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Schmeling H, Mahler M, Levy DM, Moore K, Stevens AM, Wick J, McMillan JD, Horneff G, Assassi S, Charles J, Salazar G, Mayes MD, Silverman ED, Klien-Gitelman M, Lee T, Brunner HI, Reed AM, Fritzler MJ. Autoantibodies to Dense Fine Speckles in Pediatric Diseases and Controls. J Rheumatol 2015; 42:2419-26. [PMID: 26472409 DOI: 10.3899/jrheum.150567] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Autoantibodies to the dense fine speckled 70 kDa antigen (DFS70) are reported to be more common in individuals who do not have an antinuclear antibody (ANA)-associated rheumatic disease (AARD) than in patients with AARD. The frequency of anti-DFS70 antibodies has been thoroughly studied in adult but not in pediatric populations. The primary objective of this observational study was to determine the frequency of anti-DFS70 in pediatric AARD and reference cohorts. METHODS Sera from 743 children with AARD and related conditions, and 345 samples from reference cohorts (healthy children and those being investigated for AARD) were studied for anti-DFS70 autoantibodies as measured by a chemiluminescence immunoassay. A de-identified administrative database was used to retrieve demographic, serologic, and clinical data. RESULTS Anti-DFS70 antibodies were seen in 2.1% of healthy children and in 4.5% of sera from pediatric individuals referred for ANA testing. The frequency of anti-DFS70 was highest in juvenile localized scleroderma (LS; 4/29, 13.8%), juvenile dermatomyositis (JDM; 2/11, 18.2%), childhood systemic lupus erythematosus (cSLE; 19/331, 5.7%), diffuse cutaneous systemic sclerosis (1/22, 4.5%), celiac disease (2/49, 4.1%), and juvenile idiopathic arthritis (JIA; 5/202, 2.5%). Of note, anti-DFS70 antibodies were observed in 3/26 children (11.5%) with uveitis and JIA-associated uveitis. CONCLUSION The frequency of anti-DFS70 autoantibodies in healthy pediatric subjects is within the lower range of that reported in adults. Anti-DFS70 antibodies can be found in childhood SSc and cSLE, but has a remarkably high frequency in children with LS, JDM, and uveitis.
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Affiliation(s)
- Heinrike Schmeling
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Michael Mahler
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Deborah M Levy
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Katharine Moore
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Anne M Stevens
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - James Wick
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Jacob D McMillan
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Gerd Horneff
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Shervin Assassi
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Julio Charles
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Gloria Salazar
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Maureen D Mayes
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Earl D Silverman
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Marissa Klien-Gitelman
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Tzelan Lee
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Hermine I Brunner
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Ann M Reed
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Marvin J Fritzler
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
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