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McKee S, Xenakis J, Makin H, Marshall C, Winnette R, Aggarwal R, Knight S. Cutaneous Manifestations in Patients with Dermatomyositis, Are They Only Skin Deep? Dermatol Ther (Heidelb) 2024:10.1007/s13555-024-01266-1. [PMID: 39264400 DOI: 10.1007/s13555-024-01266-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Accepted: 08/23/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND Dermatomyositis (DM) is a rare and severely debilitating autoimmune disease that can affect children and adults; however, there is little understanding of the patient-reported experience and uncertainty around validated clinical outcomes assessments (COAs) that could measure changes in the condition during clinical trials of new treatments. OBJECTIVES The aim of this study was to understand the patient experience of DM, with a focus on its cutaneous manifestations, to describe the patient experience and determine the suitability of existing COA measures. METHODS Adult (≥ 18 years) patients (N = 28) with severe active cutaneous manifestations of DM were interviewed. In the 90-min interviews, open-ended questions and probes were used to elicit descriptions of key clinical manifestations and patients' experiences of DM, including the symptoms and impacts on their daily lives and wellbeing. RESULTS Patients reported 13 different skin manifestations of DM. The most common were rash (n = 28, 100%), itch (n = 28, 100%), dry skin (n = 23, 82%), and swelling of the skin (n = 17, 61%). The head and face, followed by hands, were perceived as the most bothersome body areas affected by skin manifestations, because they are exposed and visible to themselves and other people. All patients (n = 28, 100%) reported at least one impact of DM, which varied greatly between patients, but included emotional, psychological, cognitive, and physical impacts, and those affecting daily life, such as work and sleep. Over half of the patients (n = 19, 67%) reported that their daily activities were impacted by DM. CONCLUSIONS The qualitative interviews with patients revealed that the presentation of DM manifestations is highly variable but affects patients' emotional wellbeing, physical activities, and daily life significantly.
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Affiliation(s)
| | | | | | | | | | - Rohit Aggarwal
- University of Pittsburgh Medical Centre, Pittsburgh, USA
| | - Sarah Knight
- Clinical Outcomes Assessment, Clarivate, London, UK
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McKee S, Xenakis J, Makin H, Marshall C, Winnette R, Aggarwal R, Knight SL. Development of the Cutaneous Dermatomyositis Investigator Global Assessment (CDM-IGA): A De Novo IGA of Cutaneous Manifestations of Dermatomyositis. Dermatol Ther (Heidelb) 2024; 14:2127-2138. [PMID: 38976170 PMCID: PMC11333384 DOI: 10.1007/s13555-024-01220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/21/2024] [Indexed: 07/09/2024] Open
Abstract
INTRODUCTION Dermatomyositis (DM) is a rare systemic autoimmune disease characterized by a distinctive debilitating skin rash and skeletal muscle weakness. It is unclear if existing clinical outcome assessment (COA) measures include the concepts of priority to patients and those necessary to fully capture improvements in the active cutaneous manifestations of DM. This study aimed to develop the Cutaneous Dermatomyositis Investigator Global Assessment (CDM-IGA), a de novo IGA, for use in clinical trials of adult DM. METHODS Eight DM clinical experts participated in 60-min qualitative interviews consisting of concept elicitation and cognitive debriefing methodologies. Concept elicitation comprised open-ended questions with follow-up probes to explore clinicians' experiences of treating patients with DM, the impact of symptoms on patients' quality of life, and the severity levels of disease characteristics to explore DM progression. Cognitive debriefing required the clinical experts to perform a review of the CDM-IGA, designed to assess the severity of cutaneous disease activity of DM. After the interviews, a consensus meeting with three clinical experts was held to agree on any outstanding issues relating to the CDM-IGA. RESULTS The CDM-IGA was iteratively developed using the opinions of nine clinical experts. Feedback provided by all clinicians agreed that erythema was the main active cutaneous manifestation of DM and should be the primary characteristic on the CDM-IGA, split by erythema color and extent. To determine cutaneous disease severity, experts suggested adding a metric called secondary changes, which combined erosion/ulceration and lichenification, which could modify the patient's final score. Three clinical experts suggested that a photo-guide to support assessments of erythema across different skin tones could be beneficial. CONCLUSIONS A novel CDM-IGA was developed for use with adult patients with DM in clinical trials, based on an iterative development process that combined qualitative feedback from clinical experts of DM and importantly adult patients living with DM.
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Affiliation(s)
| | | | | | | | | | - Rohit Aggarwal
- University of Pittsburgh Medical Centre, Pittsburgh, USA
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Champagne E, Chénard J, Simard C, Bonanno M, Bogossian A, Roberge V, Olivier-d'Avignon M, Ummel D, Fortin G, Bergeron F, Bonenfant F. Scoping Review on Transitions in the Context of Pediatric Palliative Care. J Palliat Med 2024. [PMID: 39047058 DOI: 10.1089/jpm.2023.0673] [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: 07/27/2024] Open
Abstract
Background: Children with complex and chronic conditions receiving palliative care will likely experience many transitions during their life and their treatments. Transition periods for children with life-limiting conditions and their families can be bewildering and highly anxiety-inducing. However, clinical observations seem to point to a more heterogenous care offer, including a lack or discontinuity of services, at the expense of their quality of life. Objective: This paper aims to establish a portrait of the existing literature and identify research gaps on the multiple transitions experienced by this population. Design: A scoping review is provided, following a PRISMA protocol. MEDLINE, PubMed and CINAHL were consulted. The search strategy is based on three key concepts: (1) palliative care/complex condition, (2) child/adolescent, and (3) transition. Articles were screened with the help of Covidence. Results: A total of 72 articles are included for analysis. The aimed population is either identified by age group or by medical status. Respondents are most often parents rather than the children themselves. Transitions include: reaching adulthood, changes in care environment, changes in medical status, and school integration. Conclusion: The discussion notices a definitional murkiness about transitions and highlights the fact that the multifaceted and complex nature of transition over time is largely ignored. New research should involve a diversity of participants and include children's voices. Recommendations include clearer concept definitions, health care policies that adopt an ecosystemic approach, and professional training in the systemic family approach in palliative care.
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Affiliation(s)
- Elaine Champagne
- Chair of Religion, spirituality and health, Faculty of theology and religious sciences, Université Laval, Québec Canada
| | - Josée Chénard
- Social Work Department, Université du Québec en Outaouais, St-Jérôme Canada
| | - Chantale Simard
- Department of health sciences, Université du Québec à Chicoutimi, Canada
| | | | - Aline Bogossian
- School of Social Work, Université de Montréal, Montréal, Canada
| | - Véronique Roberge
- Department of health sciences, Université du Québec à Chicoutimi, Canada
| | | | - Deborah Ummel
- Faculty of Education, Université de Sherbrooke, Sherbrooke, Canada
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Lupu A, Sasaran MO, Jechel E, Azoicai A, Alexoae MM, Starcea IM, Mocanu A, Nedelcu AH, Knieling A, Salaru DL, Burlea SL, Lupu VV, Ioniuc I. Undercover lung damage in pediatrics - a hot spot in morbidity caused by collagenoses. Front Immunol 2024; 15:1394690. [PMID: 38994372 PMCID: PMC11236559 DOI: 10.3389/fimmu.2024.1394690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Connective tissue represents the support matrix and the connection between tissues and organs. In its composition, collagen, the major structural protein, is the main component of the skin, bones, tendons and ligaments. Especially at the pediatric age, its damage in the context of pathologies such as systemic lupus erythematosus, scleroderma or dermatomyositis can have a significant negative impact on the development and optimal functioning of the body. The consequences can extend to various structures (e.g., joints, skin, eyes, lungs, heart, kidneys). Of these, we retain and reveal later in our manuscript, mainly the respiratory involvement. Manifested in various forms that can damage the chest wall, pleura, interstitium or vascularization, lung damage in pediatric systemic inflammatory diseases is underdeveloped in the literature compared to that described in adults. Under the threat of severe evolution, sometimes rapidly progressive and leading to death, it is necessary to increase the popularization of information aimed at physiopathological triggering and maintenance mechanisms, diagnostic means, and therapeutic directions among medical specialists. In addition, we emphasize the need for interdisciplinary collaboration, especially between pediatricians, rheumatologists, infectious disease specialists, pulmonologists, and immunologists. Through our narrative review we aimed to bring up to date, in a concise and easy to assimilate, general principles regarding the pulmonary impact of collagenoses using the most recent articles published in international libraries, duplicated by previous articles, of reference for the targeted pathologies.
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Affiliation(s)
- Ancuta Lupu
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Maria Oana Sasaran
- Faculty of Medicine, "George Emil Palade" University of Medicine, Pharmacy, Science and Technology, Targu Mures, Romania
| | - Elena Jechel
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Alice Azoicai
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Monica Mihaela Alexoae
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Iuliana Magdalena Starcea
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Adriana Mocanu
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Alin Horatiu Nedelcu
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Anton Knieling
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Delia Lidia Salaru
- Faculty of Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Stefan Lucian Burlea
- Public Health and Management Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Vasile Valeriu Lupu
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Ileana Ioniuc
- Mother and Child Medicine Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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Livermore P, Ainsworth S, Beesley R, Douglas S, Earle E, Wilson D, Woolley L, Clinch J. 'The current mental health status of children and young people with JIA, and their wider family': a charity partner collaboration survey. Pediatr Rheumatol Online J 2023; 21:111. [PMID: 37798784 PMCID: PMC10557198 DOI: 10.1186/s12969-023-00898-5] [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: 07/13/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND This paper presents insight into the scale of mental health concerns for families who have a child or young person with a diagnosis of Juvenile Idiopathic Arthritis (JIA) living in any of the four nations of the United Kingdom (UK). The study's objective is to share the current experiences of those that responded to a charity survey and consider future work to improve mental health support. METHODS This work was initiated and led by five UK charity partner organisations working with families affected by JIA. Parents/carers of a child or young person with JIA, and young people with JIA, submitted self-completion online questionnaires. The questionnaire asked 19 core questions, with a focus on the mental health impact of having and living with a JIA diagnosis. Questionnaires were delivered via charity partner UK-wide mailing lists and social media. RESULTS Questionnaire were completed by 291 participants over a 3-week period in February 2022. The majority of respondents were parents (229, 79%), 103 children had been diagnosed for over six years (35%), and 131 (45%) received shared care between paediatric rheumatology centres. In total, 168 (59%) children and young people with JIA had received, were currently receiving or were waiting for mental health support. Parents reported that their child's diagnosis impacted their own mental health (218, 82%). Children and young people reported never being offered mental health support during appointments for JIA (157, 54%), and 71 (50%) of these had never received support. CONCLUSION Children and young people with JIA have significant mental health sequelae from their diagnosis. Our findings found that nearly 60% of our respondents have had or are requiring mental health support, with significant numbers of parents/carers reporting difficulties in accessing care for their child's mental health or their own mental health, due to their child's diagnosis. This unique collaborative charity-led study, illustrates the importance of timely and accessible mental health support. Further work is needed to understand why best practice guidance for mental health support is not being met consistently and to identify how to embed it into standard rheumatology care.
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Affiliation(s)
- Polly Livermore
- NIHR Advanced Clinical Academic Nursing Fellow, Infection, Immunity and Inflammation, Institute of Child Health, University College London Great Ormond Street Institute of Child Health, 6th Floor, 30 Guilford Street, WC1N 1EH, London, UK.
| | | | - R Beesley
- Juvenile Arthritis Research (JAR), Tonbridge, UK
| | - S Douglas
- Scottish Network for Arthritis in Children (SNAC), Edinburgh, Scotland
| | - E Earle
- Children's Chronic Arthritis Association (CCAA), Nuneaton, UK
| | - D Wilson
- National Rheumatoid Arthritis Society (NRAS), Berkshire, UK
| | - L Woolley
- Young People and Families, Versus Arthritis (VA), London, UK
| | - J Clinch
- Bristol Royal Hospital for Children, Bristol, UK
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Papadopoulou C, Chew C, Wilkinson MGL, McCann L, Wedderburn LR. Juvenile idiopathic inflammatory myositis: an update on pathophysiology and clinical care. Nat Rev Rheumatol 2023; 19:343-362. [PMID: 37188756 PMCID: PMC10184643 DOI: 10.1038/s41584-023-00967-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2023] [Indexed: 05/17/2023]
Abstract
The childhood-onset or juvenile idiopathic inflammatory myopathies (JIIMs) are a heterogenous group of rare and serious autoimmune diseases of children and young people that predominantly affect the muscles and skin but can also involve other organs, including the lungs, gut, joints, heart and central nervous system. Different myositis-specific autoantibodies have been identified that are associated with different muscle biopsy features, as well as with different clinical characteristics, prognoses and treatment responses. Thus, myositis-specific autoantibodies can be used to subset JIIMs into sub-phenotypes; some of these sub-phenotypes parallel disease seen in adults, whereas others are distinct from adult-onset idiopathic inflammatory myopathies. Although treatments and management have much improved over the past decade, evidence is still lacking for many of the current treatments and few validated prognostic biomarkers are available with which to predict response to treatment, comorbidities (such as calcinosis) or outcome. Emerging data on the pathogenesis of the JIIMs are leading to proposals for new trials and tools for monitoring disease.
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Affiliation(s)
- Charalampia Papadopoulou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
| | - Christine Chew
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Meredyth G Ll Wilkinson
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy R Wedderburn
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust (GOSH), London, UK.
- Rare Diseases Theme NIHR Biomedical Research Centre at GOSH, London, UK.
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK.
- Infection Immunity and Inflammation Research and Teaching Department, UCL GOS Institute of Child Health, London, UK.
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El Haddad R, El Asmar K, Hascoët C, Rossi-Semerano L, Dusser P. Well-being in chronic pediatric inflammatory rheumatic diseases: the experience of a French healthcare network. Orphanet J Rare Dis 2023; 18:46. [PMID: 36882869 PMCID: PMC9990204 DOI: 10.1186/s13023-023-02655-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVE Current management of patients with pediatric rheumatic diseases (PRD) should aim at achieving the best possible well-being. To identify sociodemographic/clinical characteristics, needed paramedical services and school accommodations associated with well-being in patients at inclusion in a French health network Réseau pour les Rhumatismes Inflammatoires Pédiatriques (RESRIP) that supports coordination of the patient's health pathway. To evaluate the evolution of well-being over time in this patients benefiting from such support. METHODS Patients > 3 years old enrolled in RESRIP (2013-2020) were included. At enrollment, data were collected on sociodemographic/clinical characteristics, ongoing medications, and paramedical and educational actions to be implemented by RESRIP. Well-being during the last 6 months was reported with a standardized questionnaire at enrollment and every 6 months. A well-being score was calculated with scores ranging from 0 to 18, 18 corresponding to absolute well-being. Patients were followed up from inclusion until June 2020. RESULTS In total, 406 patients were included and followed up for 36 months on average: 205 juvenile idiopathic arthritis, 68 connective tissue diseases, 81 auto-inflammatory diseases and 52 other diseases. The well-being score did not differ between the groups and improved significantly, by 0.04 score units, every 6 months (95% confidence interval [0.03; 0.06]). At inclusion, use of homeopathy, need for implementation of hypnosis or psychological support, occupational therapy or for adjustment of school tests were associated with worse well-being score. CONCLUSION Well-being seems associated more with the impact of chronic illness than the type of PRD underlining the importance of a comprehensive patient care.
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Affiliation(s)
- Rita El Haddad
- Réseau Rhumatismes Inflammatoires Pédiatriques (RESRIP), Bourg-la-Reine, France
- Public Health Faculty, Lebanese University, Fanar, Lebanon
- Faculty of Medicine, Université Paris-Saclay, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Khalil El Asmar
- Faculty of Medicine, Université Paris-Saclay, Université Paris Sud, Le Kremlin Bicêtre, France
| | - Chrystelle Hascoët
- Réseau Rhumatismes Inflammatoires Pédiatriques (RESRIP), Bourg-la-Reine, France
| | - Linda Rossi-Semerano
- Réseau Rhumatismes Inflammatoires Pédiatriques (RESRIP), Bourg-la-Reine, France
- Paediatric Rheumatology Department, APHP, Bicêtre Hospital, Université Paris-Saclay, 94270, Le Kremlin-Bicêtre, France
- Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses Inflammatoire (CEREMAIA), Le Kremlin Bicêtre, France
| | - Perrine Dusser
- Réseau Rhumatismes Inflammatoires Pédiatriques (RESRIP), Bourg-la-Reine, France.
- Paediatric Rheumatology Department, APHP, Bicêtre Hospital, Université Paris-Saclay, 94270, Le Kremlin-Bicêtre, France.
- Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses Inflammatoire (CEREMAIA), Le Kremlin Bicêtre, France.
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Patel RN, Esparza VG, Lai JS, Gray EL, Reeve BB, Chang RW, Cella D, Ardalan K. Comparison of Patient-Reported Outcomes Measurement Information System Computerized Adaptive Testing Versus Fixed Short Forms in Juvenile Myositis. Arthritis Care Res (Hoboken) 2023; 75:381-390. [PMID: 34328696 PMCID: PMC8800940 DOI: 10.1002/acr.24760] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 06/24/2021] [Accepted: 07/27/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be administered via computerized adaptive testing (CAT) or fixed short forms (FSFs), but the empirical benefits of CAT versus FSFs are unknown in juvenile myositis (JM). The present study was undertaken to assess whether PROMIS CAT is feasible, precise, correlated with FSFs, and less prone to respondent burden and floor/ceiling effects than FSFs in JM. METHODS Patients 8-17 years of age (self-report and parent proxy) and parents of patients 5-7 years of age (only parent proxy) completed PROMIS fatigue, pain interference, upper extremity function, mobility, anxiety, and depressive symptoms measures. Pearson correlations, paired t-tests, and Cohen's d were calculated between PROMIS CAT and FSFs. McNemar's test assessed floor/ceiling effects between CAT and FSFs. Precision and respondent burden were examined across the T score range. RESULTS Data from 67 patient-parent dyads were analyzed. CAT and FSF mean scores did not significantly differ except in parent proxy anxiety and fatigue (effect size 0.23 and 0.19, respectively). CAT had less pronounced floor/ceiling effects at the less symptomatic extreme in all domains except self-report anxiety. Increased item burden and higher SEs were seen in less symptomatic scorers for CAT. Modified stopping rules limiting CAT item administration did not decrease precision. CONCLUSION PROMIS CAT appears to be feasible and correlated with FSFs. CAT had less pronounced floor/ceiling effects, allowing detection of individual differences in less symptomatic patients. Modified stopping rules for CAT may decrease respondent burden. CAT can be considered for long-term follow-up of JM patients.
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Affiliation(s)
- Ruchi N. Patel
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Jin-Shei Lai
- Departments of Medical Social Sciences and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Elizabeth L. Gray
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bryce B. Reeve
- Center for Health Measurement, Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
| | - Rowland W. Chang
- Departments of Preventive Medicine, Medicine, and Physical Medicine & Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - David Cella
- Departments of Medical Social Sciences, Neurology, Pediatrics, Preventive Medicine, and Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kaveh Ardalan
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC
- Division of Rheumatology, Ann & Robert H. Lurie Children’s Hospital of Chicago; Departments of Pediatrics and Medical Social Sciences, Northwestern University Feinberg School of Medicine
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van Schelven F, van der Meulen E, Wessels E, Boeije HR. Let Us Talk Treatment: Using a Digital Body Map Tool to Examine Treatment Burden and Coping Strategies Among Young People with a Chronic Condition. Patient Prefer Adherence 2023; 17:517-529. [PMID: 36891325 PMCID: PMC9987530 DOI: 10.2147/ppa.s400702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/09/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE Treatment for a chronic condition can pose a heavy burden on young people and affect their quality of life. The present study examined young people's experiences with treatment burden and their coping strategies. PATIENTS AND METHODS The body mapping method was employed, in which a life-sized outline of someone's body is traced and populated with visual representations, symbols and words. For the present study, a digital tool for body mapping was developed. This is a chat robot which helps young people make a body map by asking questions about their lives, wellbeing and the influence of their treatment on this. In two series of three workshops, ten young people (16 to 25 years) with a chronic, somatic condition created individual body maps using this tool. The body maps were discussed in the group to obtain insight into experiences with treatment burden. The findings were analysed using thematic analysis. In all stages of the study, two adolescents with a chronic condition were involved as co-researchers. RESULTS The results show that young people with a chronic condition experience considerable treatment burden. Although treatment reduces their symptoms, it also leads to physical and emotional side-effects, restrictions of meaningful activities, issues with future planning, reduced independence, and autonomy and loneliness. Young people apply several strategies to cope with this burden, such as seeking support from others, focusing on the positive, ignoring treatment advice, and seeing a psychologist. CONCLUSION Treatment burden is a subjective experience and not merely based on the number or types of treatment. It is therefore vital that young people with a chronic condition discuss their experiences with their care provider. This can help to tailor treatment decisions to their lives and needs.
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Affiliation(s)
- Femke van Schelven
- Department Perspective of Patients and Clients in Healthcare, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
- Correspondence: Femke van Schelven, Netherlands Institute for Health Services Research, Otterstraat 118, Utrecht, 3513, CR, the Netherlands, Email
| | | | - Elise Wessels
- JongPIT, Amsterdam, the Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Hennie R Boeije
- Department Perspective of Patients and Clients in Healthcare, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
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Boros C, McCann L, Simou S, Cancemi D, Ambrose N, Pilkington CA, Cortina-Borja M, Wedderburn LR. Juvenile Dermatomyositis: what comes next? Long-term outcomes in childhood myositis from a patient perspective. Pediatr Rheumatol Online J 2022; 20:102. [PMID: 36384526 PMCID: PMC9670456 DOI: 10.1186/s12969-022-00754-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 10/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To describe long-term outcomes in JDM using patient questionnaires and link to longitudinal, prospectively collected data for each patient within the Juvenile Dermatomyositis Cohort and Biomarker Study, UK and Ireland (JDCBS) to determine outcome predictors. METHODS: JDCBS participants aged ≥ 16y completed the SF36, HAQ and a questionnaire regarding current disease features, medications, education and employment. Data collected from the JDCBS included disease subtype, demographics, clinical and laboratory features. Intensity indices were calculated for physician VAS, modified skin DAS, CMAS and MMT8 by dividing area under the curve (AUC) from longitudinal score trajectories by duration of study follow-up (y). Relationships between questionnaire and JDCBS clinical / laboratory data were investigated fitting statistical models appropriate for cross sectional and longitudinal data. RESULTS Of 190 questionnaires sent, 84 (44%) were returned. Average age of respondents was 20.6 years (SD 3.9), time since diagnosis was 12.4 years (SD 5.0), age at onset was 9.2 years (SD 4.3), female to male ratio 4.25:1. Forty-nine (59%) self-reported persistently active disease, 54 (65%) were still taking immunosuppressive medication. 14/32 at school/higher education reported myositis adversely affecting academic results. 18-24 year-olds were twice as likely to be unemployed compared the UK population (OR = 0.456, 95% CI 0.24, 0.84, p = 0.001). Participants ≥ 18 years were three times as likely to be living with a parent/guardian (OR = 3.39, p < 0.001). SF36 MCS and MMT8 intensity index scores were significantly correlated (ρ = 0.328, p = 0.007). CONCLUSIONS After 12.4 years, questionnaire responders reported self-perceived high rates of persistently active disease and medication use, reduced rates of employment and were more likely to live with a parent/guardian. Perceived persistently active muscle disease appeared to affect quality of life in these patients and was the most significant contributor to long-term outcomes. Our findings highlight the importance of including the patient perspective in the assessment of long term outcomes, so that that we can start to target initial management strategies more effectively based on a combination of clinical and patient-reported data.
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Affiliation(s)
- C. Boros
- grid.1010.00000 0004 1936 7304University of Adelaide Discipline of Paediatrics Adelaide, Adelaide, Australia
| | - L. McCann
- grid.417858.70000 0004 0421 1374Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - S. Simou
- grid.83440.3b0000000121901201Infection, Immunity and Inflammation Teaching and Research Department, UCL GOS Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - D. Cancemi
- grid.83440.3b0000000121901201Infection, Immunity and Inflammation Teaching and Research Department, UCL GOS Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK
| | - N. Ambrose
- Blackrock Clinic, Blackrock, Co, Rock Road, Dublin, A94E4X7 Ireland
| | | | - M. Cortina-Borja
- grid.83440.3b0000000121901201Population, Policy and Practice Teaching and Research Department, UCL GOS Institute of Child Health, London, UK
| | - L. R Wedderburn
- grid.83440.3b0000000121901201Infection, Immunity and Inflammation Teaching and Research Department, UCL GOS Institute of Child Health, 30 Guilford Street, London, WC1N 1EH UK ,grid.451056.30000 0001 2116 3923Great Ormond Street Hospital for Children (GOSH), NIHR Biomedical Research Centre, London, UK
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The importance of children and young person involvement in scoping the need for a paediatric glucocorticoid-associated patient reported outcome measure. BMC Rheumatol 2022; 6:80. [PMID: 36243873 PMCID: PMC9568975 DOI: 10.1186/s41927-022-00312-9] [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: 03/27/2022] [Accepted: 10/05/2022] [Indexed: 11/30/2022] Open
Abstract
Background For many children and young people (CYP) with paediatric rheumatic conditions, glucocorticoid medications and their associated side-effects have a substantial impact on disease experience. Whilst there are physician-rated measures of glucocorticoid toxicity, no parallel patient reported measure has been developed to date for CYP with rheumatic disease. This manuscript describes a series of public patient involvement (PPI) events to inform the development of a future paediatric glucocorticoid-associated patient reported outcome measure (PROM). Methods One large group PPI event was advertised to CYP with experience of glucocorticoid medication use and their parents through clinicians, charities and existing PPI groups. This featured education on the team’s research into glucocorticoid medication and interactive polls/structured discussion to help participants share their experiences. Further engagement was sought for PPI group work to co-develop future glucocorticoid studies, including development of a glucocorticoid associated PROM. Quantitative and qualitative feedback was collected from online questionnaires. The initiative was held virtually due to the Covid-19 pandemic. Results Nine families (n = 15) including 6 CYP joined the large group PPI event. Online pre-attendance and post-attendance questionnaires showed improvement in mean self-reported confidence [1 = not at all confident, 5 = very confident] in the following: what steroid medications are (pre = 3.9, post = 4.8), steroid side effects (pre = 3.8, post = 4.6), patient-reported outcome measures (pre = 2.0, post = 4.5), available research on steroids (pre = 2.2, post = 3.5). Five families (n = 7) were involved in a monthly PPI group who worked alongside the research team to identify priorities in glucocorticoid research, produce age-appropriate study materials, identify barriers to study participation (e.g. accessibility & convenience) and recommend appropriate modalities for dissemination. The participants found discussing shared experiences and learning about research to be the most enjoyable aspects of the initiative. Conclusions This PPI initiative provided a valuable forum for families, including young children, to share their perspectives. Here, the authors explore the effective use of PPI in a virtual setting and provide a unique case study for the involvement of CYP in PROM development. The monthly PPI group also identified a need for the development of a new PROM related to glucocorticoid medication use and provided unique insights into how such a study could be structured. Supplementary Information The online version contains supplementary material available at 10.1186/s41927-022-00312-9.
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12
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Livermore P, Gibson F, Mulligan K, Wedderburn LR, McCann LJ, Gray S. Mapping the current psychology provision for children and young people with juvenile dermatomyositis. Rheumatol Adv Pract 2021; 5:rkab062. [PMID: 34671713 PMCID: PMC8522803 DOI: 10.1093/rap/rkab062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Juvenile Dermatomyositis (JDM) is a rare, chronic autoimmune condition of
childhood, with known psychosocial implications. In this study, we sought to
establish current psychological support for children and young people across
the UK with rheumatic conditions, with a specific focus on those with
JDM. Methods Electronic surveys were distributed to the 15 centres that belong to the JDM
Research Group in the UK, collecting responses from health-care
professionals in the fields of medicine, nursing and psychology. Results One hundred per cent of professionals from medicine and nursing replied from
all 15 centres. Of these, 7 (47%) did not have a named psychologist
as part of their rheumatology team, despite the majority [13 (87%)]
having >200 paediatric rheumatology patients. Of the remaining
centres, hospital psychology provision varied considerably. When rating
their service, only 3 (8%) of 40 professionals scored their service
as five (where one is poor and five is excellent); there were wide
discrepancies in these scores. Many challenges were discussed, including
limited psychology provision, lack of time and difficulties in offering
support across large geographical areas. Conclusion Many of the challenges discussed are applicable to other centres worldwide.
Suggestions have been proposed that might help to improve the situation for
children and young people with rheumatic conditions, including JDM. Based on
these findings, we suggest that rheumatology teams maximize use of these
data to advocate and work toward more comprehensive psychology provision and
support in their individual centres.
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Affiliation(s)
- Polly Livermore
- Rheumatology Department, University College London Great Ormond Street Institute of Child Health.,Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust.,NIHR Biomedical Research Centre at Great Ormond Street Hospital.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London
| | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust.,School of Health Sciences, University of Surrey, Guildford
| | - Kathleen Mulligan
- Centre of Health Services Research, University of London.,East London NHS Foundation Trust, London
| | - Lucy R Wedderburn
- Rheumatology Department, University College London Great Ormond Street Institute of Child Health.,NIHR Biomedical Research Centre at Great Ormond Street Hospital.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, London
| | - Liza J McCann
- Rheumatology Department, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Suzanne Gray
- Psychological Services, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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13
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Wilkinson MGL, Wu W, O’Brien K, Deakin CT, Wedderburn LR, Livermore P. A survey to understand the feelings towards and impact of COVID-19 on the households of juvenile dermato myositis patients from a parent or carer perspective. Rheumatol Adv Pract 2021; 5:rkab058. [PMID: 34541451 PMCID: PMC8445511 DOI: 10.1093/rap/rkab058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/14/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This aim of this study was to gain a better understanding of how parents and carers feel about the effects and impact of the coronavirus disease 2019 (COVID-19) pandemic lockdown and how this impacted upon their child/young person with JDM. METHOD We approached 139 participants from the JDM Cohort Biomarker Study (JDCBS), with specific consent to approach electronically for research studies. A secure electronic questionnaire with study introduction was sent to participants for their parents and carers around the UK to complete. It consisted of 20 questions about the impact of the pandemic on their child or young person's clinical care. Data were analysed quantitatively and qualitatively. RESULTS There were 76 (55%) responses to the survey. More than 50% of participants were actively being treated for their JDM at the point of survey completion as recorded by their parent or carer. More than 40% attested to disrupted treatment owing to COVID-19. The biggest impact upon clinical care was cancellation of appointments, initiating virtual appointments and extension of time between blood tests. Parents and carers expressed their own feelings of worry, concern and anxiety, but also those of their child or young person. CONCLUSION Families who have a child or young person with JDM have been affected by COVID-19. Qualitative comments highlight that it has been a very difficult time. Further investigation is required into this area and could be compared with research on the effects of COVID-19 on other patient groups with chronic disease.
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Affiliation(s)
- Meredyth Grace Llewellyn Wilkinson
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, University College London
- NIHR Biomedical Research Centre at GOSH, London, UK
| | - Wing Wu
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, University College London
| | - Kathryn O’Brien
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, University College London
| | - Claire T Deakin
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, University College London
- NIHR Biomedical Research Centre at GOSH, London, UK
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, University College London
- NIHR Biomedical Research Centre at GOSH, London, UK
| | - Polly Livermore
- Infection, Immunity and Inflammation Programme Research and Teaching Department, UCL Great Ormond Street Institute of Child Health
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCLH and GOSH, University College London
- NIHR Biomedical Research Centre at GOSH, London, UK
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14
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Deakin CT, Papadopoulou C, McCann LJ, Martin N, Al-Obaidi M, Compeyrot-Lacassagne S, Pilkington CA, Tansley SL, McHugh NJ, Wedderburn LR, De Stavola BL. Identification and prediction of novel classes of long-term disease trajectories for patients with juvenile dermatomyositis using growth mixture models. Rheumatology (Oxford) 2021; 60:1891-1901. [PMID: 33146389 PMCID: PMC8023987 DOI: 10.1093/rheumatology/keaa497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 07/11/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives Uncertainty around clinical heterogeneity and outcomes for patients with JDM represents a major burden of disease and a challenge for clinical management. We sought to identify novel classes of patients having similar temporal patterns in disease activity and relate them to baseline clinical features. Methods Data were obtained for n = 519 patients, including baseline demographic and clinical features, baseline and follow-up records of physician’s global assessment of disease (PGA), and skin disease activity (modified DAS). Growth mixture models (GMMs) were fitted to identify classes of patients with similar trajectories of these variables. Baseline predictors of class membership were identified using Lasso regression. Results GMM analysis of PGA identified two classes of patients. Patients in class 1 (89%) tended to improve, while patients in class 2 (11%) had more persistent disease. Lasso regression identified abnormal respiration, lipodystrophy and time since diagnosis as baseline predictors of class 2 membership, with estimated odds ratios, controlling for the other two variables, of 1.91 for presence of abnormal respiration, 1.92 for lipodystrophy and 1.32 for time since diagnosis. GMM analysis of modified DAS identified three classes of patients. Patients in classes 1 (16%) and 2 (12%) had higher levels of modified DAS at diagnosis that improved or remained high, respectively. Patients in class 3 (72%) began with lower DAS levels that improved more quickly. Higher proportions of patients in PGA class 2 were in DAS class 2 (19%, compared with 16 and 10%). Conclusion GMM analysis identified novel JDM phenotypes based on longitudinal PGA and modified DAS.
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Affiliation(s)
- Claire T Deakin
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospitals and Great Ormond Street Hospital, London, UK.,NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Charalampia Papadopoulou
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Rheumatology Unit, Great Ormond Street Hospital, London, UK
| | - Liza J McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Neil Martin
- Rheumatology Department, Royal Hospital for Sick Children, Glasgow
| | | | | | | | - Sarah L Tansley
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Neil J McHugh
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, UCL, London, UK.,Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospitals and Great Ormond Street Hospital, London, UK.,NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK.,Rheumatology Unit, Great Ormond Street Hospital, London, UK
| | - Bianca L De Stavola
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
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Sørensen K, Skirbekk H, Kvarstein G, Wøien H. I don't want to think about it: a qualitative study of children (6-18 years) with rheumatic diseases and parents' experiences with regular needle injections at home. Pediatr Rheumatol Online J 2021; 19:8. [PMID: 33482852 PMCID: PMC7821489 DOI: 10.1186/s12969-021-00495-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overall outcomes of pediatric rheumatic diseases (RD) have improved due to treatment with biologic agents and methotrexate. For many children, this treatment often entails regular needle injections. Pain and fear of needle injections are common in childhood, but how children and parents handle long-term needle injections at home has not been fully explored. This study aimed to explore how regular needle injections affect children with RD and their parents in their daily living. METHODS This explorative qualitative study used individual interviews and focus groups to ensure a comprehensive investigation of the topic. Children aged 6 to 16 years (n = 7) and their parents (n = 8) were interviewed individually 4 to 6 months after the onset of needle injection treatment. The focus groups included children aged 11 to 17 years (n = 9) and parents (n = 8) with a minimum of 6 months of experience with injection treatment. Data were analyzed using thematic analysis. RESULTS The main themes; "challenges," "motivational factors," and "routines" captured experiences and strategies that influenced the continuation of needle injections at home. Many children feared the moment immediately before the needle stick, although they had become accustomed to the pain. Most parents felt insecure about handling needle injections and lacked follow-up from healthcare providers. The children's experience of treatment effects and self-confidence were essential to maintain motivation for further injections. A number of coping strategies helped children focus away from injection related discomfort, often discovered by chance. Facilitating firm routines and shared responsibility within families helped children develop self-confidence during the procedure. Children and parents struggled to find suitable information on the Internet. CONCLUSIONS Children and parents experienced long-term needle injections challenging. They used their own limited resources and cooperated within the families to create routines and to introduce coping strategies necessary to manage and keep up with the procedure. Although the injection itself was not experienced very painful, the discomfort, worries and impact on daily life represented far more than a little needle stick, and thus needs more attention from healthcare providers.
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Affiliation(s)
- Kari Sørensen
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Undergraduate Studies Lovisenberg Diaconal University College, Oslo, Norway
| | - Helge Skirbekk
- Department of Undergraduate Studies Lovisenberg Diaconal University College, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - Gunnvald Kvarstein
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Hilde Wøien
- Department of Nursing Science, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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16
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Cunningham N, Reid M, Fabricius J, Danguecan A, Ardalan K, Knight A. Anxiety and depression in childhood rheumatologic conditions: A topical review. INDIAN JOURNAL OF RHEUMATOLOGY 2021. [DOI: 10.4103/injr.injr_127_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Leung AKC, Lam JM, Alobaida S, Leong KF, Wong AHC. Juvenile Dermatomyositis: Advances in Pathogenesis, Assessment, and Management. Curr Pediatr Rev 2021; 17:273-287. [PMID: 33902423 DOI: 10.2174/1573396317666210426105045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Juvenile dermatomyositis is the most common inflammatory myopathy in the pediatric age group and a major cause of mortality and morbidity in individuals with childhood rheumatic diseases. Mounting evidence suggests that early diagnosis and timely aggressive treatment are associated with better outcomes. OBJECTIVE The purpose of this article is to provide readers with an update on the evaluation, diagnosis, and the treatment of juvenile dermatomyositis. METHODS A PubMed search was performed in Clinical Queries using the key term "juvenile dermatomyositis" in the search engine. The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. The search was restricted to English literature. The information retrieved from the above search was used in the compilation of the present article. RESULTS Juvenile dermatomyositis is a chronic autoimmune inflammatory condition characterized by systemic capillary vasculopathy that primarily affects the skin and muscles with possible involvement of other organs. In 2017, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) developed diagnostic criteria for juvenile idiopathic inflammatory myopathies and juvenile dermatomyositis. In the absence of muscle biopsies which are infrequently performed in children, scores (in brackets) are assigned to four variables related to muscle weakness, three variables related to skin manifestations, one variable related to other clinical manifestations, and two variables related to laboratory measurements to discriminate idiopathic inflammatory myopathies from non-idiopathic inflammatory myopathies as follows: objective symmetric weakness, usually progressive, of the proximal upper extremities (0.7); objective symmetric weakness, usually progressive, of the proximal lower extremities (0.8); neck flexors relatively weaker than neck extensors (1.9); leg proximal muscles relatively weaker than distal muscles (0.9); heliotrope rash (3.1); Gottron papules (2.1); Gottron sign (3.3); dysphagia or esophageal dysmotility (0.7); the presence of anti-Jo-1 autoantibody (3.9); and elevated serum levels of muscle enzymes (1.3). In the absence of muscle biopsy, a definite diagnosis of idiopathic inflammatory myopathy can be made if the total score is ≥7.5. Patients whose age at onset of symptoms is less than 18 years and who meet the above criteria for idiopathic inflammatory myopathy and have a heliotrope rash, Gottron papules or Gottron sign are deemed to have juvenile dermatomyositis. The mainstay of therapy at the time of diagnosis is a high-dose corticosteroid (oral or intravenous) in combination with methotrexate. CONCLUSION For mild to moderate active muscle disease, early aggressive treatment with high-dose oral prednisone alone or in combination with methotrexate is the cornerstone of management. Pulse intravenous methylprednisolone is often preferred to oral prednisone in more severely affected patients, patients who respond poorly to oral prednisone, and those with gastrointestinal vasculopathy. Other steroid-sparing immunosuppressive agents such as cyclosporine and cyclophosphamide are reserved for patients with contraindications or intolerance to methotrexate and for refractory cases, as the use of these agents is associated with more adverse events. Various biological agents have been used in the treatment of juvenile dermatomyositis. Data on their efficacy are limited, and their use in the treatment of juvenile dermatomyositis is considered investigational.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta,Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, The University of British Columbia, Vancouver, British Columbia,Canada
| | - Saud Alobaida
- Department of Dermatology, King Faisal Specialist Hospital & Research Centre, Riyadh,Saudi Arabia
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur,Malaysia
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta,Canada
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18
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McCann LJ, Hedrich CM. Is it time to re-think juvenile-onset Rheumatic and Musculoskeletal Diseases? - First steps towards individualised treatments to meet agreed targets. Clin Immunol 2020; 223:108647. [PMID: 33310069 DOI: 10.1016/j.clim.2020.108647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Liza J McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Christian M Hedrich
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK.
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Zhong D, Wu C, Bai J, Zhao J, Xu D, Li M, Wang Q, Wang F, Zeng X. Aberrant expression of cell-free nucleosomes in dermatomyositis/polymyositis. Dermatol Ther 2020; 33:e14460. [PMID: 33107160 DOI: 10.1111/dth.14460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 12/01/2022]
Abstract
Nucleosomes are typically located intracellularly, and extracellular levels of nucleosomes indicated the degree of cell death. We postulated aberrant nucleosomes expression in dermatomyositis (DM) and polymyositis (PM). To assess the aberrant expression of circulating nucleosomes in DM and polymyositis. 76 consecutive DM and PM patients from 1 September 2017 to 31 October 2018 were enrolled in this study, in addition to 20 healthy controls. The levels of circulating nucleosomes, with 16 kinds of detectable myositis-specific antibodies (MSAs) were detected in IIMs patients using enzyme-linked immunosorbent assay kit (ELISA). Receiver operating characteristic (ROC) curve analysis was performed for evaluating the ability of this candidate marker for detecting DM/PM. The results showed that the levels of circulating nucleosomes in DM/PM patients were significantly higher than that in normal individuals. Specifically, elevated levels of nucleosomes were associated with MDA5 Ab, ARS, and TIF1γAb. In addition, elevated levels of circulating nucleosomes correlated with skin eruption. This study has evidenced nucleosomes as a potential new biomarker of DM/PM. Aberrant nucleosomes expression occurs in myositis patients and the difference in nucleosomes expression between patients with and without skin eruption is statistically significant. A unique expression profile of elevated serum nucleosomes was detected in DM/PM-MDA5 Ab(+), ASS, and TIF1γAb(+).
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Affiliation(s)
- Danli Zhong
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Chanyuan Wu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jingjing Bai
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dong Xu
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Qian Wang
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | | | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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20
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Ardalan K, Adeyemi O, Wahezi DM, Caliendo AE, Curran ML, Neely J, Kim S, Correll CK, Brunner EJ, Knight AM. Parent Perspectives on Addressing Emotional Health for Children and Young Adults With Juvenile Myositis. Arthritis Care Res (Hoboken) 2020; 73:18-29. [PMID: 32986925 DOI: 10.1002/acr.24466] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/22/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To assess parent perspectives regarding the emotional health impact of juvenile myositis (JM) on patients and families, and to assess preferences for emotional health screening and interventions. METHODS Parents of children and young adults with JM were purposively sampled for participation in focus groups at the Cure JM Foundation National Family Conference in 2018. Groups were stratified by patient age group (6-12, 13-17, and 18-21 years), and conversations were audiorecorded, transcribed verbatim, and co-coded via content analysis, with subanalysis by age group. A brief survey assessed preferences for specific emotional health interventions. RESULTS Forty-five parents participated in 6 focus groups. Themes emerged within 2 domains: emotional challenges, and screening and interventions. Themes for emotional challenges comprised the impact of JM on: 1) patient emotional health, particularly depression and anxiety; 2) parent emotional health characterized by sadness, grief, anger, guilt, and anxiety; and 3) family dynamics, including significant sibling distress. Subanalysis revealed similar themes across age groups, but the theme of resiliency emerged specifically for young adults. Themes for emotional health screening and interventions indicated potential issues with patient transparency, several barriers to resources, the facilitator role of rheumatology providers, and preferred intervention modalities of online and in-person resources, with survey responses most strongly supporting child/parent counseling and peer support groups. CONCLUSION JM is associated with intense patient and family distress, although resiliency may emerge by young adulthood. Despite existing barriers, increasing access to counseling, peer support groups, and online resources with rheumatology facilitation may be effective intervention strategies.
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Affiliation(s)
- Kaveh Ardalan
- Duke University Medical Center, Durham, North Carolina, and Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Anne E Caliendo
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Jessica Neely
- University of California San Francisco Medical Center, San Francisco
| | - Susan Kim
- University of California San Francisco Medical Center, San Francisco
| | | | | | - Andrea M Knight
- Hospital for Sick Children and University of Toronto Faculty of Medicine, Toronto, Ontario, Canada, and University of Pennsylvania Perelman School of Medicine, Philadelphia
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Livermore P, Wedderburn LR, Gibson F. You give me a name that I can’t say, but I have to explain what it is every day: the power of poetry to share stories from young people with a rare disease. JOURNAL OF POETRY THERAPY 2019. [DOI: 10.1080/08893675.2020.1694210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- P. Livermore
- Infection, Immunity and Inflammation Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
| | - L. R. Wedderburn
- Infection, Immunity and Inflammation Research and Teaching Department, University College London Great Ormond Street Institute of Child Health, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
| | - F. Gibson
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- School of Health Sciences, University of Surrey, Guildford, UK
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