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Khojah A, Pachman LM, Bukhari A, Trinh C, Morgan G, Pandey S, Le Poole IC, Klein-Gitelman MS. Decreased Peripheral Blood Natural Killer Cell Count in Untreated Juvenile Dermatomyositis Is Associated with Muscle Weakness. Int J Mol Sci 2024; 25:7126. [PMID: 39000234 PMCID: PMC11241205 DOI: 10.3390/ijms25137126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 07/16/2024] Open
Abstract
Juvenile Dermatomyositis (JDM) is the most common inflammatory myopathy in pediatrics. This study evaluates the role of Natural Killer (NK) cells in Juvenile Dermatomyositis (JDM) pathophysiology. The study included 133 untreated JDM children with an NK cell count evaluation before treatment. NK cell subsets (CD56low/dim vs. CD 56bright) were examined in 9 untreated children. CD56 and perforin were evaluated in situ in six untreated JDM and three orthopedic, pediatric controls. 56% of treatment-naive JDM had reduced circulating NK cell counts, designated "low NK cell". This low NK group had more active muscle disease compared to the normal NK cell group. The percentage of circulating CD56low/dim NK cells was significantly lower in the NK low group than in controls (0.55% vs. 4.6% p < 0.001). Examination of the untreated JDM diagnostic muscle biopsy documented an increased infiltration of CD56 and perforin-positive cells (p = 0.023, p = 0.038, respectively). Treatment-naive JDM with reduced circulating NK cell counts exhibited more muscle weakness and higher levels of serum muscle enzymes. Muscle biopsies from treatment-naive JDM displayed increased NK cell infiltration, with increased CD56 and perforin-positive cells.
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Affiliation(s)
- Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia;
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL 60611, USA
| | - Lauren M. Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Ameera Bukhari
- College of Science, Taif University, Taif 21944, Saudi Arabia
| | - Chi Trinh
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL 60611, USA
- Wellesley College, 106 Central St, Wellesley, MA 02481, USA
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL 60611, USA
| | - Surya Pandey
- Robert H. Lurie Comprehensive Cancer Center, Skin Biology and Diseases Resource-Based Center, Chicago, IL 60611, USA
| | - I. Caroline Le Poole
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H. Lurie Comprehensive Cancer Center, Skin Biology and Diseases Resource-Based Center, Chicago, IL 60611, USA
| | - Marisa S. Klein-Gitelman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 East Chicago Avenue, Box 50, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Bukhari A, Khojah A, Marin W, Khramtsov A, Khramtsova G, Costin C, Morgan G, Ramesh P, Klein-Gitelman MS, Le Poole IC, Pachman LM. Increased Otoferlin Expression in B Cells Is Associated with Muscle Weakness in Untreated Juvenile Dermatomyositis: A Pilot Study. Int J Mol Sci 2023; 24:10553. [PMID: 37445728 PMCID: PMC10341737 DOI: 10.3390/ijms241310553] [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] [Received: 05/02/2023] [Revised: 06/15/2023] [Accepted: 06/19/2023] [Indexed: 07/15/2023] Open
Abstract
Otoferlin mRNA expression is increased in JDM patients' PBMCs and muscle compared to healthy controls. This study aims to evaluate the role of otoferlin in JDM disease pathophysiology and its association with disease activity in untreated children with JDM. A total of 26 untreated JDM (88.5% female, 92.3% white, non-Hispanic) and 15 healthy controls were included in this study. Otoferlin mRNA expression was determined by qRT-PCR before and a few months after therapy. Detailed flow cytometry of various cell surface markers and cytoplasmic otoferlin was performed to identify cells expressing otoferlin. In addition, muscle otoferlin expression was evaluated in situ in six untreated JDM patients and three healthy controls. There was a significant increase in otoferlin expression in JDM children compared to controls (Median 67.5 vs. 2.1; p = 0.001). There was a positive correlation between mRNA otoferlin expression and the following disease activity markers: disease activity scores (DAS)-total (rs = 0.62, p < 0.001); childhood myositis assessment scale (CMAS) (rs = -0.61, p = 0.002); neopterin (rs = 0.57, p = 0.004) and von Willebrand factor antigen (vWF: Ag) (rs = 0.60, p = 0.004). Most of the otoferlin-positive cells were unswitched B cells (63-99.4%), with 65-75% of them expressing plasmablast markers (CD19+, IgM+, CD38hi, CD24-). The findings of this pilot study suggest that otoferlin expression is associated with muscle weakness, making it a possible biomarker of disease activity. Additionally, B cells and plasmablasts were the primary cells expressing otoferlin.
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Affiliation(s)
- Ameera Bukhari
- College of Science, Taif University, Taif 21944, Saudi Arabia
| | - Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah 24381, Saudi Arabia
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Wilfredo Marin
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA (G.K.)
| | - Andrey Khramtsov
- Department of Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Galina Khramtsova
- Stanley Manne Children’s Research Institute, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA (G.K.)
| | - Christopher Costin
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
| | - Prathyaya Ramesh
- Department of Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Department of Dermatology, Microbiology & Immunology, Northwestern University, Chicago, IL 60611, USA
| | - Marisa S. Klein-Gitelman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - I. Caroline Le Poole
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Department of Dermatology, Microbiology & Immunology, Northwestern University, Chicago, IL 60611, USA
| | - Lauren M. Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Gibbs E, Khojah A, Morgan G, Ehwerhemuepha L, Pachman LM. The von Willebrand Factor Antigen Reflects the Juvenile Dermatomyositis Disease Activity Score. Biomedicines 2023; 11:biomedicines11020552. [PMID: 36831088 PMCID: PMC9953073 DOI: 10.3390/biomedicines11020552] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/03/2023] [Accepted: 02/06/2023] [Indexed: 02/16/2023] Open
Abstract
OBJECTIVE This study determined if an accessible, serologic indicator of vascular disease activity, the von Willebrand factor antigen (vWF:Ag), was useful to assess disease activity in children with juvenile dermatomyositis (JDM), a rare disease, but the most common of the pediatric inflammatory myopathies. METHODS A total of 305 children, median age 10 years, 72.5% female, 76.5% white, with definite/probable JDM at diagnosis, were enrolled in the Ann & Robert H. Lurie Cure JM Juvenile Myositis Repository, a longitudinal database. Disease Activity Score (DAS) and vWF:Ag data were obtained at each visit. These data were analyzed using generalized estimating equation (GEE) models (both linear and logistic) to determine if vWF:Ag reflects disease severity in children with JDM. A secondary analysis was performed for untreated active JDM to exclude the effect of medications on vWF:Ag. RESULT The vWF:Ag test was elevated in 25% of untreated JDM. We found that patients with elevated vWF:Ag had a 2.55-fold higher DAS total (CI95: 1.83-3.27, p < 0.001). Patients with difficulty swallowing had 2.57 higher odds of elevated vWF:Ag (CI95: 1.5-4.38, p < 0.001); those with more generalized skin involvement had 2.58-fold higher odds of elevated vWF:Ag (CI95: 1.27-5.23, p = 0.006); and those with eyelid peripheral blood vessel dilation had 1.32-fold higher odds of elevated vWF:Ag (CI95: 1.01-1.72, p = 0.036). Untreated JDM with elevated vWF:Ag had more muscle weakness and higher muscle enzymes, neopterin and erythrocyte sedimentation rate compared to JDM patients with a normal vWF:Ag. CONCLUSION vWF:Ag elevation is a widely accessible concomitant of active disease in 25% of JDM.
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Affiliation(s)
- Ellie Gibbs
- Department of Biological Sciences, Wellesley College, Wellesley, MA 02481, USA
| | - Amer Khojah
- Department of Pediatrics, College of Medicine, Umm Al-Qura University, Makkah 21421, Saudi Arabia
| | - Gabrielle Morgan
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Cure-JM Center of Excellence in Juvenile Myositis Research and Care, Chicago, IL 60611, USA
| | - Louis Ehwerhemuepha
- Computational Research, Children’s Hospital of Orange County Research Institute, Orange, CA 92868, USA
| | - Lauren M. Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Cure-JM Center of Excellence in Juvenile Myositis Research and Care, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Correspondence:
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Khojah A, Morgan G, Pachman LM. Clues to Disease Activity in Juvenile Dermatomyositis: Neopterin and Other Biomarkers. Diagnostics (Basel) 2021; 12:8. [PMID: 35054173 PMCID: PMC8774344 DOI: 10.3390/diagnostics12010008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 11/17/2022] Open
Abstract
Easily accessible biomarkers are urgently needed to evaluate immune activation in Juvenile Dermatomyositis (JDM). The goal of this retrospective study is to define immunological and clinical differences between untreated JDM patients with either normal or elevated (>10 mmol/L) levels of neopterin, a biomarker of macrophage activation. We included all JDM with neopterin data obtained before initiating medical therapy. We assessed T, B, NK cell populations, muscle enzymes, and disease activity scores for skin (sDAS), muscle (mDAS), total (tDAS), the duration of untreated disease, disease course, and myositis-specific antibody (MSA). Seventy-nine percent of 139 untreated JDM patients had elevated serum neopterin. The group with elevated neopterin had significantly more active disease: tDAS 11.9 vs. 8.1 (p < 0.0001), mDAS 5.8 vs. 3.1 (p < 0.0001), sDAS 6.1 vs. 4.9 (p = 0.0002), aldolase 24.0 vs. 7.6 U/L (p < 0.0001), von Willebrand factor antigen (p < 0.0001), and ESR 19.8 vs. 11.5 mm/hr (p = 0.01). The flow cytometry documented both reduced T cells (1494 vs. 2278/mm3, p = 0.008) and NK cells (145 vs. 240/mm3, p = 0.003). TNFα-308AA/AG polymorphism was more common in children with elevated neopterin than TNFα-308GG (p 0.05). We conclude that the availability of neopterin data will contribute to the rapid assessment of untreated JDM disease activity.
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Affiliation(s)
- Amer Khojah
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA;
- Division of Allergy & Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Gabrielle Morgan
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL 60611, USA;
| | - Lauren M. Pachman
- Division of Pediatric Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL 60611, USA;
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Cure JM Center of Excellence, Stanley Manne Research Center, Chicago, IL 60611, USA;
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Ll Wilkinson MG, Deakin CT, Papadopoulou C, Eleftheriou D, Wedderburn LR. JAK inhibitors: a potential treatment for JDM in the context of the role of interferon-driven pathology. Pediatr Rheumatol Online J 2021; 19:146. [PMID: 34563217 PMCID: PMC8466894 DOI: 10.1186/s12969-021-00637-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/28/2021] [Indexed: 12/29/2022] Open
Abstract
Juvenile Idiopathic Inflammatory Myopathies (IIM) are a group of rare diseases that are heterogeneous in terms of pathology that can include proximal muscle weakness, associated skin changes and systemic involvement. Despite options for treatment, many patients continue to suffer resistant disease and lasting side-effects. Advances in the understanding of the immunopathology and genetics underlying IIM may specify new therapeutic targets, particularly where conventional treatment has not achieved a clinical response. An upregulated type I interferon signature is strongly associated with disease and could be a prime target for developing more specific therapeutics. There are multiple components of the IFN pathway that could be targeted for blockade therapy.Downstream of the cytokine receptor complexes are the Janus kinase-signal transducers and activators of transcription (JAK-STAT) pathway, which consists of JAK1-3, TYK2, and STAT1-6. Therapeutic inhibitors have been developed to target components of this pathway. Promising results have been observed in case studies reporting the use of the JAK inhibitors, Baricitinib, Tofacitinib and Ruxolitinib in the treatment of refractory Juvenile Dermatomyositis (JDM). There is still the question of safety and efficacy for the use of JAK inhibitors in JDM that need to be addressed by clinical trials. Here we review the future for the use of JAK inhibitors as a treatment for JDM.
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Affiliation(s)
- Meredyth G Ll Wilkinson
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, University College London, London, UK.
- NIHR Biomedical Research Centre at GOSH, London, UK.
| | - Claire T Deakin
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, University College London, London, UK
- NIHR Biomedical Research Centre at GOSH, London, UK
| | - Charalampia Papadopoulou
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Despina Eleftheriou
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, University College London, London, UK
- NIHR Biomedical Research Centre at GOSH, London, UK
- Rheumatology, Great Ormond Street Hospital, Great Ormond Street, London, UK
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Muthukumar A, Narasimhan M, Li QZ, Mahimainathan L, Hitto I, Fuda F, Batra K, Jiang X, Zhu C, Schoggins J, Cutrell JB, Croft CL, Khera A, Drazner MH, Grodin JL, Greenberg BM, Mammen PP, Morrison SJ, de Lemos JA. In-Depth Evaluation of a Case of Presumed Myocarditis After the Second Dose of COVID-19 mRNA Vaccine. Circulation 2021; 144:487-498. [PMID: 34133883 PMCID: PMC8340727 DOI: 10.1161/circulationaha.121.056038] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text.
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Affiliation(s)
- Alagarraju Muthukumar
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Madhusudhanan Narasimhan
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Quan-Zhen Li
- Department of Immunology (Q.-Z.L.), University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Lenin Mahimainathan
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Imran Hitto
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Franklin Fuda
- Department of Pathology (A.M., M.N., L.M., I.H., F.F.), University of Texas Southwestern Medical Center, Dallas
| | - Kiran Batra
- Department of Radiology (K.B.), University of Texas Southwestern Medical Center, Dallas
| | - Xuan Jiang
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Chengsong Zhu
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - John Schoggins
- Department of Microbiology (J.S.), University of Texas Southwestern Medical Center, Dallas
| | - James B. Cutrell
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Carol L. Croft
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Amit Khera
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Mark H. Drazner
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Justin L. Grodin
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Benjamin M. Greenberg
- Department of Neurology and Neurotherapeutics (B.M.G.), University of Texas Southwestern Medical Center, Dallas
- Department of Pediatrics (B.M.G.), University of Texas Southwestern Medical Center, Dallas
| | - Pradeep P.A. Mammen
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
| | - Sean J. Morrison
- Howard Hughes Medical Institute (S.J.M.), University of Texas Southwestern Medical Center, Dallas
- Children’s Medical Center Research Institute (S.J.M.), University of Texas Southwestern Medical Center, Dallas
| | - James A. de Lemos
- Department of Internal Medicine (Q.-Z.L., X.J., C.Z., J.B.C., C.L.C., A.K., M.H.D., J.L.G., P.P.A.M., J.A.d.L.), University of Texas Southwestern Medical Center, Dallas
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Paolilo RB, Pinho PDC. Eye pain in 13-year-old teenager: a case report of idiopathic orbital myositis. HEADACHE MEDICINE 2021. [DOI: 10.48208/headachemed.2021.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Image in Headache Medicine
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Pachman LM, Khojah AM. Advances in Juvenile Dermatomyositis: Myositis Specific Antibodies Aid in Understanding Disease Heterogeneity. J Pediatr 2018; 195:16-27. [PMID: 29576174 PMCID: PMC5881602 DOI: 10.1016/j.jpeds.2017.12.053] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/27/2017] [Accepted: 12/18/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Lauren M Pachman
- Department of Pediatrics , Northwestern University Feinberg School of Medicine, Chicago, IL; Stanley Manne Children's Research Institute, Cure JM Center of Excellence in Juvenile Myositis (JM) Research, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Amer M Khojah
- Department of Pediatrics, Division of Pediatric Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
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