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Kastelic MS, Roman-González A, De Paula Colares Neto G, De Paula FJA, Reza-Albarrán AA, Morales LR, Tormo S, Meza-Martínez AI. Latin-American consensus on the transition into adult life of patients with X-linked hypophosphatemia. Endocrine 2024; 84:76-91. [PMID: 38117452 PMCID: PMC10987342 DOI: 10.1007/s12020-023-03624-z] [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: 08/05/2023] [Accepted: 11/22/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION X-linked hypophosphatemia is an orphan disease of genetic origin and multisystem involvement. It is characterized by a mutation of the PHEX gene which results in excess FGF23 production, with abnormal renal and intestinal phosphorus metabolism, hypophosphatemia and osteomalacia secondary to chronic renal excretion of phosphate. Clinical manifestations include hypophosphatemic rickets leading to growth abnormalities and osteomalacia, myopathy, bone pain and dental abscesses. The transition of these patients to adult life continues to pose challenges to health systems, medical practitioners, patients and families. For this reason, the aim of this consensus is to provide a set of recommendations to facilitate this process and ensure adequate management and follow-up, as well as the quality of life for patients with X-linked hypophosphatemia as they transition to adult life. MATERIALS AND METHODS Eight Latin American experts on the subject participated in the consensus and two of them were appointed as coordinators. The consensus work was done in accordance with the nominal group technique in 6 phases: (1) question standardization, (2) definition of the maximum number of choices, (3) production of individual solutions or answers, (4) individual question review, (5) analysis and synthesis of the information and (6) synchronic meetings for clarification and voting. An agreement was determined to exist with 80% votes in favor in three voting cycles. RESULTS AND DISCUSSION Transition to adult life in patients with hypophosphatemia is a complex process that requires a comprehensive approach, taking into consideration medical interventions and associated care, but also the psychosocial components of adult life and the participation of multiple stakeholders to ensure a successful process. The consensus proposes a total of 33 recommendations based on the evidence and the knowledge and experience of the experts. The goal of the recommendations is to optimize the management of these patients during their transition to adulthood, bearing in mind the need for multidisciplinary management, as well as the most relevant medical and psychosocial factors in the region.
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Affiliation(s)
- Maria Sofia Kastelic
- Pediatric Endocrinology department, Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina
| | - Alejandro Roman-González
- Endocrinology department, Hospital Universitario San Vicente Fundación, Medellín, Colombia.
- Universidad de Antioquia, Medellin, Colombia.
| | | | - Francisco J A De Paula
- Department of Internal Medicine, Faculdade de Medicina de Ribeirão Preto-USP, Ribeirão Preto, Brasil
| | - Alfredo Adolfo Reza-Albarrán
- Department of endocrinology and metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Lilian Reyes Morales
- Chief of the Department of Pediatric Nephrology of the National Institute of Pediatrics, Ciudad de México, México
| | - Silvina Tormo
- Department of endocrinology and metabolism, Hospital Nacional Posadas. El Palomar, Buenos Aires, Argentina
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Kontzias A, Petryna O, Nakasato P, Efthimiou P. Diagnosing and Treating Systemic Juvenile Idiopathic Arthritis and Adult-Onset Still's Disease as Part of the Still's Disease Continuum. Mediterr J Rheumatol 2024; 35:45-57. [PMID: 38756937 PMCID: PMC11094444 DOI: 10.31138/mjr.290323.dat] [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: 03/29/2023] [Revised: 11/02/2023] [Accepted: 12/11/2023] [Indexed: 05/18/2024] Open
Abstract
Aim We have summarised the existing evidence supporting the concept that systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still's disease (AOSD) are part of the same Still's disease spectrum. Methods A PubMed/Embase database search was conducted using specific search strings and free text words to screen for relevant articles. The search was limited to studies in humans, published up to June 2023, in English-language. Summary sJIA and AOSD are rare autoinflammatory disorders that have similar pathophysiological and clinical features. The clinical presentations of sJIA and AOSD are highly variable, with differential diagnoses that include a broad range of malignancies, infectious diseases, and autoimmune disorders, which contribute to delays in diagnosis. Several sets of classification exist to help diagnose patients in clinical practice; the International League of Associations for Rheumatology criteria for sJIA and the Yamaguchi and Fautrel criteria for AOSD are the most-used criteria. The therapeutic strategy for Still's disease aims to relieve signs and symptoms, prevent irreversible joint damage and potentially life-threatening complications, and avoid deleterious side effects of treatment. Recently, targeted therapies such as interleukin (IL)-1 and IL-6 inhibitors have become available for the treatment of sJIA and AOSD. While these biologics were originally largely reserved for patients in whom non-steroidal anti-inflammatory drugs, corticosteroids and conventional synthetic disease-modifying anti-rheumatic drugs had failed, they are increasingly used earlier in the treatment paradigm. Among IL-1 inhibitors, canakinumab is the only biologic approved in the US for the treatment of both sJIA and AOSD.
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Affiliation(s)
- Apostolos Kontzias
- Department of Internal Medicine, Division of Rheumatology, Allergy and Immunology, Stony Brook University Hospital, Stony Brook, NY, USA
| | - Olga Petryna
- Department of Medicine, White Plains Hospital, White Plains, NY, USA
| | | | - Petros Efthimiou
- Department of Medicine, White Plains Hospital, White Plains, NY, USA
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Eveillard LA, Quartier P, Ouldali N, Bader-Meunier B, Aeschlimann F, Abasq C, Ballot C, Bouric P, Desdoits A, Dumaine C, Galeotti C, Hentgen V, Lefevre-Utile A, Chausset A, Hubiche T, Kupfer-Bessaguet I, Leclerq-Mercier S, Mallet S, Melki I, Merlin E, Miquel J, Piram M, Talmud D, Garcelon N, Vinit C, Welfringer A, Bourrat E, Meinzer U. Association of atypical skin manifestations at the onset of systemic juvenile idiopathic arthritis with difficult-to-treat disease: A retrospective multicenter study. J Am Acad Dermatol 2022; 87:1425-1428. [PMID: 35963289 DOI: 10.1016/j.jaad.2022.07.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Laurye-Anne Eveillard
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France; Centre de Recherche sur l'Inflammation, INSERM, UMR 1149, Université Paris Cité, Paris, France
| | - Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit, Rare Disease Reference Centre (RAISE), IMAGINE Institute, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Naim Ouldali
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Brigitte Bader-Meunier
- Pediatric Immunology-Hematology and Rheumatology Unit, Rare Disease Reference Centre (RAISE), IMAGINE Institute, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Florence Aeschlimann
- Pediatric Immunology-Hematology and Rheumatology Unit, Rare Disease Reference Centre (RAISE), IMAGINE Institute, Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Claire Abasq
- Department of Dermatology, Brest University Hospital, Brest, France
| | - Claire Ballot
- Pediatric hematology, Jean-Minjoz Hospital, Besançon, France
| | - Pauline Bouric
- CH Auray-Vannes, Hôpital Bretagne Atlantique, Paediatric Department, Boulevard du Général Guillaudot, Vannes Cedex, France
| | - Alexandra Desdoits
- Department of Pediatric Surgery, CHU de Caen, AutoImmune and Systemic Diseases in Children (RAISE), Reference Centre for Autoinflammatory Disorders (CEREMAI), Caen, France
| | - Cécile Dumaine
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Caroline Galeotti
- Department of Pediatric Rheumatology, Reference Centre for Autoinflammatory diseases and amyloidosis (CEREMAIA), Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Véronique Hentgen
- Reference Centre for Autoinflammatory Disorders (CEREMAI) Centre Hospitalier de Versailles, Le Chesnay Cedex, France
| | - Alain Lefevre-Utile
- Université de Paris, INSERM, U976 HIPI Unit, Institut de Recherche Saint-Louis, Paris, France; Assistance Puplique-Hôpitaux de Paris (APHP), General Pediatrics and Pediatric Emergency Department, Jean Verdier Hospital, Bondy, France
| | - Aurélie Chausset
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand, France; CRECHE Unit, INSERM, CIC 1405, Clermont Auvergne University, Clermont-Ferrand, France
| | - Thomas Hubiche
- Department of Dermatology, Université Côte d'Azur, Nice, France
| | | | - Stéphanie Leclerq-Mercier
- Pathology Department, Necker-Enfants Malades Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Isabelle Melki
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Etienne Merlin
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand, France; CRECHE Unit, INSERM, CIC 1405, Clermont Auvergne University, Clermont-Ferrand, France
| | - Juliette Miquel
- Department of Pediatrics, CHU Reunion Saint-Pierre, Reunion Island, France
| | - Maryam Piram
- Department of Pediatrics, Pediatric Dermatology Unit, CHI Sainte Justine, CHU Sainte Justine Research Centre, University of Montreal, Montreal, Quebec, Canada
| | - Deborah Talmud
- Pediatric Department, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Nicolas Garcelon
- Institut Imagine, Centre de Recherche des Cordeliers, Equipe 22, UMR 1138, INSERM, Paris, France
| | - Caroline Vinit
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Anne Welfringer
- Department of Dermatology, Reference Centre for Genodermatoses and Rare Skin Disease (MAGEC), Necker-Enfants Malades Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Emmanuelle Bourrat
- Department of Dermatology, Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Ulrich Meinzer
- General Pediatrics, Department of Infectious Disease and Internal Medicine, Reference center for Rheumatic, AutoImmune and Systemic diseases in children (RAISE) Robert Debré University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris Cité, Paris, France; Centre de Recherche sur l'Inflammation, INSERM, UMR 1149, Université Paris Cité, Paris, France.
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Sahba S, Huurnink A, Van den Berg JM, Tuitert B, Vastert SJ, Ten Tusscher GW. Systemic Juvenile Idiopathic Arthritis in two children; case report on clinical course, challenges in diagnosis and the role of FDG‐PET/CT‐scan. Clin Case Rep 2022; 10:e05900. [PMID: 35734189 PMCID: PMC9190680 DOI: 10.1002/ccr3.5900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA, also called Still's disease) is a rare childhood auto‐inflammatory disease with significant morbidity. This case report illustrates the clinical course and highlights diagnostic challenges. FDG‐PET/CT imaging may be beneficial in the diagnostic process for some cases, in order to achieve rapid diagnosis and early treatment.
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Affiliation(s)
- S. Sahba
- Department of PaediatricsDijklander Hospital HoornHoornThe Netherlands
| | - A. Huurnink
- Department of Nuclear MedicineDijklander Hospital HoornHoornThe Netherlands
| | - J. M. Van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious DiseasesEmma Children's Hospital, Amsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
| | - B. Tuitert
- Department of PaediatricsDijklander Hospital HoornHoornThe Netherlands
| | - S. J. Vastert
- Department of Paediatric Rheumatology and ImmunologyWilhelmina Children's Hospital UtrechtUtrecht UniversityUtrechtThe Netherlands
| | - G. W. Ten Tusscher
- Department of PaediatricsDijklander Hospital HoornHoornThe Netherlands
- Department of General PracticeAmsterdam UMC, University of AmsterdamAmsterdamThe Netherlands
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Ailioaie LM, Ailioaie C, Litscher G. Implications of SARS-CoV-2 Infection in Systemic Juvenile Idiopathic Arthritis. Int J Mol Sci 2022; 23:ijms23084268. [PMID: 35457086 PMCID: PMC9029451 DOI: 10.3390/ijms23084268] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/30/2022] [Accepted: 04/10/2022] [Indexed: 12/15/2022] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a serious multifactorial autoinflammatory disease with a significant mortality rate due to macrophage activation syndrome (MAS). Recent research has deepened the knowledge about the pathophysiological mechanisms of sJIA-MAS, facilitating new targeted treatments, and biological disease-modifying antirheumatic drugs (bDMARDs), which significantly changed the course of the disease and prognosis. This review highlights that children are less likely to suffer severe COVID-19 infection, but at approximately 2–4 weeks, some cases of multisystem inflammatory syndrome in children (MIS-C) have been reported, with a fulminant course. Previous established treatments for cytokine storm syndrome (CSS) have guided COVID-19 therapeutics. sJIA-MAS is different from severe cases of COVID-19, a unique immune process in which a huge release of cytokines will especially flood the lungs. In this context, MIS-C should be reinterpreted as a special MAS, and long-term protection against SARS-CoV-2 infection can only be provided by the vaccine, but we do not yet have sufficient data. COVID-19 does not appear to have a substantial impact on rheumatic and musculoskeletal diseases (RMDs) activity in children treated with bDMARDs, but the clinical features, severity and outcome in these patients under various drugs are not yet easy to predict. Multicenter randomized controlled trials are still needed to determine when and by what means immunoregulatory products should be administered to patients with sJIA-MAS with a negative corticosteroid response or contraindications, to optimize their health and safety in the COVID era.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania; (L.M.A.); (C.A.)
| | - Constantin Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iasi, Romania; (L.M.A.); (C.A.)
| | - Gerhard Litscher
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Research Unit for Complementary and Integrative Laser Medicine, Traditional Chinese Medicine (TCM) Research Center Graz, Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 39, 8036 Graz, Austria
- Correspondence: ; Tel.: +43-316-385-83907
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Sato H, Inoue Y, Kawashima Y, Nakajima D, Ishikawa M, Konno R, Nakamura R, Kato D, Mitsunaga K, Yamamoto T, Yamaide A, Tomiita M, Hoshioka A, Ohara O, Shimojo N. In-Depth Serum Proteomics by DIA-MS with In Silico Spectral Libraries Reveals Dynamics during the Active Phase of Systemic Juvenile Idiopathic Arthritis. ACS OMEGA 2022; 7:7012-7023. [PMID: 35252692 PMCID: PMC8892657 DOI: 10.1021/acsomega.1c06681] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/03/2022] [Indexed: 05/09/2023]
Abstract
In serum proteomics using mass spectrometry, the number of detectable proteins is reduced due to high-abundance proteins, such as albumin. However, recently developed data-independent acquisition mass spectrometry (DIA-MS) proteomics technology has made it possible to remarkably improve the number of proteins in a serum analysis by removing high-abundance proteins. Using this technology, we analyzed sera from patients with systemic juvenile idiopathic arthritis (sJIA), a rare pediatric disease. As a result, we identified 2727 proteins with a wide dynamic range derived from various tissue leakages. We also selected 591 proteins that differed significantly in their active phases. These proteins were involved in many inflammatory processes, and we also identified immunoproteasomes, which were not previously found in serum, suggesting that they may be involved in the pathogenesis of sJIA. A detailed high-depth DIA-MS proteomic analysis of serum may be useful for understanding the pathogenesis of sJIA and may provide clues for the development of new biomarkers.
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Affiliation(s)
- Hironori Sato
- Department
of Applied Genomics, Kazusa DNA Research
Institute, Kisarazu, Chiba 292-0818, Japan
- Department
of Pediatrics, Graduate School of Medicine, Chiba University, Chiba, Chiba 260-8677, Japan
| | - Yuzaburo Inoue
- Department
of Allergy and Rheumatology, Chiba Children’s
Hospital, Chiba, Chiba 266-0007, Japan
- Division
of Cancer Genetics, Chiba Cancer Center
Research Institute, Chiba, Chiba 260-8717, Japan
| | - Yusuke Kawashima
- Department
of Applied Genomics, Kazusa DNA Research
Institute, Kisarazu, Chiba 292-0818, Japan
| | - Daisuke Nakajima
- Department
of Applied Genomics, Kazusa DNA Research
Institute, Kisarazu, Chiba 292-0818, Japan
| | - Masaki Ishikawa
- Department
of Applied Genomics, Kazusa DNA Research
Institute, Kisarazu, Chiba 292-0818, Japan
| | - Ryo Konno
- Department
of Applied Genomics, Kazusa DNA Research
Institute, Kisarazu, Chiba 292-0818, Japan
| | - Ren Nakamura
- Department
of Applied Genomics, Kazusa DNA Research
Institute, Kisarazu, Chiba 292-0818, Japan
| | - Daigo Kato
- Department
of Allergy and Rheumatology, Chiba Children’s
Hospital, Chiba, Chiba 266-0007, Japan
| | - Kanako Mitsunaga
- Department
of Allergy and Rheumatology, Chiba Children’s
Hospital, Chiba, Chiba 266-0007, Japan
| | - Takeshi Yamamoto
- Department
of Allergy and Rheumatology, Chiba Children’s
Hospital, Chiba, Chiba 266-0007, Japan
- Benaroya
Research Institute at Virginia Mason, Seattle, Washington 98101-2795, United States
| | - Akiko Yamaide
- Department
of Allergy and Rheumatology, Chiba Children’s
Hospital, Chiba, Chiba 266-0007, Japan
| | - Minako Tomiita
- Department
of Clinical Research, National Hospital
Organization Shimoshizu National Hospital, Yotsukaido, Chiba 284-0003, Japan
| | - Akira Hoshioka
- Department
of Allergy and Rheumatology, Chiba Children’s
Hospital, Chiba, Chiba 266-0007, Japan
| | - Osamu Ohara
- Department
of Applied Genomics, Kazusa DNA Research
Institute, Kisarazu, Chiba 292-0818, Japan
| | - Naoki Shimojo
- Center for
Preventive Medical Sciences, Chiba University, Chiba, Chiba 263-8522, Japan
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Malengier-Devlies B, Metzemaekers M, Wouters C, Proost P, Matthys P. Neutrophil Homeostasis and Emergency Granulopoiesis: The Example of Systemic Juvenile Idiopathic Arthritis. Front Immunol 2021; 12:766620. [PMID: 34966386 PMCID: PMC8710701 DOI: 10.3389/fimmu.2021.766620] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 11/23/2021] [Indexed: 12/21/2022] Open
Abstract
Neutrophils are key pathogen exterminators of the innate immune system endowed with oxidative and non-oxidative defense mechanisms. More recently, a more complex role for neutrophils as decision shaping cells that instruct other leukocytes to fine-tune innate and adaptive immune responses has come into view. Under homeostatic conditions, neutrophils are short-lived cells that are continuously released from the bone marrow. Their development starts with undifferentiated hematopoietic stem cells that pass through different immature subtypes to eventually become fully equipped, mature neutrophils capable of launching fast and robust immune responses. During severe (systemic) inflammation, there is an increased need for neutrophils. The hematopoietic system rapidly adapts to this increased demand by switching from steady-state blood cell production to emergency granulopoiesis. During emergency granulopoiesis, the de novo production of neutrophils by the bone marrow and at extramedullary sites is augmented, while additional mature neutrophils are rapidly released from the marginated pools. Although neutrophils are indispensable for host protection against microorganisms, excessive activation causes tissue damage in neutrophil-rich diseases. Therefore, tight regulation of neutrophil homeostasis is imperative. In this review, we discuss the kinetics of neutrophil ontogenesis in homeostatic conditions and during emergency myelopoiesis and provide an overview of the different molecular players involved in this regulation. We substantiate this review with the example of an autoinflammatory disease, i.e. systemic juvenile idiopathic arthritis.
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Affiliation(s)
- Bert Malengier-Devlies
- Department of Microbiology, Immunology and Transplantation, Laboratory of Immunobiology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Mieke Metzemaekers
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Carine Wouters
- Department of Microbiology, Immunology and Transplantation, Laboratory of Immunobiology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.,Division of Pediatric Rheumatology, University Hospitals Leuven, Leuven, Belgium.,European Reference Network for Rare Immunodeficiency, Autoinflammatory and Autoimmune Diseases (RITA) at University Hospital Leuven, Leuven, Belgium
| | - Paul Proost
- Department of Microbiology, Immunology and Transplantation, Laboratory of Molecular Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Patrick Matthys
- Department of Microbiology, Immunology and Transplantation, Laboratory of Immunobiology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
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Hur P, Yi E, Ionescu-Ittu R, Manceur AM, Lomax KG, Cammarota J, Xie J, Gautam R, Nakasato P, Sanghera N, Kim N, Grom AA. Reasons for Initiating Canakinumab among Patients with Systemic Juvenile Idiopathic Arthritis and Adult-Onset Still's Disease in the U.S. Real-World Settings. Rheumatol Ther 2021; 9:265-283. [PMID: 34874547 PMCID: PMC8814295 DOI: 10.1007/s40744-021-00402-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/15/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction The aim of this study was to understand the reasons for canakinumab initiation among patients with Still’s disease, including systemic juvenile idiopathic arthritis (SJIA) and adult-onset Still’s disease (AOSD), in US clinical practice. Methods Physicians retrospectively reviewed the medical charts of patients with Still’s disease (regardless of age at symptom onset) who were prescribed canakinumab from 2016 to 2018. Patients aged < 16 years at symptom onset were classified as having SJIA and those aged ≥ 16 years at symptom onset (calculated from case-record forms) were classified as having AOSD. Patient treatment history and physician reasons for canakinumab initiation were analyzed. Overall results were presented as SJIA/AOSD. Sensitivity analyses were performed for the robustness of the results. Results Forty-three physicians in the USA (rheumatologists/dermatologists/immunologists/allergists: 51.2/27.9/11.6/9.3%; subspecialty in adults/pediatrics: 67.4/32.6%) abstracted information for 72 patients with SJIA/AOSD (SJIA/AOSD/age unknown at symptom onset: 75.0/18.1/6.9%; mean age 19.4 years; children 61.1%; females 56.9%). Most patients (90.3%) received treatment directly preceding canakinumab initiation (etanercept 27.7%; anakinra 18.5%; adalimumab 16.9%); the respective treatment was discontinued due to lack of efficacy/effectiveness (43.1%) and availability of a new treatment (27.8%). Most common reasons for canakinumab initiation were physician perceived/experienced efficacy/effectiveness of canakinumab (77.8%; children/adults: 81.8/71.4%), lack-of-response to previous treatment (45.8%; children/adults: 36.4/60.7%), convenient administration/dosing (26.4%; children/adults: 29.5/21.4%) and ability to discontinue/spare steroids (25.0%; children/adults: 20.5/32.1%). The sensitivity analysis provided similar results. Conclusions In US clinical practice, physician perceived/experienced efficacy/effectiveness of canakinumab and lack-of-response to previous treatment were the primary reasons for canakinumab initiation among patients with SJIA/AOSD. Physician perceived/experienced efficacy/effectiveness and convenient administration/dosing of canakinumab were the most common reasons for canakinumab initiation among children, whereas lack-of-response to previous treatment and ability to discontinue/spare steroids being the most frequent reasons among adults. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00402-z.
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Affiliation(s)
- Peter Hur
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Esther Yi
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | | | - Jipan Xie
- Analysis Group, Inc, Los Angeles, CA, USA
| | - Raju Gautam
- Novartis Healthcare Pvt. Ltd, Hyderabad, India
| | | | | | - Nina Kim
- Baylor Scott and White Medical Center-Temple, Temple, TX, USA.,The University of Texas at Austin, Austin, TX, USA
| | - Alexei A Grom
- Division of Pediatric Rheumatology, Children's Hospital Medical Center, MLC 4010, 3333 Burnet Avenue, Cincinnati, OH, 45229, USA.
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Garner AJ, Saatchi R, Ward O, Hawley DP. Juvenile Idiopathic Arthritis: A Review of Novel Diagnostic and Monitoring Technologies. Healthcare (Basel) 2021; 9:1683. [PMID: 34946409 PMCID: PMC8700900 DOI: 10.3390/healthcare9121683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/29/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and is characterized by an often insidious onset and a chronic relapsing-remitting course, once diagnosed. With successive flares of joint inflammation, joint damage accrues, often associated with pain and functional disability. The progressive nature and potential for chronic damage and disability caused by JIA emphasizes the critical need for a prompt and accurate diagnosis. This article provides a review of recent studies related to diagnosis, monitoring and management of JIA and outlines recent novel tools and techniques (infrared thermal imaging, three-dimensional imaging, accelerometry, artificial neural networks and fuzzy logic) which have demonstrated potential value in assessment and monitoring of JIA. The emergence of novel techniques to assist clinicians' assessments for diagnosis and monitoring of JIA has demonstrated promise; however, further research is required to confirm their clinical utility.
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Affiliation(s)
- Amelia J. Garner
- The Medical School, University of Sheffield, Sheffield S10 2TN, UK
| | - Reza Saatchi
- Industry and Innovation Research Institute, Sheffield Hallam University, Sheffield S1 1WB, UK;
| | - Oliver Ward
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield S10 2TH, UK; (O.W.); (D.P.H.)
| | - Daniel P. Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield S10 2TH, UK; (O.W.); (D.P.H.)
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Atypical Presentation of Systemic Arthritis in a Toddler with Down Syndrome. Case Rep Pediatr 2021; 2021:6567770. [PMID: 34422425 PMCID: PMC8373510 DOI: 10.1155/2021/6567770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/06/2021] [Indexed: 12/17/2022] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a chronic, inflammatory disease of childhood, which is characterized by the combination of arthritis, serositis, daily, high-spiking fevers, and evanescent macular rash and can present with the life-threatening complication of macrophage activation syndrome (MAS). Children with Down syndrome (DS) have complex medical challenges related to abnormalities in their immune system, which can cause a broad spectrum of disease manifestations, which can occur atypically. Children with DS are at increased risk for arthritis and interstitial lung disease (ILD) associated with sJIA that has high mortality. This case report outlines an atypical presentation of sJIA in a 21-month-old male with DS in which fever was not part of the initial presentation of sJIA and then later developed MAS and ILD. Due to broad spectrum of disease and atypical presentation in children with DS, this case report was created to increase awareness of atypical presentations of rheumatic disease in children with DS.
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12
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Induction of apoptosis in activated RAW 264.7 cells and inhibition of pro-inflammatory mediators in rat air pouch by ethylacetate fraction of Ocimum gratissimum leaves. ADVANCES IN TRADITIONAL MEDICINE 2021. [DOI: 10.1007/s13596-021-00554-x] [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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13
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Mosa DM. Bicipital synovial cyst as the sole musculoskeletal presentation of systemic juvenile idiopathic arthritis-case report. Mod Rheumatol Case Rep 2021; 5:246-249. [PMID: 33430713 DOI: 10.1080/24725625.2020.1869509] [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: 10/22/2022]
Abstract
To describe a unique presentation of fever and bilateral bicipital synovial cysts in young female with systemic juvenile idiopathic arthritis (SJIA). A previous healthy 5-year-old female presented with spiking fever and sudden painless bilateral swelling on the flexor aspect of the upper arm. Ultrasonography confirmed a cystic structure with multiple septae, thickening and tenosynovitis of bicipital tendon but without Doppler signals inside or shoulder synovitis, enlightens the term of non-articular synovitis. Thorough analysis of clinical manifestations, disease assessment measures, laboratory findings and imaging of arm swellings eventually disclosed unusual case of SJIA. Systemic juvenile idiopathic arthritis should be considered in case of spiking fever with bicipital synovial cysts. Ultrasound is a useful diagnostic tool in this condition.
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Affiliation(s)
- Doaa Mosad Mosa
- Rheumatology and Rehabilitation Department, Mansoura University, Mansoura City, Egypt
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14
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Maller J, Fox E, Park KT, Paul SS, Baszis K, Borocco C, Prahalad S, Quartier P, Reinhardt A, Schonenberg-Meinema D, Shipman-Duensing L, Terreri MT, Simard J, Lavi I, Chalom E, Hsu J, Zisman D, Mellins ED. Inflammatory Bowel Disease in Children With Systemic Juvenile Idiopathic Arthritis. J Rheumatol 2020; 48:567-574. [PMID: 32541073 DOI: 10.3899/jrheum.200230] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The incidence of inflammatory bowel disease (IBD) in juvenile idiopathic arthritis (JIA) is higher than in the general pediatric population. However, reports of IBD in the systemic JIA (sJIA) subtype are limited. We sought to characterize sJIA patients diagnosed with IBD and to identify potential contributing risk factors. METHODS Using an internationally distributed survey, we identified 16 patients with sJIA who were subsequently diagnosed with IBD (sJIA-IBD cohort). Five hundred twenty-two sJIA patients without IBD were identified from the CARRA Legacy Registry and served as the sJIA-only cohort for comparison. Differences in demographic, clinical characteristics, and therapy were assessed using chi-square test, Fisher exact test, t-test, and univariate and multivariate logistic regression, as appropriate. RESULTS Of the patients with sJIA-IBD, 75% had a persistent sJIA course and 25% had a history of macrophage activation syndrome. sJIA-IBD subjects were older at sJIA diagnosis, more often non-White, had a higher rate of IBD family history, and were more frequently treated with etanercept or canakinumab compared to sJIA-only subjects. Sixty-nine percent of sJIA-IBD patients successfully discontinued sJIA medications following IBD diagnosis, and sJIA symptoms resolved in 9 of 12 patients treated with tumor necrosis factor-α (TNF-α) inhibitors. CONCLUSION IBD in the setting of sJIA is a rare occurrence. The favorable response of sJIA symptoms to therapeutic TNF-α inhibition suggests that the sJIA-IBD cohort may represent a mechanistically distinct sJIA subgroup. Our study highlights the importance of maintaining a high level of suspicion for IBD when gastrointestinal involvement occurs in patients with sJIA and the likely broad benefit of TNF-α inhibition in those cases.
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Affiliation(s)
- Justine Maller
- J. Maller, MD, PhD, Department of Pediatrics, Division of Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Emily Fox
- E. Fox, MD, Department of Pediatrics, Division of Rheumatology, Stanford University School of Medicine, Stanford, California, and Department of Pediatrics, Division of Rheumatology, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, Missouri, USA
| | - K T Park
- K.T. Park, MD, Department of Pediatrics, Division of Gastroenterology, Stanford University School of Medicine, Stanford, California, USA
| | - Sarah Sertial Paul
- S. Sertial Paul, DO, Department of Pediatrics, Goryeb Children's Hospital, Morristown, New Jersey, USA
| | - Kevin Baszis
- K. Baszis, MD, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Charlotte Borocco
- C. Borocco, MD, Paris University, Imagine Institute and Pediatric Hematology-Immunology and Rheumatology Unit, Necker Hospital, AP-HP, Paris, France
| | - Sampath Prahalad
- S. Prahalad, MD, Department of Pediatrics and Department of Genetics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Pierre Quartier
- P. Quartier, MD, Paris University, Imagine Institute, RAISE Reference Centre and Pediatric Hematology-Immunology and Rheumatology Unit, Necker Hospital, AP-HP, Paris, France
| | - Adam Reinhardt
- A. Reinhardt, MD, Department of Pediatrics, Boys Town National Research Hospital, Omaha, Nebraska, USA
| | - Dieneke Schonenberg-Meinema
- D. Schonenberg-Meinema, MD, Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Amsterdam Universitair Medische Centra, Amsterdam, the Netherlands
| | - Lauren Shipman-Duensing
- L. Shipman-Duensing, MD, Department of Pediatrics, Division of Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Maria Teresa Terreri
- M.T. Terreri, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Julia Simard
- J. Simard, ScD, Department of Health Research & Policy, Division of Epidemiology, and Department of Medicine, Division of Immunology & Rheumatology, Stanford University, Stanford, California, USA
| | - Idit Lavi
- I. Lavi, MA, Department of Community Medicine and Epidemiology, Carmel Medical Center, Haifa, Israel
| | - Elizabeth Chalom
- E. Chalom, MD, Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Joyce Hsu
- J. Hsu, MD, Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, Stanford University School of Medicine, Stanford, California, USA
| | - Devy Zisman
- D. Zisman, MD, Carmel Medical Center, Rheumatology Unit, The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Elizabeth D Mellins
- E.D. Mellins, MD, Department of Pediatrics, Division of Human Gene Therapy, Program in Immunology, Stanford University School of Medicine, Stanford, California, USA.
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Vastert SJ, Jamilloux Y, Quartier P, Ohlman S, Osterling Koskinen L, Kullenberg T, Franck-Larsson K, Fautrel B, de Benedetti F. Anakinra in children and adults with Still's disease. Rheumatology (Oxford) 2020; 58:vi9-vi22. [PMID: 31769856 PMCID: PMC6878842 DOI: 10.1093/rheumatology/kez350] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/17/2019] [Indexed: 12/29/2022] Open
Abstract
Systemic juvenile idiopathic arthritis and adult-onset Still’s disease are rare autoinflammatory disorders with common features, supporting the recognition of these being one disease—Still’s disease—with different ages of onset. Anakinra was recently approved by the European Medicines Agency for Still’s disease. In this review we discuss the reasoning for considering Still’s disease as one disease and present anakinra efficacy and safety based on the available literature. The analysis of 27 studies showed that response to anakinra in Still’s disease was remarkable, with clinically inactive disease or the equivalent reported for 23–100% of patients. Glucocorticoid reduction and/or stoppage was reported universally across the studies. In studies on paediatric patients where anakinra was used early or as first-line treatment, clinically inactive disease and successful anakinra tapering/stopping occurred in >50% of patients. Overall, current data support targeted therapy with anakinra in Still’s disease since it improves clinical outcome, especially if initiated early in the disease course.
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Affiliation(s)
- Sebastiaan J Vastert
- Department of Pediatric Rheumatology and Laboratory of Translational Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Yvan Jamilloux
- Department of Internal Medicine Hospices Civils de Lyon, Croix-Rousse Hospital, Lyon, France
| | - Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit, RAISE Rare Disease Reference Centre, IMAGINE Institute, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France.,Université Paris-Descartes, Paris, France
| | | | | | | | | | - Bruno Fautrel
- Department of Rheumatology, AP-HP Pitié-Salpêtrière Hospital, Paris, France
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16
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Saper VE, Chen G, Deutsch GH, Guillerman RP, Birgmeier J, Jagadeesh K, Canna S, Schulert G, Deterding R, Xu J, Leung AN, Bouzoubaa L, Abulaban K, Baszis K, Behrens EM, Birmingham J, Casey A, Cidon M, Cron RQ, De A, De Benedetti F, Ferguson I, Fishman MP, Goodman SI, Graham TB, Grom AA, Haines K, Hazen M, Henderson LA, Ho A, Ibarra M, Inman CJ, Jerath R, Khawaja K, Kingsbury DJ, Klein-Gitelman M, Lai K, Lapidus S, Lin C, Lin J, Liptzin DR, Milojevic D, Mombourquette J, Onel K, Ozen S, Perez M, Phillippi K, Prahalad S, Radhakrishna S, Reinhardt A, Riskalla M, Rosenwasser N, Roth J, Schneider R, Schonenberg-Meinema D, Shenoi S, Smith JA, Sönmez HE, Stoll ML, Towe C, Vargas SO, Vehe RK, Young LR, Yang J, Desai T, Balise R, Lu Y, Tian L, Bejerano G, Davis MM, Khatri P, Mellins ED. Emergent high fatality lung disease in systemic juvenile arthritis. Ann Rheum Dis 2019; 78:1722-1731. [PMID: 31562126 PMCID: PMC7065839 DOI: 10.1136/annrheumdis-2019-216040] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To investigate the characteristics and risk factors of a novel parenchymal lung disease (LD), increasingly detected in systemic juvenile idiopathic arthritis (sJIA). METHODS In a multicentre retrospective study, 61 cases were investigated using physician-reported clinical information and centralised analyses of radiological, pathological and genetic data. RESULTS LD was associated with distinctive features, including acute erythematous clubbing and a high frequency of anaphylactic reactions to the interleukin (IL)-6 inhibitor, tocilizumab. Serum ferritin elevation and/or significant lymphopaenia preceded LD detection. The most prevalent chest CT pattern was septal thickening, involving the periphery of multiple lobes ± ground-glass opacities. The predominant pathology (23 of 36) was pulmonary alveolar proteinosis and/or endogenous lipoid pneumonia (PAP/ELP), with atypical features including regional involvement and concomitant vascular changes. Apparent severe delayed drug hypersensitivity occurred in some cases. The 5-year survival was 42%. Whole exome sequencing (20 of 61) did not identify a novel monogenic defect or likely causal PAP-related or macrophage activation syndrome (MAS)-related mutations. Trisomy 21 and young sJIA onset increased LD risk. Exposure to IL-1 and IL-6 inhibitors (46 of 61) was associated with multiple LD features. By several indicators, severity of sJIA was comparable in drug-exposed subjects and published sJIA cohorts. MAS at sJIA onset was increased in the drug-exposed, but was not associated with LD features. CONCLUSIONS A rare, life-threatening lung disease in sJIA is defined by a constellation of unusual clinical characteristics. The pathology, a PAP/ELP variant, suggests macrophage dysfunction. Inhibitor exposure may promote LD, independent of sJIA severity, in a small subset of treated patients. Treatment/prevention strategies are needed.
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Affiliation(s)
- Vivian E Saper
- Pediatrics, Stanford University, Stanford, California, USA
| | - Guangbo Chen
- Institute for Immunity, Transplantation and Infection, Center for Biomedical Informatics Research, Medicine, Stanford University, Stanford, California, USA
| | - Gail H Deutsch
- Pathology, Seattle Children's Hospital, Seattle, Washington, USA
- University of Washington School of Medicine, Seattle, Washington, USA
| | | | | | | | - Scott Canna
- Pediatrics, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Grant Schulert
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robin Deterding
- Children's Hospital Colorado, Aurora, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jianpeng Xu
- Pediatrics, Stanford University, Stanford, California, USA
| | - Ann N Leung
- Radiology, Stanford University, Stanford, California, USA
| | - Layla Bouzoubaa
- Public Health Services, Biostatistics, University of Miami School of Medicine, Miami, Florida, USA
| | - Khalid Abulaban
- Helen DeVos Children's Hospital, Grand Rapids, Michigan, USA
- Michigan State University, East Lansing, Michigan, USA
| | - Kevin Baszis
- Pediatrics, Washington University in Saint Louis, Saint Louis, Missouri, USA
| | - Edward M Behrens
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James Birmingham
- Medicine, Metro Health Hospital, Wyoming, Michigan, USA
- University of Michigan, Ann Arbor, Michigan, USA
| | - Alicia Casey
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Michal Cidon
- Pediatrics, Children's Hospital of Los Angeles, Los Angeles, California, USA
- University of Southern California, Los Angeles, California, USA
| | - Randy Q Cron
- Children's of Alabama, Birmingham, Alabama, USA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Aliva De
- Pediatrics, Columbia University Medical Center, New York, New York, USA
| | | | - Ian Ferguson
- Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Martha P Fishman
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Steven I Goodman
- Arthritis Associates of South Florida, Delray Beach, Florida, USA
| | - T Brent Graham
- Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Alexei A Grom
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Kathleen Haines
- Joseph M Sanzari Children's Hospital, Hackensack, New Jersey, USA
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Melissa Hazen
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren A Henderson
- Boston Children's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Assunta Ho
- Pediatrics, Prince of Wales Hospital, New Territories, Hong Kong
- Faculty of Medicine, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Maria Ibarra
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- School of Medicine, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Christi J Inman
- Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Rita Jerath
- Children's Hospital of Georgia, Augusta, Georgia, USA
- Augusta University, Augusta, Georgia, USA
| | - Khulood Khawaja
- Pediatrics, Al Mafraq Hospital, Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | - Marisa Klein-Gitelman
- Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Khanh Lai
- Pediatrics, University of Utah Health Sciences Center, Salt Lake City, Utah, USA
| | - Sivia Lapidus
- Joseph M Sanzari Children's Hospital, Hackensack, New Jersey, USA
- Hackensack University Medical Center, Hackensack, New Jersey, USA
| | - Clara Lin
- Children's Hospital Colorado, Aurora, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jenny Lin
- Children's Hospital at Montefiore, Bronx, New York, USA
- Yeshiva University Albert Einstein College of Medicine, Bronx, New York, USA
| | - Deborah R Liptzin
- Children's Hospital Colorado, Aurora, Colorado, USA
- University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Diana Milojevic
- Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
| | - Joy Mombourquette
- Pediatrics, Kaiser Permanente Roseville Medical Center, Roseville, California, USA
| | - Karen Onel
- Pediatrics, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Seza Ozen
- Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Maria Perez
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Kathryn Phillippi
- Akron Children's Hospital, Akron, Ohio, USA
- Northeast Ohio Medical University, Rootstown, Ohio, USA
| | - Sampath Prahalad
- Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Suhas Radhakrishna
- Rady Children's Hospital, San Diego, California, USA
- Pediatrics, University of California San Diego, La Jolla, California, USA
| | - Adam Reinhardt
- Pediatrics, University of Nebraska Medical Center College of Medicine, Omaha, Nebraska, USA
| | - Mona Riskalla
- Pediatrics, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Natalie Rosenwasser
- Pediatrics, Hospital for Special Surgery, New York, New York, USA
- Weill Cornell Medical College, New York, New York, USA
| | - Johannes Roth
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Rayfel Schneider
- Hospital for Sick Children, Toronto, Ontario, Canada
- Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Dieneke Schonenberg-Meinema
- Emma Children's Hospital AMC, Amsterdam, The Netherlands
- University of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Susan Shenoi
- University of Washington School of Medicine, Seattle, Washington, USA
- Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Judith A Smith
- Pediatrics, University of Wisconsin Madison School of Medicine and Public Health, Madison, Wisconsin, USA
| | | | - Matthew L Stoll
- Children's of Alabama, Birmingham, Alabama, USA
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christopher Towe
- Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sara O Vargas
- Harvard Medical School, Boston, Massachusetts, USA
- Pathology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Richard K Vehe
- Pediatrics, University of Minnesota Medical School Twin Cities, Minneapolis, Minnesota, USA
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
| | - Lisa R Young
- Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacqueline Yang
- Institute for Immunity, Transplantation and Infection, Center for Biomedical Informatics Research, Medicine, Stanford University, Stanford, California, USA
| | - Tushar Desai
- Medicine, Institute for Stem Cell Biology and Regenerative Medicine, Stanford University, Stanford, California, USA
| | - Raymond Balise
- Public Health Services, Biostatistics, University of Miami School of Medicine, Miami, Florida, USA
| | - Ying Lu
- Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Lu Tian
- Biomedical Data Science, Stanford University, Stanford, California, USA
| | - Gill Bejerano
- Genetics, Stanford University, Stanford, California, USA
| | - Mark M Davis
- Institute for Immunity, Transplantation and Infection, Microbiology and Immunology, Stanford University, Stanford, California, USA
| | - Purvesh Khatri
- Institute for Immunity, Transplantation and Infection, Center for Biomedical Informatics Research, Medicine, Stanford University, Stanford, California, USA
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Yazılıtaş F, Özdel S, Şimşek D, Aydoğ Ö, Çakıcı EK, Can GG, Güngör T, Bülbül M. Tocilizumab for juvenile idiopathic arthritis: a single-center case series. SAO PAULO MED J 2019; 137:517-522. [PMID: 32159638 PMCID: PMC9754278 DOI: 10.1590/1516-3180.2018.0489220719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 07/22/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the commonest chronic rheumatic disease among children. When not treated effectively, JIA can lead to functional disability, due to joint damage, along with long-term morbidities. OBJECTIVES To describe the use of tocilizumab therapy for 11 patients with polyarticular JIA (pJIA) and systemic JIA (sJIA) who presented inadequate response or were refractory to disease-modifying anti-rheumatic drugs (DMARDs) and/or other biological therapies; and to evaluate its benefits, safety and tolerability. DESIGN AND SETTING Observational retrospective case series at a tertiary-level training and research hospital. METHODS We reviewed the medical records of 11 consecutive patients with JIA who received tocilizumab (anti-IL-6) therapy in our pediatric nephrology and rheumatology outpatient clinic. We analyzed their demographic data, clinical and laboratory findings, treatment response and adverse reactions. We determined the efficacy of tocilizumab treatment using the American College of Rheumatology (ACR) pediatric (Pedi) response criteria, including ACR Pedi 30, 50, 70 and 90 scores. We used the Wilcoxon test to compare measurements before and after treatment. RESULTS Tocilizumab was given to seven patients with sJIA and four with pJIA (one of the pJIA patients was rheumatoid factor-positive). In most patients, we observed improvement of symptoms, absence of articular and extra-articular inflammation and continued inactive disease. ACR Pedi 30, 50 and 70 scores were achieved by 90.9% of the patients. Five patients showed minor side effects, possibly due to use of tocilizumab. CONCLUSIONS Tocilizumab therapy should be considered for treating patients with diagnoses of pJIA or sJIA who are resistant to non-biological DMARDs and/or other biological therapies.
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Affiliation(s)
- Fatma Yazılıtaş
- MD. Physician and Pediatric Nephrologist, Department of Pediatric Nephrology, Dr. Sami Ulus Kadin Doğum Çocuk Sağliği ve Hastaliklari Eğitim ve Araştirma Hastanesi, Sağlik Bilimleri Üniversitesi, Ankara, Turkey.
| | - Semanur Özdel
- MD. Physician and Pediatric Rheumatologist, Department of Pediatric Rheumatology, Dr. Sami Ulus Kadin Doğum Çocuk Sağliği ve Hastaliklari Eğitim ve Araştirma Hastanesi, Sağlik Bilimleri Üniversitesi, Ankara, Turkey.
| | - Doğan Şimşek
- MD. Physician and Pediatric Rheumatologist, Department of Pediatric Rheumatology, Dr. Sami Ulus Kadin Doğum Çocuk Sağliği ve Hastaliklari Eğitim ve Araştirma Hastanesi, Sağlik Bilimleri Üniversitesi, Ankara, Turkey.
| | - Özlem Aydoğ
- MD. Physician, Professor, Pediatric Nephrologist and Rheumatologist, Department of Pediatric Nephrology and Rheumatology, Ondokuz Mayis Üniversitesi Tip Fakültesi, Samsun, Turkey.
| | - Evrim Kargın Çakıcı
- MD. Physician and Pediatric Nephrologist, Department of Pediatric Nephrology, Dr. Sami Ulus Kadin Doğum Çocuk Sağliği ve Hastaliklari Eğitim ve Araştirma Hastanesi, Sağlik Bilimleri Üniversitesi, Ankara, Turkey.
| | - Gökçe Gür Can
- MD. Physician and Pediatric Nephrologist, Department of Pediatric Nephrology, Dr. Sami Ulus Kadin Doğum Çocuk Sağliği ve Hastaliklari Eğitim ve Araştirma Hastanesi, Sağlik Bilimleri Üniversitesi, Ankara, Turkey.
| | - Tülin Güngör
- MD. Physician and Pediatric Nephrologist, Department of Pediatric Nephrology, Dr. Sami Ulus Kadin Doğum Çocuk Sağliği ve Hastaliklari Eğitim ve Araştirma Hastanesi, Sağlik Bilimleri Üniversitesi, Ankara, Turkey.
| | - Mehmet Bülbül
- MD. Physician, Professor, Pediatric Nephrologist and Rheumatologist, Department of Pediatric Nephrology and Rheumatology, Dr. Sami Ulus Kadin Doğum Çocuk Sağliği ve Hastaliklari Eğitim ve Araştirma Hastanesi, Sağlik Bilimleri Üniversitesi, Ankara, Turkey.
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Kudela H, Drynda S, Lux A, Horneff G, Kekow J. Comparative study of Interleukin-18 (IL-18) serum levels in adult onset Still's disease (AOSD) and systemic onset juvenile idiopathic arthritis (sJIA) and its use as a biomarker for diagnosis and evaluation of disease activity. BMC Rheumatol 2019; 3:4. [PMID: 30886992 PMCID: PMC6394042 DOI: 10.1186/s41927-019-0053-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 01/25/2019] [Indexed: 12/29/2022] Open
Abstract
Background Signs and symptoms establish the diagnosis of adult onset Still’s disease (AOSD) as well as of systemic onset juvenile idiopathic arthritis (sJIA). The published data regarding the importance of IL-18 as a marker for diagnosis and disease activity so far are conflicting. The aim of this study was to clarify the role of IL-18 as a diagnostic and disease activity marker in AOSD and sJIA. Methods Thirty adult patients diagnosed with AOSD and twenty children diagnosed with sJIA were included in the study. Clinical and laboratory data were obtained retrospectively for each patient visit whenever IL-18 serum levels were determined. IL-18 levels were determined by ELISA. Sixty-five adults and twenty-three children presenting with fever and/or arthritis who did not meet the criteria for a diagnosis of AOSD or sJIA served as comparison groups. Rau’s criteria and CRP values were used to evaluate disease activity. Results IL-18 levels were significantly elevated in patients with active AOSD compared to AOSD patients in remission and to the comparison group with a median of 16,327 pg/ml, 470 pg/ml, and 368 pg/ml, respectively (p < 0.001). Analogous to AOSD in active sJIA, the median IL-18 serum level was significantly higher with 21,512 pg/ml than in the comparison group with 2580 pg/ml (p < 0.001). At our cut-off point of 5000 pg/ml, the calculated specificity of IL-18 to establish the diagnosis of AOSD was 96.9%, and the sensitivity 63.3% (AUC = 0.870, p < 0.001). For the diagnosis of sJIA, a cut-off value of 10,000 pg/ml was chosen with a specificity of 100% and a sensitivity of 60% (AUC = 0.774, p = 0.003). At a cut-off value of 5000 pg/ml, the specificity was 62% and the sensitivity 65%. Conclusions This study gives further evidence to earlier publications of elevated IL-18 serum levels in active AOSD and sJIA, with up to 1000-fold higher concentrations compared to other rheumatic diseases. A clear association of IL-18 serum levels with disease activity in AOSD was found. The results support the use of IL-18 as an important biomarker in AOSD and sJIA. Electronic supplementary material The online version of this article (10.1186/s41927-019-0053-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Holger Kudela
- 1Clinic of Rheumatology, University of Magdeburg, Sophie-von-Boetticher-Strasse 1, 39245 Vogelsang-Gommern, Germany
| | - Susanne Drynda
- 1Clinic of Rheumatology, University of Magdeburg, Sophie-von-Boetticher-Strasse 1, 39245 Vogelsang-Gommern, Germany
| | - Anke Lux
- 2Institute for Biometry and Medical Informatics, University of Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany
| | - Gerd Horneff
- Department of General Pediatrics, Asklepios Clinic Sankt Augustin, Arnold-Janssen Strasse 29, 53757 Sankt Augustin, Germany.,4Department of Pediatric and Adolescents medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Joern Kekow
- 1Clinic of Rheumatology, University of Magdeburg, Sophie-von-Boetticher-Strasse 1, 39245 Vogelsang-Gommern, Germany
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19
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Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a distinctive subtype of juvenile idiopathic arthritis, characterized by fever and arthritis, often accompanied by rash, sometimes by generalized lymphadenopathy, hepatosplenomegaly, and serositis. The diagnosis requires adequate exclusion of infectious, oncologic, autoimmune, and autoinflammatory diseases. Macrophage activation syndrome, a serious and potentially fatal complication of sJIA, requires prompt evaluation and treatment. Newer biologic agents, particularly interleukin-1 and interleukin-6 inhibitors, are highly effective and have transformed the treatment approach by reducing the use of systemic glucocorticoids. Primary care providers have a crucial role in monitoring children with sJIA for disease-related complications and medication-related adverse events.
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Affiliation(s)
- Jennifer J Y Lee
- Department of Paediatrics, Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Rayfel Schneider
- Department of Paediatrics, Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
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20
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Cepika AM, Banchereau R, Segura E, Ohouo M, Cantarel B, Goller K, Cantrell V, Ruchaud E, Gatewood E, Nguyen P, Gu J, Anguiano E, Zurawski S, Baisch JM, Punaro M, Baldwin N, Obermoser G, Palucka K, Banchereau J, Amigorena S, Pascual V. A multidimensional blood stimulation assay reveals immune alterations underlying systemic juvenile idiopathic arthritis. J Exp Med 2017; 214:3449-3466. [PMID: 28935693 PMCID: PMC5679164 DOI: 10.1084/jem.20170412] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/25/2017] [Accepted: 09/08/2017] [Indexed: 12/26/2022] Open
Abstract
The etiology of autoinflammation in systemic juvenile idiopathic arthritis is unclear. Cepika et al. use integrated analysis of multidimensional blood stimulation data, applied to patients while off treatment and in complete remission, to reveal underlying cellular and molecular mechanisms that might predispose to disease. The etiology of sporadic human chronic inflammatory diseases remains mostly unknown. To fill this gap, we developed a strategy that simultaneously integrates blood leukocyte responses to innate stimuli at the transcriptional, cellular, and secreted protein levels. When applied to systemic juvenile idiopathic arthritis (sJIA), an autoinflammatory disease of unknown etiology, this approach identified gene sets associated with specific cytokine environments and activated leukocyte subsets. During disease remission and off treatment, sJIA patients displayed dysregulated responses to TLR4, TLR8, and TLR7 stimulation. Isolated sJIA monocytes underexpressed the IL-1 inhibitor aryl hydrocarbon receptor (AHR) at baseline and accumulated higher levels of intracellular IL-1β after stimulation. Supporting the demonstration that AHR down-regulation skews monocytes toward macrophage differentiation, sJIA monocytes differentiated in vitro toward macrophages, away from the dendritic cell phenotype. This might contribute to the increased incidence of macrophage activation syndrome in these patients. Integrated analysis of high-dimensional data can thus unravel immune alterations predisposing to complex inflammatory diseases.
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Affiliation(s)
| | | | - Elodie Segura
- Institut National de la Santé et de la Recherche Medicale U932, Institut Curie, PSL Research University, Paris, France
| | - Marina Ohouo
- Baylor Institute for Immunology Research, Dallas, TX
| | | | | | | | - Emily Ruchaud
- Baylor Institute for Immunology Research, Dallas, TX
| | | | - Phuong Nguyen
- Baylor Institute for Immunology Research, Dallas, TX
| | - Jinghua Gu
- Baylor Institute for Immunology Research, Dallas, TX
| | | | | | | | | | | | | | - Karolina Palucka
- Baylor Institute for Immunology Research, Dallas, TX.,The Jackson Laboratory for Genomic Medicine, Farmington, CT
| | | | - Sebastian Amigorena
- Institut National de la Santé et de la Recherche Medicale U932, Institut Curie, PSL Research University, Paris, France
| | - Virginia Pascual
- Baylor Institute for Immunology Research, Dallas, TX .,University of Texas Southwestern Medical Center, Dallas, TX.,Texas Scottish Rite Hospital for Children, Dallas, TX
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21
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Xia Y, Cui P, Li Q, Liang F, Li C, Yang J. Extremely elevated IL-18 levels may help distinguish systemic-onset juvenile idiopathic arthritis from other febrile diseases. ACTA ACUST UNITED AC 2017; 50:e5958. [PMID: 28225869 PMCID: PMC5343556 DOI: 10.1590/1414-431x20165958] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 11/22/2016] [Indexed: 12/20/2022]
Abstract
The aim of this research was to explore whether IL-18 can be a serological marker for the diagnosis of systemic-onset juvenile idiopathic arthritis (sJIA). A total of 23 sJIA patients (13 males, median age 8.2), 20 acute lymphoblastic leukemia (ALL) patients, 18 patients with severe infections (SIF), 26 Kawasaki disease (KD) patients, 18 juvenile idiopathic arthritis (JIA) patients, and 25 healthy control patients were selected for this study. Enzyme-linked immunosorbent assays (ELISAs) were used to determine the serum concentrations of the S100A8, S100A9, and IL-6 proteins. The serum IL-18 levels were detected by a cytometric bead array (CBA). The serum IL-6 concentrations in various disease groups were significantly higher than that in the healthy control group. The IL-6 concentrations exhibited no significant difference between disease groups. The S100A8 level in the sJIA group was significantly higher than those of the ALL, JIA, and healthy control groups but showed no significant difference compared to the SIF and KD groups. The S100A9 serum concentration in the sJIA group was significantly higher than those in the ALL and healthy control groups and exhibited no significant difference from the SIF, KD, and JIA groups. The IL-18 level of the sJIA group was significantly higher than that of the other febrile disease groups. The IL-18 serum concentration may be used as a biological serum marker to distinguish sJIA from other febrile diseases.
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Affiliation(s)
- Y Xia
- Department of Rheumatology, Shenzhen Children's Hospital, Shenzhen, Guangzhou, China
| | - P Cui
- Department of Rheumatology, Shenzhen Children's Hospital, Shenzhen, Guangzhou, China
| | - Q Li
- Department of Rheumatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - F Liang
- Department of Rheumatology, Shenzhen Children's Hospital, Shenzhen, Guangzhou, China
| | - C Li
- Department of Rheumatology, Shenzhen Children's Hospital, Shenzhen, Guangzhou, China
| | - J Yang
- Department of Rheumatology, Shenzhen Children's Hospital, Shenzhen, Guangzhou, China
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22
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Herberg JA, Kaforou M, Wright VJ, Shailes H, Eleftherohorinou H, Hoggart CJ, Cebey-Lopez M, Carter MJ, Janes VA, Gormley S, Shimizu C, Tremoulet AH, Barendregt AM, Salas A, Kanegaye J, Pollard AJ, Faust SN, Patel S, Kuijpers T, Martinon-Torres F, Burns JC, Coin LJM, Levin M. Diagnostic Test Accuracy of a 2-Transcript Host RNA Signature for Discriminating Bacterial vs Viral Infection in Febrile Children. JAMA 2016; 316:835-45. [PMID: 27552617 PMCID: PMC5997174 DOI: 10.1001/jama.2016.11236] [Citation(s) in RCA: 208] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
IMPORTANCE Because clinical features do not reliably distinguish bacterial from viral infection, many children worldwide receive unnecessary antibiotic treatment, while bacterial infection is missed in others. OBJECTIVE To identify a blood RNA expression signature that distinguishes bacterial from viral infection in febrile children. DESIGN, SETTING, AND PARTICIPANTS Febrile children presenting to participating hospitals in the United Kingdom, Spain, the Netherlands, and the United States between 2009-2013 were prospectively recruited, comprising a discovery group and validation group. Each group was classified after microbiological investigation as having definite bacterial infection, definite viral infection, or indeterminate infection. RNA expression signatures distinguishing definite bacterial from viral infection were identified in the discovery group and diagnostic performance assessed in the validation group. Additional validation was undertaken in separate studies of children with meningococcal disease (n = 24) and inflammatory diseases (n = 48) and on published gene expression datasets. EXPOSURES A 2-transcript RNA expression signature distinguishing bacterial infection from viral infection was evaluated against clinical and microbiological diagnosis. MAIN OUTCOMES AND MEASURES Definite bacterial and viral infection was confirmed by culture or molecular detection of the pathogens. Performance of the RNA signature was evaluated in the definite bacterial and viral group and in the indeterminate infection group. RESULTS The discovery group of 240 children (median age, 19 months; 62% male) included 52 with definite bacterial infection, of whom 36 (69%) required intensive care, and 92 with definite viral infection, of whom 32 (35%) required intensive care. Ninety-six children had indeterminate infection. Analysis of RNA expression data identified a 38-transcript signature distinguishing bacterial from viral infection. A smaller (2-transcript) signature (FAM89A and IFI44L) was identified by removing highly correlated transcripts. When this 2-transcript signature was implemented as a disease risk score in the validation group (130 children, with 23 definite bacterial, 28 definite viral, and 79 indeterminate infections; median age, 17 months; 57% male), all 23 patients with microbiologically confirmed definite bacterial infection were classified as bacterial (sensitivity, 100% [95% CI, 100%-100%]) and 27 of 28 patients with definite viral infection were classified as viral (specificity, 96.4% [95% CI, 89.3%-100%]). When applied to additional validation datasets from patients with meningococcal and inflammatory diseases, bacterial infection was identified with a sensitivity of 91.7% (95% CI, 79.2%-100%) and 90.0% (95% CI, 70.0%-100%), respectively, and with specificity of 96.0% (95% CI, 88.0%-100%) and 95.8% (95% CI, 89.6%-100%). Of the children in the indeterminate groups, 46.3% (63/136) were classified as having bacterial infection, although 94.9% (129/136) received antibiotic treatment. CONCLUSIONS AND RELEVANCE This study provides preliminary data regarding test accuracy of a 2-transcript host RNA signature discriminating bacterial from viral infection in febrile children. Further studies are needed in diverse groups of patients to assess accuracy and clinical utility of this test in different clinical settings.
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Affiliation(s)
- Jethro A Herberg
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Myrsini Kaforou
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Victoria J Wright
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Hannah Shailes
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Hariklia Eleftherohorinou
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Clive J Hoggart
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Miriam Cebey-Lopez
- Translational Paediatrics and Infectious Diseases section, Department of Paediatrics, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Galicia, Spain, and Grupo de Investigación en Genética, Vacunas, Infecciones y Pediatría (GENVIP), Healthcare research Institute of Santiago de Compostela and Universidade de Santiago de Compostela, Spain
| | - Michael J Carter
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Victoria A Janes
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Stuart Gormley
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
| | - Chisato Shimizu
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Adriana H Tremoulet
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Anouk M Barendregt
- Emma Children’s Hospital, Department of Paediatric Haematology, Immunology & Infectious Disease, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Antonio Salas
- Translational Paediatrics and Infectious Diseases section, Department of Paediatrics, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Galicia, Spain, and Grupo de Investigación en Genética, Vacunas, Infecciones y Pediatría (GENVIP), Healthcare research Institute of Santiago de Compostela and Universidade de Santiago de Compostela, Spain
- Unidade de Xenética, Departamento de Anatomía Patolóxica e Ciencias Forenses, and Instituto de Ciencias Forenses, Grupo de Medicina Xenómica, Spain
| | - John Kanegaye
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Andrew J Pollard
- Department of Paediatrics, University of Oxford and the NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Saul N Faust
- NIHR Wellcome Trust Clinical Research Facility, University of Southampton UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sanjay Patel
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Taco Kuijpers
- Emma Children’s Hospital, Department of Paediatric Haematology, Immunology & Infectious Disease, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Sanquin Research and Landsteiner Laboratory, Department of Blood Cell Research, Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Federico Martinon-Torres
- Translational Paediatrics and Infectious Diseases section, Department of Paediatrics, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Galicia, Spain, and Grupo de Investigación en Genética, Vacunas, Infecciones y Pediatría (GENVIP), Healthcare research Institute of Santiago de Compostela and Universidade de Santiago de Compostela, Spain
| | - Jane C Burns
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
- Rady Children’s Hospital San Diego, San Diego, California, USA
| | - Lachlan JM Coin
- Institute for Molecular Bioscience, University of Queensland, St Lucia, Queensland, Australia
| | - Michael Levin
- Section of Paediatrics, Division of Infectious Diseases, Department of Medicine, Imperial College London, London W2 1PG, UK
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Batu ED. Biologic therapies in systemic juvenile idiopathic arthritis. Expert Opin Orphan Drugs 2016. [DOI: 10.1080/21678707.2016.1177511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ezgi Deniz Batu
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Jain D, Aggarwal HK, Rao A, Mittal A, Jain P. Macrophage activation syndrome in a patient with systemic onset of the juvenile idiopathic arthritis. Reumatologia 2016; 54:42-7. [PMID: 27407277 PMCID: PMC4847331 DOI: 10.5114/reum.2016.58763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 02/27/2016] [Indexed: 11/30/2022] Open
Abstract
Systemic onset juvenile idiopathic arthritis (sJIA) is defined as arthritis affecting one or more joint usually in the juvenile age group (< 16 years of age) with or preceded by fever of at least 2 weeks duration that is documented to be daily ("quotidian") for at least 3 days which may be associated with evanescent (non-fixed) erythematous rash or generalized lymph node enlargement or hepatomegaly/splenomegaly/both or serositis. Macrophage activation syndrome (MAS) is a life-threatening complication of sJIA marked by sudden onset of non-remitting high fever, profound depression in all three blood cell lines (i.e. leukopenia, anemia, and thrombocytopenia), hepatosplenomegaly, lymphadenopathy, and elevated serum liver enzyme levels. In children with systemic juvenile idiopathic arthritis, the clinical picture may mimic sepsis or an exacerbation of the underlying disease. We report a case of a 16-year-old female patient presenting with high grade fever with joint pains and generalized weakness which proved to be systemic onset juvenile idiopathic arthritis with macrophage activation syndrome after ruling out all other differential diagnoses and responded well to intravenous steroids.
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Affiliation(s)
- Deepak Jain
- Pt B D Sharma University of Health Sciences, Rohtak, India
| | | | - Avinash Rao
- Pt B D Sharma University of Health Sciences, Rohtak, India
| | - Anshul Mittal
- Pt B D Sharma University of Health Sciences, Rohtak, India
| | - Promil Jain
- Pt B D Sharma University of Health Sciences, Rohtak, India
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25
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Yokota S, Itoh Y, Morio T, Origasa H, Sumitomo N, Tomobe M, Tanaka K, Minota S. Tocilizumab in systemic juvenile idiopathic arthritis in a real-world clinical setting: results from 1 year of postmarketing surveillance follow-up of 417 patients in Japan. Ann Rheum Dis 2015; 75:1654-60. [PMID: 26644233 PMCID: PMC5013079 DOI: 10.1136/annrheumdis-2015-207818] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 10/03/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate the safety and effectiveness of tocilizumab (TCZ) in patients with systemic juvenile idiopathic arthritis (sJIA) in real-world clinical settings in Japan. METHODS Paediatric patients with sJIA initiating TCZ between April 2008 and February 2012 and those previously enrolled in clinical trials who initiated TCZ before April 2008 were enrolled in a Japanese registry surveillance programme. Safety and effectiveness parameters were collected for 52 weeks. RESULTS Of 417 patients enrolled, mean age was 11.2 years and 48.0% were female. TCZ exposure was 407.0 patient-years (PYs). Baseline corticosteroid use was higher than in clinical trials. Rates of total adverse events (AEs) and serious AEs (SAEs) were 224.3/100 PYs and 54.5/100 PYs, respectively, with SAEs higher than previously reported. The most frequent AEs and SAEs were infections and infestations (69.8/100 PYs and 18.2/100 PYs, respectively). 74 serious infections occurred in 55 patients (18.2/100 PYs); higher than previously reported. 26 macrophage activation syndrome events were reported in 24 patients (6.4/100 PYs). Fever and rash symptoms improved from baseline to week 52 (54.6% to 5.6% and 43.0% to 5.6%, respectively). At 4 weeks, 8 weeks and 52 weeks, 90.5%, 96.2% and 99.0% of patients achieved normal C reactive protein levels (<0.3 mg/dL), respectively. CONCLUSIONS These first real-world data demonstrated that TCZ was well tolerated, with acceptable safety and effectiveness in patients with sJIA. Higher incidences of SAEs and serious infections may be due to differences, such as corticosteroid use and concomitant diseases, between patient populations enrolled in previously reported clinical trials and this study.
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Affiliation(s)
- Shumpei Yokota
- Chugai Tocilizumab JIA Safety Evaluation Comittee, Kanagawa, Japan Yokohama City University School of Medicine, Kanagawa, Japan
| | - Yasuhiko Itoh
- Chugai Tocilizumab JIA Safety Evaluation Comittee, Kanagawa, Japan Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Tomohiro Morio
- Chugai Tocilizumab JIA Safety Evaluation Comittee, Kanagawa, Japan Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideki Origasa
- Chugai Tocilizumab JIA Safety Evaluation Comittee, Kanagawa, Japan Division of Biostatistics and Clinical Epidemiology, University of Toyama School of Medicine, Toyama, Japan
| | - Naokata Sumitomo
- Chugai Tocilizumab JIA Safety Evaluation Comittee, Kanagawa, Japan Saitama International Medical Center, Saitama, Japan
| | | | | | - Seiji Minota
- Chugai Tocilizumab JIA Safety Evaluation Comittee, Kanagawa, Japan Jichi Medical School, Tochigi, Japan
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Consensus of the Spanish society of pediatric rheumatology for transition management from pediatric to adult care in rheumatic patients with childhood onset. Rheumatol Int 2015; 35:1615-24. [PMID: 25917856 DOI: 10.1007/s00296-015-3273-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 04/16/2015] [Indexed: 10/23/2022]
Abstract
To develop recommendations on the transition from pediatric care to adult care in patients with chronic inflammatory rheumatic diseases with childhood onset based. Recommendations were generated following nominal group methodology and Delphi technique. A panel of 16 experts was established. A systematic literature review (on transitional care) and a narrative review were performed and presented to the panel in the first panel meeting to be discussed. A first draft of recommendations was generated and circulated. Focal groups with adolescents, young adults and parents were organized. In a second meeting, the focus group results along with the input from invited psychologist were used to establish definitive recommendations. Then, a Delphi process (two rounds) was carried out. A group of 72 pediatric and adult rheumatologists took part. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70 % voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford center for evidence-based medicine levels of evidence. Transition care was defined as a purposeful, planned process that addresses the medical, psychosocial and educational/vocational needs of adolescents and young adults with chronic inflammatory rheumatic diseases with childhood onset as they move from child-centered to adult-oriented healthcare systems. The consensus covers: transition needs, barriers and facilitators, transitional issues (objectives, participants, content, phases, timing, plans, documentation and responsibilities), physicians' and other health professionals' knowledge and skill requirements, models/programs, and strategies and guideline for implementation. Preliminary recommendations and agreement grade are shown in the Table (first Delphi round). These recommendations are intended to provide health professionals, patients, families and other stakeholders with a consensus on the transition process from pediatric to adult care.
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Hoy SM. Canakinumab: A Review of Its Use in the Management of Systemic Juvenile Idiopathic Arthritis. BioDrugs 2015; 29:133-42. [DOI: 10.1007/s40259-015-0123-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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28
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Kostik MM, Dubko MF, Masalova VV, Snegireva LS, Kornishina TL, Chikova IA, Isupova EA, Kuchinskaya EM, Glebova NI, Buchinskaya NV, Kalashnikova OV, Chasnyk VG. Successful treatment with tocilizumab every 4 weeks of a low disease activity group who achieve a drug-free remission in patients with systemic-onset juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2015; 13:4. [PMID: 25685108 PMCID: PMC4328569 DOI: 10.1186/1546-0096-13-4] [Citation(s) in RCA: 9] [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: 05/07/2014] [Accepted: 01/15/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Systemic juvenile idiopathic arthritis (SoJIA) is the most striking form of juvenile idiopathic arthritis. The aim of our study was to evaluate the clinical responses and outcomes of children with SoJIA to IL-6 blockade using two different tocilizumab (TCZ) treatment protocols designed for milder and more severe SoJIA patient groups, and evaluate the possibility of achieving biologic-free remission. METHODS Thirty-seven active SoJIA children who have failed treatment with corticosteroids and other DMARDs were included in our retrospective study. TCZ doses were prescribed in two treatment approaches: every 2 weeks TCZ dosing (Q2W) and every 4 weeks TCZ dosing (Q4W). The patients were assigned to these two groups by the study physicians depending on the severity of the SoJIA disease as judged by each clinician. RESULTS Thirty-three of the 37 children successfully completed the trial. TCZ was discontinued in 11patients during the trial. Seven children achieved inactive disease and were allowed to stop the TCZ and 4 had severe adverse events requiring drug cessation. Currently 7 patients continue to have TCZ-free remission [4/7 remission off-medication, 3/7still on methotrexate (MTX)]. This mixed group had a median treatment duration of 1002 days. The children in remission off of all medications, TCZ and MTX, had a median remission duration of 1162 days (ranged 932-1301 days). Compared to the patients assigned to the Q2W TCZ treatment group, the patients assigned to the Q4W TCZ group had a milder SoJIA course. The patients had higher levels of hemoglobin, total proteins, and serum albumins. They had lower white blood cell counts (WBC), % granulocytes, CRP, ESR, ferritins, and LDH. These children had a lower frequency of internal organ involvement, fewer relapses during TCZ treatment, and no macrophage activation syndrome episodes. CONCLUSIONS Our experience with TCZ for SoJIA supports the excellent result of other studies. What may be novel is our finding that thisIL-6 blockade with TCZ may be able to be utilized at a less frequent dosing schedule in mild SoJIA compared to severe SoJIA. We discuss other factors that may increase the probability of a patient reaching TCZ-free remission.
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Affiliation(s)
- Mikhail M Kostik
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Margarita F Dubko
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Vera V Masalova
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Ludmila S Snegireva
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Tatyana L Kornishina
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Irina A Chikova
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Eugenia A Isupova
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Ekaterina M Kuchinskaya
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Natalia I Glebova
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Natalia V Buchinskaya
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Olga V Kalashnikova
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
| | - Vyacheslav G Chasnyk
- Hospital Pediatric Department, Saint-Petersburg State Pediatric Medical University, Lytovskaya 2, Saint-Petersburg, 194100 Russia
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Clinical features of juvenile idiopathic arthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00101-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Herlin T. Tocilizumab for the treatment of systemic juvenile idiopathic arthritis. Expert Rev Clin Immunol 2014; 8:517-25. [DOI: 10.1586/eci.12.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tugal-Tutkun I, Quartier P, Bodaghi B. Disease of the year: juvenile idiopathic arthritis-associated uveitis--classification and diagnostic approach. Ocul Immunol Inflamm 2014; 22:56-63. [PMID: 24410427 DOI: 10.3109/09273948.2013.871565] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease and the most common systemic association of uveitis in children. JIA is subdivided into seven clinically more homogeneous subtypes, using the International League of Associations for Rheumatology (ILAR) classification system: systemic arthritis, oligoarthritis, rheumatoid factor (RF)-negative polyarthritis, RF-positive polyarthritis, psoriatic arthritis, enthesitis-related arthritis, and undifferentiated arthritis. Uveitis is very rare in patients with systemic onset JIA and in patients with juvenile-onset rheumatoid arthritis. Patients with early-onset antinuclear antibody (ANA)-positive oligoarticular JIA have the highest risk of developing chronic iridocyclitis. Ocular involvement in enthesitis-related arthritis is characterized by recurrent acute symptomatic iridocyclitis. The diagnosis and differential diagnosis of JIA are based on history, physical examination, and laboratory investigations, including complete blood count, acute-phase reactants, ANA, RF, HLA-B27, and musculoskeletal imaging studies. Recent studies have revealed distinct gene expression profiles that may be useful in the diagnosis, classification, and follow-up of JIA patients.
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Affiliation(s)
- Ilknur Tugal-Tutkun
- Department of Ophthalmology, Istanbul University, Istanbul Faculty of Medicine , Istanbul , Turkey
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Abstract
Tocilizumab (RoActemra(®); Actemra(®)) is a recombinant humanized monoclonal antibody that acts as an interleukin-6 receptor antagonist. Both in the US and EU, tocilizumab has been approved for the treatment of two subtypes of juvenile idiopathic arthritis (JIA), namely systemic JIA (sJIA) and polyarticular JIA (pJIA), in patients aged ≥2 years. These approvals are based on favorable results from two randomized, double-blind, placebo-controlled, multinational, phase III trials in which patients aged 2-17 years with active sJIA (TENDER) or pJIA (CHERISH) received an intravenous dose of tocilizumab based on bodyweight every 2 or 4 weeks, respectively. Tocilizumab met the primary endpoint in both of these ongoing, multi-part studies. That is, in TENDER, significantly more tocilizumab recipients than placebo recipients achieved a JIA American College of Rheumatology (ACR) 30 response plus absence of fever, as assessed at the end of a 12-week double-blind treatment period, while in CHERISH, significantly fewer tocilizumab recipients than placebo recipients experienced a JIA ACR 30 flare during a 24-week double-blind withdrawal period (all patients had previously received open-label tocilizumab in a 16-week lead-in phase). Tocilizumab was generally well tolerated in the TENDER trial. Infections (e.g. upper respiratory tract infection and pharyngitis or nasopharyngitis) accounted for just over one-third of all reported adverse events in this trial; tocilizumab-treated patients appeared to have an approximately 11 % risk of a serious infection per year of treatment. Clinical laboratory abnormalities included neutropenia and elevated aminotransferase levels. The tolerability profile of tocilizumab in CHERISH was generally consistent with that of the drug in TENDER.
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Hemophagocytic lymphohistiocytosis: critical reappraisal of a potentially under-recognized condition. Front Med 2013; 7:492-8. [PMID: 24127015 DOI: 10.1007/s11684-013-0292-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 08/18/2013] [Indexed: 10/26/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially life threatening, hyper inflammatory syndrome of diverse etiologies. Cardinal signs include prolonged fever, organomegaly, and persistent unexplained cytopenias. In spite of the well known diagnostic criteria put forth by HLH society, this continues to pose great diagnostic challenge in both pediatric and adult intensive care settings. We describe 4 adult (2 males, 2 females, aged 19, 29, 40, and 17 years) and 3 pediatric (2 males, 1 female, aged 1 month, 6 months, and 12 years) patients with secondary HLH who satisfied the HLH-2004 diagnostic criteria. Definite evidence of hemophagocytosis was noted in 4 patients on initial bone marrow examination. The underlying etiologies were as follows: Rickettsia tsutsugamushi (case 1), autoimmune disorder (case 2), systemic onset juvenile idiopathic arthritis (sJIA) (case 3), unknown bite (possibly a venomous snake) (case 4), Plasmodium vivax (case 5), Cytomegalo virus (case 6), and Mycobacterium tuberculosis (case 7). In one patient, hemophagocytosis was presumed to have been exacerbated by administration of granulocyte monocyte colony stimulating factor (GMCSF) for severe neutropenia. Two patients died with disseminated intravascular coagulation (DIC) and multi organ failure within few days of HLH diagnosis. Immunosuppressive therapy was started in 3 patients, and etoposide was started in one patient only. Due to lack of specificity of diagnostic criteria, diagnosing and differentiating HLH from its closest mimickers like sepsis/septic shock may be quite challenging in critically ill patients. Therefore, increasing awareness among physicians is essential for early diagnosis and effective therapy to reduce the mortality.
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Cobb JE, Hinks A, Thomson W. The genetics of juvenile idiopathic arthritis: current understanding and future prospects. Rheumatology (Oxford) 2013; 53:592-9. [DOI: 10.1093/rheumatology/ket314] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Efthimiou P, Moorthy LN, Mavragani CP, Skokos D, Fautrel B. Adult Onset Still's Disease and Autoinflammation. Int J Inflam 2012; 2012:964751. [PMID: 22988543 PMCID: PMC3437651 DOI: 10.1155/2012/964751] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 06/26/2012] [Indexed: 12/23/2022] Open
Affiliation(s)
- Petros Efthimiou
- Rheumatology Division, Lincoln Medical & Mental Health Center, 234 E. 149th st, New York, NY 10451, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY 10021, USA
| | - L. Nandini Moorthy
- Division of Pediatric Rheumatology, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, 1 Robert Wood Johnson Place, New Brunswick, NJ 08901, USA
| | - Clio P. Mavragani
- Department of Physiology, School of Medicine, University of Athens, M. Asias 75, 11527 Athens, Greece
| | - Dimitris Skokos
- Immunity & Inflammation Department, Regeneron Pharmaceuticals, Inc, 777 Old Saw Mill River Road Tarrytown, NY 10591, USA
| | - Bruno Fautrel
- Pierre et Marie Curie University (Paris 6), Service de Rhumatologie, Groupe Hospitalier Pitié-Salpêtrière, 83 Boulevard de l'Hôpital, 75013 Paris, France
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Silverman RB, Quinn SM. Successful ICU Care of a 14-Year-Old With Total Artificial Circulation Using Two Ventricular Assist Devices for 118 Days. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/1944451612456702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Within the first year following orthotopic heart transplantation, the patient is at risk of graft failure, rejection, and infection. Late mortality is often due to allograph vasculopathy. Most of the patients with primary graft failure will usually recover with temporary mechanical ventricular assist support; however, on occasion the patient must be retransplanted. For the patient who suffers primary graft failure necessitating explanation and bridging until a new suitable graft is found, there are several total artificial heart options. However, in the pediatric population these options are limited. The authors’ surgical colleagues were able to fashion a paracorporeal total artificial heart constructed with 2 ventricular assist devices. In this case report, the authors discuss a pediatric patient who had to be explanted and supported for an extended amount of time. This article describes the incidence of cardiomyopathy in juvenile rheumatoid arthritis patients, the choice of extracorporeal membrane oxygenation/extracorporeal complete life support versus ventricular assist devices for support, the major causes of primary graft failure, and the authors’ experience in caring for an adolescent with such a device for a protracted length of time (118 days).
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Affiliation(s)
- Richard B. Silverman
- Department of Anesthesiology & Critical Care, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sean M. Quinn
- Department of Anesthesiology & Critical Care, Miller School of Medicine, University of Miami, Miami, Florida
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37
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Is Still's Disease an Autoinflammatory Syndrome? Int J Inflam 2012; 2012:480373. [PMID: 22611516 PMCID: PMC3350968 DOI: 10.1155/2012/480373] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 02/28/2012] [Accepted: 03/01/2012] [Indexed: 02/07/2023] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA), formerly called Still's disease, is officially classified as a subset of juvenile idiopathic arthritis (JIA). Beside arthritis, it is characterized by prominent systemic features and a marked inflammatory response. Even if it is still included in the group of juvenile arthritides, sJIA is set apart from all the other forms of JIA. This disorder has markedly distinct clinical and laboratory features suggesting a different pathogenesis. sJIA does not show any association with HLA genes or with autoantibodies and is characterised by an uncontrolled activation of phagocytes with hypersecretion of IL-1 and IL-6. Based on clinical and laboratory features, as well as on new acquisitions on the pathogenesis, it seems evident that sJIA is an autoinflammatory disease related to abnormality in innate immune system. The new insights on the pathogenesis of sJIA have therefore dramatically changed the approach to treatment, with the development of targeted treatments (anti-IL-1 and anti-IL-6 agents) more effective and safer than earlier medications.
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Restrepo R, Lee EY. Epidemiology, pathogenesis, and imaging of arthritis in children. Orthop Clin North Am 2012; 43:213-25, vi. [PMID: 22480470 DOI: 10.1016/j.ocl.2012.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Juvenile idiopathic arthritis is a broad term used to describe a series of chronic arthritis occurring in children younger than 16 years of age. Even though the cause is not fully understood, several clues regarding the pathogenesis have been found. Diagnosis of the different types of juvenile idiopathic arthritis is made clinically, and imaging plays a role in answering specific questions pertaining to disease classification, staging, and outcome of treatment options.
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Affiliation(s)
- Ricardo Restrepo
- Department of Radiology, Miami Children's Hospital, 2100 Southwest 62nd Avenue, Miami, FL 33155, USA.
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