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Sezer M, Aydın F, Kurt T, Tekgöz N, Tekin ZE, Karagöl C, Çakar N, Acar B. Prediction of inactive disease and relapse in oligoarticular juvenile idiopathic arthritis. Mod Rheumatol 2020; 31:1025-1030. [PMID: 33050742 DOI: 10.1080/14397595.2020.1836788] [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: 10/23/2022]
Abstract
OBJECTIVE The aim of this study is to describe clinical features of patients with oligoarticular juvenile idiopathic arthritis (JIA) who achieved inactive disease at 3rd month and also to determine the predictors of relapse and extended course. METHODS In the cohort study, 88 patients with oligoarticular JIA were retrospectively analyzed. The demographic data, clinical features, medications, relapse rates were recorded. Juvenile Arthritis Disease Activity Score (JADAS) and American College of Rheumatology Pediatric criteria were used to measure disease activity and treatment response at 3, 6 and 12 months. RESULTS Fifty-nine (67%) patients were females and the mean age at diagnosis was 7.9 ± 4.3 years. The odds of achieving inactive disease (JADAS ≤1) at 3rd month were increased by a lower JADAS27 score at admission. Forty-one (48.8%) of 84 patients relapsed. Ankle involvement at onset, high JADAS27 score at admission, increased ESR at admission and presence of synovial hypertrophy in imaging were risk factors for occurrence of relapse. CONCLUSION Our results show that a significant proportion of oligoarticular JIA patients relapse after inactive period. JADAS is a useful tool to guide the treatment decisions of patients who may be at risk of high disease activity and relapse.
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Affiliation(s)
- Müge Sezer
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Fatma Aydın
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Tuba Kurt
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nilüfer Tekgöz
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Zahide Ekici Tekin
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Cüneyt Karagöl
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nilgün Çakar
- Department of Pediatric Rheumatology, Ankara University School of Medicine, Ankara, Turkey
| | - Banu Acar
- Department of Pediatric Rheumatology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Więch P, Sałacińska I, Bazaliński D, Dąbrowski M. Body composition and phase angle as an indicator of nutritional status in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2018; 16:82. [PMID: 30587206 PMCID: PMC6307257 DOI: 10.1186/s12969-018-0297-y] [Citation(s) in RCA: 6] [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: 10/29/2018] [Accepted: 12/05/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common chronic, systemic autoimmune connective tissue disease diagnosed in children and adolescents. An important aspect of monitoring of children with JIA is a precise assessment of the nutritional status to identify children and adolescents at risk of malnutrition. The aim of the study was to assess the body composition and phase angle in children diagnosed with JIA in comparison to age and sex matched healthy children since there are scarce reports in paediatric patients. METHODS A total of 46 children and adolescents aged 4-18 years, with JIA were included in the cross-sectional study. Controls were selected from the group of healthy children and adolescents. Children with diagnosed JIA and healthy children were strictly matched for age and gender. In both groups BIA with phase angle calculation was performed. RESULTS Phase angle score was significantly lower in the study group compared to control group (5.45 ± 0.64 vs. 5.85 ± 0.80, p = 0.010). Also lower percentage of body cell mass (50.63 ± 3.46 vs. 52.70 ± 4.06, p = 0.010) and muscle mass (46.02 ± 6.32 vs. 49.53 ± 6.67, p = 0.005) were revealed. In the analysis of subtypes of JIA we found significant differences between children and adolescents with polyarthritis compared to control group, while no significant differences were found between patients with oligoarthritis and control group. CONCLUSIONS The obtained results indicate a higher risk of malnutrition in children and adolescents with JIA compared to healthy peers, predominantly in patients with polyarthritis.
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Affiliation(s)
- Paweł Więch
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Al. mjr. W. Kopisto 2 a, 35-310, Rzeszów, Poland.
| | - Izabela Sałacińska
- 0000 0001 2154 3176grid.13856.39Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Al. mjr. W. Kopisto 2 a, 35-310 Rzeszów, Poland
| | - Dariusz Bazaliński
- 0000 0001 2154 3176grid.13856.39Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Al. mjr. W. Kopisto 2 a, 35-310 Rzeszów, Poland
| | - Mariusz Dąbrowski
- 0000 0001 2154 3176grid.13856.39Institute of Nursing and Health Sciences, Faculty of Medicine, University of Rzeszów, Al. mjr. W. Kopisto 2 a, 35-310 Rzeszów, Poland ,Diabetic Outpatient Clinic, Medical Center “Beta-Med”, Pl. Wolności 17, 35-073 Rzeszów, Poland
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Abstract
Juvenile idiopathic arthritis is the most common chronic rheumatic disease of unknown aetiology in childhood and predominantly presents with peripheral arthritis. The disease is divided into several subgroups, according to demographic characteristics, clinical features, treatment modalities and disease prognosis. Systemic juvenile idiopathic arthritis, which is one of the most frequent disease subtypes, is characterized by recurrent fever and rash. Oligoarticular juvenile idiopathic arthritis, common among young female patients, is usually accompanied by anti-nuclear antibodie positivity and anterior uveitis. Seropositive polyarticular juvenile idiopathic arthritis, an analogue of adult rheumatoid arthritis, is seen in less than 10% of paediatric patients. Seronegative polyarticular juvenile idiopathic arthritis, an entity more specific for childhood, appears with widespread large- and small-joint involvement. Enthesitis-related arthritis is a separate disease subtype, characterized by enthesitis and asymmetric lower-extremity arthritis. This disease subtype represents the childhood form of adult spondyloarthropathies, with human leukocyte antigen-B27 positivity and uveitis but commonly without axial skeleton involvement. Juvenile psoriatic arthritis is characterized by a psoriatic rash, accompanied by arthritis, nail pitting and dactylitis. Disease complications can vary from growth retardation and osteoporosis secondary to treatment and disease activity, to life-threatening macrophage activation syndrome with multi-organ insufficiency. With the advent of new therapeutics over the past 15 years, there has been a marked improvement in juvenile idiopathic arthritis treatment and long-term outcome, without any sequelae. The treatment of juvenile idiopathic arthritis patients involves teamwork, including an experienced paediatric rheumatologist, an ophthalmologist, an orthopaedist, a paediatric psychiatrist and a physiotherapist. The primary goals of treatment are to eliminate active disease, to normalize joint function, to preserve normal growth and to prevent long-term joint damage. Timely and aggressive treatment is important to provide early disease control. The first-line treatment includes disease-modifying anti-rheumatic drugs (methotrexate, sulphasalazine, leflunomide) in combination with corticosteroids, used in different dosages and routes (oral, intravenous, intra-articular). Intra-articular application of steroids seems to be an effective treatment modality, especially in monoarthritis. Biological agents should be added in the treatment of unresponsive patients. Anti-tumour necrosis factor agents (etanercept, infliximab, adalimumab), anti-interleukin-1 agents (anakinra, canakinumab), anti- interleukin-6 agents (tocilizumab) and T-cell regulatory agents (abatacept) have been shown to be safe and effective in childhood patients. Recent studies reported sustained reduction in joint damage with even complete clinical improvement in paediatric patients, compared to previous data.
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Affiliation(s)
- Kenan Barut
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Sezgin Şahin
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
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Finch SL, Rosenberg AM, Vatanparast H. Vitamin D and juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2018; 16:34. [PMID: 29769136 PMCID: PMC5956785 DOI: 10.1186/s12969-018-0250-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Accepted: 05/07/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Vitamin D has been implicated in the pathogenesis of autoimmune diseases. While the roles of vitamin D in other autoimmune diseases have been investigated, less is known about the role of vitamin D in chronic childhood arthritis. MAIN BODY This review summarizes and evaluates evidence relating to 25-hydroxyvitamin D (25(OH)D) and chronic childhood arthritis. A scoping literature review was conducted using Ovid Medline, Ovid Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Scopus. Further, we geo-mapped the results of the studies to identify the patterns of the association between vitamin D and chronic childhood arthritis across the globe. Of 38 studies reporting 25(OH)D concentrations in childhood chronic arthritis, 32 (84.2%) reported that a significant number of children had suboptimal (< 75 nmol/L) status. CONCLUSION The data indicate suboptimal vitamin D status in children with chronic arthritis. Further, the association between low vitamin D and increased arthritis activity follow a north-south geographical gradient.
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Affiliation(s)
- Sarah L. Finch
- 0000 0001 2154 235Xgrid.25152.31College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
| | - Alan M. Rosenberg
- 0000 0001 2154 235Xgrid.25152.31Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Hassan Vatanparast
- College of Pharmacy & Nutrition and School of Public Health, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK, S7N 2Z4, Canada.
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Cavallo S, Brosseau L, Toupin-April K, Wells GA, Smith CA, Pugh AG, Stinson J, Thomas R, Ahmed S, Duffy CM, Rahman P, Àlvarez-Gallardo IC, Loew L, De Angelis G, Feldman DE, Majnemer A, Gagnon IJ, Maltais D, Mathieu MÈ, Kenny GP, Tupper S, Whitney-Mahoney K, Bigford S. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Structured Physical Activity in the Management of Juvenile Idiopathic Arthritis. Arch Phys Med Rehabil 2017; 98:1018-1041. [DOI: 10.1016/j.apmr.2016.09.135] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/15/2016] [Accepted: 09/27/2016] [Indexed: 12/31/2022]
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Ahmad HS, Othman G, Farrag SE, El-Hafez AA, Monir AA. Subclinical heart failure in juvenile idiopathic arthritis: a consequence of chronic inflammation and subclinical atherosclerosis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2016. [DOI: 10.4103/1110-161x.181881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Avenarius DFM, Ording Müller LS, Rosendahl K. Erosion or normal variant? 4-year MRI follow-up of the wrists in healthy children. Pediatr Radiol 2016; 46:322-30. [PMID: 26637316 PMCID: PMC4767868 DOI: 10.1007/s00247-015-3494-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 09/03/2015] [Accepted: 10/28/2015] [Indexed: 12/02/2022]
Abstract
BACKGROUND A large proportion of healthy children have wrist changes on MRI, namely carpal depressions, findings that have been described as pathological in children with juvenile idiopathic arthritis. OBJECTIVE We performed follow-up imaging in a cohort of healthy children to evaluate carpal surface depressions over time, focusing on the presence of overlying cartilage as a potential discriminator between normal variants and true erosions. MATERIALS AND METHODS 74 of the initial cohort of 89 healthy children (83%) had a re-scan of their wrists using the same protocol, including coronal T1 and fat-saturated T2 sequences. A cartilage-selective sequence was added for this study. We registered number and location of bony depressions and presence of overlying cartilage. RESULTS The total number of carpal depressions increased by age group and over time; their location was unchanged in 370 of 487 (76%) carpal sites and 91 of 117 (78%) metacarpal sites. In total, 426 of the 1,087 (39.2%) bony depressions were covered by cartilage, with a decreasing percentage by age (P = 0.001). CONCLUSION Normal appearances during growth, such as bony depressions, should not be mistaken for pathology. There must be additional findings to support a diagnosis of disease. A cartilage sequence may add to the diagnostic image analysis.
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Affiliation(s)
- Derk F. M. Avenarius
- />Faculty of Health Sciences, University of Tromsø, 9037 Tromsø, Norway , />Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | | | - Karen Rosendahl
- />Department of Radiology, Haukeland University Hospital, Bergen, Norway , />Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
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Brosseau L, Toupin-April K, Wells G, Smith CA, Pugh AG, Stinson JN, Duffy CM, Gifford W, Moher D, Sherrington C, Cavallo S, De Angelis G, Loew L, Rahman P, Marcotte R, Taki J, Bisaillon J, King J, Coda A, Hendry GJ, Gauvreau J, Hayles M, Hayles K, Feldman B, Kenny GP, Li JX, Briggs AM, Martini R, Feldman DE, Maltais DB, Tupper S, Bigford S, Bisch M. Ottawa Panel Evidence-Based Clinical Practice Guidelines for Foot Care in the Management of Juvenile Idiopathic Arthritis. Arch Phys Med Rehabil 2015; 97:1163-1181.e14. [PMID: 26707409 DOI: 10.1016/j.apmr.2015.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Revised: 10/15/2015] [Accepted: 11/09/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To create evidence-based guidelines evaluating foot care interventions for the management of juvenile idiopathic arthritis (JIA). DATA SOURCES An electronic literature search of the following databases from database inception to May 2015 was conducted: MEDLINE (Ovid), EMBASE (Ovid), Cochrane CENTRAL, and clinicaltrials.gov. STUDY SELECTION The Ottawa Panel selection criteria targeted studies that assessed foot care or foot orthotic interventions for the management of JIA in those aged 0 to ≤18 years. The Physiotherapy Evidence Database scale was used to evaluate study quality, of which only high-quality studies were included (score, ≥5). A total of 362 records were screened, resulting in 3 full-text articles and 1 additional citation containing supplementary information included for the analysis. DATA EXTRACTION Two reviewers independently extracted study data (intervention, comparator, outcome, time period, study design) from the included studies by using standardized data extraction forms. Directed by Cochrane Collaboration methodology, the statistical analysis produced figures and graphs representing the strength of intervention outcomes and their corresponding grades (A, B, C+, C, C-, D+, D, D-). Clinical significance was achieved when an improvement of ≥30% between the intervention and control groups was present, whereas P>.05 indicated statistical significance. An expert panel Delphi consensus (≥80%) was required for the endorsement of recommendations. DATA SYNTHESIS All included studies were of high quality and analyzed the effects of multidisciplinary foot care, customized foot orthotics, and shoe inserts for the management of JIA. Custom-made foot orthotics and prefabricated shoe inserts displayed the greatest improvement in pain intensity, activity limitation, foot pain, and disability reduction (grades A, C+). CONCLUSIONS The use of customized foot orthotics and prefabricated shoe inserts seems to be a good choice for managing foot pain and function in JIA.
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Affiliation(s)
- Lucie Brosseau
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada.
| | - Karine Toupin-April
- Department of Pediatrics, Faculty of Medicine, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - George Wells
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Christine A Smith
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Arlanna G Pugh
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jennifer N Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada; Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M Duffy
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Wendy Gifford
- Faculty of Health Sciences, School of Nursing Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - David Moher
- Clinical Epidemiology Program, Ottawa Methods Center, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Catherine Sherrington
- Musculoskeletal Division, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Sabrina Cavallo
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Gino De Angelis
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Laurianne Loew
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Prinon Rahman
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rachel Marcotte
- Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Jade Taki
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, Ottawa, Ontario, Canada
| | - Jacinthe Bisaillon
- Faculty of Health Sciences, School of Nursing Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Judy King
- Physiotherapy Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea Coda
- Faculty of Health and Medicine - Health Precinct, School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Gordon J Hendry
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Lanarkshire, United Kingdom
| | - Julie Gauvreau
- Podiatry Clinic of Outaouais, Hospital Boulevard, Gatineau, Québec, Canada
| | - Martin Hayles
- Hayles Foot and Ankle Clinic, Ottawa, Ontario, Canada
| | - Kay Hayles
- Hayles Foot and Ankle Clinic, Ottawa, Ontario, Canada
| | - Brian Feldman
- Department of Pediatrics and Medicine, University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Glen P Kenny
- Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Jing Xian Li
- Faculty of Health Sciences, School of Human Kinetics, Ottawa, Ontario, Canada
| | - Andrew M Briggs
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Rose Martini
- Occupational Therapy Program, Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Debbie Ehrmann Feldman
- School of Public Health, Option Epidemiology, University of Montreal, Montreal, Quebec, Canada
| | - Désirée B Maltais
- Physiotherapy Program, Department of Rehabilitation, Pavillon Ferdinand-Vandry, Université Laval, Québec, Quebec, Canada
| | - Susan Tupper
- School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sarah Bigford
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Marg Bisch
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Du N, Jiang K, Sawle AD, Frank MB, Wallace CA, Zhang A, Jarvis JN. Dynamic tracking of functional gene modules in treated juvenile idiopathic arthritis. Genome Med 2015; 7:109. [PMID: 26497493 PMCID: PMC4619406 DOI: 10.1186/s13073-015-0227-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 10/01/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND We have previously shown that childhood-onset rheumatic diseases show aberrant patterns of gene expression that reflect pathology-associated co-expression networks. In this study, we used novel computational approaches to examine how disease-associated networks are altered in one of the most common rheumatic diseases of childhood, juvenile idiopathic arthritis (JIA). METHODS Using whole blood gene expression profiles derived from children in a pediatric rheumatology clinical trial, we used a network approach to understanding the impact of therapy and the underlying biology of response/non-response to therapy. RESULTS We demonstrate that therapy for JIA is associated with extensive re-ordering of gene expression networks, even in children who respond inadequately to therapy. Furthermore, we observe distinct differences in the evolution of specific network properties when we compare children who have been treated successfully with those who have inadequate treatment response. CONCLUSIONS Despite the inherent noisiness of whole blood gene expression data, our findings demonstrate how therapeutic response might be mapped and understood in pathologically informative cells in a broad range of human inflammatory diseases.
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Affiliation(s)
- Nan Du
- Department of Computer Sciences and Engineering, University at Buffalo, Buffalo, NY, USA.
| | - Kaiyu Jiang
- Department of Pediatrics, Rheumatology Research, University at Buffalo School of Medicine, Buffalo, NY, USA.
| | - Ashley D Sawle
- The Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA.
| | - Mark Barton Frank
- Oklahoma Medical Research Foundation, Clinical Immunology Program, Oklahoma City, OK, USA.
| | - Carol A Wallace
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
| | - Aidong Zhang
- Department of Computer Sciences and Engineering, University at Buffalo, Buffalo, NY, USA.
| | - James N Jarvis
- Department of Pediatrics, Rheumatology Research, University at Buffalo School of Medicine, Buffalo, NY, USA.
- Genetics, Genomics, and Bioinformatics Program, University at Buffalo, Buffalo, NY, USA.
- Pediatric Rheumatology Research, University at Buffalo Clinical & Translational Research Center, 875 Ellicott St, Buffalo, NY, 14203, USA.
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Jednacz E, Rutkowska-Sak L. Assessment of the body composition and parameters of the cardiovascular risk in juvenile idiopathic arthritis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:619023. [PMID: 25839035 PMCID: PMC4369879 DOI: 10.1155/2015/619023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/06/2014] [Accepted: 08/26/2014] [Indexed: 12/17/2022]
Abstract
The study was aimed to evaluate cardiovascular risk parameters, body mass index (BMI) centiles for sex and age, and body fat percentage using the electric bioimpedance method in children with juvenile idiopathic arthritis (JIA). 30 children with JIA participated in the study. A control group included 20 children. Patients were well matched for the age and sex. The body mass and body fat percentage were determined using the segmental body composition analyser; the BMI centiles were determined. All patients had the following parameters determined: lipid profile, hsCRP, homocysteine, and IL-6. The intima media thickness (IMT) was measured. Patients with JIA had significantly lower body weight, BMI, and the BMI centile compared to the control group. The IL-6 levels were significantly higher in patients with JIA compared to the control group. There were no differences between two groups with regard to the lipid profile, % content of the fat tissue, homocysteine levels, hsCRP, and IMT. Further studies are necessary to search for reasons for lower BMI and BMI centile in children with JIA and to attempt to answer the question of whether lower BMI increases the cardiovascular risk in these patients, similarly as in patients with rheumatoid arthritis (RA).
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Affiliation(s)
- Ewa Jednacz
- Paediatric Clinic of Rheumatology, Institute of Rheumatology, Spartanska 1, 02-637 Warsaw, Poland
| | - Lidia Rutkowska-Sak
- Paediatric Clinic of Rheumatology, Institute of Rheumatology, Spartanska 1, 02-637 Warsaw, Poland
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Albarouni M, Becker I, Horneff G. Predictors of response to methotrexate in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2014; 12:35. [PMID: 25143761 PMCID: PMC4138941 DOI: 10.1186/1546-0096-12-35] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 08/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The response to methotrexate so far is unpredictable in patients with juvenile idiopathic arthritis. Thus such predictors have to be determined in a large patient cohort. METHODS Demographic, clinical, articular and laboratory variables of patients newly treated with methotrexate were analysed by bivariate and logistic regression analysis to identify predictors of response to methotrexate. Minimal response was defined by the American College of Rheumatology pediatric (PedACR) 30 and strong response by the PedACR 70 criteria. RESULTS The patient population consisted of 731 patients. At month 3, 77.4% and at month 12 83.1% of patients were responders according to the PedACR 30 criteria, while 43.1% and 65.9% of patients had a PedACR 70 response at month 3 and at month 12. Thus minimal response was frequently already reached at month 3 while strong response to MTX treatment took usually longer to achieve. In multivariate analysis the number of tender joints (p = 0.002), active joints (p < 0.001), concomitant use of NSAID (p = 0.027) and the parents evaluation of overall well-being (p < 0.001) were significant baseline parameters for minimal response at month 3, while at month 12 the determinants for reaching PedACR 70 were a disease duration < 1 year (p =0.001), a lower number of tender (p <0.001) but a higher number of active joints (p <0.001), a higher score of the parent's evaluation of child's pain (p =0.029), and the presence of morning stiffness (p =0.014). CONCLUSIONS Baseline parameters for minimal response after 3 months of treatment and strong response after 12 months of treatment could be identified. Beside parameters defining activity and severity of disease, the disease duration and the concomitant use of NSAID were influencing factors. Overall the model of prediction could support physicians in making treatment decisions.
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Affiliation(s)
- Mohamed Albarouni
- Centre of Paediatric Rheumatology, Department of General Paediatrics, Asklepios Klinik Sankt Augustin, Arnold-Janssen Str. 29, D-53757 Sankt Augustin, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany
| | - Gerd Horneff
- Centre of Paediatric Rheumatology, Department of General Paediatrics, Asklepios Klinik Sankt Augustin, Arnold-Janssen Str. 29, D-53757 Sankt Augustin, Germany
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13
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Tudur Smith C, Williamson PR, Beresford MW. Methodology of clinical trials for rare diseases. Best Pract Res Clin Rheumatol 2014; 28:247-62. [DOI: 10.1016/j.berh.2014.03.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Jiang K, Frank M, Chen Y, Osban J, Jarvis JN. Genomic characterization of remission in juvenile idiopathic arthritis. Arthritis Res Ther 2013; 15:R100. [PMID: 24000795 PMCID: PMC4062846 DOI: 10.1186/ar4280] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Introduction The attainment of remission has become an important end point for clinical trials in juvenile idiopathic arthritis (JIA), although we do not yet have a full understanding of what remission is at the cell and molecular level. Methods Two independent cohorts of patients with JIA and healthy child controls were studied. RNA was prepared separately from peripheral blood mononuclear cells (PBMC) and granulocytes to identify differentially expressed genes using whole genome microarrays. Expression profiling results for selected genes were confirmed by quantitative, real-time polymerase chain reaction (RT-PCR). Results We found that remission in JIA induced by either methotrexate (MTX) or MTX plus a TNF inhibitor (etanercept, Et) (MTX + Et) is characterized by numerous differences in gene expression in peripheral blood mononuclear cells and in granulocytes compared with healthy control children; that is, remission is not a restoration of immunologic normalcy. Network analysis of the differentially expressed genes demonstrated that the steroid hormone receptor superfamily member hepatocyte nuclear factor 4 alpha (HNF4α) is a hub in several of the gene networks that distinguished children with arthritis from controls. Confocal microscopy revealed that HNF4a is present in both T lymphocytes and granulocytes, suggesting a previously unsuspected role for this transcription factor in regulating leukocyte function and therapeutic response in JIA. Conclusions These findings provide a framework from which to understand therapeutic response in JIA and, furthermore, may be used to develop strategies to increase the frequency with which remission is achieved in adult forms of rheumatoid arthritis.
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Prince FHM, van Suijlekom-Smit LWA. Cost of biologics in the treatment of juvenile idiopathic arthritis: a factor not to be overlooked. Paediatr Drugs 2013; 15:271-80. [PMID: 23606042 DOI: 10.1007/s40272-013-0023-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Biologics are a promising treatment option for juvenile idiopathic arthritis (JIA) but drug costs are very high compared to conventional treatment. From a socioeconomic view the additional costs of new interventions should be weighed against their incremental health benefits compared to standard care. Therefore we evaluated data on cost-effectiveness of biologics in JIA. We searched Medline, Embase, and The York Centre for Reviews and Dissemination database for relevant literature. Current data show that biologics are reducing direct and indirect healthcare costs if one excludes the costs of the drug itself. The costs of biologics are more than ten times as high as conventional drug treatment. As a result of limited data, no comparison on cost-effectiveness between biologics could be performed. Although data on long-term cost-effectiveness of biologics are lacking, the expectation is that they will be cost-effective in the long-term. The idea behind this is that biologic treatment should be administered to patients that without these drugs would incur high direct and indirect costs due to continuous severe disease resulting in irreversible disabilities. In our opinion the best cost benefit could be gained if these patients receive biologic treatment introduced early in the disease. This is in order to minimize irreversible damage to the joints and minimize need for long-term biologic therapy by early suppression of the disease. To support these hypotheses future research is needed on long-term cost-effectiveness of all biologics used in JIA.
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Affiliation(s)
- Femke H M Prince
- Department of Pediatrics, H8-270, Emma Children's Hospital, Amsterdam Medical Centre, The Netherlands.
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MRI of the wrist in juvenile idiopathic arthritis: erosions or normal variants? A prospective case-control study. Pediatr Radiol 2013; 43:785-95. [PMID: 23283407 DOI: 10.1007/s00247-012-2575-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 11/09/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Bony depressions at the wrist resembling erosions are frequently seen on MRI in healthy children. The accuracy of MRI in detecting early bony destruction is therefore questionable. We compared findings on MRI of the wrist in healthy children and those with juvenile idiopathic arthritis (JIA) to investigate markers for true disease. MATERIALS AND METHODS We compared the number and localisation of bony depressions at the wrist in 85 healthy children and 68 children with JIA, ages 5-15 years. The size of the wrist was assessed from a radiograph of the wrist performed on the same day as the MRI. RESULTS No significant difference in the number of bony depressions in the carpal bones was seen between healthy children and children with JIA at any age. Depressions are found in similar locations in the two groups, except for a few sites, where bony depressions were seen exclusively in the JIA group, particularly at the CMC joints. The wrist was significantly smaller in children with JIA (P < 0.001). CONCLUSIONS Using adult scoring systems and standard MR sequences in the assessment of bone destruction in children may lead to overstaging or understaging of disease. At present, standard MRI sequences cannot easily be used for assessment of early signs of erosions in children.
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McErlane F, Beresford MW, Baildam EM, Thomson W, Hyrich KL. Recent developments in disease activity indices and outcome measures for juvenile idiopathic arthritis. Rheumatology (Oxford) 2013; 52:1941-51. [PMID: 23630368 DOI: 10.1093/rheumatology/ket150] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
There has been a concerted and important international effort to develop and validate disease activity and outcome instruments specific to JIA in recent years. This review aims to describe the disease assessment indices important to routine clinical care and integral to the design of outcome studies and clinical trials in JIA. In view of the increasing number of JIA clinical studies and clinical trials, together with a number of national and international paediatric biologic registers, it is important that knowledge of these new outcome measures is widespread, such that results can be placed in a meaningful context.
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Affiliation(s)
- Flora McErlane
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester Academic Health Sciences Centre, Stopford Building, Oxford Road, Manchester M13 9PT, UK.
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Trachana M, Pratsidou-Gertsi P, Badouraki M, Haidich AB, Pardalos G. Achievement of clinical remission in patients with juvenile idiopathic arthritis under a 2-10-year Etanercept exposure. Clin Rheumatol 2013; 32:1191-7. [PMID: 23604548 DOI: 10.1007/s10067-013-2261-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 03/15/2013] [Accepted: 04/06/2013] [Indexed: 10/26/2022]
Abstract
The objective of this retrospective study was to record the achievement of clinical remission (CR) in juvenile idiopathic arthritis patients under a 2-10 years' administration of Etanercept (ETN) and to detect any variables associated with CR. Patients previously resistant to conventional regimens were enrolled. The annual impact of ETN was assessed by: (a) the American College of Rheumatology pediatric criteria (ACRpedi), (b) the pre- and posttreatment disease activity score (juvenile arthritis disease activity score [JADAS71]), and (c) Wallace's criteria for CR. A total of 41 patients (F: 31) were registered. The median age and disease duration at baseline were 10.6 and 4.17 years, respectively, and their disease course was mainly polyarthritis (32/41). In respect to baseline, there was an impressive JADAS71 reduction posttreatment, most prominent after the first year. From year 1 to 5, more than 50 % of the patients achieved and retained CR and 66 % reached an ACRpedi 70, whereas after the 5th year, no patient was withdrawn due to an ACRpedi <30. JADAS71 at baseline was not associated with the subsequent CR achievement. However, JADAS71 1-year posttreatment had a significant association with the CR of the second posttreatment year, (p = 0.028, OR 0.79; 95 % CI 0.63-0.98) and a similar trend was observed for the following years. These findings emphasize the sustained impact of ETN in the achievement of CR. A low JADAS71 score 1-year posttreatment, may be associated with the maintenance of CR over the next treatment year.
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Affiliation(s)
- Maria Trachana
- Pediatric Immunology and Rheumatology Referral Center, 1st Department of Pediatrics, Aristotle University, Ippokration Hospital, Thessaloniki, Greece.
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Marzan KAB. Role of adalimumab in the management of children and adolescents with juvenile idiopathic arthritis and other rheumatic conditions. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2012; 3:85-93. [PMID: 24600289 PMCID: PMC3916012 DOI: 10.2147/ahmt.s22607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Treatment of children and adolescents with juvenile idiopathic arthritis and other pediatric rheumatic diseases has evolved. Where once there was only a limited arsenal of medications, with significant side effects and inadequate efficacy, today, with an increased understanding of the pathogenesis of these diseases, there is a wider variety of more targeted and effective treatments. TNF-α is a cytokine involved in a number of inflammatory pathways in pediatric rheumatic diseases. The emergence of biologic modifiers that target TNF-α has been pivotal in providing the ability to deliver early and aggressive treatment. Adalimumab, a recombinant monoclonal antibody to TNF-α, is an important therapeutic option, which affords children and adolescents with chronic illnesses an improved quality of life.
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Vlahos AP, Theocharis P, Bechlioulis A, Naka KK, Vakalis K, Papamichael ND, Alfantaki S, Gartzonika K, Mavridis A, Michalis LK, Siamopoulou A. Changes in vascular function and structure in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2012; 63:1736-44. [PMID: 21905249 DOI: 10.1002/acr.20613] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Chronic inflammatory diseases in adults have been associated with increased cardiovascular risk and impaired vascular function. We aimed to assess the presence of early vascular dysfunction in patients with juvenile idiopathic arthritis (JIA) and investigate the role of inherent inflammatory process of JIA in vascular health. METHODS Thirty patients with JIA (age range 7-18 years) were compared to 33 age- and sex-matched controls. Endothelial function (brachial artery flow-mediated dilation [FMD]), carotid intima-media thickness (IMT), and arterial stiffness were examined. Endothelial inflammation was assessed by intercellular adhesion molecule 1 (ICAM-1) and P-selectin measurements. RESULTS Patients with JIA showed decreased FMD compared to controls (P = 0.001), independent of age (P = 0.9 among age subgroups). Baseline differences in erythrocyte sedimentation rate, ICAM-1, and glucose between the 2 groups accounted for the difference in FMD. The presence of systemic JIA was associated with greater IMT compared to patients with oligoarticular disease, polyarticular disease, or controls (P = 0.014, P = 0.069, and P = 0.046, respectively). The difference in IMT between systemic versus oligoarticular/polyarticular JIA was attributed to the following risk factors: age, body mass index, blood pressure, disease activity, and corticosteroids use. There were no differences in arterial stiffness indices between JIA patients and controls or between patients with systemic versus nonsystemic disease. CONCLUSION Endothelial function is impaired in patients with JIA at a very young age, while IMT is increased only in the presence of systemic JIA. Vascular dysfunction may be partly attributed to the effects of disease-related characteristics (inflammation, disease activity, and medications).
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Nordal E, Zak M, Aalto K, Berntson L, Fasth A, Herlin T, Lahdenne P, Nielsen S, Straume B, Rygg M. Ongoing disease activity and changing categories in a long-term nordic cohort study of juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2011; 63:2809-18. [DOI: 10.1002/art.30426] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Beresford MW. Juvenile idiopathic arthritis: new insights into classification, measures of outcome, and pharmacotherapy. Paediatr Drugs 2011; 13:161-73. [PMID: 21500870 DOI: 10.2165/11588140-000000000-00000] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Significant advances have taken place in recent years in our understanding of the aetiopathogenesis, management, and clinical outcome of juvenile idiopathic arthritis (JIA). Fundamental to this advancement has been international collaborative efforts of the clinical scientific community and all those involved in the multidisciplinary care of children and young people with JIA. A key factor has been facing the challenge of developing a robust classification system for JIA, a clinically very heterogeneous group of conditions. JIA illustrates the necessity of disease classification to enable scientific progress but also the iterative and evolving process this entails. What is emerging is the imperative to improve our understanding of the biologic and genetic basis of JIA to underpin classification systems. Growing emphasis is centered on improved holistic care and outcome of children and young people with JIA. The expectation of patients, their families, and clinicians is the goal of inactive disease, remission off treatment, and the health and psychosocial well-being of young people emerging into adulthood. Validated tools that reflect these challenges are being developed, including those measuring disease improvement, flare, remission and minimal disease activity, health-related quality of life, and composite scores of activity and damage. Clinical research networks have driven success in developing an evidence-base for the treatment of JIA. Randomized comparative trials have demonstrated the benefit of early use of intra-articular corticosteroid injections, and the importance of methotrexate as the first-line, disease-modifying antirheumatic drug in JIA. The introduction of biologic therapies has opened a major new epoch in the medical management of JIA, with recent trials published on etanercept, infliximab, adalimumab, abatacept, tocilizumab, and anakinra. This review focuses on recent advances in JIA, especially developments in its classification, validation of appropriate measures of holistic outcome, and the specific contribution of established and newer pharmacologic agents available for treating children and young people.
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Affiliation(s)
- Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine (Child Health), University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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Stanevicha V, Eglite J, Zavadska D, Sochnevs A, Lazareva A, Guseinova D, Shantere R, Gardovska D. HLA B27 allele types in homogeneous groups of juvenile idiopathic arthritis patients in Latvia. Pediatr Rheumatol Online J 2010; 8:26. [PMID: 20946671 PMCID: PMC2964715 DOI: 10.1186/1546-0096-8-26] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2010] [Accepted: 10/14/2010] [Indexed: 01/04/2023] Open
Abstract
UNLABELLED Juvenile idiopathic arthritis (JIA) is a heterogeneous condition and therapeutic strategies vary in different JIA types. The routinely accepted practice to start with Sulphasalazine (SS) as the first line treatment in patients with HLA B27 positive JIA proves to be ineffective in a large proportion of children. OBJECTIVE to investigate HLA B27 positive JIA patients clinical characteristics, determined HLA B27 allele types and their connection with antirheumatic treatment in homogenous patient groups. MATERIALS AND METHODS 56 patients diagnosed with JIA and observed over the period 2006 to 2009 included in the study. HLAB27 allele types were determined using PCR method. RESULTS In HLA B27 positive JIA patients mean disease onset was 12.34 ± 3.3 years. Most common (44%) JIA type was enthesitis related arthritis. Positive response to the treatment with SS was found in 32% of patients, Methotrexate (MTX) - in 43%, combined treatment - SS with MTX was effective in 12.5%. 12.5% of patients required combination MTX with Enbrel.Eight HLA B27 allele types were found in JIA patients in Latvia: *2702, *2703, *2704, *2705, *2710, *2715, *2717, *2728. The most common was *2705 - in 55% of cases. Among all the patients enthesitis related arthritis most commonly occurred in patients with HLAB*2705 allele (OR = 2.01, p < 0.02), oligoarthritis in patients with *2710 allele (OR = 3.0, p < 0.04) and polyarthritis with *2717 allele (OR = 3.0, p < 0.05). In patients with *2705 allele effective treatment was MTX (OR = 1.13, p < 0.03) and MTX with SS (OR = 2.02, p < 0.05), but in patients having *2703 allele - MTX with Enbrel (OR = 2.94, p < 0.02). CONCLUSIONS There are 8 different HLA B27 alleles in JIA patients in Latvia and the most common is *2705, but in order to assert them to be disease associated alleles, more extensive studies are needed, including control group of HLA B27 positive healthy individuals. Standard treatment approach with SS proves to be unsatisfactory in the majority of JIA patients. To improve children's quality of life achieving rapid disease control, the first line treatment in HLA B27 positive patients should be MTX. In order to start with the most appropriate drug it is necessary to determine HLAB 27 type at the onset of disease.
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Affiliation(s)
- Valda Stanevicha
- Department of Pediatrics, Riga Stradins University, Latvia Vienības gatve 45, Rīga, LV 1004, Latvia.
| | - Jelena Eglite
- Laboratory of clinical immunology and immunogenetics, Riga Stradins University, Latvia Biķernieku iela 29- 30, Rīga, LV 1039, Latvia
| | - Dace Zavadska
- Department of Pediatrics, Riga Stradins University, Latvia Vienības gatve 45, Rīga, LV 1004, Latvia
| | - Arturs Sochnevs
- Laboratory of clinical immunology and immunogenetics, Riga Stradins University, Latvia Kr.Valdemāra iela 111- 3, Rīga, LV 1010, Latvia
| | - Arina Lazareva
- Department of Pediatrics, Riga Stradins University, Latvia Adrese: Aviācijas iela 5- 46, Rīga, LV 5- 46, Latvia
| | - Dinara Guseinova
- Children University hospital, Department of Rheumatology Vienības gatve 45, Rīga, LV 1004, Latvia
| | - Ruta Shantere
- Children University hospital, Department of Rheumatology Vienības gatve 45, Rīga, LV 1004, Latvia
| | - Dace Gardovska
- Department of Pediatrics, Riga Stradins University, Latvia Vienības gatve 45, Rīga, LV 1004, Latvia
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Sawhney S, Agarwal M. Outcome measures in pediatric rheumatology. Indian J Pediatr 2010; 77:1183-9. [PMID: 20938818 DOI: 10.1007/s12098-010-0208-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 07/14/2010] [Indexed: 11/30/2022]
Abstract
Children with rheumatologic disorders need periodic systematic evaluation of their disease status so that all aspects of the child's life that are affected can be adequately assessed. The commonest rheumatologic disease that afflicts children is Juvenile Idiopathic Arthritis (JIA). The child with JIA should have several domains assessed at regular intervals. These outcome measures include the physical, functional and the quality of life assessment measures. No single measure can capture the full impact of the disease on the child's life. This article highlights the key outcome measures in a child with JIA and introduces the readers to several disease measurement tools that have been developed for assessment of outcome for the child with JIA.
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Affiliation(s)
- Sujata Sawhney
- Pediatric Rheumatology Unit, Centre for Child Health, Sir Ganga Ram Hospital, New Delhi, India.
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Beresford MW, Cleary AG, Foster HE, Hutchinson E, Baildam EM, Davies K. Comment on: Developing standards of care for patients with juvenile idiopathic arthritis. Rheumatology (Oxford) 2010; 49:2227-9. [DOI: 10.1093/rheumatology/keq215] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lelieveld OTHM, Armbrust W, Geertzen JHB, de Graaf I, van Leeuwen MA, Sauer PJJ, van Weert E, Bouma J. Promoting physical activity in children with juvenile idiopathic arthritis through an internet-based program: results of a pilot randomized controlled trial. Arthritis Care Res (Hoboken) 2010; 62:697-703. [PMID: 20191468 DOI: 10.1002/acr.20085] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with juvenile idiopathic arthritis (JIA) are less physically active than healthy peers. Therefore, we developed an Internet-based intervention to improve physical activity (PA). The aim of this study was to examine the effectiveness of the program in improving PA. METHODS PA was determined by activity-related energy expenditure, PA level, time spent on moderate to vigorous PA, and the number of days with > or =1 hour of moderate to vigorous activity, and was assessed with a 7-day activity diary. Aerobic exercise capacity was assessed by means of a Bruce treadmill test and was recorded as maximum endurance time. Disease activity was assessed by using the JIA core set. Adherence was electronically monitored. RESULTS Of 59 patients, 33 eligible patients were included and randomized in an intervention (n = 17, mean +/- SD age 10.6 +/- 1.5 years) or control waiting-list group (n = 16, mean +/- SD age 10.8 +/- 1.4 years). All patients completed baseline and T1 testing. PA significantly improved in both groups. Maximum endurance time significantly improved in the intervention group but not in the control group. In a subgroup analysis for patients with low PA (intervention: n = 7, control: n = 5), PA improved in the intervention group but not in the control group. The intervention was safe, feasible, and showed a good adherence. CONCLUSION An Internet-based program for children with JIA ages 8-12 years directed at promoting PA in daily life effectively improves PA in those patients with low PA levels. It is also able to improve endurance and it is safe, feasible, and has good adherence.
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Kuna AT, Lamot L, Miler M, Harjacek M, Simundic AM, Vrkic N. Antibodies to mutated citrullinated vimentin and antibodies to cyclic citrullinated peptides in juvenile idiopathic arthritis. Clin Chem Lab Med 2010; 47:1525-30. [PMID: 19842993 DOI: 10.1515/cclm.2009.288] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The goal of the study was to assess the presence of antibodies to mutated citrullinated vimentin (anti-MCV) and cyclic citrullinated peptides (anti-CCP) in patients with juvenile idiopathic arthritis (JIA) compared with patients with other juvenile onset rheumatic diseases. METHODS The study included 56 patients who fulfilled the International League of Associations for Rheumatology (ILAR) classification criteria for JIA, and 17 control patients with other juvenile onset rheumatic diseases. Data on six core outcome variables and the Sharp score were collected for patients with JIA. Sera and synovial fluid, if available, were tested for anti-CCP and anti-MCV antibodies using a commercial enzyme-linked immunosorbent assay (ELISA). RESULTS Anti-MCV antibodies were positive in 3/56 (5.4%) and anti-CCP in 1/56 (1.8%) of patients with JIA. Two out of three anti-MCV positive patients (one of them also anti-CCP positive) were found to be rheumatoid factor (RF)-positive with polyarticular disease. Within the control group, anti-MCV was positive in 4/17 (23.5%) patients, while anti-CCP positivity was not observed. No correlation between anti-MCV with anti-CCP antibody levels was found for any of the six core outcome variables or for the adapted Sharp score. CONCLUSIONS Our results show that antibodies targeting citrullinated proteins are not a useful diagnostic marker for JIA, but can indicate severe patterns of disease in JIA.
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Affiliation(s)
- Andrea Tesija Kuna
- University Department of Chemistry, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
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Hayward K, Wallace CA. Recent developments in anti-rheumatic drugs in pediatrics: treatment of juvenile idiopathic arthritis. Arthritis Res Ther 2009; 11:216. [PMID: 19291269 PMCID: PMC2688259 DOI: 10.1186/ar2619] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common autoimmune-autoinflammatory disease in childhood and affects approximately 1 in 1,000 children. Despite advances in diagnosis and treatment options, JIA remains a chronic condition for most affected children. Recent evidence suggests that disease control at onset may determine the tempo of subsequent disease course and long-term outcomes, and raises the concept of a therapeutic window of opportunity in patients with JIA. This underscores the importance of early aggressive treatment in patients with JIA. With the advent of novel biologic therapeutics, the repertoire of agents available for treatment of children with JIA has greatly increased. The present article will summarize recent developments in the medical treatment of children with JIA and will offer insights into emerging therapies.
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Affiliation(s)
- Kristen Hayward
- Division of Rheumatology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way, NE MS R-5420, Seattle, WA 98105, USA.
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Abstract
PURPOSE OF REVIEW Quality improvement is a mandate for all individuals and institutions in medicine. Quality improvement has spread to the specialty certifying boards, resident education accreditation, licensure boards, and hospital medical staff offices. This review summarizes the thrust of quality improvement, provides justification for the conduct of quality improvement work, and reviews the progress in development of quality measures in rheumatology to date. RECENT FINDINGS The American College of Rheumatology, quality of care, and quality measure committees have developed quality indicators for rheumatoid arthritis, gout, osteoporosis, and drug safety. Pediatric rheumatology is charged with developing quality measures for juvenile idiopathic arthritis; thus, there is a commitment to improve the processes and patient outcomes. Quality improvement science has progressed over the last decade and employs methodology that utilizes small number and rapid improvement cycles. Examples of this quality improvement methodology are elaborated in this review. SUMMARY The review summarizes the history and current mandates for quality improvement in the medical community, progress made in the development of quality measures for adult rheumatologic conditions, and preliminary quality measures for juvenile idiopathic arthritis, and cites examples of quality improvement in progress in the pediatric rheumatology.
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Bibliography. Current world literature. Systemic lupus erythematosus and Sjögren's syndrome. Curr Opin Rheumatol 2008; 20:631-2. [PMID: 18698190 DOI: 10.1097/bor.0b013e3283110091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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