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Collie MM, Chen DP, Hu Y, Blazek LN, Derebail VK, Wu EY, Jain K, Orzechowski N, Poulton CJ, Henderson CD, Falk RJ, Hogan SL. Examining the role of patient-reported external factors and risk of relapse in anti-neutrophilic cytoplasmic autoantibody vasculitis. FRONTIERS IN NEPHROLOGY 2024; 4:1404451. [PMID: 39015144 PMCID: PMC11249541 DOI: 10.3389/fneph.2024.1404451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/27/2024] [Indexed: 07/18/2024]
Abstract
The role of stressors, insect bites, and infections on disease relapse of ANCA vasculitis has yet to be entirely explored, with limited retrospective studies focused on disease onset from small participant cohorts. Our study analyzes longitudinal survey data from 2011-2022 to evaluate this perspective from a large ANCA vasculitis cohort. We collected surveys every three to six months to obtain information on self-reported psychological stressors and significant life events, insect bites, and infections throughout clinical disease. We defined cohorts as those who relapsed (Relapse Cohort) and controls as those who did not relapse (Remission Cohort) during the study period. Survey responses were retrospectively reviewed during a 15-month timeframe prior to relapse or during 15 months of remission and categorized by type of stress event, insect bite, and infections at every available 3-month interval. There were no significant differences in stress and insect bites between the relapse and remission cohorts. Patients who relapsed reported more frequent upper respiratory infections and other infections, such as those affecting the skin and eyes, but there were no significant differences in the incidence of pulmonary or urinary infections compared to the remission cohort. There was a significant difference in reported upper respiratory infections 9 to 15 months prior to the relapse date, indicating a remote history of infections as a potentially significant physical stressor that may contribute to disease relapse. More frequent patient-reported infections, specifically upper respiratory infections, may contribute to patient vulnerability to relapse. Counseling and close monitoring of patients after infectious symptoms could aid in earlier detection of disease flares. Future studies are essential to further understand the importance of distal risk factors and how they impact relapse.
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Affiliation(s)
- Mary M. Collie
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Dhruti P. Chen
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Yichun Hu
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Lauren N. Blazek
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Vimal K. Derebail
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Eveline Y. Wu
- Division of Pediatric Allergy, Immunology, and Rheumatology, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Koyal Jain
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Nicole Orzechowski
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Caroline J. Poulton
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Candace D. Henderson
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Ronald J. Falk
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
| | - Susan L. Hogan
- University of North Carolina (UNC) Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
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Logel SN, Maru J, Whitehead J, Brady C, Walch A, Lasarev M, Rehm JL, Millington K. Higher Rates of Certain Autoimmune Diseases in Transgender and Gender Diverse Youth. Transgend Health 2023. [DOI: 10.1089/trgh.2022.0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
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3
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Bieber K, Hundt JE, Yu X, Ehlers M, Petersen F, Karsten CM, Köhl J, Kridin K, Kalies K, Kasprick A, Goletz S, Humrich JY, Manz RA, Künstner A, Hammers CM, Akbarzadeh R, Busch H, Sadik CD, Lange T, Grasshoff H, Hackel AM, Erdmann J, König I, Raasch W, Becker M, Kerstein-Stähle A, Lamprecht P, Riemekasten G, Schmidt E, Ludwig RJ. Autoimmune pre-disease. Autoimmun Rev 2023; 22:103236. [PMID: 36436750 DOI: 10.1016/j.autrev.2022.103236] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
Approximately 5% of the world-wide population is affected by autoimmune diseases. Overall, autoimmune diseases are still difficult to treat, impose a high burden on patients, and have a significant economic impact. Like other complex diseases, e.g., cancer, autoimmune diseases develop over several years. Decisive steps in the development of autoimmune diseases are (i) the development of autoantigen-specific lymphocytes and (often) autoantibodies and (ii) potentially clinical disease manifestation at a later stage. However, not all healthy individuals with autoantibodies develop disease manifestations. Identifying autoantibody-positive healthy individuals and monitoring and inhibiting their switch to inflammatory autoimmune disease conditions are currently in their infancy. The switch from harmless to inflammatory autoantigen-specific T and B-cell and autoantibody responses seems to be the hallmark for the decisive factor in inflammatory autoimmune disease conditions. Accordingly, biomarkers allowing us to predict this progression would have a significant impact. Several factors, such as genetics and the environment, especially diet, smoking, exposure to pollutants, infections, stress, and shift work, might influence the progression from harmless to inflammatory autoimmune conditions. To inspire research directed at defining and ultimately targeting autoimmune predisease, here, we review published evidence underlying the progression from health to autoimmune predisease and ultimately to clinically manifest inflammatory autoimmune disease, addressing the following 3 questions: (i) what is the current status, (ii) what is missing, (iii) and what are the future perspectives for defining and modulating autoimmune predisease.
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Affiliation(s)
- Katja Bieber
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Jennifer E Hundt
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Xinhua Yu
- Priority Area Chronic Lung Diseases, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Marc Ehlers
- Institute of Nutritional Medicine, University of Lübeck and University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Frank Petersen
- Priority Area Chronic Lung Diseases, Research Center Borstel, Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany
| | - Christian M Karsten
- Institute for Systemic Inflammation Research, University of Lübeck, 23562 Lübeck, Germany
| | - Jörg Köhl
- Institute for Systemic Inflammation Research, University of Lübeck, 23562 Lübeck, Germany; Division of Immunobiology, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany; Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel; Unit of Dermatology and Skin Research Laboratory, Baruch Padeh Medical Center, Poriya, Israel
| | - Kathrin Kalies
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Anika Kasprick
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Stephanie Goletz
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Jens Y Humrich
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Rudolf A Manz
- Institute for Systemic Inflammation Research, University of Lübeck, 23562 Lübeck, Germany
| | - Axel Künstner
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Christoph M Hammers
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | - Reza Akbarzadeh
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Hauke Busch
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany
| | | | - Tanja Lange
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Hanna Grasshoff
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Alexander M Hackel
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Jeanette Erdmann
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany
| | - Inke König
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Walter Raasch
- Institute of Experimental and Clinical Pharmacology and Toxicology, University of Lübeck, Lübeck, Germany
| | - Mareike Becker
- Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Anja Kerstein-Stähle
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Enno Schmidt
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany; Department of Dermatology, University of Lübeck, Lübeck, Germany
| | - Ralf J Ludwig
- Lübeck Institute of Experimental Dermatology and Center for Research on Inflammation of the Skin, University of Lübeck, Germany.
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Badarnee M, Tirosh I, Kreitler S. Psychological tendencies of children with juvenile idiopathic arthritis. Scand J Psychol 2022; 63:624-633. [PMID: 35689406 PMCID: PMC9796744 DOI: 10.1111/sjop.12839] [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: 10/12/2021] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 01/07/2023]
Abstract
A bulk of studies showed an association between stressful events and juvenile idiopathic arthritis (JIA) but failed to identify specific psychological tendencies that contribute to the patients' vulnerability to stress. The purpose of this paper is to identify psychological tendencies specific to JIA that would unravel characteristic sources of stress. The study is based on the cognitive orientation model of health, which enables us to identify these kinds of tendencies in terms of four belief types (beliefs about self, general beliefs, beliefs about norms, and goals) that refer to specific themes. This is a case-control-cohort study that included a sample of 36 patients (mean age = 12.44 years, SD = 2.97, 21 females) and 41 matched controls (mean age = 13.15 years, SD = 2.01, 22 females). The JIA cognitive-orientation questionnaire was administered, and relevant medical parameters were recorded. The belief types differentiated between the two groups, and the patients were characterized using six themes. Examples of the themes are being over-sensitive, striving for success, and not fulfilling duties well. The themes differentiated between the participants' groups with an accuracy of 89.1%. The likelihood of the patients being characterized by the themes is 3.24-9.35 times more than the controls. The psychological tendencies of JIA were discussed as generators of stress (e.g., being over-sensitive) and cognitive conflicts (e.g., the contradiction between striving for success versus not fulfilling duties well). Also, the suggested reflections of these tendencies in the health workers' and patients' relationships, such as egalitarian interaction, and non-formal communication style, were described.
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Affiliation(s)
- Muhammad Badarnee
- School of Psychological SciencesTel‐Aviv UniversityTel AvivIsrael,The Psycho‐Oncology Research CenterThe Chaim Sheba Medical CenterRamat GanIsrael
| | - Irit Tirosh
- Sackler Faculty of MedicineTel‐Aviv UniversityTel AvivIsrael,The Edmond and Lily Safra Children's HospitalThe Chaim Sheba Medical CenterRamat GanIsrael
| | - Shulamith Kreitler
- School of Psychological SciencesTel‐Aviv UniversityTel AvivIsrael,The Psycho‐Oncology Research CenterThe Chaim Sheba Medical CenterRamat GanIsrael
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5
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How does age determine the development of human immune-mediated arthritis? Nat Rev Rheumatol 2022; 18:501-512. [PMID: 35948692 PMCID: PMC9363867 DOI: 10.1038/s41584-022-00814-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/08/2022]
Abstract
Does age substantially affect the emergence of human immune-mediated arthritis? Children do not usually develop immune-mediated articular inflammation during their first year of life. In patients with juvenile idiopathic arthritis, this apparent ‘immune privilege’ disintegrates, and chronic inflammation is associated with variable autoantibody signatures and patterns of disease that resemble adult arthritis phenotypes. Numerous mechanisms might be involved in this shift, including genetic and epigenetic predisposing factors, maturation of the immune system with a progressive modulation of putative tolerogenic controls, parallel development of microbial dysbiosis, accumulation of a pro-inflammatory burden driven by environmental exposures (the exposome) and comorbidity-related drivers. By exploring these mechanisms, we expand the discussion of three (not mutually exclusive) hypotheses on how these factors can contribute to the differences and similarities between the loss of immune tolerance in children and the development of established immune-mediated arthritis in adults. These three hypotheses relate to a critical window in genetics and epigenetics, immune maturation, and the accumulation of burden. The varied manifestation of the underlying mechanisms among individuals is only beginning to be clarified, but the establishment of a framework can facilitate the development of an integrated understanding of the pathogenesis of arthritis across all ages. In this Review, the authors discuss age-related arthropathy and the similarities and differences between childhood loss of immune tolerance and adult development of immune-mediated arthritis, and develop three hypotheses describing age-related mechanisms that contribute to the onset of arthritis. The arthritis-free ‘immune privilege’ of early childhood is overridden by multiple mechanisms, progressively and age-dependently, generating recognizable patterns of chronic inflammatory arthritis. The emergence of arthritis involves interconnected mechanisms related to immune priming, to a situational susceptibility and to the accumulation of an inflammatory burden. The accumulation of epigenetic drift may contribute to differences across ages. The exposome is expected to contribute to arthritis emergence in adults as well as in children.
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Abstract
Studying environmental risk factors for pediatric rheumatic diseases (PRD) is important because the identification of these factors may lead to strategies to prevent disease, and to new insights into pathogenesis and therapeutic targets. Compared with other chronic diseases, there are few environmental epidemiology studies in PRD. Although strong risk factors common to all PRDs have not been identified, some exposures including infection, smoke exposure, and ultraviolet radiation have been associated with several of them. High-technology studies, especially of microbiomics and metabolomics, are increasing and will likely lead to new understandings of the complex interplay between environment, genetics, and disease.
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Clarke SLN, Mageean KS, Maccora I, Harrison S, Simonini G, Sharp GC, Relton CL, Ramanan AV. Moving from nature to nurture: a systematic review and meta-analysis of environmental factors associated with juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 61:514-530. [PMID: 34382060 PMCID: PMC8824412 DOI: 10.1093/rheumatology/keab627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/10/2021] [Accepted: 07/21/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives JIA is the most common paediatric rheumatic disease, thought to be influenced by both genetics and the environment. Identifying environmental factors associated with disease risk will improve knowledge of disease mechanism and ultimately benefit patients. This review aimed to collate and synthesize the current evidence of environmental factors associated with JIA. Methods Four databases (MEDLINE, Embase, Web of Science and Cumulative Index to Nursing and Allied Health Literature) were searched from inception to January 2020. Study quality was rated using the Newcastle-Ottawa Scale. Pooled estimates for each environmental factor were generated using a random-effects, inverse-variance method, where possible. The remaining environmental factors were synthesized in narrative form. Results This review includes 66 environmental factors from 39 studies (11 cohort and 28 case-control studies) over 45 years. Study sample sizes ranged from 41 to 1.9 million participants. Eight environmental factors from ten studies were meta-analysed. Caesarean section delivery was associated with increased JIA risk [pooled odds ratio (OR) 1.11, 95% CI: 1.01, 1.22]. Conversely, presence (vs absence) of siblings (pooled OR 0.60, 95% CI: 0.44, 0.81) and maternal prenatal smoking (pooled OR 0.70, 95% CI: 0.58, 0.84) were associated with decreased JIA risk. Conclusion This review identifies several environmental factors associated with JIA and demonstrates the huge breadth of environmental research undertaken over five decades. We also highlight the challenges of combining data collected over this period due to limited between study comparability, evolution in healthcare and social practices, and changing environment, which warrant consideration when planning future studies.
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Affiliation(s)
- Sarah L N Clarke
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Katie S Mageean
- Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Ilaria Maccora
- Rheumatology Unit, A Meyer Children Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Sean Harrison
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gabriele Simonini
- Rheumatology Unit, A Meyer Children Hospital, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Gemma C Sharp
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK.,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Pongratz G. Das gestresste Immunsystem und Autoimmunität. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1389-7949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
ZusammenfassungÜber einen möglichen Zusammenhang zwischen psychologischem
Stress, Immunsystem und Autoimmunität wird schon lange debattiert.
Erkenntnisse aus der Grundlagen- und epidemiologischen Forschung, die das
Verständnis für diesen komplexen Zusammenhang
erhöhen werden in dieser kurzen Übersicht zusammengestellt.
Zunächst werden bekannte anatomisch-physiologische Grundlagen
für einen Zusammenhang zwischen psychologischem Stress und
Immunsystem dargestellt. Es wird beschrieben, dass die Interaktion zwischen
Gehirn über autonomes Nervensystem und Hormonsystem bis zur
Immunzelle mit entsprechenden Rezeptoren für Neurotransmitter und
Hormone mittlerweile bis auf die molekulare Ebene gut beschrieben ist. Im
Rahmen der akuten Stressreaktion treten charakteristische
Veränderungen im Immunsystem auf, die ebenfalls gut dokumentiert
sind. In einem zweiten Teil wird dann beschrieben welche
Veränderungen im Rahmen einer chronischen Stressbelastung am
Immunsystem auftreten können und zuletzt wird diskutiert inwiefern
diese Veränderungen auch für pathophysiologische
Zustände des Immunsystems, z. B. im Rahmen von
Autoimmunerkrankungen, relevant sein könnten. Zusammenfassend
führt akuter Stress, im Sinne der optimalen Vorbereitung einer
fight&flight Situation, zu einer Steigerung der Immunfunktion
v. a. der humoralen Immunität, wohingegen die Auswirkungen
von chronischem Stress weniger klar definiert sind und es eher zu einer
Immundysregulation mit verminderter basaler Immunfunktion, v. a. der
zytotoxischen Funktion aber einer gesteigerten Reaktion nach Aktivierung,
v. a. im angeborenen Immunschenkel kommt. Epidemiologische Daten
belegen gut, dass chronischer Stress zu einer erhöhten
Suzeptibilität für Autoimmunerkrankungen führt.
Erste klinische Anwendungen, wie beispielsweise die gezielte neuronale
Stimulation des N. vagus sind in Erprobung, für einen breiteren
klinischen Einsatz sollten aber die biologischen Netzwerkstrukturen noch
besser verstanden werden, um die besten Angriffspunkte zu finden.
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Affiliation(s)
- Georg Pongratz
- Poliklinik, Funktionsbereich und Hiller Forschungszentrum für Rheumatologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Günther F, Fleck M, Straub R. Wechselwirkungen zwischen neuroendokrinem System und Immunsystem bei chronisch-entzündlichen Systemerkrankungen. AKTUEL RHEUMATOL 2021. [DOI: 10.1055/a-1322-9936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungHormonelle und neuronale Signalwege können die Manifestation einer chronisch-entzündlichen Systemerkrankung entweder begünstigen oder verhindern. Bei bereits manifester Erkrankung modulieren Hormone und Neurotransmitter den Krankheitsverlauf, in dem sie die Krankheitsaktivität erhöhen oder abschwächen. Beispiele hierfür sind der entzündungshemmende Einfluss der körpereigenen und exogenen Glukokortikoide und die entzündungsfördernden Effekte von Stress bei chronisch-entzündlichen Systemerkrankungen. Bei chronisch-entzündlichen Systemerkrankungen ringt das aktivierte Immunsystem mit dem Gehirn und anderen Organsystemen um Energie, was zu vielfältigen Erkrankungsfolgen und Folgeerkrankungen führt: „sickness behaviour“ mit Fatigue-Symptomatik und depressiven Symptomen, Schlafstörungen, Anorexie, Fehl- und Mangelernährung, Knochenabbau, Muskelabbau und kachektische Fettsucht, Insulinresistenz mit Hyperinsulinämie (begleitet von einer Resistenz gegenüber dem Insulin-like growth factor 1), Dyslipidämie, Veränderungen der Steroidhormonachsen, Störungen der Hypothalamus-Hypophysen-Gonaden-Achse, erhöhter Sympathikotonus, herabgesetzte Aktivität des parasympathischen Nervensystems, arterielle Hypertonie und Volumenbelastung, Entzündungsanämie und zirkadiane Rhythmik der Symptomausprägung. Diese für die Patienten gravierenden Folgeerkrankungen, welche den chronisch-entzündlichen Systemerkrankungen inhärent sind, sollten konsequent therapiert werden.
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Affiliation(s)
- Florian Günther
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum, Bad Abbach, Deutschland
| | - Martin Fleck
- Klinik und Poliklinik für Rheumatologie/Klinische Immunologie, Asklepios Klinikum, Bad Abbach, Deutschland
| | - Rainer Straub
- Internal Medicine, University Hospital Regensburg, Regensburg, Deutschland
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Rubinstein TB, Bullock DR, Ardalan K, Mowrey WB, Brown NM, Bauman LJ, Stein REK. Adverse Childhood Experiences Are Associated with Childhood-Onset Arthritis in a National Sample of US Youth: An Analysis of the 2016 National Survey of Children's Health. J Pediatr 2020; 226:243-250.e2. [PMID: 32553837 DOI: 10.1016/j.jpeds.2020.06.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine whether there is an association between adverse childhood experiences (ACEs) and childhood-onset arthritis, comparing youth with arthritis to both healthy youth and youth with other acquired chronic physical diseases (OCPD); and to examine whether ACEs are associated with disease-related characteristics among children with arthritis. STUDY DESIGN In a cross-sectional analysis of data from the 2016 National Survey of Children's Health we examined whether ACEs were associated with having arthritis vs either being healthy or having a nonrheumatologic OCPD. ACE scores were categorized as 0, 1, 2-3, ≥4 ACEs. Multinomial logistic regression models examined associations between ACEs and health status while adjusting for age, sex, race/ethnicity, and poverty status. Among children with arthritis, associations between ACEs and disease-related characteristics were assessed by Pearson χ2 analyses. RESULTS Compared with children with no ACEs, children with 1, 2-3, and ≥4 ACEs had an increased odds of having arthritis vs being healthy (adjusted OR for ≥4 ACEs, 9.4; 95% CI, 4.0-22.1) and vs OCPD (adjusted OR for ≥4 ACEs, 3.7; 95% CI-1.7, 8.1). Among children with arthritis, ACEs were associated with worse physical impairment. CONCLUSIONS Children with higher numbers of ACEs are more likely to have arthritis, when arthritis status is compared either with being healthy or with having OCPD. Further studies are needed to determine the direction of the association between ACEs and childhood arthritis, its impact on disease course, and potential intervention targets that might mitigate these effects.
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Affiliation(s)
- Tamar B Rubinstein
- Division of Pediatric Rheumatology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Division of Pediatric Rheumatology, Children's Hospital at Montefiore, Bronx, NY.
| | - Danielle R Bullock
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Kaveh Ardalan
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, Durham, NC; Division of Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL; Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Wenzhu B Mowrey
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Nicole M Brown
- Albert Einstein College of Medicine, Bronx, NY; Strong Children Wellness Medical Group Jamaica, NY
| | - Laurie J Bauman
- Division of Academic General Pediatrics, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Department of Psychiatry and Behavioral Science, Albert Einstein College of Medicine, Bronx, NY
| | - Ruth E K Stein
- Division of Developmental Medicine, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY; Division of Developmental Medicine, Children's Hospital at Montefiore, Bronx, NY
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Waite-Jones JM, Swallow V, Madill A. From 'neurotic' to 'managing' mother: The 'medical career' experienced by mothers of a child diagnosed with Juvenile Idiopathic Arthritis. Br J Health Psychol 2020; 25:324-338. [PMID: 32150659 DOI: 10.1111/bjhp.12409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/13/2020] [Indexed: 11/27/2022]
Abstract
Objective Despite increased research into how caring for a child diagnosed with juvenile idiopathic arthritis (JIA) affects mothers, more needs to be known about ways in which such experiences transform their lives. Insight into the experiences of such mothers was sought through analysis of interviews with eight mothers and one father caring for a child with JIA. Design The study is situated within a larger project involving families with a child with JIA. A social constructionist approach was adopted and grounded theory including a 'negative case,' guided gathering and analysing data. Individual, semi-structured interviews were conducted based on the research question: 'What is it like to be the mother of a child with juvenile idiopathic arthritis?' Results Findings suggest that mothers find difficulty living up to the 'ideal mother' expected within Western society when forced to provide competing demands of age-related, yet illness-relevant care. The unpredictable nature of JIA means mothers face a lack of understanding from professionals so become hyper-vigilant, 'battling' on behalf of their ill child. A self-perpetuating loop develops if this is misperceived as being overprotective, leaving mothers vulnerable to being judged 'neurotic'. However, with experience, often at an emotional cost, such mothers' confidence in managing the competing demands of caring for their ill child increases such they can navigate a positive journey from 'neurotic' to 'managing' mother. Conclusions Understanding this process could help health care professionals reduce stressful experiences faced by mothers when caring for a chronically ill child. Statement of contribution What is already known on this subject? Mothers of chronically ill children are often diagnosed with anxiety and depression. Such mothers will have taken over managing their child's condition, and this can include negative experiences within the health care system. Qualitative methods enable deeper understanding of the experiences of mothers of chronically ill children. What does the study add? Potentially gendered position of mothers of children with chronic conditions. Taken for granted assumptions implicitly underpin interactions between mothers and some professionals. Greater partnership between mothers and professionals ultimately improves the care of the ill child.
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Affiliation(s)
| | - Veronica Swallow
- Department of Nursing and Midwifery, Sheffield Hallam University, UK
| | - Anna Madill
- School of Psychology, University of Leeds, UK
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Horton DB, Shenoi S. Review of environmental factors and juvenile idiopathic arthritis. Open Access Rheumatol 2019; 11:253-267. [PMID: 31807094 PMCID: PMC6842741 DOI: 10.2147/oarrr.s165916] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/30/2019] [Indexed: 12/11/2022] Open
Abstract
Juvenile idiopathic arthritis is a common rheumatic disease that presents as chronic childhood arthritis. JIA is considered a multifactorial disease that may result from diverse genetic and environmental risk factors. A minority of the population-attributable risk of JIA is estimated to be due to familial factors. Thus, non-genetic or environmental factors likely account for a majority of the risk of developing JIA. Yet, while substantial data have linked environmental factors to the development of rheumatoid arthritis, similar evidence regarding JIA is sparse. This narrative review provides updates on recent literature about environmental factors that might influence the risk of developing JIA, including studies about potentially beneficial and harmful influences as well as factors with unclear effects.
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Affiliation(s)
- Daniel B Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.,Rutgers Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA.,Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Susan Shenoi
- Department of Pediatrics, Division of Pediatric Rheumatology, Seattle Children's Hospital and Research Center and University of Washington, Seattle, WA, USA
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13
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Gross J, Oubaya N, Eymard F, Hourdille A, Chevalier X, Guignard S. Stressful life events as a trigger for rheumatoid arthritis onset within a year: a case-control study. Scand J Rheumatol 2017; 46:507-508. [PMID: 28766391 DOI: 10.1080/03009742.2017.1324910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- J Gross
- a Department of Rheumatology , APHP Henri Mondor Hospital , Créteil , France
| | - N Oubaya
- b Department of Public Health , APHP Henri Mondor Hospital , Créteil , France.,c Clinical Epidemiology and Ageing Unit , University of Paris-Est , Créteil , France
| | - F Eymard
- a Department of Rheumatology , APHP Henri Mondor Hospital , Créteil , France
| | - A Hourdille
- a Department of Rheumatology , APHP Henri Mondor Hospital , Créteil , France
| | - X Chevalier
- a Department of Rheumatology , APHP Henri Mondor Hospital , Créteil , France
| | - S Guignard
- a Department of Rheumatology , APHP Henri Mondor Hospital , Créteil , France
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Shenoi S, Shaffer ML, Wallace CA. Environmental Risk Factors and Early-Life Exposures in Juvenile Idiopathic Arthritis: A Case-Control Study. Arthritis Care Res (Hoboken) 2017; 68:1186-94. [PMID: 26618899 DOI: 10.1002/acr.22806] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/08/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Juvenile idiopathic arthritis (JIA) is a heterogeneous group of disorders characterized by chronic arthritis in children with unknown etiology. Although research evaluating environmental or early-life exposures in JIA is scarce, there are data to suggest that infections, smoking exposure, and lack of breastfeeding play a role. This case-control study investigated the association of selected environmental and early-life risk factors with the development of JIA. METHODS JIA cases were identified at a major pediatric rheumatology outpatient clinic. Each case was asked to identify up to 3 healthy playmates of similar age and same sex to serve as controls. Parents/caregivers of cases and controls completed a questionnaire on selected environmental and early-life exposures. Conditional logistic regression adjusted for age and socioeconomic status was used to determine the odds ratio (OR) for developing JIA with 95% confidence intervals (95% CIs) for the playmate-matched design. RESULTS Included in the study were 225 JIA cases and 138 controls. Compared to playmate-matched controls, preterm delivery (OR 1.8 [95% CI 1.2-2.7]) was associated with JIA. There was no association between JIA and household smoking or maternal prenatal smoking, breastfeeding, hospitalization with infection in the first year of life, daycare attendance before 6 years of age, household pets, or residential area prior to the onset of JIA. CONCLUSION There was no association between the previously reported risk factors of smoking, early-life infection, or breastfeeding and development of JIA in this study. The association of preterm delivery with JIA needs to be further studied.
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Affiliation(s)
- S Shenoi
- University of Washington School of Medicine and Seattle Children's Hospital and Research Institute, Seattle
| | - M L Shaffer
- Seattle Children's Research Institute, Seattle, Washington
| | - C A Wallace
- University of Washington School of Medicine and Seattle Children's Hospital and Research Institute, Seattle
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15
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Psychoneuroimmunology-developments in stress research. Wien Med Wochenschr 2017; 168:76-84. [PMID: 28600777 DOI: 10.1007/s10354-017-0574-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/19/2017] [Indexed: 01/23/2023]
Abstract
Links between the central nervous stress system and peripheral immune cells in lymphoid organs have been detailed through 50 years of intensive research. The brain can interfere with the immune system, where chronic psychological stress inhibits many functions of the immune system. On the other hand, chronic peripheral inflammation-whether mild (during aging and psychological stress) or severe (chronic inflammatory diseases)-clearly interferes with brain function, leading to disease sequelae like fatigue but also to overt psychiatric illness. In recent years, it has been observed that psychological stress can be disease permissive, as in chronic inflammatory diseases, cancer, cardiovascular diseases, acute and chronic viral infections, sepsis, asthma, and others. We recognized that stress reactivity is programmed for a lifetime during a critical period between fetal life and early childhood, which then influences stress behavior and stress responses in adulthood. First phase II clinical studies, e.g., on cognitive behavioral therapy and mind-body therapies (e. g., mindfulness-based stress reduction), are available that show some benefits in stressful human diseases such as breast cancer and others. The field of psychoneuroimmunology has reached a firm ground and invites therapeutic approaches based on Good Clinical Practice phase III multicenter randomized controlled trials to influence stress responses and outcome in chronic illness.
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Golemati CV, Mavragani CP, Lionaki S, Karaiskos D, Moutsopoulos HM. Stress and Disease Onset in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Front Psychiatry 2017; 8:286. [PMID: 29375403 PMCID: PMC5770743 DOI: 10.3389/fpsyt.2017.00286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/01/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To explore the potential contribution of stress as a trigger for disease onset in patients with antineutrophil cytoplasmic antibody (ANCA) associated vasculitis (AAV). METHODS 53 AAV and 85 rheumatoid arthritis (RA) patients as well as 53 healthy controls (HC) were thoroughly asked for the number and impact of stressful life events, coping strategies, and available social support 12 months prior to disease onset. Anxiety, depression, personality dimensions, insomnia, and fatigue were also determined. RESULTS AAV patients reported higher scoring of the impact of stressful life events compared to the RA and HC group prior to disease onset (2.8 ± 3.1 vs 1.8 ± 2.1 vs 1.7 ± 2.3, p-values: 0.047 and 0.053, respectively). While the number of reported stressful events was found to be significantly higher in AAV vs RA patients but not HC, certain coping strategies and social support features were more commonly implemented by AAV patients compared to HC, but not RA patients. As far as personality and other psychosocial characteristics, AAV patients displayed significantly higher psychoticism traits compared to RA, with no other differences being detected between AAV patients and both RA and HC. After adjusting for potential cofounders, scoring of the impact of stressful life events >3 was independently associated with AAV development compared to both RA and HC [ORs (95% CI): 4.6 (1.6-13.4) and 4.4 (1.0-19.0), respectively]. CONCLUSION The perceived impact of stressful life events prior to disease onset emerged as a contributing factor for AAV development.
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Affiliation(s)
- Christina V Golemati
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Clio P Mavragani
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Physiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Sophia Lionaki
- Department of Nephrology, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Karaiskos
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Haralampos M Moutsopoulos
- Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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17
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Udo T, Purcell K, Grilo CM. Perceived weight discrimination and chronic medical conditions in adults with overweight and obesity. Int J Clin Pract 2016; 70:1003-1011. [PMID: 28032427 PMCID: PMC5215793 DOI: 10.1111/ijcp.12902] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 10/02/2016] [Indexed: 11/30/2022] Open
Abstract
AIM This study investigated whether perceived weight discrimination is associated with increased risk for major chronic medical conditions and whether the associations persist after adjusting for other stressful life events in addition to BMI, physical activity and sociodemographic variables. METHODS The study included 21 357 overweight/obese adults (52.9% women) from the 2001 to 2002 and 2004 to 2005 National Survey of Alcohol and Related Conditions. RESULTS Perceived weight discrimination was significantly associated with risk for arteriosclerosis, diabetes, high cholesterol, myocardial infarction, minor heart conditions and stomach ulcers. Perceived weight discrimination was associated with reporting more stressful life events. After adjusting additionally for stressful life events in the final multiple logistic regression, associations with arteriosclerosis, diabetes and minor cardiac conditions remained significant. Gender-stratified analyses revealed that perceived weight discrimination was associated with different medical conditions in women than men, and many associations became non-significant when adjusting for stressful life events, particularly for women. CONCLUSIONS Among overweight/obese adults, perceived weight discrimination is associated with significantly increased risk for obesity-related chronic medical conditions even after adjusting for BMI, physical activity and sociodemographic variables. Accounting for other acute stressful life events may also be important in understanding the health effects of perceived weight discrimination. Such added health risk of overweight/obesity posed by perceived weight discrimination warrants public health and policy interventions against weight discrimination to reduce the socioeconomic burden of obesity.
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Affiliation(s)
- Tomoko Udo
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA
| | - Katherine Purcell
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, 12144, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06510
- National Center on Addiction and Substance Abuse (at Yale), New Haven, CT. 06510
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Oberle EJ, Harris JG, Verbsky JW. Polyarticular juvenile idiopathic arthritis - epidemiology and management approaches. Clin Epidemiol 2014; 6:379-93. [PMID: 25368531 PMCID: PMC4216020 DOI: 10.2147/clep.s53168] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a group of disorders characterized by arthritis persisting for at least 6 weeks with onset before the age of 16 years. Within this cluster of conditions, the polyarticular form (involving more than four joints within the first 6 months) is further divided based on the presence of rheumatoid factor. Children with polyarticular JIA pose unique diagnostic and therapeutic challenges compared to children with involvement of fewer joints. Polyarticular JIA patients tend to have a more refractory course and therefore are at increased risk for joint damage, resulting in poorer functional outcomes and decreased quality of life. Although the ability to treat this disorder continues to improve, especially with the advent of biologic agents, there is still much about the epidemiology and pathogenesis of polyarticular JIA that is unknown. The epidemiology of polyarticular JIA varies worldwide with a vast difference in reported cases between different global regions as well as within individual countries. Several genetic risk loci have been identified conferring increased susceptibility to JIA, many within the human leukocyte antigen region. Beyond the genome, environmental factors also seem to contribute to the etiology of polyarticular JIA. This review article will focus on the epidemiology and current treatments of polyarticular JIA and briefly discuss genetic and environmental influences on the pathogenesis of JIA as well as new and emerging therapies.
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Affiliation(s)
- Edward J Oberle
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Julia G Harris
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - James W Verbsky
- Department of Pediatrics, Division of Rheumatology, Medical College of Wisconsin, Milwaukee, WI, USA
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Kalinina Ayuso V, Makhotkina N, van Tent-Hoeve M, de Groot-Mijnes JD, Wulffraat NM, Rothova A, de Boer JH. Pathogenesis of juvenile idiopathic arthritis associated uveitis: the known and unknown. Surv Ophthalmol 2014; 59:517-31. [DOI: 10.1016/j.survophthal.2014.03.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 03/24/2014] [Accepted: 03/25/2014] [Indexed: 12/17/2022]
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20
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Nozoe KT, Polesel DN, Boin AC, Berro LF, Moreira GA, Tufik S, Andersen ML. The role of sleep in Juvenile idiopathic arthritis patients and their caregivers. Pediatr Rheumatol Online J 2014; 12:20. [PMID: 24940169 PMCID: PMC4060140 DOI: 10.1186/1546-0096-12-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022] Open
Abstract
Juvenile idiopathic arthritis is a chronic disease that may lead to various consequences for patients and caregivers, especially in relation to sleep quality. Sleep is an essential process for homeostasis of the organism. In general, caregivers of children with JIA are more susceptible to these sleep disorders and a lower quality of life. This impairment in sleep can potentially affect the health of caregiver. For this reason, it is very important to continue to evaluate the quality of sleep in caregivers and how to support these JIA children's caregivers more effectively.
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Affiliation(s)
- Karen Tieme Nozoe
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - André Campiolo Boin
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Laís Fernanda Berro
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | | | - Sergio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Monica Levy Andersen
- Department of Psychobiology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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