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Fautrel B, Mitrovic S, De Matteis A, Bindoli S, Antón J, Belot A, Bracaglia C, Constantin T, Dagna L, Di Bartolo A, Feist E, Foell D, Gattorno M, Georgin-Lavialle S, Giacomelli R, Grom AA, Jamilloux Y, Laskari K, Lazar C, Minoia F, Nigrovic PA, Oliveira Ramos F, Ozen S, Quartier P, Ruscitti P, Sag E, Savic S, Truchetet ME, Vastert SJ, Wilhelmer TC, Wouters C, Carmona L, De Benedetti F. EULAR/PReS recommendations for the diagnosis and management of Still's disease, comprising systemic juvenile idiopathic arthritis and adult-onset Still's disease. Ann Rheum Dis 2024:ard-2024-225851. [PMID: 39317417 DOI: 10.1136/ard-2024-225851] [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: 03/21/2024] [Accepted: 06/07/2024] [Indexed: 09/26/2024]
Abstract
Systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still's disease (AOSD) are considered the same disease, but a common approach for diagnosis and management is still missing. METHODS In May 2022, EULAR and PReS endorsed a proposal for a joint task force (TF) to develop recommendations for the diagnosis and management of sJIA and AOSD. The TF agreed during a first meeting to address four topics: similarity between sJIA and AOSD, diagnostic biomarkers, therapeutic targets and strategies and complications including macrophage activation syndrome (MAS). Systematic literature reviews were conducted accordingly. RESULTS The TF based their recommendations on four overarching principles, highlighting notably that sJIA and AOSD are one disease, to be designated by one name, Still's disease.Fourteen specific recommendations were issued. Two therapeutic targets were defined: clinically inactive disease (CID) and remission, that is, CID maintained for at least 6 months. The optimal therapeutic strategy relies on early use of interleukin (IL-1 or IL-6 inhibitors associated to short duration glucocorticoid (GC). MAS treatment should rely on high-dose GCs, IL-1 inhibitors, ciclosporin and interferon-γ inhibitors. A specific concern rose recently with cases of severe lung disease in children with Still's disease, for which T cell directed immunosuppressant are suggested. The recommendations emphasised the key role of expert centres for difficult-to-treat patients. All overarching principles and recommendations were agreed by over 80% of the TF experts with a high level of agreement. CONCLUSION These recommendations are the first consensus for the diagnosis and management of children and adults with Still's disease.
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Affiliation(s)
- Bruno Fautrel
- Rheumatology, CEREMAIA Reference Center (ERN RITA) , Sorbonne Université - AP-HP, Pitié-Salpêtrière Hospital, Paris, France
- INSERM UMR-S 1136, Team 5, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
- CRI-IMIDIATE Clinical Research Network, Assistance Publique - Hopitaux de Paris, Paris, France
| | - Stéphane Mitrovic
- Rheumatology, CEREMAIA Reference Center (ERN RITA) , Sorbonne Université - AP-HP, Pitié-Salpêtrière Hospital, Paris, France
| | - Arianna De Matteis
- Division of Rheumatology, ERN RITA center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Sara Bindoli
- Rheumatology, Università degli Studi di Padova, Padova, Veneto, Italy
| | - Jordi Antón
- Department of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
- CSUR Enfermedades Autoinmunes y Autoinflamatorias, ERN RITA, Barcelona, Spain
| | - Alexandre Belot
- Department of Paediatric Nephrology, Rheumatology, Dermatology, Hôpital Femme-Mère Enfant, Université Claude Bernard-Lyon 1, Bron, France
- Centre International de Recherche en Infectiologie (CIRI), Inserm UMR 1111, CNRS, UMR5308, Ecole Normale Supérieure de Lyon, Lyon, France
- National Reference Centres for Rheumatism & AutoImmune diseaSes in children (RAISE) and Autoinflammatory diseases & Amyloidosis (CEREMAIA), ERN RITA RECONNECT, Lyon, France
| | - Claudia Bracaglia
- Division of Rheumatology, ERN RITA center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Tamàs Constantin
- Unit of Paediatric Rheumatology, Semmelweis University, Budapest, Hungary
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milano, Italy
| | | | - Eugen Feist
- Rheumatology and Clinical Immunology, HELIOS Fachklinik Vogelsang/Gommern, Vogelsang, Sachsen-Anhalt, Germany
| | - Dirk Foell
- Department of Rheumatology and Clinical Immunology, Children Hospital, University of Muenster, Muenster, Germany
| | - Marco Gattorno
- UOSD Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sophie Georgin-Lavialle
- Internal Medicine, CEREMAIA Reference Center (ERN RITA), Tenon Hospital , Sorbonne Université, AP-HP, Paris, France
| | - Roberto Giacomelli
- Università Campus Bio-Medico di Roma Facoltà Dipartimentale di Medicina e Chirurgia, Roma, Italy
| | - Alexei A Grom
- Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Yvan Jamilloux
- Internal Medicine, CEREMAIA Reference Center (ERN RITA), Croix Rousse Hospital, Hospices Civils de Lyon - Université Claude Bernard - Lyon 1, Lyon, France
| | - Katerina Laskari
- Rheumatology Unit, 1st Dept. of Propaedeutic Internal Medicine, National & Kapodistrian University of Athens Medical School, Athens, Greece
| | - Calin Lazar
- Department of Pediatric Rheumatology, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj-Napocca, Romania
| | - Francesca Minoia
- Pediatria e Immunoreumatologia, IRCCS Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Peter A Nigrovic
- Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Boston, MA, USA
- Immunology, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Filipa Oliveira Ramos
- Unidade de Reumatologia Pediátrica, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Center, Lisbon, Portugal
| | - Seza Ozen
- Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Pierre Quartier
- Pediatric Immuno-Hematology and Rheumatology Unit, RAISE Reference Center (ERN RECONNECT), Hopital universitaire Necker-Enfants malades, Paris, France
- IMAGINE Institute, Université de Paris, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Piero Ruscitti
- Division of Rheumatology, Department of Clinical Sciences and Applied Biotechnology, University of L'Aquila, L'Aquila, Abruzzo, Italy
| | - Erdal Sag
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Sinisa Savic
- Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Clinical Immunology and Allergy, NIHR-Leeds Biomedical research centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Marie-Elise Truchetet
- Rhumatologie, CHU Bordeaux, Bordeaux, France
- ImmunoConcEpT, UMR 5164, Université de Bordeaux, CNRS, Bordeaux, France
- Centre de Référence Maladies Autoimmunes et Systémiques rares Est / Sud Ouest (RESO), RECONNECT ERN, FHU ACRONIM, CHU Bordeaux, Bordeaux, France
| | - Sebastiaan J Vastert
- Pediatric Immunology, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Carine Wouters
- Pediatric Immunology, University Hospital Gasthuisberg, Leuven, Belgium
- Department of Pediatric Rheumatology, Centre for Rare Immune Deficiency, Autoimmune and Autoinflammatory Diseases, UZ Leuven, Leuven, Belgium
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Madrid, Spain
| | - Fabrizio De Benedetti
- Division of Rheumatology, ERN RITA center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
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2
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Fiorino EK, Fishman MP. Approach to the patient with Childhood Interstitial and Diffuse Lung Disease. Pediatr Pulmonol 2024; 59:2267-2275. [PMID: 39056528 DOI: 10.1002/ppul.27162] [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: 09/26/2023] [Revised: 06/06/2024] [Accepted: 06/25/2024] [Indexed: 07/28/2024]
Abstract
Childhood Interstitial and Diffuse Lung Disease (chILD) encompasses a group of rare, chronic lung disorders in infants and children with overlapping clinical features but diverse etiologies. The clinical presentation of chILD is of chronic or recurring respiratory signs and symptoms, often including increased work of breathing and hypoxia, with diffuse radiographic abnormalities on chest imaging. Recognition can be challenging since some clinical features overlap with those of more common pediatric respiratory diseases including asthma and recurrent viral infections, among others. chILD should be considered as an underlying diagnosis when a patient's respiratory symptoms seem disproportionate to the clinical scenario and/or persist. The diagnostic process involves multiple steps and is tailored to the individual patient. Nearly all children will undergo imaging and pulmonary function testing, many will undergo bronchoscopy with bronchoalveolar lavage, many will receive genetic testing, and some will require lung biopsy. Treatment includes preventive care, evaluation for comorbidities, pharmacotherapy according to diagnosis, and ongoing disease surveillance, including revisiting genetic and histopathologic results as new clinical information becomes available and as our understanding of these rare disorders improves. The purpose of this review is to provide a broad approach to the diagnosis and management of patients with chILD.
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Affiliation(s)
- Elizabeth K Fiorino
- Northwell, New Hyde Park, New York, USA
- Departments of Science Education and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Martha P Fishman
- Harvard Medical School, Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
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3
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Saper VE, Tian L, Verstegen RHJ, Conrad CK, Cidon M, Hopper RK, Kuo CS, Osoegawa K, Baszis K, Bingham CA, Ferguson I, Hahn T, Horne A, Isupova EA, Jones JT, Kasapcopur Ö, Klein-Gitelman MS, Kostik MM, Ozen S, Phadke O, Prahalad S, Randell RL, Sener S, Stingl C, Abdul-Aziz R, Akoghlanian S, Al Julandani D, Alvarez MB, Bader-Meunier B, Balay-Dustrude EE, Balboni I, Baxter SK, Berard RA, Bhattad S, Bolaria R, Boneparth A, Cassidy EA, Co DO, Collins KP, Dancey P, Dickinson AM, Edelheit BS, Espada G, Flanagan ER, Imundo LF, Jindal AK, Kim HA, Klaus G, Lake C, Lapin WB, Lawson EF, Marmor I, Mombourquette J, Ogunjimi B, Olveda R, Ombrello MJ, Onel K, Poholek C, Ramanan AV, Ravelli A, Reinhardt A, Robinson AD, Rouster-Stevens K, Saad N, Schneider R, Selmanovic V, Sefic Pasic I, Shenoi S, Shilo NR, Soep JB, Sura A, Taber SF, Tesher M, Tibaldi J, Torok KS, Tsin CM, Vasquez-Canizares N, Villacis Nunez DS, Way EE, Whitehead B, Zemel LS, Sharma S, Fernández-Viña MA, Mellins ED. Interleukin (IL)-1/IL-6-Inhibitor-Associated Drug Reaction With Eosinophilia and Systemic Symptoms (DReSS) in Systemic Inflammatory Illnesses. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024:S2213-2198(24)00692-5. [PMID: 39002722 DOI: 10.1016/j.jaip.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/30/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND After introducing IL-1/IL-6 inhibitors, some patients with Still and Still-like disease developed unusual, often fatal, pulmonary disease. This complication was associated with scoring as DReSS (drug reaction with eosinophilia and systemic symptoms) implicating these inhibitors, although DReSS can be difficult to recognize in the setting of systemic inflammatory disease. OBJECTIVE To facilitate recognition of IL-1/IL-6 inhibitor-DReSS in systemic inflammatory illnesses (Still/Still-like) by looking at timing and reaction-associated features. We evaluated outcomes of stopping or not stopping IL-1/IL-6 inhibitors after DReSS reaction began. METHODS In an international study collaborating primarily with pediatric specialists, we characterized features of 89 drug-reaction cases versus 773 drug-exposed controls and compared outcomes of 52 cases stopping IL-1/IL-6 inhibitors with 37 cases not stopping these drugs. RESULTS Before the reaction began, drug-reaction cases and controls were clinically comparable, except for younger disease-onset age for reaction cases with preexisting cardiothoracic comorbidities. After the reaction began, increased rates of pulmonary complications and macrophage activation syndrome differentiated drug-reaction cases from drug-tolerant controls (P = 4.7 × 10-35 and P = 1.1 × 10-24, respectively). The initial DReSS feature was typically reported 2 to 8 weeks after initiating IL-1/IL-6 inhibition. In drug-reaction cases stopping versus not stopping IL-1/IL-6-inhibitor treatment, reaction-related features were indistinguishable, including pulmonary complication rates (75% [39 of 52] vs 76% [28 of 37]). Those stopping subsequently required fewer medications for treatment of systemic inflammation, had decreased rates of macrophage activation syndrome, and improved survival (P = .005, multivariate regression). Resolution of pulmonary complications occurred in 67% (26 of 39) of drug-reaction cases who stopped and in none who continued inhibitors. CONCLUSIONS In systemic inflammatory illnesses, recognition of IL-1/IL-6-inhibitor-associated reactions followed by avoidance of IL-1/IL-6 inhibitors significantly improved outcomes.
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Affiliation(s)
- Vivian E Saper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif.
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Stanford, Calif
| | - Ruud H J Verstegen
- Hospital for Sick Children, Division of Clinical Pharmacology and Toxicology, Toronto, Ontario, Canada
| | - Carol K Conrad
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Michal Cidon
- Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, Calif
| | - Rachel K Hopper
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Christin S Kuo
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Kazutoyo Osoegawa
- Histocompatibility & Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, Calif
| | - Kevin Baszis
- Department of Pediatrics, Washington University in Saint Louis School of Medicine, Saint Louis, Mo
| | | | - Ian Ferguson
- Department of Pediatrics, Yale University School of Medicine, New Haven, Conn
| | - Timothy Hahn
- Pennsylvania State University College of Medicine, Hershey, Pa
| | - Annacarin Horne
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - Eugenia A Isupova
- Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Jordan T Jones
- Children's Mercy Hospital, Kansas City, Mo; University of Kansas School of Medicine, Kansas City, Mo
| | - Özgür Kasapcopur
- Department of Pediatrics, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Marisa S Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Ill; Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Mikhail M Kostik
- Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Seza Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - Omkar Phadke
- University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | - Rachel L Randell
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Seher Sener
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | | | - Rabheh Abdul-Aziz
- University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY
| | - Shoghik Akoghlanian
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - Dalila Al Julandani
- Bristol Royal Hospital for Children Bristol, University of Bristol, Bristol, United Kingdom
| | | | - Brigitte Bader-Meunier
- Hopital Universitaire Necker-Enfants Malades, Department of Paediatric Hematology-Immunology and Rheumatology, Reference Center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE), Imagine Institute, Inserm, Paris, France
| | - Erin E Balay-Dustrude
- Seattle Children's Hospital Research Center, Seattle, Wash; Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash
| | - Imelda Balboni
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Sarah K Baxter
- Seattle Children's Hospital Research Center, Seattle, Wash; Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash
| | - Roberta A Berard
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Sagar Bhattad
- Pediatric Immunology and Rheumatology, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Roxana Bolaria
- Department of Pediatrics, University of British Columbia, Victoria, British Columbia, Canada
| | - Alexis Boneparth
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Elaine A Cassidy
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pa
| | - Dominic O Co
- Department of Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wis
| | - Kathleen P Collins
- The University of Tennessee Health Science Center, Memphis, Tenn; LeBonheur Children's Hospital, Memphis, Tenn
| | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Aileen M Dickinson
- Department of Pediatrics, University of California Los Angeles David Geffen School of Medicine, Los Angeles, Calif
| | - Barbara S Edelheit
- University of Connecticut School of Medicine, Farmington, Conn; Connecticut Children's Medical Center, Hartford, Conn
| | - Graciela Espada
- Hospital de Niños Dr Ricardo Gutierrez, Buenos Aires, Argentina
| | - Elaine R Flanagan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | - Lisa F Imundo
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Ankur K Jindal
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Hyoun-Ah Kim
- Department of Rheumatology, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Günter Klaus
- Philipps-University of Marburg and KfH Pediatric Kidney Center, Marburg, Germany
| | - Carol Lake
- Translational Genetics and Genomics Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, Md
| | - W Blaine Lapin
- University of Connecticut School of Medicine, Farmington, Conn; Connecticut Children's Medical Center, Hartford, Conn
| | - Erica F Lawson
- University of California San Francisco, San Francisco, Calif
| | - Itay Marmor
- Dana-Dwek Children's Hospital Tel Aviv, Tel Aviv, Israel
| | - Joy Mombourquette
- Department of Pediatrics, Kaiser Permanente California, Roseville, Calif
| | - Benson Ogunjimi
- Centre for Health Economics Research and Modeling of Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Rebecca Olveda
- University of California San Francisco, San Francisco, Calif
| | - Michael J Ombrello
- Translational Genetics and Genomics Section, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health, Bethesda, Md
| | - Karen Onel
- Hospital for Special Surgery, New York, NY; Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | | | | | - Angelo Ravelli
- IRCCS Istituto Giannina Gaslini, Genova, Italy; Università degli Studi di Genova, Genova, Italy
| | | | | | - Kelly Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | - Nadine Saad
- University of Michigan, Michigan Medicine, Ann Arbor, Mich
| | - Rayfel Schneider
- Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Velma Selmanovic
- Children's Hospital University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Irmina Sefic Pasic
- Children's Hospital University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Susan Shenoi
- Seattle Children's Hospital Research Center, Seattle, Wash; Department of Pediatrics, University of Washington School of Medicine, Seattle, Wash
| | - Natalie R Shilo
- Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pa
| | | | - Angeli Sura
- State University of New York (SUNY) Upstate Medical University, Syracuse, NY
| | - Sarah F Taber
- Hospital for Special Surgery, New York, NY; Department of Pediatrics, Weill Cornell Medicine, New York, NY
| | - Melissa Tesher
- University of Chicago Pritzker School of Medicine, Chicago, Ill
| | | | - Kathryn S Torok
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, Pa
| | - Cathy Mei Tsin
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | | | - Diana S Villacis Nunez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Ga; Children's Healthcare of Atlanta, Atlanta, Ga
| | - Emily E Way
- Inova L.J. Murphy Children's Hospital, Falls Church, Va
| | | | - Lawrence S Zemel
- University of Connecticut School of Medicine, Farmington, Conn; Connecticut Children's Medical Center, Hartford, Conn
| | - Surbhi Sharma
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
| | - Marcelo A Fernández-Viña
- Histocompatibility & Immunogenetics Laboratory, Stanford Blood Center, Palo Alto, Calif; Department of Pathology, Stanford University School of Medicine, Stanford, Calif
| | - Elizabeth D Mellins
- Department of Pediatrics, Stanford University School of Medicine, Stanford, Calif
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Aires BP, Wobma H, Samad A, Chandler MT, Chang MH, Dedeoglu F, Fishman MP, Klouda T, Levin J, Halyabar O, Saleeb SF, Tworetzky W, Son MBF, Newburger JW, Casey A, Henderson LA. Severe Features of Systemic Juvenile Idiopathic Arthritis in Patients With Congenital Heart Disease. J Rheumatol 2024; 51:811-817. [PMID: 38825355 PMCID: PMC11296918 DOI: 10.3899/jrheum.2024-0180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/04/2024]
Abstract
OBJECTIVE To describe the clinical features of patients with congenital heart disease (CHD) who subsequently developed systemic juvenile idiopathic arthritis (sJIA). METHODS We conducted a retrospective review of patients diagnosed with CHD and sJIA at our institution. Detailed clinical, laboratory, and radiographic data were collected from the medical record and reviewed with each patient's primary medical team. RESULTS Five patients with sJIA and CHD were identified. Each child had a unique cardiac anatomy, but all the patients required surgical repair during the first year of life. Four children had thymectomies at the time of cardiac surgery. Classic signs of sJIA such as fever (n = 5), rash (n = 5), and arthritis (n = 4) developed after surgical intervention in all the patients. The individuals in this cohort displayed risk factors associated with severe sJIA, including disease onset before 2 years of age (n = 5), elevated interleukin 18 levels (n = 5), baseline eosinophilia prior to initiation of biologic disease-modifying antirheumatic drugs (n = 4), and positivity for HLA-DRB1*15:01 alleles (n = 4). Macrophage activation syndrome (MAS) occurred in 3 patients and sJIA-associated lung disease (sJIA-LD) was identified in 4 patients. Two children died from complications of their cardiac and/or pulmonary disease. CONCLUSION We identified an association between CHD and severe forms of sJIA. Although these findings will need to be confirmed in larger, multicenter cohorts, the results highlight the importance of considering a diagnosis of sJIA in children with CHD and remaining vigilant for complications such as MAS and sJIA-LD.
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Affiliation(s)
- Barbara Pontes Aires
- B. Pontes Aires, MD, Department of Pediatrics, Tufts Medical Center, Tufts University School of Medicine, and Department of Pediatrics, Boston Children's Hospital
| | - Holly Wobma
- H. Wobma, MD, PhD, M.T. Chandler, MD, MPH, M.H. Chang, MD, PhD, F. Dedeoglu, MD, O. Halyabar, MD, M.B.F. Son, MD, L.A. Henderson, MD, MMSc, Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Aaida Samad
- A. Samad, MD, M.P. Fishman, MD, T. Klouda, DO, J. Levin, MD, MBI, A. Casey, MD, Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School
| | - Mia T Chandler
- H. Wobma, MD, PhD, M.T. Chandler, MD, MPH, M.H. Chang, MD, PhD, F. Dedeoglu, MD, O. Halyabar, MD, M.B.F. Son, MD, L.A. Henderson, MD, MMSc, Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Margaret H Chang
- H. Wobma, MD, PhD, M.T. Chandler, MD, MPH, M.H. Chang, MD, PhD, F. Dedeoglu, MD, O. Halyabar, MD, M.B.F. Son, MD, L.A. Henderson, MD, MMSc, Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Fatma Dedeoglu
- H. Wobma, MD, PhD, M.T. Chandler, MD, MPH, M.H. Chang, MD, PhD, F. Dedeoglu, MD, O. Halyabar, MD, M.B.F. Son, MD, L.A. Henderson, MD, MMSc, Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Martha P Fishman
- A. Samad, MD, M.P. Fishman, MD, T. Klouda, DO, J. Levin, MD, MBI, A. Casey, MD, Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School
| | - Timothy Klouda
- A. Samad, MD, M.P. Fishman, MD, T. Klouda, DO, J. Levin, MD, MBI, A. Casey, MD, Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School
| | - Jonathan Levin
- A. Samad, MD, M.P. Fishman, MD, T. Klouda, DO, J. Levin, MD, MBI, A. Casey, MD, Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School
| | - Olha Halyabar
- H. Wobma, MD, PhD, M.T. Chandler, MD, MPH, M.H. Chang, MD, PhD, F. Dedeoglu, MD, O. Halyabar, MD, M.B.F. Son, MD, L.A. Henderson, MD, MMSc, Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Susan F Saleeb
- S.F. Saleeb, MD, W. Tworetzky, MD, J.W. Newburger, MD, MPH, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wayne Tworetzky
- S.F. Saleeb, MD, W. Tworetzky, MD, J.W. Newburger, MD, MPH, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mary Beth F Son
- H. Wobma, MD, PhD, M.T. Chandler, MD, MPH, M.H. Chang, MD, PhD, F. Dedeoglu, MD, O. Halyabar, MD, M.B.F. Son, MD, L.A. Henderson, MD, MMSc, Division of Immunology, Boston Children's Hospital, Harvard Medical School
| | - Jane W Newburger
- S.F. Saleeb, MD, W. Tworetzky, MD, J.W. Newburger, MD, MPH, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alicia Casey
- A. Samad, MD, M.P. Fishman, MD, T. Klouda, DO, J. Levin, MD, MBI, A. Casey, MD, Division of Pulmonary Medicine, Boston Children's Hospital, Harvard Medical School
| | - Lauren A Henderson
- H. Wobma, MD, PhD, M.T. Chandler, MD, MPH, M.H. Chang, MD, PhD, F. Dedeoglu, MD, O. Halyabar, MD, M.B.F. Son, MD, L.A. Henderson, MD, MMSc, Division of Immunology, Boston Children's Hospital, Harvard Medical School;
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Liu M, Gong Y, Lin M, Ma Q. Comprehensive analysis of juvenile idiopathic arthritis patients' immune characteristics based on bulk and single-cell sequencing data. Front Mol Biosci 2024; 11:1359235. [PMID: 38751447 PMCID: PMC11094213 DOI: 10.3389/fmolb.2024.1359235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/21/2024] [Indexed: 05/18/2024] Open
Abstract
Background The pathogenesis of juvenile idiopathic arthritis (JIA) is strongly influenced by an impaired immune system. However, the molecular mechanisms underlying its development and progression have not been elucidated. In this study, the computational methods TRUST4 were used to construct a T-cell receptor (TCR) and B-cell receptor (BCR) repertoire from the peripheral blood of JIA patients via bulk RNA-seq data, after which the clonality and diversity of the immune repertoire were analyzed. Results Our findings revealed significant differences in the frequency of clonotypes between the JIA and healthy control groups in terms of the TCR and BCR repertoires. This work identified specific V genes and J genes in TCRs and BCRs that could be used to expand our understanding of JIA. After single-cell RNA analysis, the relative percentages of CD14 monocytes were significantly greater in the JIA group. Cell-cell communication analysis revealed the significant role of the MIF signaling pathway in JIA. Conclusion In conclusion, this work describes the immune features of both the TCR and BCR repertoires under JIA conditions and provides novel insight into immunotherapy for JIA.
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Ruscitti P, Cantarini L, Nigrovic PA, McGonagle D, Giacomelli R. Recent advances and evolving concepts in Still's disease. Nat Rev Rheumatol 2024; 20:116-132. [PMID: 38212542 DOI: 10.1038/s41584-023-01065-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
Still's disease is a rare inflammatory syndrome that encompasses systemic juvenile idiopathic arthritis and adult-onset Still's disease, both of which can exhibit life-threatening complications, including macrophage activation syndrome (MAS), a secondary form of haemophagocytic lymphohistiocytosis. Genetic insights into Still's disease involve both HLA and non-HLA susceptibility genes, suggesting the involvement of adaptive immune cell-mediated immunity. At the same time, phenotypic evidence indicates the involvement of autoinflammatory processes. Evidence also implicates the type I interferon signature, mechanistic target of rapamycin complex 1 signalling and ferritin in the pathogenesis of Still's disease and MAS. Pathological entities associated with Still's disease include lung disease that could be associated with biologic DMARDs and with the occurrence of MAS. Historically, monophasic, recurrent and persistent Still's disease courses were recognized. Newer proposals of alternative Still's disease clusters could enable better dissection of clinical heterogeneity on the basis of immune cell profiles that could represent diverse endotypes or phases of disease activity. Therapeutically, data on IL-1 and IL-6 antagonism and Janus kinase inhibition suggest the importance of early administration in Still's disease. Furthermore, there is evidence that patients who develop MAS can be treated with IFNγ antagonism. Despite these developments, unmet needs remain that can form the basis for the design of future studies leading to improvement of disease management.
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Affiliation(s)
- Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Peter A Nigrovic
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
- Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK
- National Institute for Health Research (NIHR) Leeds Biomedical Research Centre (BRC), Leeds Teaching Hospitals, Leeds, UK
| | - Roberto Giacomelli
- Clinical and research section of Rheumatology and Clinical Immunology, Fondazione Policlinico Campus Bio-Medico, Rome, Italy
- Rheumatology and Clinical Immunology, Department of Medicine, University of Rome "Campus Biomedico", School of Medicine, Rome, Italy
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Ding P, Du Y, Jiang X, Chen H, Huang L. Establishment and analysis of a novel diagnostic model for systemic juvenile idiopathic arthritis based on machine learning. Pediatr Rheumatol Online J 2024; 22:18. [PMID: 38243323 PMCID: PMC10797915 DOI: 10.1186/s12969-023-00949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/21/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Systemic juvenile idiopathic arthritis (SJIA) is a form of childhood arthritis with clinical features such as fever, lymphadenopathy, arthritis, rash, and serositis. It seriously affects the growth and development of children and has a high rate of disability and mortality. SJIA may result from genetic, infectious, or autoimmune factors since the precise source of the disease is unknown. Our study aims to develop a genetic-based diagnostic model to explore the identification of SJIA at the genetic level. METHODS The gene expression dataset of peripheral blood mononuclear cell (PBMC) samples from SJIA was collected from the Gene Expression Omnibus (GEO) database. Then, three GEO datasets (GSE11907-GPL96, GSE8650-GPL96 and GSE13501) were merged and used as a training dataset, which included 125 SJIA samples and 92 health samples. GSE7753 was used as a validation dataset. The limma method was used to screen differentially expressed genes (DEGs). Feature selection was performed using Lasso, random forest (RF)-recursive feature elimination (RFE) and RF classifier. RESULTS We finally identified 4 key genes (ALDH1A1, CEACAM1, YBX3 and SLC6A8) that were essential to distinguish SJIA from healthy samples. And we combined the 4 key genes and performed a grid search as well as 10-fold cross-validation with 5 repetitions to finally identify the RF model with optimal mtry. The mean area under the curve (AUC) value for 5-fold cross-validation was greater than 0.95. The model's performance was then assessed once more using the validation dataset, and an AUC value of 0.990 was obtained. All of the above AUC values demonstrated the strong robustness of the SJIA diagnostic model. CONCLUSIONS We successfully developed a new SJIA diagnostic model that can be used for a novel aid in the identification of SJIA. In addition, the identification of 4 key genes that may serve as potential biomarkers for SJIA provides new insights to further understand the mechanisms of SJIA.
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Affiliation(s)
- Pan Ding
- Department of Medical Record Statistics, Wenzhou People's Hospital, Wenzhou, China
| | - Yi Du
- Lianyungang Maternal and Child Health Hospital, Lianyungang, China
| | - Xinyue Jiang
- Zhoushan Center for Disease Control and Prevention, Zhoushan, China
| | - Huajian Chen
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China.
| | - Li Huang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou, China.
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Gagro A, Tomičić M, Škarić I, Dawidowsky B. Case report: Suspected transfusion-related acute lung injury type II in a child with refractory systemic juvenile idiopathic arthritis complicated by macrophage activation syndrome. Front Pediatr 2024; 11:1237111. [PMID: 38259599 PMCID: PMC10801163 DOI: 10.3389/fped.2023.1237111] [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: 06/08/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Transfusion-related acute lung injury is a rare but potentially fatal complication, which may appear during or post-transfusion of blood products. Patients with macrophage activation syndrome, a serious life-threatening complication associated with systemic juvenile idiopathic arthritis, often require transfusion or administration of blood products for correction of cytopenia, coagulopathy and hypofibrinogenemia. Case report A 6-year-old girl with a past medical history of systemic juvenile idiopathic arthritis had the first relapse of the disease during which she developed macrophage activation syndrome. During this life-threatening complication, she received a second dose of whole blood derived filtered and irradiated platelets from a single male donor due to profound thrombocytopenia. Approximately one hour post-infusion, the patient developed progressive dyspnea, hypoxemia and bilateral pulmonary edema. She was promptly intubated and placed on mechanical ventilation for 40 h. Clinical, laboratory and radiological findings, as well as the success of supportive ventilation therapy were highly suggestive of transfusion-related acute lung injury, a life-threatening complication that occurs within six hours of blood component transfusion. Blood immunology showed no presence of anti-human neutrophil antigen and anti-leukocyte antigen class I and class II antibodies in the donor's or patient's plasma. Conclusion To the best of our knowledge, we report the first case of a child with systemic juvenile idiopathic arthritis complicated with macrophage activation syndrome who developed type II transfusion-related acute lung injury following platelet transfusion. It is important to consider transfusion-related acute lung injury in transfusion settings in these children and apply critical and restrictive approach for platelet transfusion.
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Affiliation(s)
- Alenka Gagro
- Department of Pediatrics, Zagreb Children’s Hospital, School of Medicine, University of Zagreb, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Maja Tomičić
- Department of Platelet and Leukocyte Diagnosis and Hemostasis, Croatian Institute of Transfusion Medicine, Zagreb, Croatia
| | - Ivančica Škarić
- Department of Anesthesiology, Resuscitation and Intensive Care Medicine, Zagreb Children’s Hospital, Zagreb, Croatia
| | - Barbara Dawidowsky
- Department of Pediatric Surgery, Zagreb Children’s Hospital, Zagreb, Croatia
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9
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Hinze CH, Foell D, Kessel C. Treatment of systemic juvenile idiopathic arthritis. Nat Rev Rheumatol 2023; 19:778-789. [PMID: 37923864 DOI: 10.1038/s41584-023-01042-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2023] [Indexed: 11/06/2023]
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is an inflammatory disease with hallmarks of severe systemic inflammation, which can be accompanied by arthritis. Contemporary scientific insights set this paediatric disorder on a continuum with its counterpart, adult-onset Still disease (AOSD). Patients with sJIA are prone to complications, including life-threatening hyperinflammation (macrophage activation syndrome (sJIA-MAS)) and sJIA-associated lung disease (sJIA-LD). Meanwhile, the treatment arsenal in sJIA has expanded markedly. State-of-the-art therapeutic approaches include biologic agents that target the IL-1 and IL-6 pathways. Beyond these, a range of novel agents are on the horizon, some of them already being used on a compassionate use basis, including JAK inhibitors and biologic agents that target IL-18, IFNγ, or IL-1β and IL-18 simultaneously. However, sJIA, sJIA-MAS and sJIA-LD still pose challenging conundrums to rheumatologists treating paediatric and adult patients worldwide. Although national and international consensus treatment plans exist for the treatment of 'classic' sJIA, the treatment approaches for early sJIA without arthritis, and for refractory or complicated sJIA, are not well defined. Therefore, in this Review we outline current approaches for the treatment of sJIA and provide an outlook on knowledge gaps.
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Affiliation(s)
- Claas H Hinze
- Department of Paediatric Rheumatology and Immunology, Münster University Hospital, Münster, Germany
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, Münster University Hospital, Münster, Germany.
| | - Christoph Kessel
- Department of Paediatric Rheumatology and Immunology, Münster University Hospital, Münster, Germany
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10
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Ruscitti P, Sota J, Vitale A, Lopalco G, Iannone F, Morrone M, Giardini HAM, D'Agostin MA, Antonelli IPDB, Almaghlouth I, Asfina KN, Khalil N, Sfikakis PP, Laskari K, Tektonidou M, Ciccia F, Iacono D, Riccio F, Ragab G, Hussein MA, Govoni M, Ruffilli F, Direskeneli H, Alibaz-Oner F, Giacomelli R, Navarini L, Bartoloni E, Riccucci I, Martín-Nares E, Torres-Ruiz J, Cipriani P, Di Cola I, Hernández-Rodríguez J, Gómez-Caverzaschi V, Dagna L, Tomelleri A, Makowska J, Brzezinska O, Iagnocco A, Bellis E, Caggiano V, Gaggiano C, Tarsia M, Mormile I, Emmi G, Sfriso P, Monti S, Erten Ş, Del Giudice E, Lubrano R, Conti G, Olivieri AN, Lo Gullo A, Tharwat S, Karamanakos A, Gidaro A, Maggio MC, La Torre F, Cardinale F, Ogunjimi B, Maier A, Sebastiani GD, Opris-Belinski D, Frassi M, Viapiana O, Bizzi E, Carubbi F, Fotis L, Tufan A, Kardas RC, Więsik-Szewczyk E, Jahnz-Różyk K, Fabiani C, Frediani B, Balistreri A, Rigante D, Cantarini L. The administration of methotrexate in patients with Still's disease, "real-life" findings from AIDA Network Still Disease Registry. Semin Arthritis Rheum 2023; 62:152244. [PMID: 37517110 DOI: 10.1016/j.semarthrit.2023.152244] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/26/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES To describe clinical characteristics of patients with Still's disease treated with methotrexate (MTX) and to assess drug effectiveness evaluating change in disease activity, reduction of inflammatory markers, and glucocorticoid (GC)-sparing effect. METHODS Patients with Still's disease treated with MTX were assessed among those included in AIDA Network Still Disease Registry. RESULTS In this registry, 171 patients with Still's disease were treated with MTX (males 43.3%, age 37.1 ± 16.0 years). They were mainly characterised by joint features and fever without a prominent multiorgan involvement. MTX was administered with GCs in 68.4% of patients, with other conventional synthetic DMARDs in 6.4%, and with biologic DMARDs in 25.1%. A significant reduction of the modified systemic score was observed, and 38.6% patients were codified as being in clinical remission at the end of follow-up. The concomitant administration of a biologic DMARD resulted a predictor of the clinical remission. Furthermore, a reduction of inflammatory markers and ferritin levels was observed following the administration of MTX. Additionally, a marked reduction of the dosage of concomitant GCs was identified, while 36.7% discontinued such drugs. Male gender appeared as a predictor of GC discontinuation. MTX was discontinued in 12.3% of patients because of adverse effects, and in 12.3% for lack of efficacy. CONCLUSIONS Clinical characteristics of patients with Still's disease treated with MTX were described, mainly joint features and fever without a prominent multiorgan involvement. The clinical usefulness of MTX was reported in reducing the disease activity, decreasing the inflammatory markers, and as GC-sparing agent.
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Affiliation(s)
- Piero Ruscitti
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Jurgen Sota
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Antonio Vitale
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | - Maria Morrone
- Rheumatology Unit, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
| | | | - Marília Ambuel D'Agostin
- Rheumatology Division, Hospital das Clinicas (HCFMUSP), Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Ibrahim Almaghlouth
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Kazi Nur Asfina
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Najma Khalil
- Rheumatology Unit, Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Petros P Sfikakis
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina Laskari
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Tektonidou
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesco Ciccia
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Daniela Iacono
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Flavia Riccio
- Dipartimento di Medicina di Precisione, Università della Campania L. Vanvitelli, Naples, Italy
| | - Gaafar Ragab
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Egypt; Faculty of Medicine, Newgiza University, Egypt
| | - Mohamed A Hussein
- Internal Medicine Department, Rheumatology and Clinical Immunology Unit, Faculty of Medicine, Cairo University, Egypt
| | - Marcello Govoni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Francesca Ruffilli
- Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna - Ferrara, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Haner Direskeneli
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, Pendik, Istanbul, Turkey
| | - Fatma Alibaz-Oner
- Division of Rheumatology, Department of Internal Medicine, Marmara University School of Medicine, Pendik, Istanbul, Turkey
| | - Roberto Giacomelli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research and Clinical Unit of Immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Luca Navarini
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; Research and Clinical Unit of Immunorheumatology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Ilenia Riccucci
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Eduardo Martín-Nares
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, 14080, Mexico
| | - Jiram Torres-Ruiz
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga No. 15, Col. Sección XVI, Tlalpan, 14080, Mexico
| | - Paola Cipriani
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ilenia Di Cola
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - José Hernández-Rodríguez
- Vasculitis Research Unit and Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Verónica Gómez-Caverzaschi
- Vasculitis Research Unit and Autoinflammatory Diseases Clinical Unit, Department of Autoimmune Diseases, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, and Vita-Salute San Raffaele University, Milan, Italy
| | - Joanna Makowska
- Department of Rheumatology, Medical University of Lodz, Łódz, Poland
| | - Olga Brzezinska
- Department of Rheumatology, Medical University of Lodz, Łódz, Poland
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, AO Mauriziano di Torino, Turin, Italy
| | - Elisa Bellis
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, AO Mauriziano di Torino, Turin, Italy
| | - Valeria Caggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Carla Gaggiano
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Maria Tarsia
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy
| | - Ilaria Mormile
- Department of Translational Medical Sciences (DiSMeT) and Center for Basic and Clinical Immunology Research (CISI), University of Naples Federico II, 80131 Naples, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Centre for Inflammatory Diseases, Monash Medical Centre, Monash University Department of Medicine, Melbourne, VIC, Australia
| | - Paolo Sfriso
- Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Sara Monti
- Rheumatology Department, Istituto di ricovero e cura a carattere scientifico Policlinico S. Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Şükran Erten
- Department of Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Emanuela Del Giudice
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Italy
| | - Riccardo Lubrano
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Polo Pontino, Italy
| | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU), "G. Martino" Messina, Italy
| | - Alma Nunzia Olivieri
- Dipartimento della donna, del bambino e di chirurgia generale e specialistica, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
| | | | - Samar Tharwat
- Internal Medicine Department, Rheumatology and Immunology Unit, Faculty of Medicine, Mansoura University, Dakahlia, Egypt
| | - Anastasios Karamanakos
- Joint Academic Rheumatology Program, First Department of Propedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonio Gidaro
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, Milan, Italy
| | - Maria Cristina Maggio
- University Department PROMISE "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco La Torre
- Department of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
| | - Fabio Cardinale
- Department of Pediatrics, Pediatric Rheumatology Center, Giovanni XXIII Pediatric Hospital, University of Bari, Bari, Italy
| | - Benson Ogunjimi
- Division of Paediatric Rheumatology, Department of Paediatrics, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Center for Health Economics Research and Modelling Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Universiteitsplein 1 Wilrijk, 2610, Belgium; Antwerp Center for Pediatric Rheumatology and Autoinflammatory Diseases, Antwerp, Belgium
| | - Armin Maier
- Rheumatology Unit, Department of Medicine, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Daniela Opris-Belinski
- Rheumatology and Internal Medicine Department, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Micol Frassi
- Rheumatology and Clinical Immunology, Spedali Civili and Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Ombretta Viapiana
- Rheumatology Section, Department of Medicine, University of Verona, Verona, Italy
| | - Emanuele Bizzi
- Internal Medicine, Fatebenefratelli Hospital, Milan, Italy
| | - Francesco Carubbi
- Department of Life, Health & Environmental Sciences, University of L'Aquila and Internal Medicine and Nephrology Unit, Department of Medicine, ASL Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | - Lampros Fotis
- Department of Pediatrics, Attikon General Hospital, National and Kapodistrian University of Athens, Greece
| | - Abdurrahman Tufan
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Riza Can Kardas
- Division of Rheumatology, Department of Internal Medicine, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ewa Więsik-Szewczyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Pulmonology, Allergy and Clinical Immunology, Central Clinical Hospital of the Ministry of National Defence, Military Institute of Medicine, Warsaw, Poland
| | - Claudia Fabiani
- Ophthalmology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Bruno Frediani
- Unit of Rheumatology, Azienda Ospedaliero-Universitaria Senese, Siena, Italy
| | - Alberto Balistreri
- Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Donato Rigante
- Department of Life Sciences and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Rare Diseases and Periodic Fevers Research Centre, Università Cattolica Sacro Cuore, Rome, Italy
| | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Research Center of Systemic Autoinflammatory Diseases and Behçet's Disease Clinic, University of Siena, Siena, Italy.
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11
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Chen K, Zeng H, Togizbayev G, Martini A, Zeng H. New classification criteria for juvenile idiopathic arthritis. Int J Rheum Dis 2023; 26:1889-1892. [PMID: 37807617 DOI: 10.1111/1756-185x.14813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 10/10/2023]
Affiliation(s)
- Kexin Chen
- Department of Pediatric Allergy, Immunology and Rheumatology, Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Haisheng Zeng
- Department of Rheumatology and Immunology, Dongguan Children's Hospital, Dongguan, Guangdong Province, China
| | | | - Alberto Martini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Child and Maternal Health, University of Genoa, Genoa, Italy
| | - Huasong Zeng
- Department of Pediatric Allergy, Immunology and Rheumatology, Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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12
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Gao FQ, Zhang JM, Li CF. Clinical Presentation and Treatment of Juvenile Idiopathic Arthritis Combined with Lung Disease: A Narrative Review. Rheumatol Ther 2023; 10:507-522. [PMID: 36906693 PMCID: PMC10008073 DOI: 10.1007/s40744-023-00542-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/13/2023] [Indexed: 03/13/2023] Open
Abstract
Juvenile idiopathic Arthritis (JIA) is a common rheumatic disorder in children that can cause multiple systems to be affected simultaneously, leading to severe clinical symptoms and a high mortality rate in those with pulmonary involvement. Pleurisy is the most common manifestation of pulmonary involvement. At the same time, other conditions, such as pneumonia, interstitial lung disease, occlusive bronchiectasis, and alveolar protein deposition, have been increasingly reported in recent years. This review aims to provide an overview of the clinical manifestations of JIA lung damage and the current treatment options to assist in identifying and treating JIA lung involvement.
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Affiliation(s)
- Feng-Qiao Gao
- Department of Rheumatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Nan Li Shi Road No. 56, Beijing, 100045 China
| | - Jun-Mei Zhang
- Department of Rheumatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Nan Li Shi Road No. 56, Beijing, 100045 China
| | - Cai-Feng Li
- Department of Rheumatology, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Nan Li Shi Road No. 56, Beijing, 100045 China
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Schettini N, Corazza M, Schenetti C, Pacetti L, Borghi A. Urticaria: A Narrative Overview of Differential Diagnosis. Biomedicines 2023; 11:1096. [PMID: 37189714 PMCID: PMC10136346 DOI: 10.3390/biomedicines11041096] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/08/2023] Open
Abstract
Urticaria is an inflammatory skin disorder that may occur in isolation or associated with angioedema and/or anaphylaxis. Clinically, it is characterized by the presence of smooth, erythematous or blanching, itchy swelling, called wheals or hives, which greatly vary in size and shape and last less than 24 h before fading to leave normal skin. Urticaria is the consequence of mast-cell degranulation that can be caused by immunological or non-immunological mechanisms. From a clinical point of view, many skin conditions can mimic urticaria and their recognition is mandatory for a correct management and therapeutic approach. We have reviewed all of the main relevant studies which addressed differential diagnosis of urticarial, published until December 2022. The National Library of Medicine PubMed database was used for the electronic research. The present review offers a clinical narrative overview, based on the available literature, of the principal skin disorders that can be misdiagnosed as urticaria (mainly autoinflammatory or autoimmune disorders, drug-induced reactions, and hyperproliferative diseases). The aim of this review is to provide clinicians a useful tool for correctly suspecting and identifying all of these conditions.
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Affiliation(s)
| | | | | | - Lucrezia Pacetti
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, 44121 Ferrara, Italy
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Nossent JC, Kelty E, Keen H, Preen D, Inderjeeth C. Systemic juvenile idiopathic arthritis: frequency and long-term outcome in Western Australia. Rheumatol Int 2023; 43:1357-1362. [PMID: 36988674 DOI: 10.1007/s00296-023-05318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/18/2023] [Indexed: 03/30/2023]
Abstract
Systemic juvenile idiopathic arthritis (S-JIA) is a rare but potentially life threatening autoinflammatory condition of childhood. Given the limited data on S-JIA from the Australasian region, we investigated the epidemiological characteristics and long-term disease outcome in S-JIA. All hospitalised patients under the age of 16 years registered with ICD-10-AM code M08.2 in in the period 1999-2014 were identified in longitudinally linked administrative health data across all Western Australian (WA) hospitals. Incidence and point prevalence estimate were per 100,000 population with Poisson regression to analyse the incidence trend. Readmissions with S-JIA as primary diagnosis were considered flares with rates for flare and other complication reported per 100 person years with 95% confidence intervals (CI). Annual S-JIA incidence was 0.61/100,000 (CI 0.28-1.25) (46 incident cases, 71.7% girls, median age 6.5 years) and stable over time as S-JIA point prevalence reached 7.15/100,000 (CI 5.29-7.45) at the end of study. Most incident cases were diagnosed in winter and spring, but documented preceding infections were rare. During a median follow-up of 8 years, disease flares occurred in 24% of patients with higher flares rate in boys (58.3; CI 44.5-74.9) than girls (14.7; CI 9.9-20.9). No deaths occurred and arthroplasty was the main, but uncommon S-JIA complication (4%). However, readmission (86.3; CI 76.4-97.2) and ED visit (73.3; CI 64.2-83.4) rates for illnesses other than S-JIA were substantial. S-JIA is as rare in WA as in other regions and while s-JIA incurred no deaths in the era of biologics, it associated with a significant long-term burden of (co-) morbidity.
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Affiliation(s)
- Johannes C Nossent
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.
- Rheumatology Group, School of Medicine, University of Western Australia, 35 Stirling Highway (M503), Perth, Australia.
| | - Erin Kelty
- School of Population and Global Health, University of Western Australia, Nedlands, Perth, Australia
| | - Helen Keen
- Rheumatology Group, School of Medicine, University of Western Australia, 35 Stirling Highway (M503), Perth, Australia
- Fiona Stanley Hospital, Perth, Australia
| | - David Preen
- School of Population and Global Health, University of Western Australia, Nedlands, Perth, Australia
| | - Charles Inderjeeth
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
- Rheumatology Group, School of Medicine, University of Western Australia, 35 Stirling Highway (M503), Perth, Australia
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Di Cola I, Cipriani P, Ruscitti P. Perspectives on the use of non-biological pharmacotherapy for adult-onset Still's disease. Expert Opin Pharmacother 2022; 23:1577-1587. [PMID: 36124816 DOI: 10.1080/14656566.2022.2126764] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The treatment of the patients with adult-onset Still's disease (AOSD) remains largely empirical and it is based on the administration of immunosuppressive drugs. In this work, we described the use of non-biological pharmacotherapies for AOSD. AREA COVERED Although nonsteroidal anti-inflammatory drugs (NSAIDs) are employed during the diagnostic phase, glucocorticoids (GCs) are the first-line therapy, administered at the beginning of the disease. As second-line therapy, conventional synthetic disease modifying anti-rheumatic drugs (csDMARDs) are used when GCs do not fully control the disease and/or to reduce the dosage of concomitant GCs. Methotrexate (MTX) is the most commonly administered csDMARDs whereas calcineurin inhibitors (CNIs) are used in severe patients. The lack of achievement of clinical response may lead to the administration of biologic DMARDs, with or without csDMARDs. EXPERT OPINION The management of AOSD may benefit from the administration of non-biological pharmacotherapies, including GCs, MTX, and CNIs. These therapies showed efficacy in inducing a clinical response, in managing life-threatening complications, and may be well tolerated in combination with biologic DMARDs. However, further specific studies are needed to fully clarify the specific role of such drugs in clinical practice to improve the management of AOSD and to provide a more tailored treatment.
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Affiliation(s)
- Ilenia Di Cola
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola Cipriani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Piero Ruscitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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