer consultation was 315 ± 147 days. Transfer consultations were performed in 49 patients, including 10 patients jointly with the future adult rheumatologist. Most consultations were performed by the multidisciplinary team with a median of three team members and lasted 65.5 ± 21.3 min. The cumulative cost of all consultation and education sessions performed including the transfer appointment was 283 ± 164 Euro per patient. In addition, the cost of coordinating the transition process was 57.3 ± 15.4 Euro. CONCLUSIONS A structured transition pathway for patients with chronic autoinflammatory and autoimmune disorders is resource and time consuming and should be adequately funded.
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Affiliation(s)
- Daniela Choukair
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany.
- Center for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany.
| | - Christian Patry
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Ronny Lehmann
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Dorothea Treiber
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Georg F Hoffmann
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Center for Rare Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Corinna Grasemann
- Department of Pediatrics, St-Josef Hospital Bochum and Center for Rare Diseases, Ruhr-University, Bochum, Germany
| | - Normi Bruck
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Reinhard Berner
- Department of Pediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter Burgard
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Hanns-Martin Lorenz
- Department of Oncology, Hematology and Rheumatology (Internal Medicine V), Heidelberg University Hospital, Heildelberg, Germany
| | - Burkhard Tönshoff
- Department of Pediatrics I, Center of Pediatrics and Adolescent Medicine, University Hospital Heidelberg, Heidelberg, Germany
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3
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Horneff G, Minden K, Rolland C, Daly ACH, Borlenghi C, Ruperto N. Efficacy and safety of TNF inhibitors in the treatment of juvenile idiopathic arthritis: a systematic literature review. Pediatr Rheumatol Online J 2023; 21:20. [PMID: 36829225 PMCID: PMC9951426 DOI: 10.1186/s12969-023-00798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/29/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE A systematic literature review was conducted to summarize efficacy and safety data from studies that evaluated tumor necrosis factor inhibitors in patients with juvenile idiopathic arthritis (JIA). METHODS Relevant publications were identified via online searches (cutoff: March 16, 2021). After screening search results, outcome data were extracted if the treatment arm included ≥ 30 patients. Outcomes were described narratively, with efficacy assessed by JIA-American College of Rheumatology (ACR) response criteria and safety assessed by the incidence of serious adverse events (SAEs) per 100 patient-years (100PY). RESULTS Among 87 relevant publications included in the qualitative synthesis, 19 publications described 13 clinical trials. Across the 13 trials, the percentages of patients who achieved JIA-ACR30/50/70/90 responses at Week 12 with adalimumab ranged 71-94%, 68-90%, 55-61%, and 39-42%, respectively; with etanercept (Week 12), 73-94%, 53-78%, 36-59%, and 28%; with golimumab (Week 16), 89%, 79%, 66%, and 36%; and with infliximab (Week 14), 64%, 50%, and 22% (JIA-ACR90 not reported). SAE incidence across all time points ranged 0-13.7 SAE/100PY for adalimumab, 0-20.0 SAE/100PY for etanercept, and 10.4-24.3 SAE/100PY for golimumab (1 study). SAE incidence could not be estimated from the 2 infliximab publications. CONCLUSION Tumor necrosis factor inhibitors are effective and well tolerated in the treatment of JIA, but additional evidence from head-to-head studies and over longer periods of time, especially in the context of the transition from pediatric to adult care, would be useful.
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Affiliation(s)
- Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany. .,Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Kirsten Minden
- grid.413453.40000 0001 2224 3060German Rheumatism Research Centre Berlin (DRFZ), Leibniz Association, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Pediatric Pulmonology, Immunology, and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109IRCCS Istituto Giannina Gaslini, UOSID Centro Trial, Genoa, Italy
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Boeker LS, Kuemmerle-Deschner JB, Saur SJ, Klotsche J, Erbis G, Hansmann S. Health-related quality of life, continuity of care and patient satisfaction: long-term outcomes of former patients of the Tuebingen Transition Program (TTP) - a retrospective cohort study. Pediatr Rheumatol Online J 2022; 20:121. [PMID: 36575486 PMCID: PMC9794404 DOI: 10.1186/s12969-022-00776-6] [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: 07/14/2022] [Accepted: 11/26/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND A significant number of patients in pediatric rheumatology suffer from ongoing disease activity into adulthood and thus need to be transferred into adult care. Transition as a structured individual process of preparation and patient empowerment can reduce risks of adverse long-term outcomes. The aim of this study was to measure long-term transition outcomes such as health-related quality of life (HR-QoL), patient satisfaction, and continuity of care in former patients of the interdisciplinary Tuebingen Transition Program (TTP). METHODS In an iterative team process, a standardized questionnaire was developed including the EQ-5D-5L to measure HR-QoL, visual analogue scales to measure various items of patient satisfaction, further questions on continuity of care and physical activity and physician global assessment (PGA) to determine disease activity. HR-QoL and physical activity were compared to data from the average German population. Data was analyzed descriptively, and a logistic regression analysis was performed to identify possible predictive factors for negative outcomes. RESULTS Response rate was 28.8% (85/295), 70.6% were female and median age was 24.1 years. 70.6% were diagnosed with juvenile idiopathic arthritis (JIA). Overall, HR-QoL was high (79.8 on the EQ VAS), yet lower than in the average population. The study cohort was more physically active than the respective average age groups. Mean patient satisfaction with pediatric care (8.4; standard deviation (SD) 1.7) and with the transition program (7.9; SD 2.6) was higher than with adult care (7.7; SD 2.2). 76.5% of participants received regular rheumatologic care after transfer. After excluding all participants in remission, the drop-out rate was 4.7%. A low PGA at the time of transfer was associated with higher HR-QoL and patient satisfaction after transfer. CONCLUSIONS HR-QoL of adult patients after successful transfer to adult rheumatology is reduced compared to the general population but physical activity and achievement of clinical remission could help to prevent negative long-term outcomes. Patient satisfaction and self-management of TTP patients were generally high, whereas youth-specific issues and their impact on the disease mandate greater attention. Treatment discontinuation rates were low and mostly due to remission. Further studies should focus on the identification of early predictors of long-term outcome to improve the process and outcome of transition.
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Affiliation(s)
- Luca Samuel Boeker
- grid.411544.10000 0001 0196 8249Department of Pediatrics, Division of Pediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany
| | - Jasmin Beate Kuemmerle-Deschner
- grid.411544.10000 0001 0196 8249Department of Pediatrics, Division of Pediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany
| | - Sebastian Jonas Saur
- grid.411544.10000 0001 0196 8249Centre for Interdisciplinary Clinical Immunology, Rheumatology and Autoinflammatory Diseases and Department of Internal Medicine II (Oncology, Hematology, Immunology, Rheumatology, Pulmology), University Hospital Tuebingen, Tuebingen, Germany
| | - Jens Klotsche
- grid.418217.90000 0000 9323 8675Programme area Epidemiology and Health Care Research, German Rheumatism Research Center Berlin and Leibniz Institute, Berlin, Germany
| | - Gabriele Erbis
- grid.411544.10000 0001 0196 8249Department of Pediatrics, Division of Pediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Hansmann
- Department of Pediatrics, Division of Pediatric Rheumatology and autoinflammation reference center Tuebingen (arcT), University Hospital Tuebingen, Tuebingen, Germany.
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5
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Roberts JE, Halyabar O, Petty CR, Alfieri M, Esty B, Dallas J, Hazen M, Stein S, Son MBF. Longitudinal assessment of preparation for care transition among adolescents and young adults with rheumatologic disease: a single-center pilot study. Pediatr Rheumatol Online J 2022; 20:93. [PMID: 36271446 PMCID: PMC9587589 DOI: 10.1186/s12969-022-00751-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/26/2022] Open
Abstract
Adolescents and young adults (AYA) with rheumatologic diseases are at high risk for poor outcomes and gaps in care when transitioning from pediatric to adult care. However, tools for evaluating transition readiness and assessing the impact of transition interventions are limited. We implemented a written transition policy at our pediatric rheumatology center and evaluated preparation for transition among AYA 16 and older before and after distribution. 31 of 77 patients completed the follow-up survey (response rate 40%). Patient report of transition counseling increased following written transition policy implementation, though these results were not statistically significant in our small cohort. Most follow-up respondents (n = 19, 61%) had not yet completed care transfer; 4 (13%) had arranged a visit with an adult rheumatologist and 8 (26%) had fully transitioned to adult care. Those who successfully completed care transfer were older, had completed higher levels of education, and had significantly higher baseline transition preparation scores compared to those with no transfer arranged or planned visit only. Our single-center pilot study demonstrated that longitudinal assessment of transition preparation is feasible and that scores are significantly associated with care transfer outcomes. Tracking transition preparation over time may provide practices with information on areas of highest need for transition guidance and predict successful transfer among AYA with rheumatologic disease.
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Affiliation(s)
- Jordan E. Roberts
- grid.34477.330000000122986657Division of Rheumatology, Seattle Children’s Hospital/Seattle Children’s Research Institute, University of Washington School of Medicine, 4800 Sand Point Way NE, Mail Stop MA.7.110, Seattle, WA USA ,grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Olha Halyabar
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Carter R. Petty
- grid.2515.30000 0004 0378 8438Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA USA
| | - Maria Alfieri
- grid.38142.3c000000041936754XDepartment of Pediatrics Quality Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Brittany Esty
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Johnathan Dallas
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Melissa Hazen
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Sandra Stein
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | - Mary Beth F. Son
- grid.38142.3c000000041936754XDivision of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
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6
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Costello RE, Kearsley-Fleet L, McDonagh JE, Hyrich K, Humphreys JH. Continuing specialist care into adulthood in young people with juvenile idiopathic arthritis: a retrospective cohort study using electronic health records in England. Rheumatology (Oxford) 2022; 62:1936-1943. [PMID: 36135794 PMCID: PMC10152295 DOI: 10.1093/rheumatology/keac497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES This study aimed to measure 1) the proportion of children who continue to receive specialist care (rheumatology/ophthalmology) as adults, 2) the characteristics associated with continuing specialist care, and 3) the frequency of specialist care appointments in both paediatric and adult services. METHODS A retrospective cohort of young people with JIA was identified from UK primary care electronic health records (Clinical Practice Research Datalink (CPRD)) between 01/04/2003-31/12/2018. To be included in the study cases needed to have at least one year registration at their GP beyond age 18 and linkage to Hospital Episodes Statistics (HES) data for secondary care information. All specialist care outpatient visits were identified from HES outpatient data. RESULTS There were 666 young people included in the study. Of those, 427 (64%) received specialist care beyond age 18, 90 (13%) had their last recorded contact between 16-17 years and 149 (22%) did not continue after 16 years. Older age at diagnosis, female gender, greater deprivation and a childhood diagnosis of uveitis were associated with continuing specialist care beyond age 18. Of those continuing beyond 18, 35% (n = 153) were subsequently discharged by study end date. Of all those discharged, 32% had a missed appointment recorded after the last attended visit suggesting failure to attend. CONCLUSIONS Two-thirds of young people with JIA continue to receive specialist care beyond age 18. This is useful information for children and young people with JIA and their families planning for their future, and for clinicians planning healthcare services.
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Affiliation(s)
- Ruth E Costello
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Centre, Manchester, UK
| | - Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Centre, Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Trust, Manchester, UK.,Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children's Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Kimme Hyrich
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Centre, Manchester, UK.,NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Trust, Manchester, UK.,Kellgren Centre for Rheumatology, Manchester Royal Infirmary, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Jenny H Humphreys
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester Academic Health Centre, Manchester, UK.,Kellgren Centre for Rheumatology, Manchester Royal Infirmary, Manchester University Hospitals NHS Trust, Manchester, UK
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7
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Ma C, Dushnicky M, Talaat H, Thomas S, Cellucci T, Garner S, Heale L, Matsos M, Beattie K, Batthish M. Self-Reported Transition Readiness of Adolescent Patients with Rheumatic Disease: Do the Parents Agree? J Pediatr 2022; 247:155-159. [PMID: 35561803 DOI: 10.1016/j.jpeds.2022.05.009] [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] [Received: 01/21/2022] [Revised: 04/05/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022]
Abstract
Our objective was to compare transition readiness assessment scores from adolescents with rheumatic disease with their parents and analyze their level of agreement. We found that adolescents and parents generally agree on the level of the transition readiness; however, there is occasional disagreement in specific domains.
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Affiliation(s)
- Christina Ma
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Molly Dushnicky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Habeba Talaat
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Steffy Thomas
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Tania Cellucci
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Stephanie Garner
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Liane Heale
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Matsos
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karen Beattie
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
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8
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Saez C, Nassi L, Wright T, Makris UE, Kramer J, Bermas BL, Solow EB, Bitencourt N. Therapeutic recreation camps for youth with childhood-onset systemic lupus erythematosus: perceived psychosocial benefits. Pediatr Rheumatol Online J 2022; 20:39. [PMID: 35672791 PMCID: PMC9171737 DOI: 10.1186/s12969-022-00702-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/02/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The psychosocial burden of having a chronic disease can be substantial for adolescents with childhood-onset systemic lupus erythematosus (cSLE). Current literature is scarce on interventions that can improve psychosocial outcomes for this population. Therapeutic recreation camps have been proposed as a beneficial experience for chronically ill pediatric populations. However, their effective components have not been well characterized in patients with cSLE. In this study, we sought to understand the various components of the camp experience for adolescents with cSLE from both the patient and parent perspective. METHODS We recruited patients with cSLE who had participated in one or more annual, weekend-long recreational lupus camp(s) near Dallas, Texas. Semi-structured in-depth telephone interviews were conducted from March-June 2020 with both the patients and parents. Questions focused on overall patient experience, psychosocial impact of camp participation, coping skills gained, and opportunities to prepare for the transition from pediatric to adult care. Interviews were coded and analyzed using inductive thematic analysis. RESULTS We interviewed 9 current and former campers (ages 16-24), including a current camp counselor, and 3 of their parents separately. Reported benefits included a positive impact on social support through peer bonding, opportunities to develop coping mechanisms through structured activities and peer/medical staff interactions, opportunities for education about the cSLE disease experience, improved adherence through peer modeling, overall increase in self-efficacy, and better parental insight into the patient experience. Participants also provided suggestions for expansion and improvement in program development to optimize educational opportunities for both campers and parents. In addition, they advocated for longitudinal social support and community building. CONCLUSIONS In this qualitative study, in which cSLE patients and their parents reflected on their experiences with therapeutic recreation camps, we found several perceived benefits impacting the patient and parent experience. Participants expressed a desire for more educational opportunities that could contribute to their successful transition from pediatric to adult care. Further studies are needed to demonstrate the effects of therapeutic recreation camps on the psychosocial health of this population.
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Affiliation(s)
- Cristina Saez
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA
| | - Lorien Nassi
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA ,grid.416991.20000 0000 8680 5133Texas Scottish Rite Hospital for Children, Dallas, Texas USA
| | - Tracey Wright
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA ,grid.416991.20000 0000 8680 5133Texas Scottish Rite Hospital for Children, Dallas, Texas USA
| | - Una E. Makris
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA ,grid.422201.70000 0004 0420 5441Veterans Administration North Texas Health Care System, Dallas, Texas USA
| | - Justin Kramer
- grid.264756.40000 0004 4687 2082Texas A&M University, College Station, Texas USA
| | - Bonnie L. Bermas
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA
| | - E. Blair Solow
- grid.267313.20000 0000 9482 7121University of Texas Southwestern Medical Center, Dallas, Texas USA
| | - Nicole Bitencourt
- Loma Linda University Medical Center, 11175 Campus Street, Coleman Pavilion, Loma Linda, CA, 92354, USA.
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Tanigava NY, Sakamoto AP, Franco AS, Balbi GG, Sales LP, Aikawa NE, Terreri MT, Pereira RM. Social impact of disease parameters and damage accrual in adult Brazilian patients with childhood-onset Systemic Lupus Erythematosus. Lupus 2022; 31:944-952. [PMID: 35467441 DOI: 10.1177/09612033221097798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe the frequency and investigate potential associations of unemployment, need of financial assistance and health-related quality of life in adult patients with childhood-onset Systemic Lupus Erythematosus (cSLE). METHODS In this multicenter cross-sectional retrospective cohort study including cSLE adult patients, questionnaires were applied evaluating demographic characteristics, medical history, treatment, receipt of government financial assistance, work status, quality of life, economic classification, disease activity, and damage accrual. Disease activity and disease damage were measured at the study visit. RESULTS Sixty-nine cSLE patients with a median age of 21 years from two Brazilian tertiary centers were included (median disease duration 9 years). Twenty-eight (40.6%) patients were unemployed and 16 (23.2%) were receiving financial assistance or retirement pension. Work unemployment was associated with higher damage scores (OR 1.83, 95% CI 1.08 to 3.09, p = 0.024), and the need of financial assistance was associated with longer disease duration (OR 1.15, 95% CI 1.00 to 1.31, p = 0.045) and worse economic score (OR 0.87, 95% CI 0.77 to 0.99, p = 0.038). Emotional health and body image perception were the most compromised domains of quality of life but showed no association with disease parameters. Disease activity, on the other hand, was inversely associated with symptoms scores (β = -1.377, p = 0.014) and scores of adverse effects of medications (β = -1.286, p = 0.020). CONCLUSION cSLE is a disease with severe outcomes and high social burden that profoundly impacts patients. Damage accrual is a major contributor to unemployment during adulthood and its prevention must be central in the management of cSLE.
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Affiliation(s)
- Nicolas Y Tanigava
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana P Sakamoto
- Hospital Sao Paulo, 28105Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - André S Franco
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Gabriela Gm Balbi
- Hospital Sao Paulo, 28105Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucas P Sales
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nadia E Aikawa
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Maria T Terreri
- Hospital Sao Paulo, 28105Universidade Federal de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rosa Mr Pereira
- Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Abdwani R, Al Sabri R, Al Hasni Z, Rizvi S, Al Wahshi H, Al Lawati B, Al Abrawi S, Wali Y, Al Sadoon M. Transition readiness in adolescents and young adults with chronic rheumatic disease in Oman: today's needs and future challenges. Pediatr Rheumatol Online J 2022; 20:27. [PMID: 35413991 PMCID: PMC9004032 DOI: 10.1186/s12969-022-00687-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 04/05/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION In Oman, the ""transition" of health care of adolescents to adult care occurs at a young age, like many other GCC countries for cultural reasons. In order to address this concern, this study was conducted to determine the transition readiness skills of adolescents and young adults with childhood onset rheumatic diseases using a cross-cultural adaptation of the UNC TRxANSITION scale. METHODS We used a professionally translated/back translated, provider-administered UNC TRxANSITION Scale. This 32-question scale measures HCT in 10 domains including knowledge about diagnosis or treatment, diet, reproductive health, school/work, insurance, ability to self-manage and identification of new health providers. The maximum transitional score of 10, was categorized as low (1-4), moderate (4 - 7) and high (7 -10) transitional readiness scores. RESULTS We enrolled 81 Omani adolescents and young adults (AYA) with chronic childhood onset rheumatic diseases. The cohort consisted of 79% females, with mean age of 15.8 years (± 3.53) and mean disease duration of 6.95 years (± 4.83). Our cohort's overall mean score is low 5.22 (±1.68). Only 14.8% of the cohort achieved a high transition score (≥7). Significant direct relationship was observed between age and the mean transition readiness score (r = .533, P < .001). The mean transition readiness score in the younger age group (10-13 years) was 4.07 (±1.29), the middle age group (14-18 years) was 5.43 (±1.27), while the older age group (19-21 year), was 6.12 (±1.81). Mean transition score of youngest age group was found to be significantly lower than the other two age groups (p = .003). CONCLUSION Overall, the transition readiness of AYA in Oman is low compared to other western countries indicating the need to initiate a health care transition preparation program for patients with chronic diseases across the country. In addition, we need to establish regional guidelines to address the transfer and transition policies to be in line to international recommendations. As transition continues after transfer, and is preferably guided by adolescent developmental status rather than chronological age, it would be preferable to refer to the transition and transfer policies 9rather than transitional age policy) to be in line to international recommendations.
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Affiliation(s)
- Reem Abdwani
- Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khoudh 123, Muscat, Oman.
| | - Rumaitha Al Sabri
- Pediatric Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Zawan Al Hasni
- General Foundation Program, Oman Medical Specialty Board, Muscat, Oman
| | - Seyad Rizvi
- grid.412846.d0000 0001 0726 9430Department of Public Health, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Humaid Al Wahshi
- grid.416132.30000 0004 1772 5665Department of Medicine, Royal Hospital Muscat, Muscat, Oman
| | - Batool Al Lawati
- grid.412846.d0000 0001 0726 9430Department of Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Safiya Al Abrawi
- grid.416132.30000 0004 1772 5665Department of Child Health, Royal Hospital Muscat, Muscat, Oman
| | - Yassir Wali
- grid.412846.d0000 0001 0726 9430Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khoudh 123, Muscat, Oman
| | - Mona Al Sadoon
- grid.412846.d0000 0001 0726 9430Department of Child Health, College of Medicine & Health Sciences, Sultan Qaboos University, P.O. Box 35, Al Khoudh 123, Muscat, Oman
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Clarke SLN, Richmond RC, Zheng J, Spiller W, Ramanan AV, Sharp GC, Relton CL. Examining Health Outcomes in Juvenile Idiopathic Arthritis: A Genetic Epidemiology Study. ACR Open Rheumatol 2022; 4:363-370. [PMID: 35077020 PMCID: PMC8992462 DOI: 10.1002/acr2.11404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 11/06/2021] [Accepted: 11/23/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease; however, little is known about its wider health impacts. This study explores health outcomes associated with JIA genetic liability. METHODS We used publicly available genetic data sets to interrogate the genetic correlation between JIA and 832 other health-related traits using linkage disequilibrium score regression. Two-sample Mendelian randomization (2SMR) was used to examine four genetic correlates for evidence of causality. RESULTS We found robust evidence (adjusted P [Padj ] < 0.05) of genetic correlation between JIA and rheumatoid arthritis (genetic correlation [rg ] = 0.63, Padj = 0.029), hypothyroidism/myxedema (rg = 0.61, Padj = 0.041), celiac disease (CD) (rg = 0.58, Padj = 0.032), systemic lupus erythematosus (rg = 0.40, Padj = 0.032), coronary artery disease (CAD) (rg = 0.42, Padj = 0.006), number of noncancer illnesses (rg = 0.42, Padj = 0.016), paternal health (rg = 0.57, Padj = 0.032), and strenuous sports (rg = -0.52, Padj = 0.032). 2SMR analyses found robust evidence that genetic liability to JIA was causally associated with the number of noncancer illnesses reported by UK Biobank (UKBB) participants (increase of 0.03 noncancer illnesses per doubling odds of JIA, 95% confidence interval 0.01-0.05). CONCLUSION This study illustrates genetic sharing between JIA and a diversity of health outcomes. The causal association between genetic liability to JIA and noncancer illnesses suggests a need for broader health assessments of patients with JIA to reduce their potential comorbid burden. The strength of genetic correlation with hypothyroidism and CD implies that patients with JIA may benefit from CD and thyroid function screening. Strong positive genetic correlation between JIA and CAD supports the need for cardiovascular risk assessment and risk factor modification.
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Affiliation(s)
- Sarah L. N. Clarke
- Medical Research Council Integrative Epidemiology Unit, University of BristolBristolUK
- School of Population Health Sciences, University of BristolBristolUK
- Department of Paediatric Rheumatology, Bristol Royal Hospital for ChildrenBristolUK
| | - Rebecca C. Richmond
- Medical Research Council Integrative Epidemiology Unit, University of BristolBristolUK
- School of Population Health Sciences, University of BristolBristolUK
| | - Jie Zheng
- Medical Research Council Integrative Epidemiology Unit, University of BristolBristolUK
- School of Population Health Sciences, University of BristolBristolUK
| | - Wes Spiller
- Medical Research Council Integrative Epidemiology Unit, University of BristolBristolUK
- School of Population Health Sciences, University of BristolBristolUK
| | - Athimalaipet V. Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for ChildrenBristolUK
- School of Translation Health Sciences, University of BristolBristolUK
| | - Gemma C. Sharp
- Medical Research Council Integrative Epidemiology Unit, University of BristolBristolUK
- School of Population Health Sciences, University of BristolBristolUK
| | - Caroline L. Relton
- Medical Research Council Integrative Epidemiology Unit, University of BristolBristolUK
- School of Population Health Sciences, University of BristolBristolUK
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12
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Lazarević D, Đorđević S, Novaković D, Zečević M, Sušić G. Transition readiness in adolescents with juvenile idiopathic arthritis and their parents: Our single-center experience. Arch Rheumatol 2021; 37:411-416. [PMID: 36589608 PMCID: PMC9791543 DOI: 10.46497/archrheumatol.2022.9219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 11/02/2021] [Indexed: 01/04/2023] Open
Abstract
Objectives We aimed to identify characteristics of juvenile idiopathic arthritis (JIA) patients associated with good self-management skills in the transition readiness process and to investigate the readiness of JIA patients and their families for the transition into the adult healthcare system. Patients and methods Between March 2021 and June 2021, a total of 44 JIA patients (9 males, 35 females; median age: 15.1 years; range, 12.3 to 19.3 years) admitted to the pediatric rheumatology outpatient and inpatient clinics and their parents were included. Transition Readiness Assessment Questionnaire (TRAQ) was cross-culturally adapted. The TRAQ was administered to all JIA patients and their parents at one point. Demographic and clinical data were collected. Results Fourteen (31.8%) of 44 JIA patients had a concomitant disease, while 10 (22.7%) of them had uveitis. Eleven (25%) of them had a family history of autoimmune diseases. In total, 21 (47.7%) of JIA patients were receiving biologics. There was a strong correlation between older age and total TRAQ scores among patients (ρ=0.799, p<0.001) and a moderate correlation between older patient age and total TRAQ scores among parents (ρ=0.522, p<0.001). Patient and parent total TRAQ scores were strongly correlated (ρ=0.653, p<0.001). There was no significant association of JIA patient characteristics (JIA disease subtypes, disease duration, gender, concomitant diseases, uveitis, family history of autoimmune diseases, number of hospitalizations, and treatment with biologics) with TRAQ scores and JIA patients' and parents' readiness for transition. Conclusion Transition readiness of JIA patients increases with advancing age. There is no significant difference between transition readiness for JIA patients and their parents.
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Affiliation(s)
- Dragana Lazarević
- Department of Pediatric Rheumatology, Clinic of Pediatrics, University Clinical Center, Niš, Serbia
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Faculty of Medicine, University of Niš, Niš, Serbia
| | - Stefan Đorđević
- Department of Cardiology and Rheumatology, University Children`s Hospital, Belgrade, Serbia
| | - Dušica Novaković
- Department of Pediatric Rheumatology, Institute of Rheumatology, Belgrade, Serbia
| | - Maja Zečević
- Department of Pediatric Surgery, Clinic For Pediatric Surgery and Orthopedics, University Clinical Center, Niš, Serbia
| | - Gordana Sušić
- Department of Pediatric Rheumatology, Institute of Rheumatology, Belgrade, Serbia
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Shabaka A, Landaluce-Triska E, Sánchez-Álvarez JE, Fernández-Juárez G. Changing trends in presentation and indications of biopsy in lupus nephritis: data from the Spanish Registry of Glomerulonephritis. Clin Kidney J 2021; 15:703-708. [PMID: 35371447 PMCID: PMC8967535 DOI: 10.1093/ckj/sfab236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Indexed: 11/24/2022] Open
Abstract
Background With the ageing population and changes in the indications of diagnostic and protocol biopsies in systemic lupus erythematosus in recent years, an impact on the incidence and presentation of lupus nephritis (LN) is expected. The aim of this study was to analyse the epidemiological changes regarding clinical and histological presentation of LN in kidney biopsies performed from 1994 to 2019 included in the Spanish Registry of Glomerulonephritis. Methods We analysed data from 28 791 kidney biopsies from 130 Spanish hospitals comparing demographic, clinical and histological data. We divided the cohort according to the age of onset of LN into pediatric onset (<18 years), adult onset (18–50 years) and late onset (>50 years). Results The incidence of LN has decreased from 9.6% of all kidney biopsies in the period 1994–2013 to 7% in the last quarter of the observation period (2014–2019) (P < 0.001), despite an increase in the proportion of patients with LN that underwent repeat biopsies (16.6–24%; P < 0.001). The age of onset of LN has increased from 32 ± 14 to 38 ± 14 years (P < 0.001), with an increase in the proportion of late-onset LN (from 13% to 22% of incident LN; P < 0.001). There were no differences in the distribution of histological features at presentation over the study period. Patients with late-onset LN showed fewer gender differences, had lower GFR and presented with less-proliferative forms of LN compared with early-onset LN. Conclusions The frequency of biopsy-proven LN has been decreasing in recent years, despite an increasing number of repeat biopsies. Late-onset LN is increasing, presenting with worse kidney function but fewer proliferative lesions compared with younger-onset LN.
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Affiliation(s)
- Amir Shabaka
- Nephrology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
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14
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Time to First Completed Visit and Health Care Utilization Among Young Adults Transferring From Pediatric to Adult Rheumatologic Care in a Safety‐Net Hospital. Arthritis Care Res (Hoboken) 2021; 73:1730-1738. [DOI: 10.1002/acr.24409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022]
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Case S, Sinnette C, Phillip C, Grosgogeat C, Costenbader KH, Leatherwood C, Feldman CH, Son MB. Patient experiences and strategies for coping with SLE: A qualitative study. Lupus 2021; 30:1405-1414. [PMID: 34013818 DOI: 10.1177/09612033211016097] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study explored challenges that patients with systemic lupus erythematosus (SLE) and childhood-onset SLE (cSLE) face to identify modifiable influences and coping strategies in patient experiences. METHODS Participants were recruited from two academic medical centers through a Lupus Registry of individuals ≥18 years old and ≥4 1997 ACR classification criteria for SLE and a centralized data repository of cSLE patients, and participated in three focus groups. Transcripts were coded thematically and adjudicated by two independent reviewers. RESULTS Thirteen adults, 7 (54%) with cSLE, participated in focus groups. Themes were categorized into two domains: (1) challenges with SLE diagnosis and management; and (2) patient coping strategies and modifiable factors of the SLE experience. Participants identified five primary challenges: diagnostic odyssey, public versus private face of SLE, SLE-related stresses, medication adherence, and transitioning from pediatric to adult care. Coping strategies and modifiable factors included social support, open communication about SLE, and strong patient-provider relationships. Several participants highlighted positive lessons learned through their experiences with SLE, including empathy, resilience, and self-care skills. CONCLUSIONS Patients with cSLE and SLE identified common challenges, modifying influences and coping strategies based on personal experiences. A strong patient-provider relationship and trust in the medical team emerged as key modifiable factors. Deriving optimism from experiences with SLE was unique to several patients diagnosed as children or young adults. Leveraging factors that improved the participants' experiences living with SLE may be used in future studies to address vulnerabilities in care.
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Affiliation(s)
- Siobhan Case
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Division of Allergy, Immunology, and Rheumatology, Boston Children's Hospital, Boston, MA, USA
| | - Corine Sinnette
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Courtnie Phillip
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Claire Grosgogeat
- Division of Allergy, Immunology, and Rheumatology, Boston Children's Hospital, Boston, MA, USA
| | - Karen H Costenbader
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Cianna Leatherwood
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Candace H Feldman
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary Beth Son
- Division of Allergy, Immunology, and Rheumatology, Boston Children's Hospital, Boston, MA, USA
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Kittivisuit S, Lerkvaleekul B, Soponkanaporn S, Ngamjanyaporn P, Vilaiyuk S. Assessment of transition readiness in adolescents in Thailand with rheumatic diseases: a cross-sectional study. Pediatr Rheumatol Online J 2021; 19:101. [PMID: 34193176 PMCID: PMC8243449 DOI: 10.1186/s12969-021-00602-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Most childhood-onset rheumatic diseases are chronic health conditions, which need long-term care throughout adulthood. A well-organized transition care is challenging and patient assessment of transition skills is needed for transfer preparation to an adult care setting. The Transition Readiness Assessment Questionnaire (TRAQ) is used to assess transition skills in chronically ill patients. Currently, limited transition skill assessment data exist in pediatric patients with rheumatic diseases, especially in Asian countries. This study aimed to determine the transition readiness skills in patients with rheumatic diseases and ascertain predictive factors contributing to high transition readiness skills. METHODS This is a cross-sectional study. All patients with rheumatic diseases aged 15-20 years were recruited. The TRAQ was cross-culturally adapted into the Thai language with good internal consistency and reliability. Patients completed the Thai TRAQ at the recent clinic visit and took the retest at a 2-week interval. Demographic data, baseline characteristics, clinical manifestations, and disease status were collected. Descriptive and logistic regression analyses were performed. RESULTS A total of 111 patients with a mean age of 17.4 ± 1.8 years were included. Median (IQR) disease duration was 6.4 (3.2-9.0) years. The most common rheumatic disease was juvenile idiopathic arthritis (48.6%), followed by systemic lupus erythematosus (35.1%). The mean TRAQ score was 3.85 ± 0.69. Independent visits (OR 4.35, 95% CI 1.23-15.37) was a predictor of a high TRAQ score. Furthermore, dependent visits (OR 7.84, 95% CI 2.41-25.50) was a predictor of low TRAQ score in the "appointment keeping" domain, whereas inactive disease (OR 4.54, 95% CI 1.25-16.55) was a predictor of a low TRAQ score in "tracking health issues" domain. Lack of knowledge and skills on health insurance coverage, financial management, appointment arrangement, and coping with their illness were issues causing lower TRAQ score. CONCLUSIONS Patients, who had independent visits, had a higher chance to obtain higher TRAQ scores, whereas patients, who had an inactive disease or dependent visits, had less transition readiness skills. Physicians and parents should prepare to transfer patients to adult care settings, mainly encouraging independent living skills.
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Affiliation(s)
- Sirinthip Kittivisuit
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400 Bangkok, Thailand ,grid.7130.50000 0004 0470 1162Division of Rheumatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Butsabong Lerkvaleekul
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400 Bangkok, Thailand
| | - Sirisucha Soponkanaporn
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400 Bangkok, Thailand
| | - Pintip Ngamjanyaporn
- grid.10223.320000 0004 1937 0490Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Soamarat Vilaiyuk
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, 10400, Bangkok, Thailand.
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Li W, Liu S, Zhong L, Chen C. Clinical and laboratory features, disease activity, and outcomes of juvenile systemic lupus erythematosus at diagnosis: a single-center study from southern China. Clin Rheumatol 2021; 40:4545-4552. [PMID: 34142297 DOI: 10.1007/s10067-021-05784-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 05/12/2021] [Accepted: 05/19/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This retrospective study aimed to analyze the clinical and laboratory features, disease activity, and outcomes of juvenile systemic lupus erythematosus (jSLE) patients from southern China. METHODS A total of 173 jSLE patients who attended Rheumatology and Immunology Department of Meizhou People's Hospital between January 2010 and December 2019 are included for analysis. RESULTS The mean age of disease onset was 13.65 ± 2.80 (range, 5-17). The median age at diagnosis was 13.98 ± 2.88 (range, 5-17) years. The female to male ratio was 6.5:1. Renal involvement was the most prevalent clinical feature, occurred in 71.7% of the patients. A total of 27 (15.6%) patients underwent renal biopsy, and the most common type of renal pathology was class IV (44.4%). Our study demonstrated differences in antibody clusters for which the positivity rates of anti-dsDNA antibodies and anti-Sm antibodies were higher than the other jSLE cohorts reported in China and worldwide. Cyclophosphamide combined with corticosteroids was the main treatment medication. The mean SLE Disease Activity Index (SLEDAI) score at diagnosis was 14.3 ± 7.6 (range, 3-38). Five patients died during the initial diagnosis and treatment. Infection was the major cause of death. CONCLUSION The jSLE patients in this cohort had a higher prevalence of renal involvement, anti-dsDNA antibodies, and anti-Sm antibodies. Multicenter studies are needed to clarify the different clinical features of jSLE in southern China. KEY POINTS • A single-center study of juvenile systemic lupus erythematosus in clinical and laboratory features. • The jSLE patients had a higher prevalence of renal involvement and antibody disorder.
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Affiliation(s)
- Wengen Li
- Rheumatology and Immunology Department, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated To Sun Yat-Sen University, No. 63 Huangtang Road, Meijiang District, Meizhou, 514031, People's Republic of China.
| | - Sudong Liu
- Clinical Core Laboratory, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated To Sun Yat-Sen University, Meizhou, 514031, People's Republic of China
- Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, 514031, People's Republic of China
| | - Liuming Zhong
- Pediatrics Department, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated To Sun Yat-Sen University, Meizhou, 514031, People's Republic of China
| | - Chao Chen
- Rheumatology and Immunology Department, Meizhou People's Hospital (Huangtang Hospital), Meizhou Hospital Affiliated To Sun Yat-Sen University, No. 63 Huangtang Road, Meijiang District, Meizhou, 514031, People's Republic of China
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Fortuna-Reyna BDJ, Peláez-Ballestas I, García-Rodríguez F, Faugier-Fuentes E, Mendieta-Zerón S, Villarreal-Treviño AV, Rosiles-De la Garza SG, Reyes-Cordero G, Jiménez-Hernández S, Guadarrama-Orozco JH, de la O-Cavazos ME, Rubio-Pérez N. Psychosocial and economic impact of rheumatic diseases on caregivers of Mexican children. Pediatr Rheumatol Online J 2021; 19:30. [PMID: 33731150 PMCID: PMC7967951 DOI: 10.1186/s12969-021-00524-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pediatric rheumatic disease (PRD) patients and their caregivers face a number of challenges, including the consequences of the PRD in patients and the impact on multiple dimensions of the caregivers' daily lives. The objective of this study is to measure the economic, psychological and social impact that PRD has on the caregivers of Mexican children. METHODS This is a multicenter, cross-sectional study including primary caregivers of children and adolescents with PRD (JIA, JDM and JSLE) during April and November, 2019. A trained interviewer conducted the CAREGIVERS questionnaire, a specific, 28-item multidimensional tool validated to measure the impact on different dimensions of the lives of caregivers. Sociodemographic, clinical, and healthcare system data were collected for further analysis. RESULTS Two hundred participants were recruited (women 169, 84.5%, aged 38 [IQR 33-44] years); 109 (54.5%) cared for patients with JIA, 28 (14%) JDM and 63 (31.5%) JSLE. The healthcare system was found to be determinant on the impact of the disease. The emotional impact was higher in all the participants, regardless of the specific diagnoses. The social dimension showed significant differences regarding PRD, healthcare system, time to reach the center, presence of disability, active disease, cutaneous and systemic manifestations, treatment and partner. Financial and work impacts were more frequent in those caring for JSLE and less so in those with a partner. Family relationships changed in 81 caregivers (25 [12.5%] worsened and 56 [28%] improved). No variables affecting spirituality were found. For caregivers without a partner, the social networks impact increased. CONCLUSION The influence of sociodemographic factors can be devastating on families with children with a PRD. These data will help physicians to identify the areas with the greatest need for intervention to achieve comprehensive care for caregivers and their patients.
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Affiliation(s)
- Brenda de Jesús Fortuna-Reyna
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Ingris Peláez-Ballestas
- grid.414716.10000 0001 2221 3638Rheumatology Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Fernando García-Rodríguez
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Enrique Faugier-Fuentes
- grid.414757.40000 0004 0633 3412Hospital Infantil de México Federico Gómez, Servicio de Reumatología, Mexico City, Mexico
| | - Samara Mendieta-Zerón
- Instituto de Seguridad Social del Estado de México y Municipios, Hospital Regional Toluca, Toluca, Mexico
| | - Ana Victoria Villarreal-Treviño
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Sara Georgina Rosiles-De la Garza
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Greta Reyes-Cordero
- grid.440441.10000 0001 0695 3281Hospital Infantil de Especialidades del Estado de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Sol Jiménez-Hernández
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Jessica Haydee Guadarrama-Orozco
- grid.414757.40000 0004 0633 3412Departamento de Cuidados Paliativos y Calidad de Vida, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Manuel Enrique de la O-Cavazos
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Nadina Rubio-Pérez
- Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José E. González", Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460, Monterrey, Mexico.
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Kosola S, Relas H. Patients with psychiatric diagnoses have lower quality of life than other patients with juvenile rheumatic disease: a prospective study. Rheumatology (Oxford) 2021; 60:5560-5566. [PMID: 33591311 PMCID: PMC8643440 DOI: 10.1093/rheumatology/keab150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 02/05/2021] [Indexed: 01/02/2023] Open
Abstract
Objectives Transition of adolescents with chronic diseases from paediatric healthcare to adult care requires attention to maintain optimal treatment results. We examined changes in health-related quality of life (HRQoL) and disease activity among JIA patients with or without concomitant psychiatric diagnoses after transfer to an adult clinic. Methods We prospectively followed 106 consecutive patients who were transferred from the New Children’s Hospital to the Helsinki University Hospital Rheumatology outpatient clinic between April 2015 and August 2019 and who had at least one follow-up visit. HRQoL was measured using 15D, a generic instrument. Results The patients’ median age at transfer was 16 years and disease duration 4.0 years. Patients were followed for a median of 1.8 years. Disease activity and overall HRQoL remained stable, but distress (dimension 13 of 15D) increased during follow up (P=0.03). At baseline, patients with at least one psychiatric diagnosis had lower overall 15D scores [mean 0.89 (s.d. 0.14) vs 0.95 (s.d. 0.05), P <0.01] and higher disease activity [DAS28mean 1.88 (s.d. 0.66) vs 1.61 (s.d. 0.31), P = 0.01] than patients without psychiatric diagnoses. The difference in overall 15D persisted over the study period. Conclusion Transition-phase JIA patients with psychiatric diagnoses had lower HRQoL than other JIA patients. Despite reduced disease activity and pain, HRQoL of patients with psychiatric diagnoses remained suboptimal at the end of follow-up. Our results highlight the necessity of comprehensive care and support for transition-phase JIA patients.
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Affiliation(s)
- Silja Kosola
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital and University of Helsinki, PL 435, 00029 HUS, Finland
| | - Heikki Relas
- Rheumatology, Helsinki University Hospital and University of Helsinki, PL 372, 00029 HUS, Finland
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20
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Kelly A, Niddrie F, Tunnicliffe DJ, Matus Gonzalez A, Hanson C, Jiang I, Major G, Singh-Grewal D, Tymms K, Tong A. Patients' attitudes and experiences of transition from paediatric to adult healthcare in rheumatology: a qualitative systematic review. Rheumatology (Oxford) 2021; 59:3737-3750. [PMID: 32413124 DOI: 10.1093/rheumatology/keaa168] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 02/19/2020] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES We aimed to describe patients' attitudes and experiences of transition from paediatric to adult healthcare in rheumatology to inform patient-centred transitional care programmes. METHODS We searched MEDLINE, EMBASE, PsycINFO and CINAHL to August 2019 and used thematic synthesis to analyse the findings. RESULTS From 26 studies involving 451 people with juvenile-onset rheumatic conditions we identified six themes: a sense of belonging (comfort in familiarity, connectedness in shared experiences, reassurance in being with others of a similar age, desire for normality and acceptance); preparedness for sudden changes (confidence through guided introductions to the adult environment, rapport from continuity of care, security in a reliable point of contact, minimizing lifestyle disruptions); abandonment and fear of the unknown (abrupt and forced independence, ill-equipped to hand over medical information, shocked by meeting adults with visible damage and disability, vulnerability in the loss of privacy); anonymous and dismissed in adult care (deprived of human focus, sterile and uninviting environment, disregard of debilitating pain and fatigue); quest for autonomy (controlled and patronized in the paediatric environment, liberated from the authority of others, freedom to communicate openly); and tensions in parental involvement (overshadowed by parental presence, guilt of excluding parents, reluctant withdrawal of parental support). CONCLUSION Young people feel dismissed, abandoned, ill-prepared and out of control during transition. However, successful transition can be supported by preparing for changes, creating a sense of belonging and negotiating parental involvement and autonomy. Incorporating patient-identified priorities into transitional services may improve satisfaction and outcomes in young people with juvenile-onset rheumatic conditions.
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Affiliation(s)
- Ayano Kelly
- College of Health and Medicine, Australian National University.,Department of Rheumatology, The Canberra Hospital, Canberra, ACT.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle
| | - David J Tunnicliffe
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
| | | | - Camilla Hanson
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
| | - Ivy Jiang
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,School of Medicine, University of New South Wales, Randwick
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle.,School of Medicine and Public Health, University of Newcastle, Newcastle
| | - Davinder Singh-Grewal
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre/John Hunter Hospital, Newcastle.,Department of Rheumatology, The Children's Hospital at Westmead, Westmead.,Discipline of Paediatrics and Child Health, The University of Sydney, Sydney.,School of Maternal and Child Health, University of New South Wales, Randwick.,Department of Rheumatology, Liverpool Hospital, Liverpool, NSW
| | - Kathleen Tymms
- College of Health and Medicine, Australian National University.,Department of Rheumatology, The Canberra Hospital, Canberra, ACT.,Canberra Rheumatology, Canberra, ACT, Australia
| | - Allison Tong
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead.,Sydney School of Public Health, The University of Sydney, Sydney
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21
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de Oliveira RJ, Kishimoto ST, de Souza DP, Fernandes PT, Marini R, Appenzeller S. The importance of transition from pediatric to adult rheumatology care in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2021; 17:155-161. [PMID: 33393405 DOI: 10.1080/1744666x.2020.1865157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Juvenile idiopathic arthritis (JIA) is the most common rheumatic inflammatory condition in childhood. The long-term morbidity, mortality, and quality of life have improved with the earlier use of disease-modifying drugs (DMARDs) and the availability of biology disease-modifying drugs (bDMARDs). Despite the improvement of treatment, around 50% of the patients reach adulthood with articular and/or extra articular disease activity. A careful planned transition from pediatric to adult care is necessary to reduce the loss of follow-up that is associated with stopping medications, flares, and disability due to untreated arthritis or uveitis.Areas covered: This narrative review provides an overview of the importance of transition in JIA Articles were selected from Pubmed searches.Expert opinion: JIA patients, family, and healthcare workers have to be trained to provide an effective transition plan, based on local and national policies. Important aspects such as expectations, maturation, disease characteristics, disease activity, adherence, disability, and psychological aspects among others have to be considered and addressed during the transition phase to improve self-esteem, self-assurance, and quality of life.
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Affiliation(s)
- Rodrigo Joel de Oliveira
- School of Medical Science, University of Campinas, Campinas, Brazil.,Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Simone Thiemi Kishimoto
- Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil.,Pathophysiology Program, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Débora Pessoa de Souza
- School of Medical Science, University of Campinas, Campinas, Brazil.,Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil
| | - Paula Teixeira Fernandes
- Department of Sport Sciences, Faculty of Physical Education, University of Campinas, Campinas, Brazil
| | - Roberto Marini
- Department of Orthopedics, School of Medical Sciences and University of Campinas (UNICAMP), Campinas, Brazil
| | - Simone Appenzeller
- Autoimmunity Lab, School of Medical Science, University of Campinas, Campinas, Brazil.,Rheumatology Unit-Department of Medicine, School of Medical Sciences and University of Campinas (UNICAMP), São Paulo, Brazil
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22
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Jiang I, Major G, Singh-Grewal D, Teng C, Kelly A, Niddrie F, Chaitow J, O'Neill S, Hassett G, Damodaran A, Bernays S, Manera K, Tong A, Tunnicliffe DJ. Patient and parent perspectives on transition from paediatric to adult healthcare in rheumatic diseases: an interview study. BMJ Open 2021; 11:e039670. [PMID: 33397662 PMCID: PMC7783517 DOI: 10.1136/bmjopen-2020-039670] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To describe the experiences, priorities, and needs of patients with rheumatic disease and their parents during transition from paediatric to adult healthcare. SETTING Face-to-face and telephone semistructured interviews were conducted from December 2018 to September 2019 recruited from five hospital centres in Australia. PARTICIPANTS Fourteen young people and 16 parents were interviewed. Young people were included if they were English speaking, aged 14-25 years, diagnosed with an inflammatory rheumatic disease (eg, juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, panniculitis, familial Mediterranean fever) before 18 years of age. Young people were not included if they were diagnosed in the adult setting. RESULTS We identified four themes with respective subthemes: avoid repeat of past disruption (maintain disease stability, preserve adjusted personal goals, protect social inclusion); encounter a daunting adult environment (serious and sombre mood, discredited and isolated identity, fear of a rigid system); establish therapeutic alliances with adult rheumatology providers (relinquish a trusting relationship, seek person-focused care, redefine personal-professional boundaries, reassurance of alternative medical supports, transferred trust to adult doctor) and negotiate patient autonomy (confidence in formerly gained independence, alleviate burden on patients, mediate parental anxiety). CONCLUSIONS During transition, patients want to maintain disease stability, develop a relationship with their adult provider centralised on personal goals and access support networks. Strategies to comprehensively communicate information between providers, support self-management, and negotiate individualised goals for independence during transition planning may improve satisfaction, and health and treatment outcomes.
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Affiliation(s)
- Ivy Jiang
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gabor Major
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- School of Medicine and Public Health, The University of Newcastle Faculty of Health and Medicine, Callaghan, New South Wales, Australia
| | - Davinder Singh-Grewal
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Claris Teng
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Ayano Kelly
- Rheumatology, Canberra Rheumatology, Canberra City, Australian Capital Territory, Australia
- College of Health and Medicine, Australian National University Medical School, Canberra, Australian Capital Territory, Australia
| | - Fiona Niddrie
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Jeffrey Chaitow
- Department of Rheumatology, Bone and Joint Centre, Royal Newcastle Centre, John Hunter Hospital, Newcastle, New South Wales, Australia
- Department of Rheumatology, The Sydney Children's Hospitals Network Randwick and Westmead, Westmead, New South Wales, Australia
| | - Sean O'Neill
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Geraldine Hassett
- Department of Rheumatology, Liverpool Hospital, Liverpool, New South Wales, Australia
- Ingham Institute for Applied Medical Research, Liverpool, New South Wales, Australia
| | - Arvin Damodaran
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Rheumatology, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
| | - Sarah Bernays
- School of Public Health, The University of Sydney, Camperdown, New South Wales, Australia
- Global Health and Development, London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| | - Karine Manera
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David J Tunnicliffe
- Centre for Kidney Research, Children's Hospital at Westmead, Westmead, New South Wales, Australia
- University of Sydney, Sydney School of Public Health, New South Wales Ministry of Health, Sydney, New South Wales, Australia
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23
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Chang JC, Knight AM, Lawson EF. Patterns of Healthcare Use and Medication Adherence among Youth with Systemic Lupus Erythematosus during Transfer from Pediatric to Adult Care. J Rheumatol 2021; 48:105-113. [PMID: 32007936 DOI: 10.3899/jrheum.191029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Youth with systemic lupus erythematosus (SLE) transferring from pediatric to adult care are at risk for poor outcomes. We describe patterns of rheumatology/nephrology care and changes in healthcare use and medication adherence during transfer. METHODS We identified youth ages 15-25 with SLE using US private insurance claims from Optum's deidentified Clinformatics Data Mart. Rheumatology/nephrology visit patterns were categorized as (1) unilateral transfers to adult care within 12 months, (2) overlapping pediatric and adult visits, (3) lost to followup, or (4) continuing pediatric care. We used negative binomial regression and paired t tests to estimate changes in healthcare use and medication possession ratios (MPR) after the last pediatric (index) visit. We compared MPR between youth who transferred and age-matched peers continuing pediatric care. RESULTS Of the 184 youth transferred out of pediatric care, 41.8% transferred unilaterally, 31.5% had overlapping visits over a median of 12 months before final transfer, and 26.6% were lost to followup. We matched 107 youth continuing pediatric care. Overall, ambulatory care use decreased among those lost to followup. Acute care use decreased across all groups. MPR after the index date were lower in youth lost to followup (mean 0.24) compared to peers in pediatric care (mean 0.57, p < 0.001). CONCLUSION Youth with SLE with continuous private insurance coverage do not use more acute care after transfer to adult care. However, a substantial proportion fail to see adult subspecialists within 12 months and have worse medication adherence, placing them at higher risk for adverse outcomes.
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Affiliation(s)
- Joyce C Chang
- J.C. Chang, MD, MSCE, Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA;
| | - Andrea M Knight
- A.M. Knight, MD, MSCE, Division of Rheumatology, and SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Erica F Lawson
- E.F. Lawson, MD, Division of Rheumatology, University of California San Francisco Benioff Children's Hospital, San Francisco, California, USA
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24
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Kelly A, Tymms K, Fallon K, Sumpton D, Tugwell P, Tunnicliffe D, Tong A. Qualitative Research in Rheumatology: An Overview of Methods and Contributions to Practice and Policy. J Rheumatol 2021; 48:6-15. [PMID: 32669447 DOI: 10.3899/jrheum.191368] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2020] [Indexed: 12/12/2022]
Abstract
Patient-centered care is widely advocated in rheumatology. This involves collaboration among patients, caregivers, and health professionals and is particularly important in chronic rheumatic conditions because the disease and treatment can impair patients' health and well-being. Qualitative research can systematically generate insights about people's experiences, beliefs, and attitudes, which patients may not always express in clinical settings. These insights can address complex and challenging areas in rheumatology, such as treatment adherence and transition to adult healthcare services. Despite this, qualitative research comprises 1% of studies published in top-tier rheumatology journals. A better understanding about the effect and role, methods, and rigor of qualitative research is needed. This overview highlights the recent contributions of qualitative research in rheumatology, summarizes the common approaches and methods used, and outlines the key principles to guide appraisal of qualitative studies.
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Affiliation(s)
- Ayano Kelly
- A. Kelly, MBBS, FRACP, College of Health and Medicine, Australian National University, Canberra, and Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Canberra Rheumatology, Canberra, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia;
| | - Kathleen Tymms
- K. Tymms, MBBS, FRACP, College of Health and Medicine, Australian National University, and Canberra Rheumatology, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Kieran Fallon
- K. Fallon, FACSEP, College of Health and Medicine, Australian National University, and Department of Rheumatology, The Canberra Hospital, Canberra, Australia
| | - Daniel Sumpton
- D. Sumpton, MBBS, FRACP, Centre for Kidney Research, The Children's Hospital at Westmead, and Sydney School of Public Health, The University of Sydney, and Department of Rheumatology, Concord Hospital, Sydney, Australia
| | - Peter Tugwell
- P. Tugwell, MD, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Tunnicliffe
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
| | - Allison Tong
- D. Tunnicliffe, PhD, A. Tong, PhD, Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, and Sydney School of Public Health, The University of Sydney, Sydney, Australia
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25
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Pritchard L, Verschuren O, Roy M, Kaup C, Rumsey DG. Reproducibility of the Six‐Minute Walk Test in Children and Youth with Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 74:686-690. [DOI: 10.1002/acr.24492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/25/2020] [Accepted: 10/20/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Lesley Pritchard
- Department of Physical Therapy Faculty of Rehabilitation Medicine University of Alberta Canada Edmonton Alberta
| | - Olaf Verschuren
- UMC Utrecht Brain Center and Center of Excellence for Rehabilitation Medicine Utrecht University Utrecht the Netherlands
| | - Michelle Roy
- Glenrose Rehabilitation Hospital Edmonton Alberta Canada
| | - Cara Kaup
- Glenrose Rehabilitation Hospital Edmonton Alberta Canada
| | - Dax G. Rumsey
- Glenrose Rehabilitation Hospital Edmonton Alberta Canada
- Department of Pediatrics Faculty of Medicine and Dentistry University of Alberta Canada Edmonton Alberta
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26
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Zisman D, Samad A, Ardoin SP, Chira P, White P, Lavi I, von Scheven E, Lawson EF, Hing M, Mellins ED. US Adult Rheumatologists' Perspectives on the Transition Process for Young Adults With Rheumatic Conditions. Arthritis Care Res (Hoboken) 2020; 72:432-440. [PMID: 30740937 DOI: 10.1002/acr.23845] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 02/05/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the attitudes and common practices of adult rheumatologists in the US regarding health care transition (HCT) for young adults with rheumatic diseases. METHODS An anonymous online survey was sent to US adult rheumatologist members of the American College of Rheumatology to collect demographic data and information on attitudes and common practices regarding the transition process. RESULTS Of 4,064 contacted rheumatologists, 203 (5%) completed the survey. Almost half of respondents (45.1%) were never trained in transition practices, and 74.7% were not familiar with the American Academy of Pediatrics/American Academy of Family Physicians/American College of Physicians Consensus Statement About Transitions for Youth with Special Healthcare Needs. Only 56.2% felt comfortable caring for former pediatric patients. The vast majority of respondents (90.7%) did not have a multidisciplinary transition team, and 37% did not have a plan for transitioning pediatric patients into their practice. Most adult rheumatologists were unsatisfied with the current transition process (92.9%), due to insufficient resources, personnel (91.1%), and time in clinic (86.9%). They also were unsatisfied with referral data received concerning previous treatments (48.9%), hospitalization history (48%), disease activity index (45.1%), medical history summary (43.9%), comorbidities (36.4%), medication list (34.1%), and disease classification (32.6%). Three major barriers to HCT were lack of insurance reimbursement (33.7%), knowledge about community resources (30.8%), and lapses in care between primary provider and specialist (27.8%). CONCLUSION This survey identified substantial gaps in knowledge and resources regarding HCT for young adults with rheumatic diseases. These may be best addressed by further training, research, dedicated resources, adequate payment, and practice guidelines.
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Affiliation(s)
- Devy Zisman
- Carmel Medical Center and Technion, Haifa, Israel
| | - Aaida Samad
- Case Western Reserve University, Cleveland, Ohio
| | | | | | | | - Idit Lavi
- Carmel Medical Center, Haifa, Israel
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27
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Sengler C, Niewerth M, Minden K. Rheumatische Erkrankungen im Kindes- und Jugendalter: Wichtigkeit einer frühzeitigen multiprofessionellen Versorgung. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:846-855. [DOI: 10.1007/s00103-020-03173-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Johnson LM, Duenas DM, Wilfond BS. Ethical Drug Development for Rare Childhood Diseases: When There Are Limited But Promising Data in Adults, How to Choose Between Safety or Efficacy Studies? THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2020; 20:111-113. [PMID: 32208077 PMCID: PMC7506522 DOI: 10.1080/15265161.2020.1730490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
| | | | - Benjamin S. Wilfond
- Seattle Children’s Research Institute
- University of Washington School of Medicine
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29
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Jensen PT, Koh K, Cash RE, Ardoin SP, Hyder A. Inpatient mortality in transition-aged youth with rheumatic disease: an analysis of the National Inpatient Sample. Pediatr Rheumatol Online J 2020; 18:27. [PMID: 32228709 PMCID: PMC7106859 DOI: 10.1186/s12969-020-0416-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 03/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Transition from pediatric to adult care is a vulnerable time for youth with chronic diseases. In youth with rheumatic disease, studies show high rates of loss to follow up and increased disease activity. However, mortality data are lacking. In this study, we assessed whether transitional age is a risk factor for inpatient mortality. METHODS We analyzed the 2012-2014 National Inpatient Sample database, a representative sample of discharges in the United States. Individuals with rheumatic diseases were identified by International Statistical Classification of Disease - 9 (ICD-9) codes at time of discharge. Youth were categorized into three age groups: pre-transitional (11-17), transitional (18-24) and post transitional (25-31). We fitted univariable and multivariable logistic regression models to assess whether transitional age was a risk factor for inpatient mortality. RESULTS There were 30,269 hospital discharges which met our inclusion criteria of diagnosis and age. There were 195 inpatient deaths (0.7%). The most common causes of death were infection (39.5%), pulmonary disease (13.8%), and cardiac disease (11.2%). The Odds ratio for inpatient mortality of a transitional-aged individual was 1.18 compared to controls (p = 0.3). Black race (OR = 1.4), male sex (OR = 1.75), and a diagnosis of systemic sclerosis (OR = 4.81) or vasculitis (OR = 2.85) were the greatest risk factors of inpatient mortality. CONCLUSION Transitional age was not a risk factor for inpatient mortality in this study. We did identify other risk factors other than age. Further studies are required to assess if there is an increased risk of mortality in outpatients of the transitional age group.
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Affiliation(s)
| | | | | | - Stacy P Ardoin
- The Ohio State University and Nationwide Children's Hospital, Columbus, USA
| | - Ayaz Hyder
- The Ohio State University and Nationwide Children's Hospital, Columbus, USA
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31
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Heshin-Bekenstein M, Trupin L, Yelin E, von Scheven E, Yazdany J, Lawson EF. Longitudinal disease- and steroid-related damage among adults with childhood-onset systemic lupus erythematosus. Semin Arthritis Rheum 2019; 49:267-272. [PMID: 31235075 DOI: 10.1016/j.semarthrit.2019.05.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 05/01/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Determine whether adults with childhood-onset systemic lupus erythematosus (cSLE) are at increased risk for disease- and steroid-related damage as compared to individuals with adult-onset SLE (aSLE), and whether they continue to accumulate disease damage in adulthood. METHODS Data derive from the 2007-2015 cycles of the Lupus Outcomes Study, a longitudinal cohort of adults with confirmed SLE. The Brief Index of Lupus Damage (BILD), a validated, patient-reported measure, was used to assess SLE-associated damage. Participants with baseline BILD were included (N = 1035). Diagnosis at age < 18 years was defined as cSLE (N = 113). Outcome variables included BILD score at baseline and follow-up, clinically significant change in BILD score over follow-up period, and presence of steroid-related damage (cataracts, osteoporosis-related fracture, avascular necrosis or diabetes mellitus). RESULTS Mean time between baseline and follow up BILD assessment was 6.3 ± 1.7 years. In adjusted analyses, participants with cSLE and aSLE had similar levels of disease-related damage, and accumulated damage at similar rates. Participants with cSLE were more likely to report steroid-related damage (OR 1.7, 95% CI 1.1-2.8) in the adjusted analysis as compared to those with aSLE. Likelihood of steroid-related damage increased with disease duration for both groups, but was consistently higher among cSLE participants. CONCLUSION In this longitudinal cohort of adults with SLE, participants continued to accumulate damage at similar rates over time, regardless of age at onset or disease duration. Childhood-onset predicted increased risk of steroid-related damage. Aggressive use of steroid-sparing treatment strategies during childhood may be important to prevent steroid-related damage in adulthood.
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Affiliation(s)
- Merav Heshin-Bekenstein
- Division of Pediatric Rheumatology, University of California San Francisco. Address: 550 16th Street, 5th Floor, San Francisco, CA 94143-0632, United States; Pediatric Rheumatology Clinic, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, Israel.
| | - Laura Trupin
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, University of California, San Francisco. Address: 513 Parnassus Avenue, Box 0500, United States
| | - Ed Yelin
- Rosalind Russell/Ephraim Engleman Rheumatology Research Center, University of California San Francisco. Address: UCSF San Francisco, CA 94143-0920, United States
| | - Emily von Scheven
- Division of Pediatric Rheumatology, University of California San Francisco. Address: 550 16th Street, 5th Floor, San Francisco, CA 94143-0632, United States
| | - Jinoos Yazdany
- Division of Rheumatology, University of California San Francisco, 1001 Potrero Avenue, Building 30, San Francisco, CA 94110, United States
| | - Erica F Lawson
- Division of Pediatric Rheumatology, University of California San Francisco. Address: 550 16th Street, 5th Floor, San Francisco, CA 94143-0632, United States
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Unveiling the Efficacy, Safety, and Tolerability of Anti-Interleukin-1 Treatment in Monogenic and Multifactorial Autoinflammatory Diseases. Int J Mol Sci 2019; 20:ijms20081898. [PMID: 30999610 PMCID: PMC6514653 DOI: 10.3390/ijms20081898] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/13/2019] [Accepted: 04/15/2019] [Indexed: 02/01/2023] Open
Abstract
Autoinflammatory diseases (AIDs) are heterogeneous disorders characterized by dysregulation in the inflammasome, a large intracellular multiprotein platform, leading to overproduction of interleukin-1(IL-1)β that plays a predominant pathogenic role in such diseases. Appropriate treatment is crucial, also considering that AIDs may persist into adulthood with negative consequences on patients' quality of life. IL-1β blockade results in a sustained reduction of disease severity in most AIDs. A growing experience with the human IL-1 receptor antagonist, Anakinra (ANA), and the monoclonal anti IL-1β antibody, Canakinumab (CANA), has also been engendered, highlighting their efficacy upon protean clinical manifestations of AIDs. Safety and tolerability have been confirmed by several clinical trials and observational studies on both large and small cohorts of AID patients. The same treatment has been proposed in refractory Kawasaki disease, an acute inflammatory vasculitis occurring in children before 5 years, which has been postulated to be autoinflammatory for its phenotypical and immunological similarity with systemic juvenile idiopathic arthritis. Nevertheless, minor concerns about IL-1 antagonists have been raised regarding their employment in children, and the development of novel pharmacological formulations is aimed at minimizing side effects that may affect adherence to treatment. The present review summarizes current findings on the efficacy, safety, and tolerability of ANA and CANA for treatment of AIDs and Kawasaki vasculitis with a specific focus on the pediatric setting.
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Inter- and intra-observer reliability of contrast-enhanced magnetic resonance imaging parameters in children with suspected juvenile idiopathic arthritis of the hip. Pediatr Radiol 2018; 48:1891-1900. [PMID: 30076429 DOI: 10.1007/s00247-018-4216-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 06/07/2018] [Accepted: 07/13/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Previous work at our institution demonstrated discrepancies between radiologists in interpretation of contrast-enhanced magnetic resonance imaging (MRI) in suspected hip arthritis. OBJECTIVE To assess inter- and intra-observer reliability of selected MRI parameters (effusion, marrow oedema and synovial thickness and enhancement) used in the diagnosis of juvenile idiopathic arthritis. MATERIALS AND METHODS A retrospective cohort study was conducted of patients with confirmed or suspected juvenile idiopathic arthritis who underwent hip contrast-enhanced MRI between January 2011 and September 2014. Three pediatric musculoskeletal radiologists independently assessed all scans for effusion, marrow oedema, measurement of synovial thickness, synovial enhancement and subjective assessment of synovium. Categorical variables were analysed using the Cohen κ, and measurement using Bland-Altman plots. RESULTS Eighty patients were included. Interobserver reliability was moderate for effusion (κ=0.5-0.7), marrow oedema (κ=0.6), subjective synovial assessment (κ=0.4-0.5) and synovial enhancement (κ=0.1-0.5). Intra-observer reliability was highest for marrow oedema (κ=0.6-0.8) and lowest for effusion (κ=0.4-0.7). Intra-observer reliability for synovial enhancement (κ= -0.7-0.8) and subjective synovial assessment (κ=0.4-1.0) ranged from poor to excellent. For synovial thickness, intra- and interobserver Bland-Altman plots were well clustered around the mean suggesting good agreement. CONCLUSION There were large differences across variables and only moderate agreement between observers. The most reliable parameters were presence of joint effusion and bone marrow oedema and subjective assessment of synovium.
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Acceptable quality of life and low disease activity achievable among transition phase patients with rheumatic disease. Clin Rheumatol 2018; 38:785-791. [DOI: 10.1007/s10067-018-4351-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 10/06/2018] [Accepted: 10/23/2018] [Indexed: 01/25/2023]
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Sadun RE, Schanberg LE. Transition and transfer of the patient with paediatric-onset lupus: a practical approach for paediatric and adult rheumatology practices. Lupus Sci Med 2018; 5:e000282. [PMID: 30167316 PMCID: PMC6109813 DOI: 10.1136/lupus-2018-000282] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/21/2018] [Indexed: 12/14/2022]
Abstract
The prevalence of paediatric-onset SLE (pSLE) is estimated at 1million people worldwide and accounts for a significant proportion of SLE morbidity, mortality and cost. Patients with pSLE are especially vulnerable during and immediately following transfer from paediatric to adult rheumatology care, when substantial delays in care and increased disease activity are common. Transition is the process through which adolescents and young adults (AYA) develop the skills needed to succeed in the adult healthcare environment, a process that typically takes several years and may span a patient's time in paediatric and adult clinics. Recommendations for improving transition and transfer for AYA with pSLE include setting expectations of the AYA patient and family concerning transition and transfer, developing AYA's self-management skills, preparing an individualised transition plan that identifies a date for transfer, transferring at a time of medical and social stability, coordinating communication between the paediatric and adult rheumatologists (inclusive of both a medical summary and key social factors), and identifying a transition coordinator as a point person for care transfer and to monitor the AYA's arrival and retention in adult rheumatology care. Of paramount importance is empowering the adult rheumatologist with skills that enhance rapport with AYA patients, engage AYA patients and families in adult care models, promote adherence and encourage ongoing development of self-management skills.
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Affiliation(s)
- Rebecca E Sadun
- Department of Pediatrics, Division of Rheumatology, Duke Health, Durham, North Carolina, USA
- Department of Medicine, Division of Rheumatology, Duke Health, Durham, North Carolina, USA
| | - Laura E Schanberg
- Department of Pediatrics, Division of Rheumatology, Duke Health, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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Abstract
Although it has been widely acknowledged for more than two decades that transition from pediatric to adult care is a vulnerable time for adolescents and young adults with rheumatic diseases, current primary and subspecialty care transition and transfer processes remain inadequate. Barriers to improving transition include complex health care systems, neurodevelopmental challenges of adolescents and young adults, and insufficient transition-related education and resources for health care providers. Standardized, evidence-based transition interventions are sorely needed to establish best practices. Quality improvement approaches such as the Six Core Elements of Health Care Transition offer opportunities to improve transition care for teens and young adults.
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Sabbagh S, Ronis T, White PH. Pediatric rheumatology: addressing the transition to adult-orientated health care. Open Access Rheumatol 2018; 10:83-95. [PMID: 30013406 PMCID: PMC6037274 DOI: 10.2147/oarrr.s138370] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The transition from pediatric to adult health care is often a challenging process due to multiple interwoven complexities, especially for children with chronic medical conditions. Health care transition (HCT) is a process of moving from a pediatric to an adult model of health care with or without a transfer to a new clinician. This paper focuses on what is known about HCT for youth and young adults (Y/YA) with rheumatic diseases within a larger context of HCT recommendations. HCT barriers for youth, families, and providers and current evidence for a structured HCT processes are reviewed. Practical advice is offered on how to approach transition for Y/YA, what tools are available to assist in a successful transition process, and what are the areas of future research that are needed to improve the HCT evidence base.
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Affiliation(s)
- Sara Sabbagh
- Department of Rheumatology, Children's National Health System, Washington DC, USA
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - Tova Ronis
- Department of Rheumatology, Children's National Health System, Washington DC, USA
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
| | - Patience H White
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
- Department of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
- Department of Medicine, George Washington University School of Medicine and Health Sciences, Washington DC, USA,
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Relas H, Luosujärvi R, Kosola S. Outcome of transition phase patients with juvenile idiopathic arthritis. Mod Rheumatol 2018; 28:832-837. [DOI: 10.1080/14397595.2017.1416890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Heikki Relas
- Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Riitta Luosujärvi
- Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Silja Kosola
- Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Lim LSH, Pullenayegum E, Lim L, Gladman D, Feldman B, Silverman E. From Childhood to Adulthood: The Trajectory of Damage in Patients With Juvenile-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2017; 69:1627-1635. [DOI: 10.1002/acr.23199] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 01/17/2017] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Lillian Lim
- SickKids Child Health Evaluative Services; Toronto Ontario Canada
| | - Dafna Gladman
- University of Toronto and Toronto Western Hospital; Toronto Ontario Canada
| | - Brian Feldman
- The Hospital for Sick Children; Toronto Ontario Canada
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Clemente D, Leon L, Foster H, Carmona L, Minden K. Transitional care for rheumatic conditions in Europe: current clinical practice and available resources. Pediatr Rheumatol Online J 2017; 15:49. [PMID: 28599656 PMCID: PMC5466791 DOI: 10.1186/s12969-017-0179-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 06/05/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To assess European pediatric rheumatology providers' current clinical practices and resources used in the transition from child-centered to adult-oriented care. METHODS European pediatric rheumatologists were invited to complete a 17-item anonymized e-survey assessing current transition practices, transition policy awareness, and needs in advance of the publication of EULAR/PReS recommendations on transition. RESULTS The response rate was 121/276 (44%), including responses from 115 centers in 22 European Union countries. Although 32/121 (26%) responded that their centers did not offer transition services, the majority (99%) agreed that a formalized process in transitioning patients to adult care is necessary. A minority (<30%) of respondents stated that they have a written transition policy although 46% have an informal transition process. Designated staff to support transitional care were available in a minority of centers: nurse (35%), physiotherapist (15%), psychologist (15%), social worker (8%), and occupational therapist (2%). The existence of a designated team member to coordinate transition was acknowledged in many centers (64% of respondents) although just 36% use a checklist for young people as part of individualized transitional care. CONCLUSION This survey of European pediatric rheumatology providers regarding transitional care practices demonstrates agreement that transitional care is important, and wide variation in current provision of transition services exists.
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Affiliation(s)
- Daniel Clemente
- 0000 0004 1767 5442grid.411107.2Paediatric Rheumatology Unit, Hospital Infantil Universitario “Niño Jesús”, Madrid, Spain
| | - Leticia Leon
- grid.449750.bIDISSC, Hospital Clínico San Carlos; Health Sciences, Universidad Camilo José Cela, Madrid, Spain
| | - Helen Foster
- Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, and Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Kirsten Minden
- Department of Rheumatology and Clinical Immunology, and German Rheumatism Research Centre, Charité University Medicine Berlin, a Leibniz Institute, Berlin, Germany.
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41
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Kang JH, Park DJ, Lee KE, Lee JS, Choi YD, Lee SS. Comparison of clinical, serological, and prognostic differences among juvenile-, adult-, and late-onset lupus nephritis in Korean patients. Clin Rheumatol 2017; 36:1289-1295. [DOI: 10.1007/s10067-017-3641-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 04/17/2017] [Indexed: 12/31/2022]
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Miyamae T, Takei S, Itoh Y, Yamanaka H. Survey of attitudes of non-pediatric rheumatologists among councilors of the Japan College of Rheumatology regarding transitional care. Mod Rheumatol 2017; 27:1047-1050. [DOI: 10.1080/14397595.2017.1285846] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Takako Miyamae
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Pediatrics, Tokyo Women’s Medical University, Tokyo, Japan
| | - Syuji Takei
- Kagoshima University Faculty of Medicine School of Health Sciences, Kagoshima, Japan
| | - Yasuhiko Itoh
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Hisashi Yamanaka
- Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
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Pinto AJ, Benatti FB, Roschel H, de Sá Pinto AL, Silva CA, Sallum AME, Gualano B. Poor muscle strength and function in physically inactive childhood-onset systemic lupus erythematosus despite very mild disease. REVISTA BRASILEIRA DE REUMATOLOGIA 2016; 56:509-514. [PMID: 27914598 DOI: 10.1016/j.rbre.2016.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/12/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To compare muscle strength (i.e. lower- and upper-body strength) and function between physically inactive childhood-onset systemic lupus erythematosus patients (C-SLE) and healthy controls (CTRL). METHODS This was a cross-sectional study and the sample consisted of 19 C-SLE (age between 9 and 18 years) and 15 CTRL matched by age, sex, body mass index (BMI), and physical activity levels (assessed by accelerometry). Lower- and upper-body strength was assessed by the one-repetition-maximum (1-RM) test. Isometric strength was assessed through a handgrip dynamometer. Muscle function was evaluated by the timed-stands test (TST) and the timed-up-and-go test (TUG). RESULTS When compared with CTRL, C-SLE showed lower leg-press and bench-press 1-RM (p=0.026 and p=0.008, respectively), and a tendency toward lower handgrip strength (p=0.052). C-SLE showed lower TST scores (p=0.036) and a tendency toward higher TUG scores (p=0.070) when compared with CTRL. CONCLUSION Physically inactive C-SLE patients with very mild disease showed reduced muscle strength and functionality when compared with healthy controls matched by physical activity levels. These findings suggest C-SLE patients may greatly suffer from a physically inactive lifestyle than healthy controls do. Moreover, some sub-clinical "residual" effect of the disease or its pharmacological treatment seems to affect C-SLE patients even with a well-controlled disease.
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Affiliation(s)
- Ana Jéssica Pinto
- Universidade de São Paulo (USP), Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, São Paulo, SP, Brazil
| | - Fabiana Braga Benatti
- Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Hamilton Roschel
- Universidade de São Paulo (USP), Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Ana Lúcia de Sá Pinto
- Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil
| | - Clovis Artur Silva
- Universidade de São Paulo (USP), Faculdade de Medicina, Instituto da Criança, São Paulo, SP, Brazil
| | | | - Bruno Gualano
- Universidade de São Paulo (USP), Grupo de Pesquisa em Fisiologia Aplicada e Nutrição, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Divisão de Reumatologia, São Paulo, SP, Brazil.
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44
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Systematic review and critical appraisal of transitional care programmes in rheumatology. Semin Arthritis Rheum 2016; 46:372-379. [DOI: 10.1016/j.semarthrit.2016.06.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 05/26/2016] [Accepted: 06/06/2016] [Indexed: 12/30/2022]
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45
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Foster HE, Minden K, Clemente D, Leon L, McDonagh JE, Kamphuis S, Berggren K, van Pelt P, Wouters C, Waite-Jones J, Tattersall R, Wyllie R, Stones SR, Martini A, Constantin T, Schalm S, Fidanci B, Erer B, Demirkaya E, Ozen S, Carmona L. EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases. Ann Rheum Dis 2016; 76:639-646. [PMID: 27802961 DOI: 10.1136/annrheumdis-2016-210112] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/11/2016] [Accepted: 10/16/2016] [Indexed: 02/06/2023]
Abstract
To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks.
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Affiliation(s)
- Helen E Foster
- Newcastle University, Institute of Cellular Medicine (Rheumatology), Newcastle, UK
| | - Kirsten Minden
- Children's University hospital Charité, Campus Virchow, SPZ, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Clemente
- Paediatric Rheumatology Unit, Hospital Infantil Universitario "Niño Jesús", Madrid, Spain
| | - Leticia Leon
- Hospital Cí-nico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Madrid, Spain.,Health Sciences, Universidad Camilo José Cela, Madrid, Madrid, Spain
| | - Janet E McDonagh
- University of Manchester, Centre for Musculoskeletal Research, Manchester, Manchester, UK
| | - Sylvia Kamphuis
- Immunology and Infectiology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | | | - Philomine van Pelt
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Carine Wouters
- Pediatric Immunology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Rachel Tattersall
- University of Sheffield, School of Health and Related Research, Sheffield, Sheffield, UK
| | - Ruth Wyllie
- Paediatric Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | - Alberto Martini
- Pediatria II, Universita degli Studi di Genova Scuola di Scienze Mediche e Farmaceutiche, Genova, Liguria, Italy
| | | | - Susanne Schalm
- Transitionssprechstunde am Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Berna Fidanci
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey, Ankara, Turkey
| | - Burak Erer
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erkan Demirkaya
- Gulhane Military Medical Faculty, Pediatric Rheumatology Unit, FMF Arthritis Vasculitis and Orphan Disease Research in Pediatric Rheumatology (FAVOR), Etlik, Ankara 06018, Turkey, Ankara, Turkey
| | - Seza Ozen
- Pediatric Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey
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46
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Pinto AJ, Benatti FB, Roschel H, de Sá Pinto AL, Silva CA, Sallum AME, Gualano B. Redução na força muscular e capacidade funcional em pacientes fisicamente inativos com lúpus eritematoso sistêmico de início juvenil, apesar de doença muito leve. REVISTA BRASILEIRA DE REUMATOLOGIA 2016. [DOI: 10.1016/j.rbr.2016.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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47
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Pinto AJ, Miyake CNH, Benatti FB, Silva CA, Sallum AME, Borba E, de Sá-Pinto AL, Bonfá E, Gualano B. Reduced Aerobic Capacity and Quality of Life in Physically Inactive Patients With Systemic Lupus Erythematosus With Mild or Inactive Disease. Arthritis Care Res (Hoboken) 2016; 68:1780-1786. [DOI: 10.1002/acr.22905] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Revised: 02/23/2016] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
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48
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Luca NJ, Burnett HF, Ungar WJ, Moretti ME, Beukelman T, Feldman BM, Schwartz G, Bayoumi AM. Cost-Effectiveness Analysis of First-Line Treatment With Biologic Agents in Polyarticular Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2016; 68:1803-1811. [DOI: 10.1002/acr.22903] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 02/25/2016] [Accepted: 03/29/2016] [Indexed: 12/19/2022]
Affiliation(s)
- Nadia J. Luca
- Alberta Children's Hospital and University of Calgary; Calgary Alberta Canada
| | - Heather F. Burnett
- The Hospital for Sick Children and University of Toronto; Toronto Ontario Canada
| | - Wendy J. Ungar
- The Hospital for Sick Children and University of Toronto; Toronto Ontario Canada
| | - Myla E. Moretti
- The Hospital for Sick Children and University of Toronto; Toronto Ontario Canada
| | | | - Brian M. Feldman
- The Hospital for Sick Children and University of Toronto; Toronto Ontario Canada
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49
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Pregnancy outcomes in women with childhood-onset and adult-onset systemic lupus erythematosus: a comparative study. Rheumatol Int 2016; 36:1431-7. [DOI: 10.1007/s00296-016-3525-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/28/2016] [Indexed: 10/21/2022]
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50
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Sex bias in paediatric autoimmune disease – Not just about sex hormones? J Autoimmun 2016; 69:12-23. [DOI: 10.1016/j.jaut.2016.02.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 02/25/2016] [Accepted: 02/29/2016] [Indexed: 02/06/2023]
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