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Kearsley-Fleet L, Klotsche J, van Straalen JW, Costello W, D’Angelo G, Giancane G, Horneff G, Klein A, Láday M, Lunt M, de Roock S, Ruperto N, Schoemaker C, Vijatov-Djuric G, Vojinovic J, Vougiouka O, Wulffraat NM, Hyrich KL, Minden K, Swart JF. Burden of comorbid conditions in children and young people with juvenile idiopathic arthritis: a collaborative analysis of 3 JIA registries. Rheumatology (Oxford) 2022; 61:2524-2534. [PMID: 34613385 PMCID: PMC9157174 DOI: 10.1093/rheumatology/keab641] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally-UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild-to quantify the occurrence of selected comorbidities in patients with JIA. METHODS Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. RESULTS 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1-1.8%) and uveitis (15-19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). CONCLUSION This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Jens Klotsche
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Joeri W van Straalen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | - Wendy Costello
- iIrish Children’s Arthritis Network (iCAN), Bansha, Co Tipperary, Ireland
| | | | - Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Ariane Klein
- Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Matilda Láday
- Pediatric Clinical Department 1, Spitalul Clinic Judetean De Urgenta, Tîrgu-Mureș, Romania
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sytze de Roock
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Casper Schoemaker
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
- Dutch JIA Patient and Parent Organisation (Member of ENCA), Rijen, The Netherlands
| | - Gordana Vijatov-Djuric
- Faculty of Medicine, University of Novi Sad
- Department of Immunology, Allergology and Rheumatology, Institute for Child and Youth Health Care of Vojvodina, Novi Sad
| | - Jelena Vojinovic
- Faculty of Medicine, Department of Pediatric Immunology and Rheumatology, University of Nis, University Clinic Center
- Department of Pediatric Rheumatology, Clinical Center Nis, Clinic of Pediatrics, Nis, Serbia
| | - Olga Vougiouka
- ‘P a A Kyriakou’ Children’s Hospital, 2nd Paediatric Department, Athens University School of Medicine, Athens, Greece
| | - Nico M Wulffraat
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | | | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester BRC, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kirsten Minden
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joost F Swart
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
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De Matteis A, Bracaglia C, Pires Marafon D, Piscitelli AL, Alessio M, Naddei R, Orlando F, Filocamo G, Minoia F, Ravelli A, Tibaldi J, Cimaz R, Marino A, Simonini G, Mastrolia MV, La Torre F, Tricarico I, Licciardi F, Montin D, Maggio MC, Alizzi C, Martini G, Civino A, Gallizzi R, Olivieri AN, Ardenti Morini F, Conti G, De Benedetti F, Pardeo M. CANAKINUMAB IN SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS: REAL-LIFE DATA FROM A RETROSPECTIVE ITALIAN COHORT. Rheumatology (Oxford) 2021; 61:1621-1629. [PMID: 34343275 DOI: 10.1093/rheumatology/keab619] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/16/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate in real-life the effectiveness and safety of canakinumab in Italian patients with systemic juvenile idiopathic arthritis (sJIA). METHODS A retrospective multicentre study of children with sJIA was performed. Clinical features, laboratory parameters and adverse events were collected at baseline, after 6 and 12 months from starting canakinumab. The effectiveness primary outcome was clinical inactive disease (CID) off glucocorticoids (GCs) treatment at 6 months. RESULTS A total of 80 children were analyzed from 15 Italian centers. Of the 12 patients who started canakinumab in CID while receiving anakinra, all maintained CID. Of the 68 with active disease at baseline, 57.4% achieved CID off GCs at 6 months and 63.8% at 12 months. In univariate analysis, the variables significantly related with non-response were number of active joints (NAJ) ≥5, history of macrophage activation syndrome (MAS) and disease duration. Multivariate analysis confirmed the association with non-response of NAJ ≥5 (OR 6.37 (95%CI 1.69-24.02), p= 0.006) and history of MAS (OR 3.53 (95%CI 1.06-11.70), p= 0.039). No serious adverse events were recorded in this series. There were two cases of MAS during canakinumab, leading to a rate of 2.9 episodes per 100 patient year. CONCLUSION We confirm, in real-life, the efficacy of canakinumab in sJIA in a multicentric cohort. History of MAS and higher NAJ were associated with lower probability of achieving clinical inactive disease.
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Affiliation(s)
- Arianna De Matteis
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Claudia Bracaglia
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Denise Pires Marafon
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Anna Lucia Piscitelli
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Maria Alessio
- Department of Translational Medical Sciences, Pediatrics Section, University of Naples Federico II
| | - Roberta Naddei
- Department of Translational Medical Sciences, Pediatrics Section, University of Naples Federico II
| | - Francesca Orlando
- Unit of Pediatrics 2, Santobono-Pausilipon Children's Hospital, Napoli
| | - Giovanni Filocamo
- Pediatric Rheumatology, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milano
| | - Francesca Minoia
- Pediatric Rheumatology, Fondazione IRCCS Ca' Grande Ospedale Maggiore Policlinico, Milano
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova
| | - Jessica Tibaldi
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genova
| | | | | | - Gabriele Simonini
- Pediatric Rheumatology Unit, Meyer Children's University Hospital, Firenze
| | | | - Francesco La Torre
- Pediatric Rheumatology Center, Department of Pediatrics, Ospedale 'Giovanni XXIII', AOU Consorziale Policlinico, Bari
| | - Ilaria Tricarico
- Pediatric Rheumatology Center, Department of Pediatrics, Ospedale 'Giovanni XXIII', AOU Consorziale Policlinico, Bari
| | - Francesco Licciardi
- Department of Pediatrics and Infectious Diseases, School of Medicine, University of Turin, Regina Margherita Children's Hospital, Torino
| | - Davide Montin
- Department of Pediatrics and Infectious Diseases, School of Medicine, University of Turin, Regina Margherita Children's Hospital, Torino
| | | | - Clotilde Alizzi
- University Department Pro.Sa.M.I. 'G. D'Alessandro', University of Palermo, Palermo
| | - Giorgia Martini
- Department of Women's and Children's Health, University of Padua, Padova
| | - Adele Civino
- Department of Pediatrics, Division of Rheumatology and Immunology, Ospedale 'Vito Fazzi', Lecce
| | - Romina Gallizzi
- Unit of Pediatric Nephrology and Rheumatology, University of Messina, Messina
| | - Alma Nunzia Olivieri
- Department of General and Specialized Surgery for Women and Children, University 'Luigi Vanvitelli', Napoli
| | | | - Giovanni Conti
- Pediatric Nephrology and Rheumatology Unit, AOU Policlinico 'G. Martino', Messina, Italy
| | - Fabrizio De Benedetti
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
| | - Manuela Pardeo
- Division of Rheumatology, ERN RITA Center, IRCCS Ospedale Pediatrico Bambino Gesù, Roma
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Peterson RG, Xiao R, Katcoff H, Fisher BT, Weiss PF. Effect of first-line biologic initiation on glucocorticoid exposure in children hospitalized with new-onset systemic juvenile idiopathic arthritis: emulation of a pragmatic trial using observational data. Pediatr Rheumatol Online J 2021; 19:109. [PMID: 34225753 PMCID: PMC8256608 DOI: 10.1186/s12969-021-00597-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 05/09/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Glucocorticoid exposure is a significant driver of morbidity in children with systemic juvenile idiopathic arthritis (sJIA). We determined the effect of early initiation of biologic therapy (IL-1 or IL-6 inhibition) on glucocorticoid exposure in hospitalized patients with new-onset sJIA. METHODS We emulated a pragmatic sequence of trials ("pseudo-trials") of biologic initiation in children (≤ 18 years) hospitalized with new-onset sJIA utilizing retrospective data from an administrative database from 52 tertiary care children's hospitals from 2008 to 2019. Eligibility window, treatment assignment and start of follow-up between biologic and non-biologic study arms were aligned for each pseudo-trial. Patients in the source population could meet eligibility criteria at several timepoints. Mixed-effects logistic regression was used to determine the effect of biologic initiation on in-hospital glucocorticoid exposure. RESULTS Four hundred sixty-eight children met eligibility criteria, of which 19% received biologic therapy without preceding or concomitant initiation of immunomodulatory medications. This proportion significantly increased over time during the study period (p < 0.01). 1451 trial subjects were included across 4 pseudo-trials with 71 assigned to the biologic arm and 1380 assigned to the non-biologic arm. After adjustment, there was a trend toward decreased odds of glucocorticoid initiation in the biologic arm compared to the non-biologic arm (OR 0.39, 95% CI [0.13, 1.15]). CONCLUSION Biologic initiation in children hospitalized with new-onset sJIA significantly increased over time and may be associated with reduced glucocorticoid exposure. The increasing use of first-line biologic therapy may lead to clinically relevant reductions in treatment-related adverse effects of glucocorticoid-reliant therapeutic approaches.
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Affiliation(s)
- Rosemary G. Peterson
- grid.239552.a0000 0001 0680 8770Children’s Hospital of Philadelphia, Division of Rheumatology, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA USA ,Dell Children’s Medical Center, Strictly Pediatrics Building, 1301 Barbara Jordan Blvd, Suite 400, Austin, TX 78723 USA
| | - Rui Xiao
- grid.25879.310000 0004 1936 8972Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Hannah Katcoff
- grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA USA
| | - Brian T. Fisher
- grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Children’s Hospital of Philadelphia, Division of Infectious Diseases, Philadelphia, PA USA ,grid.25879.310000 0004 1936 8972Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
| | - Pamela F. Weiss
- grid.239552.a0000 0001 0680 8770Children’s Hospital of Philadelphia, Division of Rheumatology, Philadelphia, PA USA ,grid.239552.a0000 0001 0680 8770Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia Research Institute, Philadelphia, PA USA ,grid.25879.310000 0004 1936 8972Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
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4
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Tomsan H, Grady MF, Ganley TJ, Nguyen JC. Pediatric Elbow: Development, Common Pathologies, and Imaging Considerations. Semin Roentgenol 2021; 56:245-265. [PMID: 34281678 DOI: 10.1053/j.ro.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Hanna Tomsan
- Department of Radiology, Mercy Catholic Medical Center, Darby, PA
| | - Matthew F Grady
- Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Theodore J Ganley
- Divison of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA; University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jie C Nguyen
- University of Pennsylvania School of Medicine, Philadelphia, PA; Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA.
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5
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Kim D, Song J, Lee S, Jung J, Jang W. An Integrative Transcriptomic Analysis of Systemic Juvenile Idiopathic Arthritis for Identifying Potential Genetic Markers and Drug Candidates. Int J Mol Sci 2021; 22:ijms22020712. [PMID: 33445803 PMCID: PMC7828236 DOI: 10.3390/ijms22020712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 12/20/2022] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a rare subtype of juvenile idiopathic arthritis, whose clinical features are systemic fever and rash accompanied by painful joints and inflammation. Even though sJIA has been reported to be an autoinflammatory disorder, its exact pathogenesis remains unclear. In this study, we integrated a meta-analysis with a weighted gene co-expression network analysis (WGCNA) using 5 microarray datasets and an RNA sequencing dataset to understand the interconnection of susceptibility genes for sJIA. Using the integrative analysis, we identified a robust sJIA signature that consisted of 2 co-expressed gene sets comprising 103 up-regulated genes and 25 down-regulated genes in sJIA patients compared with healthy controls. Among the 128 sJIA signature genes, we identified an up-regulated cluster of 11 genes and a down-regulated cluster of 4 genes, which may play key roles in the pathogenesis of sJIA. We then detected 10 bioactive molecules targeting the significant gene clusters as potential novel drug candidates for sJIA using an in silico drug repositioning analysis. These findings suggest that the gene clusters may be potential genetic markers of sJIA and 10 drug candidates can contribute to the development of new therapeutic options for sJIA.
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6
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Yan X, Tang W, Zhang Z, Zhang Y, Luo C, Tang X. Tocilizumab in Systemic Juvenile Idiopathic Arthritis: Response Differs by Disease Duration at Medication Initiation and by Phenotype of Disease. Front Pediatr 2021; 9:735846. [PMID: 34820342 PMCID: PMC8606744 DOI: 10.3389/fped.2021.735846] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 10/01/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: We performed a single-center retrospective study to determine the different efficacy of tocilizumab (TCZ) in the early and late stages and in three phenotypic subgroups (monocyclic, polycyclic, and persistent) of systemic juvenile idiopathic arthritis (sJIA). Methods: Clinical and serological parameters of 77 sJIA patients treated by TCZ were collected from November 1, 2013 to May 1, 2019. Patients were grouped based on the duration group A < 6 months (n = 41) and group B > 6 months (n = 36) and divided into three phenotypes: monocyclic (n = 12), polycyclic (n = 14), and persistent (n = 51) course. Results: At baseline, group A had pronounced ESR, fever less active arthritis than group B (p < 0.05). After 12 weeks of therapy, TCZ alleviated fever, ESR, CRP, and systemic-onset juvenile arthritis disease activity score-27 (sJADAS27) in both group A and group B (p>0.05), while the efficacy of TCZ in relieving active arthritis in group A was better than that in group B (p<0.05). After 1 year of TCZ therapy, it showed that patients with monocyclic phenotype had the highest clinical response rate (91.7%, odds ratio = 0, 95% CI: 24-24, p = 0.00), followed by the polycyclic (28.6%, odds ratio = 2.1, 95% CI: 10.5-18.8, p = 0.00) and the persistent course (9.8%, odds ratio = 1.2, 95% CI: 9.5-13.8, p = 0.00). Conclusion: TCZ can quickly relieve fever and inflammation, especially when patients have less active arthritis with shorter disease duration. The long-term efficacy of TCZ is related to the phenotypes, among which the monocyclic is the best, and the persistent is the worst.
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Affiliation(s)
- Xin Yan
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wenjing Tang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zhiyong Zhang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yu Zhang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chong Luo
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Xuemei Tang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China Development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, China
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Peterson RG, Xiao R, James KE, Katcoff H, Fisher BT, Weiss PF. Variation in treatment of children hospitalized with new-onset systemic juvenile idiopathic arthritis in the United States. Arthritis Care Res (Hoboken) 2020; 73:1714-1721. [PMID: 33242366 DOI: 10.1002/acr.24417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/06/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Increasing evidence supports that early initiation of biologics may dramatically improve disease course and reduce glucocorticoid exposure for children with systemic juvenile idiopathic arthritis (JIA). We characterized variation in the use of first-line biologic and glucocorticoid therapy and identified drivers of variation in children hospitalized with new-onset systemic JIA. METHODS We conducted a retrospective cohort study of children hospitalized with new-onset systemic JIA from 2008-2019 utilizing a comparative pediatric database from 52 tertiary care children's hospitals. Subjects and treatment receipt were identified using International Classification of Diseases (ICD)-9 and ICD-10 discharge diagnosis codes, pharmacy billing data and clinical transaction classification codes. Mixed-effects logistic regression was used to identify patient and hospital-level factors associated with receipt of glucocorticoids and biologics. RESULTS 534 children with new-onset systemic JIA hospitalized during the study period met inclusion criteria. Twenty-nine percent received biologics and 58% received glucocorticoids. Biologic use increased over time (p < 0.001), methotrexate use decreased (p < 0.01), and glucocorticoid use remained unchanged. Biologics and glucocorticoid use varied significantly between hospitals. High annual hospital volume, intensive care unit stay, and later discharge year were significantly associated with biologic exposure. Medium-high and high annual hospital volume were significantly associated with less glucocorticoid exposure. CONCLUSION Despite increasing evidence demonstrating improved outcomes with first-line treatment with biologics, we found significant treatment variation across hospitals with many children not receiving biologics and a persistent high rate of glucocorticoid exposure. These results underscore the need for comparative efficacy studies and improved treatment standardization.
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Affiliation(s)
- Rosemary G Peterson
- Children's Hospital of Philadelphia, Division of Rheumatology, Philadelphia, PA, USA.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | - Rui Xiao
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Karen E James
- University of Utah, Primary Children's Hospital, Division of Rheumatology, Salt Lake City, UT, USA
| | - Hannah Katcoff
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA
| | - Brian T Fisher
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA.,Children's Hospital of Philadelphia, Division of Infectious Diseases, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Pamela F Weiss
- Children's Hospital of Philadelphia, Division of Rheumatology, Philadelphia, PA, USA.,Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia Research Institute, Philadelphia, PA, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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8
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[Injuries in children and adolescents with inflammatory rheumatic diseases : Special risks and techniques for fracture treatment of the growing skeleton]. Unfallchirurg 2020; 123:607-615. [PMID: 32444884 DOI: 10.1007/s00113-020-00818-2] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inflammatory rheumatic diseases in childhood and adolescence are a special challenge in the treatment of acute trauma. The pharmaceutical treatment strategies for children and adolescents have been modified. OBJECTIVE Which special aspects must be considered in young patients suffering from rheumatism when a trauma necessitates an operative procedure? MATERIAL AND METHOD A literature search was carried out to elaborate recommendations for the practice. RESULTS The joint-related alterations in young patients suffering from rheumatism differ with respect to the differently altered inflammatory rheumatic destruction. The extent of these inflammatory destructive alterations dictates the operative approach. Consequences arise in paying attention to the concurrent medication with respect to avoidance of events triggering an exacerbation and tissue infections. The bone strength necessitates an individualized selection of implants and sometimes influences the duration of follow-up treatment. In the early stages of the inflammatory process the approach in cases of trauma is no different to that for healthy patients but in later stages (Larsen stage III) it does differ. CONCLUSION An interdisciplinary concept can help to avoid disadvantages in the treatment of the underlying disease. Due to the special dysplastic anatomy and tissue alterations, trauma in these patients is a particular challenge.
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9
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Haas JP, Arbogast M. [Therapeutic options in juvenile idiopathic arthritis : Part 1: Nonsurgical treatment]. DER ORTHOPADE 2019; 47:912-918. [PMID: 30291372 DOI: 10.1007/s00132-018-3645-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The treatment of children and adolescents with juvenile idiopathic arthritis (JIA) has progressed substantially during recent years. Multiple different factors have played a role in this advancement: improved medical treatment due to the introduction of new drugs, structural improvements with provision of units specializing in childhood rheumatology, multidisciplinary treatment concepts, structured educational programs for patients and parents, improved functional treatment including sports therapy, and selective surgical and orthopedic interventions improving functional capacities. Current treatment strategies in JIA are aimed at achieving disease remission, i.e., control of disease activity and re-establishment of age-appropriate functional capacities. This review summarizes important developments in the conservative treatment of JIA. Part 2 deals with orthopedic and surgical treatment strategies.
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Affiliation(s)
- J-P Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Kinderklinik Garmisch-Partenkirchen gGmbH, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen, Deutschland.
| | - M Arbogast
- Abteilung für Rheumaorthopädie und Handchirurgie, Zentrum für Rheumatologie, Orthopädie und Schmerztherapie, Klinik Oberammergau, Oberammergau, Deutschland
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10
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Gupta A, Bagri NK, Tripathy SK, Barwad A, Phulware RH, Hari P. Successful use of tocilizumab in amyloidosis secondary to systemic juvenile idiopathic arthritis. Rheumatol Int 2019; 40:153-159. [DOI: 10.1007/s00296-019-04363-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/30/2019] [Indexed: 12/21/2022]
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Abstract
Systemic juvenile idiopathic arthritis (sJIA) is characterized by fever, arthritis, and other signs of systemic inflammation. Historically, sJIA was named Still's disease after George Frederic Still, who first reported patients. Individuals who manifest after the 16th birthday are diagnosed with adult onset Still's disease (AOSD). The pathophysiology of sJIA and AOSD are incompletely understood. Increased activation of inflammasomes and the expression of proinflammatory cytokines play a central role. S100 proteins, which can activate Toll-like receptors, thus, maintaining positive feedback loops, have also been detected at increased levels in sera from sJIA patients. Reduced expression of the immune-modulatory cytokine IL-10 may further contribute to immune cell activation and the production of proinflammatory molecules. Here, we discuss the clinical picture, differential diagnoses, the current pathophysiological understanding, and treatment options in sJIA and AOSD.
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Affiliation(s)
- C M Hedrich
- Arbeitsbereich Pädiatrische Rheumatologie und Immunologie, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Günther
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - M Aringer
- Bereich Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
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12
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Szymanski AM, Ombrello MJ. Using genes to triangulate the pathophysiology of granulomatous autoinflammatory disease: NOD2, PLCG2 and LACC1. Int Immunol 2019. [PMID: 29538758 DOI: 10.1093/intimm/dxy021] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The intersection of granulomatosis and autoinflammatory disease is a rare occurrence that can be generally subdivided into purely granulomatous phenotypes and disease spectra that are inclusive of granulomatous features. NOD2 (nucleotide-binding oligomerization domain-containing protein 2)-related disease, which includes Blau syndrome and early-onset sarcoidosis, is the prototypic example of granulomatous inflammation in the context of monogenic autoinflammation. Granulomatous inflammation has also been observed in two related autoinflammatory diseases caused by mutations in PLCG2 (phospholipase Cγ2). More recently, mutations in LACC1 (laccase domain-containing protein 1) have been identified as the cause of a monogenic form of systemic juvenile idiopathic arthritis, which does not itself manifest granulomatous inflammation, but the same LACC1 mutations have also been shown to cause an early-onset, familial form of a well-known granulomatous condition, Crohn's disease (CD). Rare genetic variants of PLCG2 have also been shown to cause a monogenic form of CD, and moreover common variants of all three of these genes have been implicated in polygenic forms of CD. Additionally, common variants of NOD2 and LACC1 have been implicated in susceptibility to leprosy, a granulomatous infection. Although no specific mechanistic link exists between these three genes, they form an intriguing web of susceptibility to both monogenic and polygenic autoinflammatory and granulomatous phenotypes.
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Affiliation(s)
- Ann Marie Szymanski
- Translational Genetics and Genomics Unit, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
| | - Michael J Ombrello
- Translational Genetics and Genomics Unit, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health & Human Services, Bethesda, MD, USA
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13
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Arthur VL, Shuldiner E, Remmers EF, Hinks A, Grom AA, Foell D, Martini A, Gattorno M, Özen S, Prahalad S, Zeft AS, Bohnsack JF, Ilowite NT, Mellins ED, Russo R, Len C, Oliveira S, Yeung RSM, Rosenberg AM, Wedderburn LR, Anton J, Haas JP, Rösen-Wolff A, Minden K, Szymanski AM, Thomson W, Kastner DL, Woo P, Ombrello MJ. IL1RN Variation Influences Both Disease Susceptibility and Response to Recombinant Human Interleukin-1 Receptor Antagonist Therapy in Systemic Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2018; 70:1319-1330. [PMID: 29609200 PMCID: PMC6105455 DOI: 10.1002/art.40498] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 03/13/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine whether systemic juvenile idiopathic arthritis (JIA) susceptibility loci that were identified by candidate gene studies demonstrate association with systemic JIA in the largest study population assembled to date. METHODS Single-nucleotide polymorphisms (SNPs) from 11 previously reported systemic JIA risk loci were examined for association in 9 populations, including 770 patients with systemic JIA and 6,947 controls. The effect of systemic JIA-associated SNPs on gene expression was evaluated in silico in paired whole genome and RNA sequencing data from the lymphoblastoid cell lines (LCLs) of 373 European subjects from the 1000 Genomes Project. Responses of systemic JIA-associated SNPs to anakinra treatment were evaluated in 38 US patients for whom treatment response data were available. RESULTS We found no association between the previously reported 26 SNPs and systemic JIA. Expanded analysis of the regions containing the 26 SNPs revealed only 1 significant association: the promoter region of IL1RN (P < 1 × 10-4 ). Systemic JIA-associated SNPs correlated with IL1RN expression in LCLs, with an inverse correlation between systemic JIA risk and IL1RN expression. The presence of homozygous IL1RN high expression alleles correlated strongly with a lack of response to anakinra therapy (odds ratio 28.7 [95% confidence interval 3.2-255.8]). CONCLUSION In our study, IL1RN was the only candidate locus associated with systemic JIA. The implicated SNPs are among the strongest known determinants of IL1RN and interleukin-1 receptor antagonist levels, linking low expression with increased systemic JIA risk. Homozygous high expression alleles predicted nonresponsiveness to anakinra therapy, making them ideal candidate biomarkers to guide systemic JIA treatment. This study is an important first step toward the personalized treatment of systemic JIA.
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Affiliation(s)
- Victoria L. Arthur
- Translational Genetics and Genomics Unit, National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US
Department of Health & Human Services, Bethesda, MD, USA
| | - Emily Shuldiner
- Translational Genetics and Genomics Unit, National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US
Department of Health & Human Services, Bethesda, MD, USA
| | - Elaine F. Remmers
- Inflammatory Disease Section, National Human Genome Research
Institute, National Institutes of Health, US Department of Health & Human
Services, Bethesda, MD, USA
| | - Anne Hinks
- Arthritis Research UK Centre for Genetics and Genomics, Centre for
Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Alexei A. Grom
- Department of Pediatrics, University of Cincinnati, College of
Medicine, Cincinnati, OH, USA
- Cincinnati Children’s Hospital Medical Center, Cincinnati,
OH, USA
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University
Hospital Münster, Münster, Germany
| | - Alberto Martini
- Direzione Scientifica, G. Gaslini Institute, Genoa, Italy
- Clinica Pediatrica e Reumatologia, G. Gaslini Institute and
University of Genoa, Genoa, Italy
| | - Marco Gattorno
- Clinica Pediatrica e Reumatologia, G. Gaslini Institute and
University of Genoa, Genoa, Italy
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara,
Turkey
| | - Sampath Prahalad
- Departments of Pediatrics and Human Genetics, Emory University
School of Medicine, Atlanta, GA, USA
- Children’s Healthcare of Atlanta, Atlanta, GA
| | - Andrew S. Zeft
- Department of Pediatrics, Cleveland Clinic, Cleveland, OH,
USA
| | - John F. Bohnsack
- Department of Pediatrics, University of Utah, Salt Lake City, UT,
USA
| | - Norman T. Ilowite
- Department of Pediatrics, Albert Einstein College of Medicine and
Children’s Hospital at Montefiore, Bronx, NY, USA
| | | | - Ricardo Russo
- Service of Immunology and Rheumatology, Hospital de Pediatria
Garrahan, Buenos Aires, Argentina
| | - Claudio Len
- Department of Pediatrics, Universidade Federal de São
Paulo, São Paulo, Brazil
| | - Sheila Oliveira
- Universidade Federal de Rio de Janeiro, Rio de Janeiro,
Brazil
| | - Rae S. M. Yeung
- Department of Pediatrics, University of Toronto, Toronto,
Canada
- Department of Immunology, University of Toronto, Toronto,
Canada
- Institute of Medical Science, University of Toronto, Toronto,
Canada
| | - Alan M. Rosenberg
- Department of Pediatrics, University of Saskatchewan, Saskatoon,
Canada
| | - Lucy R. Wedderburn
- University College London Great Ormond Street Hospital Institute of
Child Health, University College London, London, UK
- Center of Paediatric and Adolescent Rheumatology, University
College London, London, UK
- NIHR GOSH Biomedical Research Centre, London, UK
| | - Jordi Anton
- Pediatric Rheumatology Unit, Hospital Sant Joan de Déu,
Universitat de Barcelona, Barcelona, Spain
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology,
Garmisch-Partenkirchen, Germany
| | | | - Kirsten Minden
- Charité University Medicine, Berlin, Germany
- German Rheumatism Research Centre, Epidemiology Unit, Berlin,
Germany
| | - Ann Marie Szymanski
- Translational Genetics and Genomics Unit, National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US
Department of Health & Human Services, Bethesda, MD, USA
| | | | - Wendy Thomson
- Arthritis Research UK Centre for Genetics and Genomics, Centre for
Musculoskeletal Research, University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical
Centre, Central Manchester National Health Service Foundation Trust, Manchester
Academic Health Centre, University of Manchester, Manchester, UK
| | - Daniel L. Kastner
- Inflammatory Disease Section, National Human Genome Research
Institute, National Institutes of Health, US Department of Health & Human
Services, Bethesda, MD, USA
| | - Patricia Woo
- University College London Great Ormond Street Hospital Institute of
Child Health, University College London, London, UK
| | - Michael J. Ombrello
- Translational Genetics and Genomics Unit, National Institute of
Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US
Department of Health & Human Services, Bethesda, MD, USA
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14
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Toplak N, Blazina Š, Avčin T. The role of IL-1 inhibition in systemic juvenile idiopathic arthritis: current status and future perspectives. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1633-1643. [PMID: 29922038 PMCID: PMC5996857 DOI: 10.2147/dddt.s114532] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The pathogenesis, clinical course, and response to treatment in systemic juvenile idiopathic arthritis (SJIA) differ from other types of juvenile idiopathic arthritis and are similar to other interleukin-1 (IL-1)-mediated diseases. The main cytokine involved in the pathogenesis of SJIA is IL-1β, which can be neutralized by targeted anti-IL-1 therapy. In SJIA, no antibodies have been found and there is growing evidence that it is mainly an autoinflammatory and not an autoimmune disease. Before the era of biologic therapy, treatment of SJIA was primarily based on long-term treatment with high doses of glucocorticosteroids (GCS). The side effects of GCS could have a significant impact on the outcome of the disease and could cause long-term damage. Treatment with anti-IL-1 agents early in the disease course has revolutionized the management principles of SJIA. However, not all SJIA patients respond equally well to anti-IL-1 therapy, and it has been shown that age at the onset of disease, duration of the disease, number of affected joints, neutrophil count, and ferritin level can predict the response to anti-IL-1 therapy. In particular, an elevated ferritin level should prompt testing for macrophage activation syndrome (MAS), the most severe complication of SJIA. Anti-IL-1 therapy has been shown to be effective also in patients with MAS. Although anti-IL-1 agents are currently not recommended as first-line treatment, there is growing evidence that anti-IL-1 agents introduced at the beginning of SJIA could enable lower doses and a shorter duration of GCS therapy, change the long-term disease outcome, and even influence molecular disease patterns. There are currently three anti-IL-1 agents available: anakinra, canakinumab, and rilonacept. In this review, we present the current knowledge on the pathogenesis of SJIA, the rational for anti-IL-1 treatment, and future perspectives on the treatment of SJIA.
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Affiliation(s)
- Nataša Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Štefan Blazina
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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15
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Listing M, Mönkemöller K, Liedmann I, Niewerth M, Sengler C, Listing J, Foell D, Heiligenhaus A, Klein A, Horneff G, Ganser G, Haas JP, Klotsche J, Minden K. The majority of patients with newly diagnosed juvenile idiopathic arthritis achieve a health-related quality of life that is similar to that of healthy peers: results of the German multicenter inception cohort (ICON). Arthritis Res Ther 2018; 20:106. [PMID: 29848349 PMCID: PMC5977761 DOI: 10.1186/s13075-018-1588-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Achieving the best possible health-related quality of life (HRQoL) for a patient is an important treatment goal in juvenile idiopathic arthritis (JIA). We investigated the 36-month trajectories of HRQoL in children with JIA compared with healthy peers and identified the predictors of an unfavorable HRQoL. Methods Patients with a recent JIA diagnosis were enrolled in the German inception cohort study ICON. As a peer group, friends of patients of the same age and sex were asked to cooperate. Children were prospectively followed and regularly questioned about their HRQoL using the Pediatric Quality of Life Inventory 4.0 (PedsQL). Disease activity was assessed by the clinical Juvenile Arthritis Disease Activity Score (cJADAS-10), and the burden of the child’s chronic illness on their family was assessed by the Family Burden Questionnaire (FaBel). Linear mixed models were used to compare the HRQoL of the patients and their peers. Associations between the health status of a patient at enrollment and an unfavorable HRQoL (PedsQL total < 79.3) at their 3-year follow-up (FU) were analyzed by logistic regression. Results Data from 953 patients (median symptom duration 6 months, mean age 7.9 years) and 491 healthy peers (aged 8.4 years) were analyzed. During 3 years of FU, the disease activity and HRQoL of the patients improved significantly (cJADAS-10 from 9.8 (6.2) to 2.7 (3.6) and PedsQL total score from 71.7 (18.2) to 87.3 (13.9)). While the HRQoL of the patients varied among the several JIA categories at the time of enrollment, no significant differences were found at the 3-year FU. After 36 months, the HRQoL of the patients had largely converged with that of their healthy peers. JIA patients had a psychosocial health status comparable with their healthy peers, whereas a small significant mean difference remained in physical health (5.8, 95% confidence interval (CI) 4.1–7.6). Up to the 36-month FU, three-quarters of JIA patients attained a favorable HRQoL (PedsQL ≥ 79.3) which was achieved by 90% of the peers. A higher family burden, higher pain level, and lower well-being at enrollment were associated with an unfavorable HRQoL. Conclusions Under current therapeutic conditions, an HRQoL corresponding with that of healthy children is a realistic treatment goal in JIA.
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Affiliation(s)
- Miriam Listing
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany.
| | - Kirsten Mönkemöller
- Kinderkrankenhaus Amsterdamer Straße, Kliniken der Stadt Köln gGmbH, Köln, Germany
| | - Ina Liedmann
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Martina Niewerth
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Claudia Sengler
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Joachim Listing
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University of Münster, Münster, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology at St. Franziskus Hospital Münster, University of Duisburg-Essen, Duisburg, Germany
| | - Ariane Klein
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Gerd Horneff
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Gerd Ganser
- St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Johannes-Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Garmisch-Partenkirchen, Germany
| | - Jens Klotsche
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Kirsten Minden
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany
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16
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Klotsche J, Raab A, Niewerth M, Sengler C, Ganser G, Kallinich T, Niehues T, Hufnagel M, Thon A, Hospach T, Horneff G, Minden K. Outcome and Trends in Treatment of Systemic Juvenile Idiopathic Arthritis in the German National Pediatric Rheumatologic Database, 2000-2013. Arthritis Rheumatol 2017; 68:3023-3034. [PMID: 27332999 DOI: 10.1002/art.39796] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 06/16/2016] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To investigate the clinical presentation and medical treatment of patients with systemic juvenile idiopathic arthritis (JIA) during the first year of illness. Our study focused on 3-year outcomes in a subsample of patients who were followed up longitudinally. METHODS From 2000 to 2013, 597 patients with systemic JIA and a disease duration of ≤12 months were recorded in the National Pediatric Rheumatologic Database. Among those patients, 3-year outcome data were available for 133. These data included the clinical Juvenile Arthritis Disease Activity Score in 10 joints (JADAS-10) and the physician's global assessment score (on a numerical rating scale), as well as assessment of joint involvement, growth retardation, and patient-reported outcomes. RESULTS The median clinical JADAS-10 declined significantly, from 7 in 2000 to 2 in 2013, while the proportion of patients with inactive disease increased from 19% in 2000 to 41% in 2013. The rate of treatment with systemic glucocorticoids and disease-modifying antirheumatic drugs (DMARDs) remained stable from 2000 to 2013. By 2013, the proportion of patients with systemic JIA who were treated with biologic DMARDs had increased to 20%. At 3-year follow-up, 72% of patients with systemic JIA had inactive disease, and 77% had no functional limitations. Growth retardation was associated with persistently high disease activity and continuing treatment with systemic glucocorticoids. At the 3-year follow-up, one-third of patients were still being treated with systemic glucocorticoids. CONCLUSION The proportion of patients with inactive disease has increased over the past decade. Possible explanations may include improved access to specialized care, additional treatment options, and earlier or faster step-up treatment. However, challenges in the management of systemic JIA remain, as ∼30% of patients continue to present with ongoing active disease.
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Affiliation(s)
- Jens Klotsche
- German Rheumatism Research Centre Berlin and Charité University Hospital Berlin, Berlin, Germany
| | - Anna Raab
- German Rheumatism Research Centre Berlin and Charité University Hospital Berlin, Berlin, Germany
| | | | | | - Gerd Ganser
- St. Josef-Stift Sendenhorst Hospital, Sendenhorst, Germany
| | | | | | | | | | - Toni Hospach
- Olgahospital, Clinical Center Stuttgart, Stuttgart, Germany
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, St. Augustin, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre Berlin and Charité University Hospital Berlin, Berlin, Germany
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17
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Abstract
Systemic juvenile idiopathic arthritis (sJIA) and its most significant complication, macrophage activation syndrome (MAS), have traditionally been treated with steroids and non-steroidal anti-inflammatory medications. However, the introduction of biologic medications that inhibit specific cytokines, such interleukins 1 and 6, has changed the treatment paradigm for sJIA patients. In this review, we discuss the therapies currently used in the treatment of sJIA as well as novel targets and approaches under consideration, including mesenchymal stromal cell therapy and JAK inhibitors. We also discuss targeting cytokines that have been implicated in MAS, such as interferon gamma and interleukin 18.
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Affiliation(s)
- Susan Canny
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Elizabeth Mellins
- Department of Pediatrics, Program in Immunology, Stanford University, Stanford, CA, USA
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18
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Ombrello MJ, Arthur VL, Remmers EF, Hinks A, Tachmazidou I, Grom AA, Foell D, Martini A, Gattorno M, Özen S, Prahalad S, Zeft AS, Bohnsack JF, Ilowite NT, Mellins ED, Russo R, Len C, Hilario MOE, Oliveira S, Yeung RSM, Rosenberg AM, Wedderburn LR, Anton J, Haas JP, Rosen-Wolff A, Minden K, Tenbrock K, Demirkaya E, Cobb J, Baskin E, Signa S, Shuldiner E, Duerr RH, Achkar JP, Kamboh MI, Kaufman KM, Kottyan LC, Pinto D, Scherer SW, Alarcón-Riquelme ME, Docampo E, Estivill X, Gül A, Langefeld CD, Thompson S, Zeggini E, Kastner DL, Woo P, Thomson W. Genetic architecture distinguishes systemic juvenile idiopathic arthritis from other forms of juvenile idiopathic arthritis: clinical and therapeutic implications. Ann Rheum Dis 2017; 76:906-913. [PMID: 27927641 PMCID: PMC5530341 DOI: 10.1136/annrheumdis-2016-210324] [Citation(s) in RCA: 101] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 10/27/2016] [Accepted: 11/12/2016] [Indexed: 01/14/2023]
Abstract
OBJECTIVES Juvenile idiopathic arthritis (JIA) is a heterogeneous group of conditions unified by the presence of chronic childhood arthritis without an identifiable cause. Systemic JIA (sJIA) is a rare form of JIA characterised by systemic inflammation. sJIA is distinguished from other forms of JIA by unique clinical features and treatment responses that are similar to autoinflammatory diseases. However, approximately half of children with sJIA develop destructive, long-standing arthritis that appears similar to other forms of JIA. Using genomic approaches, we sought to gain novel insights into the pathophysiology of sJIA and its relationship with other forms of JIA. METHODS We performed a genome-wide association study of 770 children with sJIA collected in nine countries by the International Childhood Arthritis Genetics Consortium. Single nucleotide polymorphisms were tested for association with sJIA. Weighted genetic risk scores were used to compare the genetic architecture of sJIA with other JIA subtypes. RESULTS The major histocompatibility complex locus and a locus on chromosome 1 each showed association with sJIA exceeding the threshold for genome-wide significance, while 23 other novel loci were suggestive of association with sJIA. Using a combination of genetic and statistical approaches, we found no evidence of shared genetic architecture between sJIA and other common JIA subtypes. CONCLUSIONS The lack of shared genetic risk factors between sJIA and other JIA subtypes supports the hypothesis that sJIA is a unique disease process and argues for a different classification framework. Research to improve sJIA therapy should target its unique genetics and specific pathophysiological pathways.
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Affiliation(s)
- Michael J Ombrello
- Translational Genetics and Genomics Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health,US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Victoria L Arthur
- Translational Genetics and Genomics Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health,US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Elaine F Remmers
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Anne Hinks
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Alexei A Grom
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Hospital Münster, Münster, Germany
| | - Alberto Martini
- Department of Pediatrics, University of Genova, Genoa, Italy
- Pediatrics II Unit, Giannina Gaslini Institute, Genoa, Italy
| | - Marco Gattorno
- Pediatrics II Unit, Giannina Gaslini Institute, Genoa, Italy
| | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Sampath Prahalad
- Departments of Pediatrics and Human Genetics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Andrew S Zeft
- Department of Pediatrics, Cleveland Clinic, Cleveland, Ohio, USA
| | - John F Bohnsack
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Norman T Ilowite
- Department of Pediatrics, Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York, USA
| | | | - Ricardo Russo
- Service of Immunology and Rheumatology, Hospital de Pediatria Garrahan, Buenos Aires, Argentina
| | - Claudio Len
- Department of Pediatrics, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Sheila Oliveira
- Universidade Federal de Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rae S M Yeung
- Department of Pediatrics, University of Toronto, Toronto, Canada
- Department of Immunology, University of Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Alan M Rosenberg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Lucy R Wedderburn
- Institute of Child Health, University College London, London, UK
- Center of Paediatric and Adolescent Rheumatology, University College London, London, UK
| | - Jordi Anton
- Pediatric Rheumatology Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | | | - Kirsten Minden
- Department of Rheumatology and Clinical Immunology, Charité -University Medicine, Berlin, Germany
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Klaus Tenbrock
- Department of Pediatrics, RWTH Aachen University, Aachen, Germany
| | - Erkan Demirkaya
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Joanna Cobb
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Elizabeth Baskin
- Translational Genetics and Genomics Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health,US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Sara Signa
- Department of Pediatrics, University of Genova, Genoa, Italy
| | - Emily Shuldiner
- Translational Genetics and Genomics Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health,US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Richard H Duerr
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jean-Paul Achkar
- Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
- Department of Pathobiology, Cleveland Clinic, Cleveland, Ohio, USA
| | - M Ilyas Kamboh
- Department of Human Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kenneth M Kaufman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Leah C Kottyan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Dalila Pinto
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stephen W Scherer
- The Centre for Applied Genomics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Marta E Alarcón-Riquelme
- Center for Genomics and Oncological Research, Pfizer-University of Granada-Andalusian Government, Granada, Spain
- Unit of Chronic Inflammatory Diseases, Institute for Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Elisa Docampo
- Interdisciplinary Cluster for Applied Genoproteomics-Université de Liège, Liège, Belgium
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, and Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Xavier Estivill
- Centre for Genomic Regulation (CRG), The Barcelona Institute of Science and Technology, and Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Sidra Medical and Research Centre, Doha, Qatar
| | - Ahmet Gül
- Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | | | - Carl D Langefeld
- Department of Biostatistical Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina, USA
| | - Susan Thompson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Daniel L Kastner
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Patricia Woo
- Center of Paediatric and Adolescent Rheumatology, University College London, London, UK
| | - Wendy Thomson
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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Abstract
Systemic juvenile idiopathic arthritis (sJIA) is characterized by fever, arthritis, and other signs of systemic inflammation. Historically, sJIA was named Still's disease after George Frederic Still, who first reported patients. Individuals who manifest after the 16th birthday are diagnosed with adult onset Still's disease (AOSD). The pathophysiology of sJIA and AOSD are incompletely understood. Increased activation of inflammasomes and the expression of proinflammatory cytokines play a central role. S100 proteins, which can activate Toll-like receptors, thus, maintaining positive feedback loops, have also been detected at increased levels in sera from sJIA patients. Reduced expression of the immune-modulatory cytokine IL-10 may further contribute to immune cell activation and the production of proinflammatory molecules. Here, we discuss the clinical picture, differential diagnoses, the current pathophysiological understanding, and treatment options in sJIA and AOSD.
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Affiliation(s)
- C M Hedrich
- Arbeitsbereich Pädiatrische Rheumatologie und Immunologie, Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - C Günther
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
| | - M Aringer
- Bereich Rheumatologie, Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus, TU Dresden, Dresden, Deutschland
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20
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Machado SH, Xavier RM. Safety of tocilizumab in the treatment of juvenile idiopathic arthritis. Expert Opin Drug Saf 2017; 16:493-500. [DOI: 10.1080/14740338.2017.1303479] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Sandra Helena Machado
- Department of Internal Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil
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Giancane G, Minoia F, Davì S, Bracciolini G, Consolaro A, Ravelli A. IL-1 Inhibition in Systemic Juvenile Idiopathic Arthritis. Front Pharmacol 2016; 7:467. [PMID: 27999545 PMCID: PMC5138234 DOI: 10.3389/fphar.2016.00467] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/17/2016] [Indexed: 12/05/2022] Open
Abstract
Systemic juvenile idiopathic arthritis (sJIA) is the form of childhood arthritis whose treatment is most challenging. The demonstration of the prominent involvement of interleukin (IL)-1 in disease pathogenesis has provided the rationale for the treatment with biologic medications that antagonize this cytokine. The three IL-1 blockers that have been tested so far (anakinra, canakinumab, and rilonacept) have all been proven effective and safe, although only canakinumab is currently approved for use in sJIA. The studies on IL-1 inhibition in sJIA published in the past few years suggest that children with fewer affected joints, higher neutrophil count, younger age at disease onset, shorter disease duration, or, possibly, higher ferritin level may respond better to anti-IL-1 treatment. In addition, it has been postulated that use of IL-1 blockade as first-line therapy may take advantage of a "window of opportunity," in which disease pathophysiology can be altered to prevent the occurrence of chronic arthritis. In this review, we analyze the published literature on IL-1 inhibitors in sJIA and discuss the rationale underlying the use of these medications, the results of therapeutic studies, and the controversial issues.
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Affiliation(s)
- Gabriella Giancane
- Pediatric Rheumatology, Istituto Giannina GasliniGenova, Italy
- Pediatria II, Università degli Studi di GenovaGenova, Italy
| | | | - Sergio Davì
- Pediatric Rheumatology, Istituto Giannina GasliniGenova, Italy
| | | | - Alessandro Consolaro
- Pediatric Rheumatology, Istituto Giannina GasliniGenova, Italy
- Pediatria II, Università degli Studi di GenovaGenova, Italy
| | - Angelo Ravelli
- Pediatric Rheumatology, Istituto Giannina GasliniGenova, Italy
- Pediatria II, Università degli Studi di GenovaGenova, Italy
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22
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Blazina Š, Markelj G, Avramovič MZ, Toplak N, Avčin T. Management of Juvenile Idiopathic Arthritis: A Clinical Guide. Paediatr Drugs 2016; 18:397-412. [PMID: 27484749 DOI: 10.1007/s40272-016-0186-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease of childhood. The outcome in patients with JIA has markedly improved with the advent of biologic drugs. Although early aggressive therapy with biologics seems to be very effective, this approach leads to overtreatment in patients who would respond to classic disease-modifying anti-rheumatic drugs. Therefore, methotrexate remains first-line long-term therapy for most children with polyarticular JIA. Tumor necrosis factor-α inhibitors have shown tremendous benefit in children with refractory non-systemic JIA. Similar effects have been observed with interleukin-1 and interleukin-6 blockade in patients with systemic JIA. Correct choice and timely use of available medications to achieve early and sustained remission with as few side effects as possible remain challenges for the treating physician. In this review, a practical, clinically oriented guide to the management of JIA is provided, focusing on pharmacological treatment with non-steroidal anti-inflammatory drugs, intra-articular and systemic corticosteroids, disease-modifying anti-rheumatic drugs, and biologic agents. In addition, issues regarding treatment failure, early aggressive treatment, and drug tapering are discussed, with alternative treatment options being suggested.
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Affiliation(s)
- Štefan Blazina
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia
| | - Gašper Markelj
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia
| | - Mojca Zajc Avramovič
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia
| | - Nataša Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia.,Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Bohoričeva 20, 1525, Ljubljana, Slovenia. .,Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
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23
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Beukelman T, Xie F, Baddley JW, Chen L, Mannion ML, Saag KG, Zhang J, Curtis JR. The risk of hospitalized infection following initiation of biologic agents versus methotrexate in the treatment of juvenile idiopathic arthritis. Arthritis Res Ther 2016; 18:210. [PMID: 27655411 PMCID: PMC5032246 DOI: 10.1186/s13075-016-1109-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/05/2016] [Indexed: 11/12/2022] Open
Abstract
Background In the present study, we compared the incidence of hospitalized infection among children with juvenile idiopathic arthritis (JIA) following initiation of treatment with biologic agents versus methotrexate (MTX). Methods We used national Medicaid claims data from 2000 through 2010 to create cohorts of children with JIA who were new users of tumor necrosis factor inhibitors (TNFi), anakinra, and MTX (without concurrent biologic agent use) as defined by a 6-month baseline period of nonuse. Because most anakinra users have systemic juvenile idiopathic arthritis (SJIA), we used claims to identify MTX users who likely had SJIA. Among TNFi users, concurrent MTX use was a time-varying covariate. The study outcome was a primary hospital discharge diagnosis of infection. We calculated adjusted hazard ratios (aHRs) to compare infection rates between biologic agents and MTX. Results We identified 3075 new MTX users (160 with SJIA), 2713 new TNFi users, and 247 new anakinra users. There was no increased risk of infection associated with TNFi monotherapy versus MTX (aHR 1.19, 95 % CI 0.72–1.94) or with TNFi + MTX combination therapy versus MTX (aHR 1.23, 95 % CI 0.69–2.17). Baseline high-dose oral glucocorticoid use (≥10 mg/day of prednisone) was associated with infection (aHR 2.03 [95 % CI 1.21–3.39] versus no oral glucocorticoid). Anakinra was associated with infection versus MTX (aHR 3.53 95 % CI 1.83–6.82), but less so compared with MTX users with SJIA (aHR 2.69, 95 % CI 0.82–8.82). Conclusions Neither TNFi monotherapy nor TNFi + MTX combination therapy was significantly associated with hospitalized infection compared with MTX. Anakinra was significantly associated with infection, but there was likely residual confounding by disease phenotype.
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Affiliation(s)
- Timothy Beukelman
- The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA.
| | - Fenglong Xie
- The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
| | - John W Baddley
- The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
| | - Lang Chen
- The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
| | - Melissa L Mannion
- The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
| | - Kenneth G Saag
- The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
| | - Jie Zhang
- The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
| | - Jeffrey R Curtis
- The University of Alabama at Birmingham, 1720 2nd Ave S, Birmingham, AL, 35233, USA
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24
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Kearsley-Fleet L, Davies R, Baildam E, Beresford MW, Foster HE, Southwood TR, Thomson W, Hyrich KL. Factors associated with choice of biologic among children with Juvenile Idiopathic Arthritis: results from two UK paediatric biologic registers. Rheumatology (Oxford) 2016; 55:1556-65. [PMID: 26732349 PMCID: PMC4993954 DOI: 10.1093/rheumatology/kev429] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/25/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The objectives of this study were to describe patients starting first-line biologics for JIA, to describe characteristics over time among patients starting etanercept, and to describe patterns of second biologic prescribing. METHODS The British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study, and the Biologics for Children with Rheumatic Diseases study are ongoing prospective observational cohorts, collecting data on patients starting biologic therapy for JIA. Patients registered from 1 January 2010 starting their first biologic were compared between therapies. Patients starting etanercept before 2010 were included to analyse changes in etanercept prescribing. The pathway of patients starting a second biologic was recorded in all patients. RESULTS To 26 August 2014, 931 patients were recruited starting a first-line biologic (142 Biologics for Children with Rheumatic Diseases; 789 British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study). From 2010, patients with systemic JIA (sJIA) were almost exclusively prescribed anakinra or tocilizumab. Choice between anti-TNF therapies was largely driven by history of chronic anterior uveitis (CAU). When investigating trends in patients starting etanercept over time, disease duration at etanercept start, patients with sJIA, a history of CAU, and those who received concomitant oral corticosteroids decreased over time. Patients who started a second biologic from 1 January 2010 showed a similar stratification. CONCLUSION Although etanercept remains the most common biologic prescribed for JIA, there has been a clear shift towards the use of alternative biologics, largely driven by disease subtype and history of CAU. This channelling of children towards specific therapies should be considered carefully in future studies and in clinical guidelines and ongoing research.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester
| | - Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester
| | | | - Michael W Beresford
- Clinical Academic Department of Paediatric Rheumatology, Institute of Translational Medicine (Child Health), University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Helen E Foster
- Musculoskeletal Research Group, Institute Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Taunton R Southwood
- Department of Paediatric Rheumatology, Institute of Child Health, Birmingham Children's Hospital - NHS Trust and University of Birmingham, Birmingham
| | - Wendy Thomson
- Arthritis Research UK Centre for Genetics and Genomics, Manchester Academic Health Science Centre and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Science Centre, The University of Manchester, Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
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Effect of miR-19a and miR-21 on the JAK/STAT signaling pathway in the peripheral blood mononuclear cells of patients with systemic juvenile idiopathic arthritis. Exp Ther Med 2016; 11:2531-2536. [PMID: 27284344 DOI: 10.3892/etm.2016.3188] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 02/11/2016] [Indexed: 12/14/2022] Open
Abstract
Overexpression of the components of the Janus kinase/signal transducer and activator of transcription (JAK/STAT) signaling pathway are key factors of the pathogenic mechanisms underlying systematic juvenile idiopathic arthritis (SJIA). The present study aimed to investigate the association between microRNA (miR)-19a, miR-21 and the JAK/STAT signaling pathway. A total of 20 patients with SJIA were included in the study, and peripheral blood mononuclear cells (PBMCs) from 20 normal controls were also collected. RNAiso was used to extract total RNA, and the RNA was then reverse transcribed into cDNA. Primers were designed to detect the mRNA of miR-19a and miR-21, and U6 was set as the internal parameter. In addition, the mRNA of STAT3, suppressor of cytokine signaling 3 (SOCS3), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) was detected, and β-actin was set as the internal parameter. Reverse transcription-quantitative polymerase chain reaction was performed to detect the expression levels of these proteins in patients with SJIA and control subjects, and non-parametric tests were used to analyze the statistical differences in 2-ΔΔCq between the two groups. The expression levels of miR-19a and miR-21 were significantly lower in the SJIA group compared with the control group (P<0.05). SOCS3, TNF-α and STAT3 were shown to be the target genes of miR-19a and miR-21, as determined by Targetscan. The expression levels of STAT3, SOCS3, TNF-α and IL-6 mRNA were significantly higher compared with those of the control group (P<0.05). In the PBMCs of sthe patients with SJIA, miR-19a and miR-21 expression levels were lower compared with those of the control group, and the JAK/STAT signaling pathway was activated, which indicated that miR-19a and miR-21 may participate in the activation of the JAK/STAT signaling pathway.
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26
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Ahmed AE, Lowe D, Kirton JA, O’Brien MR, Mediana A, Frankland H, Bruce H, Kennedy T, Rogers SN, Moots RJ. Development of a Rheumatology-specific Patient Concerns Inventory and Its Use in the Rheumatology Outpatient Clinic Setting. J Rheumatol 2016; 43:779-87. [DOI: 10.3899/jrheum.150068] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2015] [Indexed: 12/14/2022]
Abstract
Objective.Successful management of rheumatic conditions involves increasing complexity of care. Delivering this in a holistic way is a growing challenge. The aim of our study was to develop a Patient Concerns Inventory (PCI) and assess it in the rheumatology clinic setting.Methods.This observational exploratory study occurred with 2 phases. In phase I, the PCI was developed after a systematic literature search, expert opinion, and 3 patient focus group discussions. In phase II, the PCI was piloted in a general rheumatology clinic.Results.Fifty-four patients were assessed in the pre-PCI group and 51 in the post-PCI group. Median (IQR) duration of consultation was 8 min (5–14) without PCI and 15 min (10–20) with PCI. The pre-PCI group raised 335 concerns from 50 patients, median (IQR) of 5 (3–10) per patient, rising post-PCI to 521 concerns, median (IQR) of 9 (5–16) from 51 patients, p = 0.002. Additional concerns predominantly arose from “physical and functional well-being” and “social care and well-being” domains. Most patients rated their experience with their doctor in the consultation as excellent or outstanding across all 11 questions in the questionnaire, both before and after the introduction of the PCI to the clinic setting.Conclusion.The PCI is a useful holistic needs assessment tool for rheumatology clinics. Although its use may initially prolong the consultation slightly, patients can raise a significantly higher number of concerns, which does not occur at the expense of patient satisfaction. This may help in identifying areas of unmet needs that previously went unnoticed.
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Sengler C, Klotsche J, Niewerth M, Liedmann I, Föll D, Heiligenhaus A, Ganser G, Horneff G, Haas JP, Minden K. The majority of newly diagnosed patients with juvenile idiopathic arthritis reach an inactive disease state within the first year of specialised care: data from a German inception cohort. RMD Open 2015; 1:e000074. [PMID: 26688748 PMCID: PMC4680591 DOI: 10.1136/rmdopen-2015-000074] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 09/11/2015] [Accepted: 09/12/2015] [Indexed: 11/26/2022] Open
Abstract
Objective To describe the disease characteristics of patients with juvenile idiopathic arthritis (JIA) included in an inception cohort, to analyse how many patients from each JIA category reach an inactive disease state within the first year of specialised care and to determine predictors for attaining inactive disease. Methods Patients with JIA were enrolled in this study at 11 large German paediatric rheumatology units within the first 12 months after diagnosis. Laboratory and clinical parameters such as JIA core criteria and data on the medication used were collected every 3 months. Non-parametric statistical testing was performed for the comparison of the JIA core criteria at follow-up. Generalised linear models were used to analyse differences in the rates at which inactive disease was reached and to determine potential predictors. Results Of the 695 patients with JIA included in this analysis, approximately 75% experienced a period of inactive disease under treatment with disease-modifying antirheumatic drugs and systemic steroids in most cases with systemic-onset JIA or polyarthritis at least once during the first 12 months in ICON. Significant improvements were observed in all JIA core criteria, in disease activity and in functional status from baseline to the 12-month follow-up. Younger age at onset, a shorter duration between symptom onset and diagnosis and a positive antinuclear antibody status increased the probability of attaining an inactive disease state. Conclusions The 12-month outcome of JIA was good under real-life conditions, with half of the patients having attained inactive disease with contemporary treatments. Since a short duration between symptom onset and diagnosis was correlated to a period of inactive disease, children suspected of having JIA should be transferred to specialised care as soon as possible.
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Affiliation(s)
- Claudia Sengler
- German Rheumatism Research Centre Berlin, a Leibniz Institute , Berlin , Germany
| | - Jens Klotsche
- Department of Paediatric Rheumatology and Immunology , University hospital Münster , Muenster , Germany
| | - Martina Niewerth
- Department of Paediatric Rheumatology and Immunology , University hospital Münster , Muenster , Germany
| | - Ina Liedmann
- Department of Paediatric Rheumatology and Immunology , University hospital Münster , Muenster , Germany
| | - Dirk Föll
- Department of Ophthalmology at St. Franziskus Hospital Münster , University of Duisburg-Essen , Muenster , Germany
| | | | - Gerd Ganser
- Asklepios Children's Hospital , Sankt Augustin , Germany
| | - Gerd Horneff
- German Center for Paediatric and Adolescent Rheumatology , Garmisch-Partenkirchen , Germany
| | - Johannes-Peter Haas
- Charité Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology , Berlin , Germany
| | - Kirsten Minden
- Department of Paediatric Rheumatology and Immunology , University hospital Münster , Muenster , Germany ; Charité Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology , Berlin , Germany
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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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29
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Current understanding of the pathophysiology of systemic juvenile idiopathic arthritis (sJIA) and target-directed therapeutic approaches. Clin Immunol 2015; 159:72-83. [DOI: 10.1016/j.clim.2015.04.018] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 04/16/2015] [Accepted: 04/19/2015] [Indexed: 01/21/2023]
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