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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Nicoară DM, Munteanu AI, Scutca AC, Brad GF, Jugănaru I, Bugi MA, Asproniu R, Mărginean O. Examining the Relationship between Systemic Immune-Inflammation Index and Disease Severity in Juvenile Idiopathic Arthritis. Cells 2024; 13:442. [PMID: 38474406 DOI: 10.3390/cells13050442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/17/2024] [Accepted: 03/02/2024] [Indexed: 03/14/2024] Open
Abstract
Juvenile Idiopathic Arthritis (JIA), the leading childhood rheumatic condition, has a chronic course in which persistent disease activity leads to long-term consequences. In the era of biologic therapy and tailored treatment, precise disease activity assessment and aggressive intervention for high disease activity are crucial for improved outcomes. As inflammation is a fundamental aspect of JIA, evaluating it reflects disease severity. Recently, there has been growing interest in investigating cellular immune inflammation indices such as the neutrophil-to-lymphocyte ratio (NLR) and systemic immune inflammation index (SII) as measures of disease severity. The aim of this retrospective study was to explore the potential of the SII in reflecting both inflammation and disease severity in children with JIA. The study comprised 74 JIA patients and 50 healthy controls. The results reveal a notable increase in median SII values corresponding to disease severity, exhibiting strong correlations with traditional inflammatory markers, including CRP and ESR (ρ = 0.714, ρ = 0.661), as well as the JADAS10 score (ρ = 0.690). Multiple regression analysis revealed the SII to be independently associated with JADAS10. Furthermore, the SII accurately distinguished patients with high disease activity from other severity groups (AUC = 0.827, sensitivity 81.5%, specificity 66%). These findings suggest that integrating the SII as an additional measure holds potential for assessing disease activity in JIA.
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Affiliation(s)
- Delia-Maria Nicoară
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Andrei-Ioan Munteanu
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Research Center for Disturbances of Growth and Development in Children BELIVE, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Alexandra-Cristina Scutca
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
| | - Giorgiana-Flavia Brad
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
| | - Iulius Jugănaru
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Research Center for Disturbances of Growth and Development in Children BELIVE, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Meda-Ada Bugi
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Ph.D. School Department, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Raluca Asproniu
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
| | - Otilia Mărginean
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Research Center for Disturbances of Growth and Development in Children BELIVE, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
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Accardo V, Pagnini I, Maccora I, Marrani E, Mastrolia MV, Simonini G. Safety and efficacy of biologic immunosuppressive treatment in juvenile idiopathic arthritis associated with inborn errors of immunity. Front Pediatr 2024; 12:1353825. [PMID: 38468871 PMCID: PMC10925618 DOI: 10.3389/fped.2024.1353825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
Objectives This study aims to describe clinical features, therapeutic outcomes, and safety profiles in patients affected by juvenile idiopathic arthritis (JIA) and inborn errors of immunity (IEI) treated with biological Disease-modifying antirheumatic drugs (DMARDs). Methods We enrolled three patients who were followed in the Pediatric Rheumatology Unit at Meyer Children's Hospital in Florence; these patients were affected by JIA, according to ILAR criteria, and IEI, according to the IUIS Phenotypical Classification for Human Inborn Errors of Immunity. Among them, two patients had 22q11.2 deletion syndrome (22q11.2DS) and one patient had X-linked agammaglobulinemia (XLA). Results Case 1: A 6-year and 2-month-old boy was affected by 22q11.2DS, associated with oligoarticular JIA, at the age of 2 years. He was treated with non-steroidal anti-inflammatory drugs (NSAIDs) and methotrexate, along with oral glucocorticoids but with no benefits. Treatment with etanercept allowed him to achieve remission after 10 months. Case 2: A 6-year and 2-month-old girl was affected by 22q11.2DS, associated with oligoarticular JIA, at the age of 3 years and 11 months. She was treated with NSAIDs, joint injections, and methotrexate but without clinical response. Treatment with Adalimumab allowed her to achieve remission after 6 months. Case 3: A 12-year and 2-month-old boy was affected by XLA, associated with polyarticular JIA, at the age of 9 years and 11 months. He was treated with NSAIDs, methotrexate, joint injections, and oral glucocorticoids with no benefits. He failed to respond to anti-TNF-alpha, tocilizumab, and abatacept. Currently, he is undergoing therapy with sirolimus plus abatacept, which allowed him to achieve remission after 4 months. Conclusions Results suggest that the use of immunosuppressive biological therapies can control disease activity in these patients. No adverse drug-related reactions were observed during the follow-up.
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Affiliation(s)
- V. Accardo
- Rheumatology Unit, Meyer Children's Hospital IRCCS, Florence, Italy
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Fiedorek D, Tang X, Sukumaran S, Collins RT, Bolin E. Pericardial effusion in children admitted with juvenile idiopathic arthritis: A multicenter retrospective cohort study from the pediatric health information system. Arch Rheumatol 2023; 38:358-366. [PMID: 38046250 PMCID: PMC10689020 DOI: 10.46497/archrheumatol.2023.9690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/25/2022] [Indexed: 12/05/2023] Open
Abstract
Objectives This study aimed to determine if the presence of a pericardial effusion is associated with adverse outcomes among children admitted with juvenile idiopathic arthritis. Patients and methods The multicenter, retrospective cohort study was conducted with 4,332 patients (1,554 males, 2,778 females; median age: 12 years; IQR, 7, 15 years) using the Pediatric Health Information System. Data from hospital admissions between January 1, 2004, and September 15, 2015, were obtained for patients with an International Disease Classification, Ninth Revision code for juvenile idiopathic arthritis. Pericardial effusion was the primary predictor variable; the outcomes of interest were length of stay, hospital costs, and readmission within 90 days. Multivariate models were created to evaluate associations between pericardial effusion and adverse outcomes. We also analyzed factors associated with increased odds of having pericardial effusion in juvenile idiopathic arthritis. Results One hundred twenty (3%) patients had a code for pericardial effusion. Children with pericardial effusion had a longer median length of stay (7 days (IQR 3, 12) vs. 3 days (IQR 2,6), p<0.001), higher median costs ($17,688 (IQR 8,657, 40,623) vs. $8,456 (IQR 4,865, 16,302), p<0.001), and greater rates of readmission (22% vs. 15%, p=0.045). Multivariate analysis demonstrated no significant association between pericardial effusion and outcomes of interest. Black race and male sex were associated with increased odds of having pericardial effusion. Conclusion Pericardial effusion is rare among children admitted with juvenile idiopathic arthritis but is associated with significant morbidity; its presence may be a marker of disease severity. Black children and males admitted with juvenile idiopathic arthritis warrant special consideration and may benefit from screening echocardiography.
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Affiliation(s)
- Daniel Fiedorek
- Department of Pediatric Cardiology, University of Arkansas For Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas, United States
| | - Xinyu Tang
- Department of Pediatric Cardiology, University of Arkansas For Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas, United States
| | - Sukesh Sukumaran
- Department of Pediatric Rheumatology, Valley Children's Hospital, Madera, California, United States
| | - R. Thomas Collins
- Department of Pediatric Cardiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, California, United States
| | - Elijah Bolin
- Department of Pediatric Cardiology, University of Arkansas For Medical Sciences and Arkansas Children's Research Institute, Little Rock, Arkansas, United States
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Salem DA, Al-Ghamdi AH, Alghamdi JM, Ismail A, Alghamdi BA, Abdelrazek E. Toxoplasma and Toxocara seropositivity in juvenile idiopathic arthritis and its relation to disease activity and type of therapies. Food Waterborne Parasitol 2023; 31:e00195. [PMID: 37256200 PMCID: PMC10225886 DOI: 10.1016/j.fawpar.2023.e00195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/03/2023] [Accepted: 05/18/2023] [Indexed: 06/01/2023] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most frequently encountered autoimmune rheumatic disease in children. To our knowledge, this is the first study aimed to estimate the frequency of Toxoplasma gondii (T. gondii) and Toxocara seropositivity in JIA and assess its relation to the disease activity, IL-10 levels, and type of the received therapies. This study was conducted on 43 JIA patients and 50 cases as a control group. All participants were evaluated by disease activity score (JADAS-27), and the presence of specific IgG and IgM antibodies against T. gondii and IgG against Toxocara species using an enzyme-linked immunosorbent assay. IL-10 serum levels were measured using an ELISA kit. The results show that JIA patients have significantly higher seropositivity for anti-T. gondii IgG compared to control subjects (p = 0.02) and a non-significant difference for Toxocara seropositivity (p = 0.41). All participants were negative for IgM anti-Toxoplasma gondii. Demographic parameters did not significantly affect these seroprevalence frequencies (p > 0.05). IL-10 was significantly higher among JIA patients compared to controls (p = 0.007) and seropositive anti-T. gondii JIA exhibited significantly higher IL-10 levels compared to seronegative ones (p = 0.03). Seropositive anti-T. gondii IgG JIA patients had a significantly higher disease activity score (JADAS-27) than seronegative anti-T. gondii IgG cases (p = 0.02). There was a significant positive correlation between anti-T. gondii IgG and JADAS-27 score (p = 0.009). A significant association was detected between T. gondii infection and DMARDs including the biological therapies (p < 0.05). Overall, this study supports a possible association between T. gondii infection and JIA, IL-10, disease activity score, and DMARDs therapies. It is possible that IL-10 plays a role in the development of JIA and contributes to persistent asymptomatic infection with T. gondii in JIA patients. As a result, a recommendation for screening tests for T. gondii infection among JIA patients is crucial before and during commencing DMARDs therapies and closely monitoring early signs of infection.
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Affiliation(s)
- Doaa A. Salem
- Department of Medical Parasitology, Mansoura University, Faculty of Medicine, Egypt
| | | | | | - Amira Ismail
- Department of Medical Parasitology, Mansoura University, Faculty of Medicine, Egypt
| | - Bakheet A. Alghamdi
- Department of Emergency Medicine, King Saud Medical City, Riyadh, Saudi Arabia
| | - Eman Abdelrazek
- Department of Rheumatology and Immunology, Mansoura University, Faculty of Medicine, Egypt
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Integrative Analysis of Transcriptome-Wide Association Study and Gene-Based Association Analysis Identifies In Silico Candidate Genes Associated with Juvenile Idiopathic Arthritis. Int J Mol Sci 2022; 23:ijms232113555. [DOI: 10.3390/ijms232113555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022] Open
Abstract
Genome-wide association study (GWAS) of Juvenile idiopathic arthritis (JIA) suffers from low power due to limited sample size and the interpretation challenge due to most signals located in non-coding regions. Gene-level analysis could alleviate these issues. Using GWAS summary statistics, we performed two typical gene-level analysis of JIA, transcriptome-wide association studies (TWAS) using FUnctional Summary-based ImputatiON (FUSION) and gene-based analysis using eQTL Multi-marker Analysis of GenoMic Annotation (eMAGMA), followed by comprehensive enrichment analysis. Among 33 overlapped significant genes from these two methods, 11 were previously reported, including TYK2 (PFUSION = 5.12 × 10−6, PeMAGMA = 1.94 × 10−7 for whole blood), IL-6R (PFUSION = 8.63 × 10−7, PeMAGMA = 2.74 × 10−6 for cells EBV-transformed lymphocytes), and Fas (PFUSION = 5.21 × 10−5, PeMAGMA = 1.08 × 10−6 for muscle skeletal). Some newly plausible JIA-associated genes are also reported, including IL-27 (PFUSION = 2.10 × 10−7, PeMAGMA = 3.93 × 10−8 for Liver), LAT (PFUSION = 1.53 × 10−4, PeMAGMA = 4.62 × 10−7 for Artery Aorta), and MAGI3 (PFUSION = 1.30 × 10−5, PeMAGMA = 1.73 × 10−7 for Muscle Skeletal). Enrichment analysis further highlighted 4 Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways and 10 Gene Ontology (GO) terms. Our findings can benefit the understanding of genetic determinants and potential therapeutic targets for JIA.
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Proof-of-Concept Study of the Use of Accelerometry to Quantify Knee Joint Movement and Assist with the Diagnosis of Juvenile Idiopathic Arthritis. TECHNOLOGIES 2022. [DOI: 10.3390/technologies10040076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood. Seven children and young people (CYP) with a diagnosis of JIA and suspected active arthritis of a single knee joint were recruited for this proof-of-concept study. The presence of active arthritis was confirmed by clinical examination. Four tri-axial accelerometers were integrated individually in elastic bands and placed above and below each knee. Participants performed ten periodic flexion-extensions of each knee joint while lying down, followed by walking ten meters in a straight path. The contralateral (non-inflamed) knee joint acted as a control. Accelerometry data were concordant with the results of clinical examination in six out of the seven patients recruited. There was a significant difference between the accelerometry measured range of movement (ROM, p-value = 0.032) of the knees with active arthritis and the healthy contralateral knees during flexion-extension. No statistically significant difference was identified between the ROM of the knee joints with active arthritis and healthy knee joints during the walking test. The study demonstrated that accelerometry may help in differentiating between healthy knee joints and those with active arthritis; however, further research is required to confirm these findings.
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Serine, N-acetylaspartate differentiate adolescents with juvenile idiopathic arthritis compared with healthy controls: a metabolomics cross-sectional study. Pediatr Rheumatol Online J 2022; 20:12. [PMID: 35144633 PMCID: PMC8832851 DOI: 10.1186/s12969-022-00672-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 01/30/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In comparison with the general population, adolescents with juvenile idiopathic arthritis (JIA) are at higher risk for morbidity and mortality. However, limited evidence is available about this condition's underlying metabolic profile in adolescents with JIA relative to healthy controls. In this untargeted, cross-sectional metabolomics study, we explore the plasma metabolites in this population. METHODS A sample of 20 adolescents with JIA and 20 controls aged 13-17 years were recruited to complete surveys, provide medical histories and biospecimens, and undergo assessments. Fasting morning plasma samples were processed with liquid chromatography-mass spectrometry. Data were centered, scaled, and analyzed using generalized linear models accounting for age, sex, and medications (p-values adjusted for multiple comparisons using the Holm method). Spearman's correlations were used to evaluate relationships among metabolites, time since diagnosis, and disease severity. RESULTS Of 72 metabolites identified in the samples, 55 were common to both groups. After adjustments, 6 metabolites remained significantly different between groups. Alpha-glucose, alpha-ketoglutarate, serine, and N-acetylaspartate were significantly lower in the JIA group than in controls; glycine and cystine were higher. Seven additional metabolites were detected only in the JIA group; 10 additional metabolites were detected only in the control group. Metabolites were unrelated to disease severity or time since diagnosis. CONCLUSIONS The metabolic signature of adolescents with JIA relative to controls reflects a disruption in oxidative stress; neurological health; and amino acid, caffeine, and energy metabolism pathways. Serine and N-acetylaspartate were promising potential biomarkers, and their metabolic pathways are linked to both JIA and cardiovascular disease risk. The pathways may be a source of new diagnostic, treatment, or prevention options. This study's findings contribute new knowledge for systems biology and precision health approaches to JIA research. Further research is warranted to confirm these findings in a larger sample.
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Lewis KA, Brooks S, Carrasco R, Carter P, Garcia A, Chiou J, Nguyen C, Rana A, Brown SA, Tiziani S, Osier N. Best practices for recruitment of adolescents for biobanking and precision health research: a retrospective analysis comparing juvenile idiopathic arthritis cases with healthy controls. Pediatr Rheumatol Online J 2021; 19:169. [PMID: 34863185 PMCID: PMC8645089 DOI: 10.1186/s12969-021-00652-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/16/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Precision health in adolescents relies on the successful collection of data and biospecimens from an adequately sized sample of cases and comparison group(s), often healthy controls, to answer the research question. This research report describes the recruitment strategy, enrollment rates, and approach utilized in a successful biobehavioral research study. The study was designed to examine key health indicators in adolescents (13-17 years of age) with juvenile idiopathic arthritis (JIA) compared to a control group of healthy adolescents. The purpose of this analysis is to establish best practices and identify strategies to overcome barriers to recruitment of older adolescents, an age group that tends to be underrepresented in research studies. METHODS A retrospective secondary analysis of data from a parent study about JIA with high consent rates was employed to explore factors affecting enrollment into the biobehavioral study. RESULTS Of the 113 subjects who were recruited to the study, 74 met the eligibility criteria and reviewed the consent form. The consented group (n=40) represents 54% of those who were eligible upon initial screening. The rate of project enrollment was 2.7 participants per month. The pediatric rheumatologists referred 85% of the JIA group, and the study's principal investigator, a nurse scientist, referred 95% of the control group. Typical recruitment strategies, such as posting on social media, distributing flyers, and cold-calling potential participants from the clinic schedule were ineffective for both cases and controls. Barriers to enrollment included scheduling and fear of venipuncture. There were no demographic characteristics that significantly explained enrollment, differentiating between those who agreed to participate compared to those who refused. Successful strategies for enrollment of adolescents into this biobehavioral research study included scheduling study visits on weekends and school holidays; an informed consent and assent process that addressed adolescent fears of venipuncture; including a JIA patient on the study team; and utilizing existing relationships to maximize enrollment efforts. CONCLUSIONS Effective recruitment and enrollment practices were relationship-specific and patient-centered. Researchers should utilize best practices to ensure that precision health for adolescents is advanced.
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Affiliation(s)
- Kimberly A. Lewis
- grid.266102.10000 0001 2297 6811Department of Physiological Nursing, School of Nursing, University of California at San Francisco, 2 Koret Way, 94143 San Francisco, CA USA ,grid.89336.370000 0004 1936 9924School of Nursing, The University of Texas at Austin, 1710 Red River St, 78712 Austin, TX USA ,grid.413578.c0000 0004 0637 322XDell Children’s Medical Center of Central Texas, 4900 Mueller Blvd, 78723 Austin, TX USA ,grid.266102.10000 0001 2297 6811Department of Physiological Nursing, University of California, San Francisco, 2 Koret Way, CA 94131 San Francisco, USA
| | - Shelby Brooks
- grid.89336.370000 0004 1936 9924School of Nursing, The University of Texas at Austin, 1710 Red River St, 78712 Austin, TX USA ,grid.413578.c0000 0004 0637 322XDell Children’s Medical Center of Central Texas, 4900 Mueller Blvd, 78723 Austin, TX USA
| | - Ruy Carrasco
- grid.264756.40000 0004 4687 2082Texas A&M University, 400 Bizzell St.,, TX 77843 College Station, USA
| | - Patricia Carter
- grid.411015.00000 0001 0727 7545Capstone College of Nursing, University of Alabama, 650 University Blvd E, 35401 Tuscaloosa, AL USA
| | - Alexandra Garcia
- grid.89336.370000 0004 1936 9924School of Nursing, The University of Texas at Austin, 1710 Red River St, 78712 Austin, TX USA
| | - Jennifer Chiou
- grid.89336.370000 0004 1936 9924Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX USA
| | - Christina Nguyen
- grid.413578.c0000 0004 0637 322XDell Children’s Medical Center of Central Texas, 4900 Mueller Blvd, 78723 Austin, TX USA
| | - Ambreen Rana
- grid.413578.c0000 0004 0637 322XDell Children’s Medical Center of Central Texas, 4900 Mueller Blvd, 78723 Austin, TX USA
| | - Sharon A. Brown
- grid.89336.370000 0004 1936 9924School of Nursing, The University of Texas at Austin, 1710 Red River St, 78712 Austin, TX USA
| | - Stefano Tiziani
- grid.89336.370000 0004 1936 9924Department of Nutritional Sciences, College of Natural Sciences, The University of Texas at Austin, Austin, TX USA
| | - Nico Osier
- grid.89336.370000 0004 1936 9924School of Nursing, The University of Texas at Austin, 1710 Red River St, 78712 Austin, TX USA ,grid.89336.370000 0004 1936 9924Department of Neurology, Dell Medical School, The University of Texas at Austin, Austin, TX USA
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Garner AJ, Saatchi R, Ward O, Hawley DP. Juvenile Idiopathic Arthritis: A Review of Novel Diagnostic and Monitoring Technologies. Healthcare (Basel) 2021; 9:1683. [PMID: 34946409 PMCID: PMC8700900 DOI: 10.3390/healthcare9121683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/29/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and is characterized by an often insidious onset and a chronic relapsing-remitting course, once diagnosed. With successive flares of joint inflammation, joint damage accrues, often associated with pain and functional disability. The progressive nature and potential for chronic damage and disability caused by JIA emphasizes the critical need for a prompt and accurate diagnosis. This article provides a review of recent studies related to diagnosis, monitoring and management of JIA and outlines recent novel tools and techniques (infrared thermal imaging, three-dimensional imaging, accelerometry, artificial neural networks and fuzzy logic) which have demonstrated potential value in assessment and monitoring of JIA. The emergence of novel techniques to assist clinicians' assessments for diagnosis and monitoring of JIA has demonstrated promise; however, further research is required to confirm their clinical utility.
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Affiliation(s)
- Amelia J. Garner
- The Medical School, University of Sheffield, Sheffield S10 2TN, UK
| | - Reza Saatchi
- Industry and Innovation Research Institute, Sheffield Hallam University, Sheffield S1 1WB, UK;
| | - Oliver Ward
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield S10 2TH, UK; (O.W.); (D.P.H.)
| | - Daniel P. Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield S10 2TH, UK; (O.W.); (D.P.H.)
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Elnaggar RK, Mahmoud WS, Abdelbasset WK, Alqahtani BA, Alrawaili SM, Elfakharany MS. Low-energy laser therapy application on knee joints as an auxiliary treatment in patients with polyarticular juvenile idiopathic arthritis: a dual-arm randomized clinical trial. Lasers Med Sci 2021; 37:1737-1746. [PMID: 34599401 DOI: 10.1007/s10103-021-03427-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 09/22/2021] [Indexed: 11/25/2022]
Abstract
Patients with juvenile idiopathic arthritis (JIA) always experience persistent pain and stiffness which induces muscle weakness, fatigue, and functional limitations. This study evaluated whether applying low-energy laser therapy (LLT) on the knee joint could be an effective adjuvant intervention for patients with JIA. Sixty children with polyarticular JIA participated and were randomly allocated to receive either LLT (wavelength λ = 903 nm; power output of 50 mW; and energy of 1.5 J) plus exercises (LLT group) or exercises alone (control group). Pain, peak concentric torque of quadriceps muscles, fatigue, and functional status were measured by the visual analogue scale, isokinetic testing system, Pediatric Quality of Life Inventory Multidimensional Fatigue Scale, and Childhood Health Assessment Questionnaire, respectively pre- and post-intervention, and at 6-month follow-up. Per the mixed-model analysis of variance, the LLT group showed a statistically more favorable improvement in pain (P = .003, ηp2 = .014), fatigue perception (P = .004, ηp2 = .015), and functional status (P = .022, ηp2 = .09) across the three assessment occasions, as compared to the control group. However, no significant difference was demonstrated between both groups concerning peak concentric torque (all P > .05). Incorporation of LLT into the standard physical rehabilitation program for patients with JIA has the potential to induce more conducive improvements in pain, fatigue, and functional performance, but is not effective for improving muscle performance.
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Affiliation(s)
- Ragab K Elnaggar
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia. .,Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt.
| | - Waleed S Mahmoud
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia.,Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Walid K Abdelbasset
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia.,Department of Physical Therapy, Kasr Al-Aini Hospital, Cairo University, Giza, Egypt
| | - Bader A Alqahtani
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia
| | - Saud M Alrawaili
- Department of Physical, Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Abdullah Ibn Amer St., Al-Kharj, 16278, PO, Saudi Arabia
| | - Mahmoud S Elfakharany
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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12
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Sieberg CB, Lebel A, Silliman E, Holmes S, Borsook D, Elman I. Left to themselves: Time to target chronic pain in childhood rare diseases. Neurosci Biobehav Rev 2021; 126:276-288. [PMID: 33774086 PMCID: PMC8738995 DOI: 10.1016/j.neubiorev.2021.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/02/2021] [Accepted: 03/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chronic pain is prevalent among patients with rare diseases (RDs). However, little is understood about how biopsychosocial mechanisms may be integrated in the unique set of clinical features and therapeutic challenges inherent in their pain conditions. METHODS This review presents examples of major categories of RDs with particular pain conditions. In addition, we provide translational evidence on clinical and scientific rationale for psychosocially- and neurodevelopmentally-informed treatment of pain in RD patients. RESULTS Neurobiological and functional overlap between various RD syndromes and pain states suggests amalgamation and mutual modulation of the respective conditions. Emotional sequelae could be construed as an emotional homologue of physical pain mediated via overlapping brain circuitry. Given their clearly defined genetic and molecular etiologies, RDs may serve as heuristic models for unraveling pathophysiological processes inherent in chronic pain. CONCLUSIONS Systematic evaluation of chronic pain in patients with RD contributes to sophisticated insight into both pain and their psychosocial correlates, which could transform treatment.
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Affiliation(s)
- Christine B Sieberg
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, 02115, USA; Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, 02115, USA
| | - Alyssa Lebel
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, 02115, USA
| | - Erin Silliman
- Biobehavioral Pediatric Pain Lab, Department of Psychiatry & Behavioral Sciences, Boston Children's Hospital, Boston, MA, 02115, USA; Division of Graduate Medical Sciences, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Scott Holmes
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, 02115, USA
| | - David Borsook
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, 02115, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Igor Elman
- Center for Pain and the Brain (P.A.I.N Group), Department of Anesthesiology, Critical Care & Pain Medicine, Boston Children's Hospital, Boston, MA 02115, USA; Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, 02139, USA
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13
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Huang YH, Hu YC, Liao CH, Chiang BL, Lu CH, Li KJ, Yang YH. Utilizing ultrasound findings of a single indicator joint to assess non-systemic juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:60. [PMID: 33926518 PMCID: PMC8082904 DOI: 10.1186/s12969-021-00550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 04/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Musculoskeletal ultrasound (MSUS) has been used worldwide in adult patients with rheumatoid arthritis (RA) but is beginning to play an increasing role in patients with juvenile idiopathic arthritis (JIA). The aim of this study was to investigate the application of MSUS findings of a single indicator joint in JIA to assess the disease activity and classify disease subtype. METHODS Thirty-five non-systemic JIA patients with a total of 62 visits were retrospectively recruited in this study. Among the involved joints, the joint with highest value of grey-scale (GS) plus power Doppler (PD) (=GSPD) was selected as the indicator joint at each visit. The correlations between each MSUS parameter (GS, PD, GSPD) of indicator joints and the Physician Global Assessment (PGA) score, the Childhood Health Assessment Questionnaire-disability index (CHAQ-DI), and laboratory data were analyzed. The ultrasound features in different subtypes of JIA were also compared. RESULTS PD was weakly correlated with the PGA score (rho = 0.323, p = 0.010), while both GS and GSPD were moderately correlated with the PGA score (rho = 0.405, p = 0.001; rho = 0.434, p = 0.000). On the other hand, GS, PD, and GSPD were weakly correlated with CHAQ-DI. Although erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) had a weak correlation with PGA, they were not statistically correlated with GS, PD, or GSPD. The proportions of effusion, synovial hypertrophy, and enthesopathy in three different subtypes, showed significant differences (Fisher's exact test, p = 0.037; p = 0.004; p = 0.019). Enthesopathy was only seen in joints of enthesitis-related arthritis (ERA), but not in joints of polyarthritis and oligoarthritis. CONCLUSIONS MSUS is an acceptable non-invasive tool for the patients with JIA, particularly for those with non-systemic JIA, that might assist disease classification, and whose parameters of the indicator joints may potentially contribute to the evaluation of disease activity.
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Affiliation(s)
- Yung-Hsien Huang
- grid.256105.50000 0004 1937 1063Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan ,grid.410769.d0000 0004 0572 8156Department of Pediatrics, New Taipei City Hospital, New Taipei City, Taiwan
| | - Ya-Chiao Hu
- grid.19188.390000 0004 0546 0241Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chun-Hua Liao
- grid.19188.390000 0004 0546 0241Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bor-Luen Chiang
- grid.19188.390000 0004 0546 0241Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cheng-Hsun Lu
- grid.412094.a0000 0004 0572 7815Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ko-Jen Li
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan. .,Department of Pediatrics, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan.
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14
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Wakeel OK, Abe AI, Awosan OB, Olapade MK, Olatoyan-Layonu TJ, Olowe OA, Adeyeba OA. Anti-Nociceptive and Anti-Inflammatory Effects of Stem Bark Extract of Ficus Capensis Thunb (Moraceae) by Bioactivity Fractionation. Antiinflamm Antiallergy Agents Med Chem 2020; 20:206-218. [PMID: 32842947 DOI: 10.2174/1871523019666200825194616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/23/2020] [Accepted: 08/05/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study investigated the antinociceptive and anti-inflammatory activities of the aqueous extract of Ficus capensis (AEFC) by bio-guided fractionation. METHODS The anti-nociceptive and anti-inflammatory effects of AEFC (250, 500, 1000 mg/kg, i.p) were assessed using acetic acid-induced writhing, hot plate, tail-flick, formalin tests, and carrageenan- induced paw edema, respectively. The AEFC was fractionated base on polarity difference into butanol, ethyl acetate, and n-hexane fractions. The fractions (500 mg/kg) obtained were subjected to the same experimental procedures mentioned above. The EAF, which exerted the most productive activities, was further subjected to fractionation procedures that yielded six fractions (labeled CF1-CF6). These fractions (200 mg/kg) were tested for potential antinociceptive and anti-inflammatory activities. Notable antagonists (Naloxone and atropine) of the nociceptive pathway were used to evaluate the mechanism of the antinociceptive action of F. capensis. RESULTS AND DISCUSSION The AEFC, BF, EAF, and CF4 caused a significant (p<0.05) reduction in the number of abdominal writhes, an increase in reaction time against the hot plate, tail-flick tests, and a significant (p<0.05) inhibition in both phases of formalin test. The AEFC, BF, EAF, CF4, and CF6 caused a significant (p<0.05) inhibition of paw edema development due to carrageenan. Atropine significantly reversed the antinociceptive effect of CF4 in both phases of the formalin test. The results obtained revealed that CF4 produced central and peripheral antinociceptive effects, while CF6 is peripherally mediated. CONCLUSION The results support the traditional uses of F. capensis in the treatment of various diseases associated with pain and inflammation. The column fraction CF4 exhibited muscarinic receptor- mediated antinociceptive activity.
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Affiliation(s)
- Oluwaseyi K Wakeel
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Abraham I Abe
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Oluropo B Awosan
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Mokaila K Olapade
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Temitope J Olatoyan-Layonu
- Department of Pharmacology and Therapeutics, Faculty of Basic Medical Sciences, College of Health Sciences, Ladoke Akintola University of Technology, Ogbomoso, Nigeria
| | - Olugbenga A Olowe
- Department of Microbiology and Parasitology, Ladoke Akintola University of Technology Ogbomoso, Osogbo, Nigeria
| | - Oluwaseyi A Adeyeba
- Department of Microbiology and Parasitology, Ladoke Akintola University of Technology Ogbomoso, Osogbo, Nigeria
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15
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Long-Term Effect of Pulsed Nd:YAG Laser in the Treatment of Children with Juvenile Rheumatoid Arthritis: A Randomized Controlled Trial. Photomed Laser Surg 2018; 36:445-451. [DOI: 10.1089/pho.2018.4444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Unal E, Batu ED, Sonmez HE, Arici ZS, Arin G, Karaca NB, Sag E, Demir S, Hakli DA, Ozcadirci A, Oflaz FB, Alpar R, Bilginer Y, Ozen S. A new biopsychosocial and clinical questionnaire to assess juvenile idiopathic arthritis: JAB-Q. Rheumatol Int 2018; 38:1557-1564. [PMID: 29869009 DOI: 10.1007/s00296-018-4075-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 05/31/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To create a new multidimensional questionnaire for the assessment of juvenile idiopathic arthritis (JIA) patients in standard clinical practice and study the validity and reliability of this questionnaire. METHODS The Juvenile Arthritis Biopsychosocial and Clinical Questionnaire (JAB-Q) was created using the Delphi technique and consensus conference following an initial literature search. The questionnaire has three parts including a clinician form, child form and parent form. This is a patient/parent-centered outcome tool, which helps us to evaluate the biopsychosocial aspects of the patient, including disease activity, posture, functional and psychosocial status, fatigue, and performance in school. From January 2015 to January 2018, 6-18 years old children with JIA were enrolled in the study. The previously validated questionnaires were also applied to each participant to validate the JAB-Q: Juvenile Idiopathic Disease Arthritis Score (JADAS) and Childhood Health Assessment Questionnaire (CHAQ), and the Family Impact Questionnaire (FIS). The same questionnaire was re-administered after one week to assess the test-retest reliability in randomly selected 50 children and their parents. RESULTS A group of experts were invited to the Delphi survey. After the Delphi tours, the final form of the questionnaire containing three parts as clinician form, child form and parent form was created. This tool was applied to 310 JIA patients and their parents. The children and parents easily handled the JAB-Q and filled the forms in around 10-15 min. The validity of the clinician, child and parents' forms were assessed by the JADAS, CHAQ, and FIS, respectively. The validity of these three scales were determined as moderate. In addition, the test-retest reliability of the clinician, child and parents' forms were considerably high. CONCLUSION JAB-Q is a valid and reliable multidimensional biopsychosocial outcome tool that can be used routinely in clinical practice of pediatric rheumatology. The main advantage of this tool is incorporation of patients' and parents' perspectives separately while providing a practical and standard setting for the clinician's evaluation. However, further validation of this tool in an independent cohort is needed to improve its applicability.
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Affiliation(s)
- Edibe Unal
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Hafize Emine Sonmez
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zehra Serap Arici
- Department of Pediatric Rheumatology, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
| | - Gamze Arin
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Nur Banu Karaca
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Erdal Sag
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Selcan Demir
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Duygu Aydin Hakli
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Aykut Ozcadirci
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Fatma Birgul Oflaz
- Department of Physical Therapy and Rehabilitation, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Reha Alpar
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey. .,Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, 06100, Ankara, Turkey.
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Miotto e Silva VB, Mitraud SDAV, Furtado RNV, Natour J, Len CA, Terreri MTDSELRA. Patients with juvenile idiopathic arthritis in clinical remission with positive power Doppler signal in joint ultrasonography have an increased rate of clinical flare: a prospective study. Pediatr Rheumatol Online J 2017; 15:80. [PMID: 29132381 PMCID: PMC5683235 DOI: 10.1186/s12969-017-0208-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 10/21/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ultrasonography (US) studies carried out on joints of juvenile idiopathic arthritis (JIA) patients in clinical remission demonstrate the presence of subclinical synovitis. The significance of subclinical synovitis and the positive power Doppler (PD) signal on US in JIA in clinical remission is not well understood. The objectives of this study were to assess whether the changes detected by US in patients with JIA in clinical remission can predict disease flare and to evaluate factors associated with flare and joint damage over 30 months of follow-up. METHODS A prospective study was performed with clinical and ultrasound evaluation in 34 joints of JIA patients in clinical remission. Clinical evaluation including physical exam, functional capacity and inflammatory markers was performed at baseline and every six months thereafter, for a total period of 30 months. US evaluation included presence of synovitis, PD signal and erosion at baseline and every 12 months thereafter. Subclinical synovitis was defined when there was synovitis with or without positive PD signal in US joints of patients in clinical remission. Flare was defined as any joint presenting clinical arthritis requiring therapy modification. RESULTS We evaluated a total of 35 patients, 28 (80%) girls, 14 (40%) persistent oligoarticular subtype, 12 (34.3%) oligoarticular extended and 9 (25.7%) polyarticular and 26 (74.3%) in remission on medication. Twenty (57.1%) patients flared. The risk of flare was five times higher in patients with positive PD signal and 14 times higher in patients in remission on medication. Regarding the assessment of joints after 6 months and 12 months of US evaluation, 70/3162 (2.2%) joints and 80/2108 (3.8%) joints flared, respectively. Joints with subclinical synovitis with positive PD signal flared more after 6 and 12 months. Twenty five of 2108 (1.2%) joints showed erosion over time. Joints with subclinical synovitis with or without positive PD signal showed more erosion. CONCLUSIONS Patients in remission on medication with subclinical synovitis with positive PD signal on US have a higher risk of flare, therefore they should be monitored closely during treatment. In the same way, joints with subclinical synovitis with or without positive PD signal should be monitored due to the risk of flare and joint damage.
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Affiliation(s)
- Vanessa Bugni Miotto e Silva
- 0000 0001 0514 7202grid.411249.bPediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Pediatric Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Borges Lagoa Street, 802, Vila Clementino, São Paulo, SP Zip code 04038-001 Brazil
| | | | - Rita Nely Vilar Furtado
- 0000 0001 0514 7202grid.411249.bRheumatology Division, Department of Medicine, UNIFESP/EPM, São Paulo, Brazil
| | - Jamil Natour
- 0000 0001 0514 7202grid.411249.bRheumatology Division, Department of Medicine, UNIFESP/EPM, São Paulo, Brazil
| | - Claudio Arnaldo Len
- 0000 0001 0514 7202grid.411249.bPediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Pediatric Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Borges Lagoa Street, 802, Vila Clementino, São Paulo, SP Zip code 04038-001 Brazil
| | - Maria Teresa de Sande e Lemos Ramos Ascensão Terreri
- 0000 0001 0514 7202grid.411249.bPediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Pediatric Department, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), Borges Lagoa Street, 802, Vila Clementino, São Paulo, SP Zip code 04038-001 Brazil
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18
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Are We Right to Consider Mesenchymal Stem Cells to Be a New Perspective for Patients with Juvenile Idiopathic Arthritis? Arch Immunol Ther Exp (Warsz) 2017; 66:267-271. [PMID: 29027570 DOI: 10.1007/s00005-017-0493-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 08/30/2017] [Indexed: 10/18/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in childhood. Up to 50% of patients are resistant to standard therapy, which includes non-steroid anti-inflammatory drugs, corticosteroids, disease-modifying anti-rheumatic drugs and biologic therapies. Intra-articular injection of mesenchymal stem cells (MSCs) is proposed as a new approach to JIA treatment. MSCs can modulate inflammation via mechanisms of both adaptive and innate immune response. They are able to inhibit T and B cell proliferation, promote regulatory T cells, suppress the maturation of dendritic cells, stimulate macrophage differentiation into M2 phenotype and reduce effectiveness of natural killer cells. They also secrete plethora of soluble factors which influence joint inflammation. Recent clinical studies reviewed in the article provide promising results which may suggest including intra-articular injection of MSCs in therapy of patients with oligoarticular JIA.
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19
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Mauro A, Rigante D, Cimaz R. Investigational drugs for treatment of juvenile idiopathic arthritis. Expert Opin Investig Drugs 2017; 26:381-387. [PMID: 28277884 DOI: 10.1080/13543784.2017.1301929] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Angela Mauro
- Department of Pediatrics, San Giacomo Hospital, Novi Ligure, Italy
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Rolando Cimaz
- Rheumatology Unit, Anna Meyer Children’s Hospital, University of Florence, Florence, Italy
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20
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Pacharapakornpong T, Vallibhakara SAO, Lerkvaleekul B, Vilaiyuk S. Comparisons of the outcomes between early and late tocilizumab treatment in systemic juvenile idiopathic arthritis. Rheumatol Int 2016; 37:251-255. [DOI: 10.1007/s00296-016-3595-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/25/2016] [Indexed: 12/19/2022]
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Abu Shady MM, Fathy HA, Ali A, Youness ER, Fathy GA. Association of neopterin as a marker of immune system activation and juvenile rheumatoid arthritis activity. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2015. [DOI: 10.1016/j.jpedp.2015.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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22
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Shady MMA, Fathy HA, Ali A, Youness ER, Fathy GA. Association of neopterin as a marker of immune system activation and juvenile rheumatoid arthritis activity. J Pediatr (Rio J) 2015; 91:352-7. [PMID: 25727025 DOI: 10.1016/j.jped.2014.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Revised: 08/31/2014] [Accepted: 09/10/2014] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To evaluate neopterin plasma concentrations in patients with active juvenile idiopathic arthritis (JIA) and correlate them with disease activity. METHODS Sixty patients diagnosed as active JIA, as well as another 60 apparently healthy age- and gender-matched children as controls, were recruited from the Pediatrics Allergy and Immunology Clinic, Ain Shams University. Disease activity was assessed by the Juvenile Arthritis Disease Activity Score 27 (JADAS-27). Laboratory investigations were performed for all patients, including determination of hemoglobin concentration (Hgb), erythrocyte sedimentation rate (ESR), and C-reactive protein. Serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), and neopterin were measured. RESULTS Significant differences were found between JIA patients and controls with regard to the mean levels of Hgb, ESR, TNF-α, IL-6, and MCP-1 (p<0.05). A statistically significant higher mean level serum neopterin concentration (p<0.05) was found in JIA patients (20.43±8.73 nmol/L) than in controls (6.88±2.87 nmol/L) (p<0.05). Positive significant correlations were detected between serum neopterin and ESR, TNF-α, IL-6, MCP-1, and JADAS-27 (p<0.05). No correlation was found between serum neopterin and CRP (p>0.05). Multiple linear regression analysis showed that JADAS- 27 and ESR were the main variables associated with serum neopterin in JIA patients (p<0.05). CONCLUSION The elevation of plasma neopterin concentrations in early JIA patients may indicate stimulation of immune response. Serum neopterin can be used as a sensitive marker for assaying background inflammation and disease activity score in JIA patients.
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Affiliation(s)
- Mones M Abu Shady
- Child Health Department, Medical Division, National Research Centre, Cairo, Egypt
| | - Hanan A Fathy
- Health Research Department, National Research Centre, Cairo, Egypt
| | - Alaa Ali
- Child Health Department, Medical Division, National Research Centre, Cairo, Egypt
| | - Eman R Youness
- Medical Biochemistry Division, National Center for Radiation and Technology, Cairo, Egypt.
| | - Gihan A Fathy
- Child Health Department, Medical Division, National Research Centre, Cairo, Egypt
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Abstract
Uveitides can be due to non-infectious and infectious etiologies. It has been observed that there is a gender difference with a greater preponderance of non-infectious uveitis in women than in men. This review will describe both non-infectious and infectious uveitides and describes some of the current autoimmune mechanisms thought to be underlying the gender difference. It will specifically look at non-infectious uveitides with systemic involvement including juvenile idiopathic arthritis, spondyloarthopathies, sarcoidosis, Behçet’s disease, and Vogt-Koyanagi-Harada disease and at uveitides without systemic involvement including sympathetic ophthalmia, birdshot chorioretinitis, and the white dot syndromes. Infectious uveitides like acute retinal necrosis, progressive outer retinal necrosis, and cytomegalovirus mediated uveitis will be mentioned. Different uveitides with female- or male- predominance are presented and discussed.
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Len CA, Miotto e Silva VB, Terreri MTRA. Importance of adherence in the outcome of juvenile idiopathic arthritis. Curr Rheumatol Rep 2014; 16:410. [PMID: 24504596 DOI: 10.1007/s11926-014-0410-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Medical treatment of juvenile idiopathic arthritis (JIA) has advanced in the last decade, and improved prognosis is a reality in daily clinical practice. Despite this improvement in the quality of treatment, the outcome can still be compromised by modifiable factors, including delayed referral to a specialist, delayed drug treatment, poor adherence to treatment, and early interruption of drug treatment. In this review we discuss the most relevant aspects related to adherence to treatment in JIA, with emphasis on: factors that affect adherence to treatment; effect of poor adherence to treatment on JIA prognosis; when to suspect and how to assess poor adherence to treatment; and strategies to promote adherence to treatment, with an emphasis on information-reinforcement education. Besides presenting the findings of other authors, we also try to report our experience of this subject, which is still a challenge for health professionals.
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Affiliation(s)
- Claudio A Len
- Pediatric Rheumatology Unit, Allergy, Immunology and Rheumatology Division, Department of Pediatrics, Escola Paulista de Medicina, Universidade Federal de São Paulo (EPM-UNIFESP), São Paulo, Brazil,
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Association of juvenile idiopathic arthritis and digeorge syndrome; a case report. IRANIAN JOURNAL OF PEDIATRICS 2014; 24:334-6. [PMID: 25562032 PMCID: PMC4276593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 12/30/2014] [Indexed: 11/23/2022]
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The role of gender in juvenile idiopathic arthritis-associated uveitis. J Ophthalmol 2014; 2014:461078. [PMID: 24701346 PMCID: PMC3950556 DOI: 10.1155/2014/461078] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/06/2014] [Indexed: 11/17/2022] Open
Abstract
Uveitis is a common complication of juvenile idiopathic arthritis (JIA) affecting up to 30% of patients with JIA. Although the typical bilateral chronic anterior uveitis associated with the persistent and extended oligoarticular and polyarticular, rheumatoid factor negative variants of JIA occurs predominantly in girls, boys may be more commonly affected in the HLA-B27 positive, enthesitis variant of JIA. While female gender has been associated with the development of the chronic anterior uveitis in children with JIA, the clinical course of JIA-associated uveitis may be worse in boys than in girls. The purpose of this paper is to review the available published literature to determine the role of gender in the clinical presentation and outcomes of patients with JIA-associated uveitis.
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Do patients with juvenile idiopathic arthritis in remission exhibit active synovitis on joint ultrasound? Rheumatol Int 2013; 34:937-45. [DOI: 10.1007/s00296-013-2909-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
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Hemophagocytic lymphohistiocytosis: critical reappraisal of a potentially under-recognized condition. Front Med 2013; 7:492-8. [PMID: 24127015 DOI: 10.1007/s11684-013-0292-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 08/18/2013] [Indexed: 10/26/2022]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an uncommon, potentially life threatening, hyper inflammatory syndrome of diverse etiologies. Cardinal signs include prolonged fever, organomegaly, and persistent unexplained cytopenias. In spite of the well known diagnostic criteria put forth by HLH society, this continues to pose great diagnostic challenge in both pediatric and adult intensive care settings. We describe 4 adult (2 males, 2 females, aged 19, 29, 40, and 17 years) and 3 pediatric (2 males, 1 female, aged 1 month, 6 months, and 12 years) patients with secondary HLH who satisfied the HLH-2004 diagnostic criteria. Definite evidence of hemophagocytosis was noted in 4 patients on initial bone marrow examination. The underlying etiologies were as follows: Rickettsia tsutsugamushi (case 1), autoimmune disorder (case 2), systemic onset juvenile idiopathic arthritis (sJIA) (case 3), unknown bite (possibly a venomous snake) (case 4), Plasmodium vivax (case 5), Cytomegalo virus (case 6), and Mycobacterium tuberculosis (case 7). In one patient, hemophagocytosis was presumed to have been exacerbated by administration of granulocyte monocyte colony stimulating factor (GMCSF) for severe neutropenia. Two patients died with disseminated intravascular coagulation (DIC) and multi organ failure within few days of HLH diagnosis. Immunosuppressive therapy was started in 3 patients, and etoposide was started in one patient only. Due to lack of specificity of diagnostic criteria, diagnosing and differentiating HLH from its closest mimickers like sepsis/septic shock may be quite challenging in critically ill patients. Therefore, increasing awareness among physicians is essential for early diagnosis and effective therapy to reduce the mortality.
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Risk factors for loss of visual acuity among patients with uveitis associated with juvenile idiopathic arthritis: the Systemic Immunosuppressive Therapy for Eye Diseases Study. Ophthalmology 2012; 120:186-92. [PMID: 23062650 DOI: 10.1016/j.ophtha.2012.07.052] [Citation(s) in RCA: 119] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 07/17/2012] [Accepted: 07/18/2012] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To describe the incidence of and risk factors for visual acuity (VA) loss and ocular complications in patients with juvenile idiopathic arthritis (JIA)-associated uveitis. DESIGN Multicenter retrospective cohort study. PARTICIPANTS A total of 327 patients (596 affected eyes) with JIA-associated uveitis managed at 5 tertiary uveitis clinics in the United States. METHODS Participants were identified from the Systemic Immunosuppressive Therapy for Eye Diseases (SITE) cohort study. Demographic and clinical characteristics were obtained for every eye of every patient at every visit via medical record review by trained expert reviewers. MAIN OUTCOME MEASURES Loss of VA to 20/50 or to 20/200 or worse thresholds and the development of ocular complications. RESULTS At presentation, 240 eyes (40.3%) had a VA of ≤20/50, 144 eyes (24.2%) had a VA of ≤20/200, and 359 eyes (60.2%) had at least 1 ocular complication. The incidences of VA loss to the ≤20/50 and ≤20/200 thresholds were 0.18 and 0.09 per eye-year (EY), respectively; the incidence of developing at least 1 new ocular complication over follow-up was 0.15/EY (95% confidence interval [CI], 0.13-0.17). However, among eyes with uveitis that had no complications at presentation, the rate of developing at least 1 ocular complication during follow-up was lower (0.04/EY; 95% CI, 0.02-0.06). Posterior synechiae, active uveitis, and prior intraocular surgery were statistically significantly associated with VA to the ≤20/50 and ≤20/200 thresholds both at presentation and during follow-up. Increasing (time-updated) anterior chamber cell grade was associated with increased rates of visual loss in a dose-dependent fashion. Use of immunosuppressive drugs was associated with a reduced risk of visual loss, particularly for the ≤20/50 outcome (hazard ratio, 0.40; 95% CI, 0.21-0.75; P<0.01). CONCLUSIONS Ocular complications and vision loss were common in our cohort. Increasing uveitis activity was associated with increased risk of vision loss, and use of immunosuppressive drugs was associated with reduced risk of vision loss, suggesting that control of inflammation and use of immunosuppression may be critical aspects in improving the outcomes of patients with JIA-related uveitis. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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