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Low JM, Hyrich KL, Ciurtin C, McErlane F, Wedderburn LR, Geifman N, Shoop-Worrall SJW. The impact of psoriasis on wellbeing and clinical outcomes in juvenile psoriatic arthritis. Rheumatology (Oxford) 2024; 63:1273-1280. [PMID: 37467079 PMCID: PMC11065439 DOI: 10.1093/rheumatology/kead370] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 06/05/2023] [Accepted: 07/10/2023] [Indexed: 07/21/2023] Open
Abstract
OBJECTIVES Juvenile PsA (JPsA) has varied clinical features that are distinctive from other JIA categories. This study investigates whether such features impact patient-reported and clinical outcomes. METHODS Children and young people (CYP) were selected if recruited to the Childhood Arthritis Prospective Study, a UK multicentre JIA inception cohort, between January 2001 and March 2018. At diagnosis, patient/parent-reported outcomes (as age-appropriate) included the parental global assessment (10 cm visual analogue scale), functional ability (Childhood Health Assessment Questionnaire (CHAQ)), pain (10 cm visual analogue scale), health-related quality of life (Child Health Questionnaire PF50 psychosocial score), mood/depressive symptoms (Moods and Feelings Questionnaire) and parent psychosocial health (General Health Questionnaire 30). Three-year outcome trajectories have previously been defined using active joint counts, physician and parent global assessments (PGA and PaGA, respectively). Patient-reported outcomes and outcome trajectories were compared in (i) CYP with JPsA vs other JIA categories and (ii) CYP within JPsA, with and without psoriasis via multivariable linear regression. RESULTS There were no significant differences in patient-reported outcomes at diagnosis between CYP with JPsA and non-JPsA. Within JPsA, those with psoriasis had more depressive symptoms (coefficient = 9.8; 95% CI: 0.5, 19.0) than those without psoriasis at diagnosis. CYP with JPsA had 2.3 times the odds of persistent high PaGA than other ILAR categories, despite improving joint counts and PGA (95% CI: 1.2, 4.6). CONCLUSION CYP with psoriasis at JPsA diagnosis report worse mood, supporting a greater disease impact in those with both skin and joint involvement. Multidisciplinary care with added focus to support wellbeing in children with JPsA plus psoriasis may help improve these outcomes.
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Affiliation(s)
- Jie Man Low
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Coziana Ciurtin
- UCL Division of Medicine, University College London, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
| | - Flora McErlane
- Department of Paediatric Rheumatology, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Lucy R Wedderburn
- Centre for Adolescent Rheumatology Versus Arthritis at UCL UCLH and GOSH, London, UK
- UCL GOS Institute of Child Health, University College London, London, UK
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Nophar Geifman
- School of Health Sciences, Faculty of Health and Medical Sciences, The University of Surrey, Surrey, UK
| | - Stephanie J W Shoop-Worrall
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
- Centre for Health Informatics, The University of Manchester, Manchester, UK
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Tuomi AK, Rebane K, Arnstad ED, Berntson L, Fasth A, Glerup M, Herlin T, Kautiainen H, Nordal E, Peltoniemi S, Rygg M, Rypdal V, Zak M, Aalto K. Body mass index is associated with health-related quality of life and disease characteristics in young adults with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2024; 22:25. [PMID: 38308280 PMCID: PMC10837959 DOI: 10.1186/s12969-023-00931-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/15/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND There is a growing interest concerning the relationship between obesity and several medical conditions and inflammation. Nevertheless, there is a lack of studies regarding body mass index (BMI) among patients with juvenile idiopathic arthritis (JIA). Our aim was to investigate the impact of BMI on health-related quality of life (HRQoL) measured with a 36-Item Short Form Survey (SF-36), disease activity, and disability in young adults with JIA. METHODS This study is a part of the population-based Nordic JIA cohort study. All newly diagnosed patients with JIA were recruited consecutively between 1997-2000 in specific regions in the Nordic countries. Patients in this sub-study were enrolled from 434 patients who attended their 18-year follow-up visit. Patients were classified according to the World Health Organization (WHO) into four groups based on their BMI. HRQoL, disease characteristics, disability, fatigue, sleep quality, physical activity, pain, comorbidities, and social status were assessed. RESULTS Three hundred fifty-five patients from the original study cohort were enrolled in this study and 72% of them were female. Mean age was 23.9 (± SD 4.4) years. A significant relationship was found between the JIA categories and BMI groups (p = 0.014). A significant relationship was also found between BMI and disease activity scores (DAS28) (p = 0.028), disability (p < 0.001), pain (p = 0.013), fatigue (p = 0.035), and sleep quality (p = 0.044). Moreover, a significant relationship between BMI and HRQoL regarding bodily pain (p = 0.010) and general health (p = 0.048) was revealed when adjusted for sex, age, and JIA subtype. CONCLUSION We discovered that BMI was significantly related to HRQoL, disease activity, and disability. BMI deserves more attention considering the treatment options and outcome of JIA in young adults.
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Affiliation(s)
- Anna-Kaisa Tuomi
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029 HUS, 00290, Helsinki, Finland.
| | - Katariina Rebane
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029 HUS, 00290, Helsinki, Finland
| | - Ellen Dalen Arnstad
- Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Lillemor Berntson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mia Glerup
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Hannu Kautiainen
- Kuopio University Hospital, Primary Health Care Unit Kuopio, Pohjois-Savo, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway and Pediatric Research Group, Tromsø, Norway
- Department of Clinical Medicine, UIT the Arctic University of Norway, Tromsø, Norway
| | - Suvi Peltoniemi
- Helsinki University Central Hospital, HUS Inflammation Center, Rheumatology and University of Helsinki, Helsinki, Finland
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs University Hospital, Trondheim, Norway
| | - Veronika Rypdal
- Department of Pediatrics, University Hospital of North Norway and Pediatric Research Group, Tromsø, Norway
| | - Marek Zak
- Department of Pediatrics, Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark
| | - Kristiina Aalto
- Pediatric Research Center, New Children's Hospital, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, P.O. Box 347, FIN-00029 HUS, 00290, Helsinki, Finland
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McGrath T, Guzman J, Tucker L, Shiff NJ, Yaskina M, Tupper S, Rumsey DG. Predictors of persisting pain in children with Juvenile Idiopathic Arthritis: a case control study nested in the ReACCh-Out cohort. Pediatr Rheumatol Online J 2023; 21:102. [PMID: 37715224 PMCID: PMC10504744 DOI: 10.1186/s12969-023-00885-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND To identify baseline predictors of persisting pain in children with Juvenile Idiopathic Arthritis (JIA), relative to patients with JIA who had similar baseline levels of pain but in whom the pain did not persist. METHODS We used data from the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) inception cohort to compare cases of 'moderate persisting pain' with controls of 'moderate decreasing pain'. Moderate pain was defined as a Visual Analogue Scale (VAS) for pain measurement score of > 3.5 cm. Follow-up was minimum 3 years. Univariate and Multivariate logistic regression models ascertained baseline predictors of persisting pain. RESULTS A total of 31 cases and 118 controls were included. Mean pain scores at baseline were 6.4 (SD 1.6) for cases and 5.9 (1.5) for controls. A greater proportion of cases than controls were females (77.4% vs 65.0%) with rheumatoid factor positive polyarthritis (12.9% vs 4.2%) or undifferentiated JIA (22.6% vs 8.5%). Oligoarthritis was less frequent in cases than controls (9.7% vs 33%). At baseline, cases had more active joints (mean of 11.4 vs 7.7) and more sites of enthesitis (4.6 vs 0.7) than controls. In the final multivariate regression model, enthesitis count at baseline (OR 1.40, CI 95% 1.19-1.76), female sex (4.14, 1.33-16.83), and the overall Quality of My Life (QoML) baseline score (0.82, 0.69-0.98) predicted development of persisting pain. CONCLUSIONS Among newly diagnosed children with JIA with moderate pain, female sex, lower overall quality of life, and higher enthesitis counts at baseline predicted development of persisting pain. If our findings are confirmed, patients with these characteristics may be candidates for interventions to prevent development of chronic pain.
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Affiliation(s)
- Tara McGrath
- Department of Pediatrics, Division of Rheumatology, University of Alberta, K3-508 ECHA; 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada.
| | - Jaime Guzman
- Department of Pediatrics, Division of Rheumatology, University of British Columbia, Vancouver, Canada
| | - Lori Tucker
- Department of Pediatrics, Division of Rheumatology, University of British Columbia, Vancouver, Canada
| | - Natalie J Shiff
- Adjunct, Department of Community Health and Epidemiology, University of Saskatchewan and Janssen Scientific Affairs LLC, Horsham, PA, UK
| | - Maryna Yaskina
- Women's and Children's Health Research Institute, University of Alberta, Edmonton, Canada
| | - Susan Tupper
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Dax G Rumsey
- Department of Pediatrics, Division of Rheumatology, University of Alberta, K3-508 ECHA; 11405 87 Ave NW, Edmonton, AB, T6G 1C9, Canada
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Brandelli YN, Chambers CT, Mackinnon SP, Parker JA, Huber AM, Stinson JN, Wildeboer EM, Wilson JP, Piccolo O. A systematic review of the psychosocial factors associated with pain in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2023; 21:57. [PMID: 37328738 DOI: 10.1186/s12969-023-00828-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/22/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Pain is one of the most frequently reported experiences amongst children with Juvenile Idiopathic Arthritis (JIA); however, the management of JIA pain remains challenging. As pain is a multidimensional experience that is influenced by biological, psychological, and social factors, the key to effective pain management lies in understanding these complex relationships. The objective of this study is to systematically review the literature on psychosocial factors of children with JIA and their caregivers 1) associated with and 2) predictive of later JIA pain intensity, frequency, and sensitivity in children 0-17 years of age. METHODS The Joanna Briggs Institute methodology for etiology and risk and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. Terms related to pain and JIA were searched in English without date restrictions across various databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Central Register of Controlled Trials) in September 2021. Two independent reviewers identified, extracted data from, and critically appraised the included studies. Conflicts were resolved via consensus. RESULTS Of the 9,929 unique studies identified, 61 were included in this review and reported on 516 associations. Results were heterogeneous, likely due to methodological differences and moderate study quality. Results identified predominantly significant associations between pain and primary and secondary appraisals (e.g., more child pain beliefs, lower parent/child self-efficacy, lower child social functioning), parent/child internalizing symptoms, and lower child well-being and health-related quality of life. Prognostically, studies had 1-to-60-month follow-up periods. Fewer beliefs of harm, disability, and no control were associated with lower pain at follow-up, whereas internalizing symptoms and lower well-being were predictive of higher pain at follow-up (bidirectional relationships were also identified). CONCLUSIONS Despite the heterogeneous results, this review highlights important associations between psychosocial factors and JIA pain. Clinically, this information supports an interdisciplinary approach to pain management, informs the role of psychosocial supports, and provides information to better optimize JIA pain assessments and interventions. It also identifies a need for high quality studies with larger samples and more complex and longitudinal analyses to understand factors that impact the pain experience in children with JIA. TRIAL REGISTRATION PROSPERO CRD42021266716.
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Affiliation(s)
- Yvonne N Brandelli
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada.
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Sean P Mackinnon
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jennifer A Parker
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Adam M Huber
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Division of Pediatric Rheumatology, IWK Health, Halifax, NS, Canada
| | - Jennifer N Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Emily M Wildeboer
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Jennifer P Wilson
- Cassie and Friends: A Society for Children with Juvenile Arthritis and Other Rheumatic Diseases, Vancouver, BC, Canada
| | - Olivia Piccolo
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
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Srinivasalu H, Treemarcki EB, Rumsey DG, Weiss PF, Colbert RA. Modified Juvenile Spondyloarthritis Disease Activity Index in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. J Rheumatol 2023; 50:532-537. [PMID: 36319008 PMCID: PMC10066819 DOI: 10.3899/jrheum.220509] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To validate the Juvenile Spondyloarthritis Disease Activity Index (JSpADA), and modified versions thereof, in a North American cohort of patients with enthesitis-related arthritis (ERA). METHODS We utilized the Childhood Arthritis and Rheumatology Research Alliance Registry database ERA cohort to validate the JSpADA and its modifications (JSpADA6-no Schober, no C-reactive protein [CRP]/erythrocyte sedimentation rate [ESR]; JSpADA7-no Schober; and JSpADA7-no CRP/ESR) using the Outcome Measures in Rheumatology principles of face validity, discriminative validity, and responsiveness to change. RESULTS There were 51 subjects (64 visits) with complete JSpADA data with a mean age of 13.7 years and disease duration of 30.9 months. Subjects were predominantly White (84.3%), and 56.9% were male and 50% were HLA-B27 positive. The JSpADA showed high correlation with the clinical 10-joint Juvenile Arthritis Disease Activity Score (cJADAS10; r = 0.81), moderate-to-high correlation with physician global assessment (PGA; r = 0.69), and low-to-fair correlation with Childhood Health Assessment Questionnaire (CHAQ; r = 0.22). The modifications of the JSpADA (JSpADA7-no Schober; JSpADA7-no CRP/ESR; and JSpADA6-no Schober, no CRP/ESR) performed similarly with high correlation with cJADAS10 (r = 0.81, 0.79, and 0.80, respectively), moderate-to-high correlation with PGA (r = 0.65, 0.67, 0.64, respectively), and low-to-fair correlation with CHAQ (r = 0.35, 0.34, 0.39, respectively). All modified versions of JSpADA had good responsiveness to change. All versions of JSpADA had excellent discriminative validity. CONCLUSION We propose the term modified JSpADA for the modification of JSpADA with 6 elements (JSpADA6-no Schober, no CRP/ESR). This shorter disease activity index may improve implementation of JSpADA in both clinical practice and research trials.
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Affiliation(s)
- Hemalatha Srinivasalu
- H. Srinivasalu, MD, Division of Rheumatology, Children's National Hospital, George Washington University School of Medicine, Washington, District of Columbia, and Pediatric Translational Research Branch, National Institute of Arthritis, Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA;
| | - Erin Brennan Treemarcki
- E.B. Treemarcki, DO, Division of Rheumatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Dax G Rumsey
- D.G. Rumsey, MD, MSc, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Pamela F Weiss
- P.F. Weiss, MD, MSCE, Division of Rheumatology, Children's Hospital of Philadelphia, and Departments of Pediatrics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Temporomandibular joint in juvenile idiopathic arthritis: magnetic resonance imaging measurements and their correlation with imaging findings. Oral Radiol 2022; 38:459-467. [PMID: 34797517 DOI: 10.1007/s11282-021-00576-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the TMJ components in patients with juvenile idiopathic arthritis (JIA) and to compare them with a control group based on magnetic resonance imaging (MRI) measurements. METHODS This study comprised an assessment of MRI measurements of 96 temporomandibular joints (TMJ) following classification criteria set by the International League of Associations for Rheumatology (ILAR). Three measurements were considered for study: condyle excursion angle (CEA), height of articular eminence (HAE) and inclination of articular eminence (IAE). All TMJs were assessed by linear measurements made by using the OnDemand 3D software. The comparison between the groups was performed by using Mann-Whitney's test. RESULTS Lower measurement values were found for IAE, HAE and CEA in JIA patients (P-values < 0.001, 0.005 and < 0.001, respectively). CONCLUSION The study showed the differences in MRI measurements between JIA patients and controls, with the former with the lowest indices.
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Sacroiliitis at diagnosis as a protective predictor against disease flare after stopping medication: outcomes of a Southeast Asian enthesitis-related arthritis (ERA) longitudinal cohort. Clin Rheumatol 2022; 41:3027-3034. [PMID: 35794290 DOI: 10.1007/s10067-022-06275-z] [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: 06/11/2022] [Revised: 06/27/2022] [Accepted: 06/29/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess short- and long-term outcomes of ERA in a large monocentric cohort in Singapore. METHODS Children diagnosed with ERA according to ILAR criteria from 2002 to 2021 were recruited. Nonparametric statistics were used to describe the data. Outcomes were defined according to modified Wallace criteria, and probabilities and predictors were determined using Kaplan-Meier survival and logistic regression analyses. RESULTS One hundred fifty-one ERA patients (male 86%; Chinese 81%) were included. The median age at onset was 11.9 years (IQR: 9.4-13.9), and disease duration was 5.3 years (IQR: 2.9-8.4). At diagnosis, 39% of the patients had sacroiliitis. HLA-B27 was positive in 83%, and biologics were used in 72% of the patients. Clinical inactive disease (CID) was achieved in 92% of the patients, of which 27% achieved within 6 months. Sacroiliitis at diagnosis is an unfavorable predictor of early CID at 6 months. Medication was discontinued in one-third of the patients. Favorable predictor of medication withdrawal includes male gender, while unfavorable predictors include positive HLA-B27 and ANA. Two-thirds of the patients with CID had at least one disease flare. Sacroiliitis at diagnosis is a protective predictor of flare after stopping medication. CONCLUSION Despite a high proportion of ERA patients achieving CID, only one-third could stop medication with high rates of disease flare. Unfavorable predictors include older age at onset, HLA-B27, and ANA positivity. While sacroiliitis at diagnosis is a negative predictor of CID at 6 months, it is associated with less disease flare after discontinuing medication.
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McHugh A, Chan A, Herrera C, Park JM, Balboni I, Gerstbacher D, Hsu JJ, Lee T, Thienemann M, Frankovich J. Profiling Behavioral and Psychological Symptoms in Children Undergoing Treatment for Spondyloarthritis and Polyarthritis. J Rheumatol 2022; 49:489-496. [PMID: 35105715 PMCID: PMC9534268 DOI: 10.3899/jrheum.210489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE Few studies examine psychopathology in different juvenile idiopathic arthritis (JIA) subtypes and disease activity states. We aimed to (1) evaluate emotional and behavioral symptoms in children with juvenile spondyloarthritis (SpA) and polyarticular arthritis (PolyA) as compared to a national normative population using the Child Behavior Checklist (CBCL), and (2) evaluate the relationship between CBCL scores and disease activity. METHODS Patients with JIA aged 6-17 years with SpA or PolyA were recruited from our pediatric rheumatology clinic from April 2018 to April 2019 and the CBCL and clinical Juvenile Arthritis Disease Activity Score in 10 joints (cJADAS10) were completed. Primary outcome measures were CBCL total competence, internalizing, externalizing, and total problems raw scores. We compared outcomes from each group to national CBCL normative data. To investigate the relationship between CBCL scores and disease activity, we ran a generalized linear regression model for all patients with arthritis with cJADAS10 as the main predictor. RESULTS There were 111 patients and 1753 healthy controls (HCs). Compared to HCs, patients with SpA or PolyA had worse total competence and internalizing scores. Higher cJADAS10 scores were associated with worse total competence, worse internalizing, and higher total problems scores. Most of these differences reached statistical significance (P < 0.01). Self-harm/suicidality was almost 4-fold higher in patients with PolyA than HCs (OR 3.6, 95% CI 1.3-9.6, P = 0.011). CONCLUSION Our study shows that patients with SpA and PolyA with more active disease have worse psychological functioning in activities, school, and social arenas, and more internalized emotional disturbances, suggesting the need for regular mental health screening by rheumatologists.
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Affiliation(s)
- Anne McHugh
- Division of Allergy, Immunology, & Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
- Division of Rheumatology, Department of Pediatrics, Wright State University Boonshoft School of Medicine, Dayton, Ohio
| | - Avis Chan
- Division of Allergy, Immunology, & Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Carolyn Herrera
- Division of Allergy, Immunology, & Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer M Park
- Rogers Behavioral Health San Francisco, Walnut Creek, California
| | - Imelda Balboni
- Division of Allergy, Immunology, & Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Dana Gerstbacher
- Division of Allergy, Immunology, & Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Joyce J. Hsu
- Division of Allergy, Immunology, & Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Tzielan Lee
- Division of Allergy, Immunology, & Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Margo Thienemann
- Division of Child and Adolescent Psychiatry and Child Development, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer Frankovich
- Division of Allergy, Immunology, & Rheumatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
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Advances in Juvenile Spondyloarthritis. Curr Rheumatol Rep 2021; 23:70. [PMID: 34255209 DOI: 10.1007/s11926-021-01036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To provide an overview of recent studies on pathogenesis, diagnosis, and management of juvenile spondyloarthritis (JSpA). RECENT FINDINGS Recent studies show differences in gut microbiome in patients with JSpA in comparison to healthy controls. There is increased recognition of the impact of the innate immune system on disease pathology. Normative reference on MRI of sacroiliac (SI) joints in children is now available. However, there is significant variability in interpretation of MRI of SI joints in children and a need for standardization. NSAIDs, physical therapy, and Tumor Necrosis Factor Inhibitors (TNFi) remain the mainstay of management for patients with JIA who have polyarthritis, sacroiliitis, and/or enthesitis as per recent ACR guidelines. Newer therapeutic options beyond TNFi are needed to manage patients who fail TNFi. This review highlights some of the recent advances in our knowledge of JSpA pathophysiology, diagnosis, and treatment. It also identifies areas in need of further research and standardization to improve our understanding and outcomes in JSpA.
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Trachtman R, Wang CM, Murray E, Szymonifka J, Pan N, Adams AB, Taber SF, Onel KB, Mandl LA. PROMIS Computer Adaptive Tests and Their Correlation With Disease Activity in Juvenile Idiopathic Arthritis. J Clin Rheumatol 2021; 27:131-135. [PMID: 31743268 PMCID: PMC10364139 DOI: 10.1097/rhu.0000000000001171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND/OBJECTIVE The importance of patient-reported outcomes, like the Patient-Reported Outcomes Measurement Information System (PROMIS) measures, is increasingly recognized both in clinical care and in research. While "short forms" have been studied in juvenile idiopathic arthritis (JIA), study of PROMIS computer adaptive tests (CATs) in JIA is limited. This cross-sectional study evaluates whether PROMIS CATs correlate with disease activity in patients with JIA. METHODS A convenience sample of patients with JIA (N = 44) was recruited from a single center. Patients and parents completed pediatric and parent proxy PROMIS CATs. Disease activity was evaluated using the Juvenile Arthritis Disease Activity Score in 71 joints (JADAS-71) and the Childhood Health Assessment Questionnaire (CHAQ). Correlation of the CAT T scores with disease activity was assessed using Spearman correlation coefficients. RESULTS Forty-four of 80 eligible subjects (29 patients and 15 parents) completed all or some PROMIS CATs. Pain interference and mobility CATs correlated moderately with JADAS-71. Nearly all correlations with the JADAS-71 were weakened when the patient global was removed. Pain interference, mobility, and fatigue were strongly correlated with the CHAQ. Among parent proxy CATs, only mobility and depressive symptoms correlated strongly with the CHAQ. CONCLUSIONS Only pain interference and mobility PROMIS CATs showed strong correlation with standard disease activity measures in JIA, and nearly all correlations were weakened when the patient global was removed. Correlations of the CATs with the CHAQ were stronger than correlations with the JADAS-71, indicating that although the CHAQ is no longer routinely used it may be a better measure of health-related quality of life in routine clinical care.
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Affiliation(s)
| | | | | | | | - Nancy Pan
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Alexa B. Adams
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Sarah F. Taber
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Karen B. Onel
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
| | - Lisa A. Mandl
- Hospital for Special Surgery, New York, NY
- Weill Cornell Medicine, New York, NY
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11
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Fisher C, Ciurtin C, Leandro M, Sen D, Wedderburn LR. Similarities and Differences Between Juvenile and Adult Spondyloarthropathies. Front Med (Lausanne) 2021; 8:681621. [PMID: 34136509 PMCID: PMC8200411 DOI: 10.3389/fmed.2021.681621] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Spondyloarthritis (SpA) encompasses a broad spectrum of conditions occurring from childhood to middle age. Key features of SpA include axial and peripheral arthritis, enthesitis, extra-articular manifestations, and a strong association with HLA-B27. These features are common across the ages but there are important differences between juvenile and adult onset disease. Juvenile SpA predominantly affects the peripheral joints and the incidence of axial arthritis increases with age. Enthesitis is important in early disease. This review article highlights the similarities and differences between juvenile and adult SpA including classification, pathogenesis, clinical features, imaging, therapeutic strategies, and disease outcomes. In addition, the impact of the biological transition from childhood to adulthood is explored including the importance of musculoskeletal and immunological maturation. We discuss how the changes associated with adolescence may be important in explaining age-related differences in the clinical phenotype between juvenile and adult SpA and their implications for the treatment of juvenile SpA.
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Affiliation(s)
- Corinne Fisher
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Division of Medicine, Department of Rheumatology (Bloomsbury), University College London, London, United Kingdom
| | - Maria Leandro
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,Division of Medicine, Department of Rheumatology (Bloomsbury), University College London, London, United Kingdom
| | - Debajit Sen
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,Department of Adolescent Rheumatology, University College London Hospitals NHS Foundation Trust, London, United Kingdom.,National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Lucy R Wedderburn
- Centre for Adolescent Rheumatology Versus Arthritis at University College London, University College London Hospital and Great Ormond Street Hospital, London, United Kingdom.,National Institute for Health Research Biomedical Research Centre at Great Ormond Street Hospital for Children, London, United Kingdom.,Infection, Immunity & Inflammation Teaching and Research Department University College London Great Ormond Street Institute of Child Health, London, United Kingdom
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12
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Weiss PF, Fuhlbrigge RC, von Scheven E, Lovell DJ, Colbert RA, Brunner HI. Children with enthesitis-related arthritis could benefit from treatments targeted for adults with spondyloarthritis. Arthritis Care Res (Hoboken) 2020; 74:1058-1064. [PMID: 33278336 DOI: 10.1002/acr.24529] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/13/2020] [Accepted: 12/01/2020] [Indexed: 12/22/2022]
Abstract
This review will summarize clinical, genetic and pathophysiologic characteristics that are shared between children with enthesitis related arthritis (ERA) with axial involvement and adults with non-radiographic, and in some cases radiographic, axial spondyloarthritis (SpA); and between children with ERA and primarily peripheral disease manifestations and adults with peripheral SpA. Due to the differences in classification criteria for children with ERA and adults with axial and peripheral SpA, the FDA granted automatic full waivers of studies in children for new medications for "axial spondyloarthropathies including ankylosing spondylitis" up until July 2020. Thus, although current juvenile idiopathic arthritis (JIA) treatment guidelines recommend the use of biologic disease modifying anti-rheumatic drugs (DMARDs) as part of the early treatment for patients with ERA, none of the FDA-approved therapies for peripheral SpA or non-radiographic axial SpA (certolizumab pegol, ixekizumab, and secukinumab) have been studied or are labelled for use in children with ERA. Considering the similarities between adult spondyloarthritis and ERA in terms of etiology, genetics, pathogenesis and clinical manifestations summarized in this review, medications approved for axial SpA or peripheral SpA should also be studied in children with active ERA involving axial or peripheral joints, respectively, with the intent to achieve labeling for use in children. Considering the current lack of effective FDA-approved therapies for ERA, the FDA should also consider requiring pediatric studies for medications that have already been approved for the treatment of adults with SpA.
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Affiliation(s)
- Pamela F Weiss
- Children's Hospital of Philadelphia, Perlman School of Medicine at the University of Pennsylvania School of Medicine, Philadelphia, USA
| | - Robert C Fuhlbrigge
- Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, USA, Cincinnati
| | - Emily von Scheven
- University of California, San Francisco. California, USA, Cincinnati
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Robert A Colbert
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, USA
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13
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Greer AE, Iversen MD. Measures of Pediatric Function and Physical Activity in Arthritis. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:499-521. [PMID: 33091268 DOI: 10.1002/acr.24239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Maura D Iversen
- Sacred Heart University, Fairfield, Connecticut, Karolinska Instituet, Stockholm, Sweden, and Brigham& Women's Hospital, Boston, Massachusetts
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14
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Tirelli F, Xiao R, Brandon TG, Burnham JM, Chang JC, Weiss PF. Determinants of disease activity change over time in Enthesitis related arthritis: effect of structured outcome monitoring and clinical decision support. Pediatr Rheumatol Online J 2020; 18:79. [PMID: 33059694 PMCID: PMC7558695 DOI: 10.1186/s12969-020-00472-3] [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: 04/15/2020] [Accepted: 10/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We aimed to test if standardized point-of-care outcome monitoring and clinical decision support (CDS), as compared to standard care, improves disease activity and patient-reported pain in children with enthesitis-related arthritis (ERA). METHODS This was a retrospective cohort study of outcomes of children with ERA after phased implementation of I) standardized outcome monitoring with CDS for polyarticular JIA, and II) CDS for ERA, compared to a pre-intervention group of historical controls. We used multivariable mixed-effects models for repeated measures to test whether implementation phase or other disease characteristics were associated with change over time in disease activity, as measured by the clinical juvenile arthritis disease activity score (cJADAS), and pain. RESULTS One hundred fifty-two ERA patients (41% incident cases) were included with a median age of 14.9 years. Implementation of standardized outcome monitoring or ERA-specific CDS did not result in significant differences in cJADAS or pain over time compared to the pre-intervention cohort. Higher cJADAS at the index visit, pain and more tender entheses were significantly associated with higher cJADAS scores over time (all p < 0.01), while biologic use was associated with lower cJADAS (p = 0.02). Regardless of intervention period, incident ERA cases had a greater rate of cJADAS improvement over time compared to prevalent cases (p < 0.01), but pain persisted over time among both incident and prevalent cases. CONCLUSIONS There was no significant effect of point-of-care outcome monitoring or CDS interventions on disease activity or pain over time in children with ERA in this single center study. Future efforts to improve disease outcomes using standardized outcome monitoring and CDS will need to consider the importance of addressing pain as a target in addition to spondyloarthritis-specific disease activity metrics.
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Affiliation(s)
- Francesca Tirelli
- grid.5608.b0000 0004 1757 3470Department of Pediatrics, Rheumatology Unit, Anna Meyer Children’s Hospital and Department of Women’s and Children’s Health, University of Padova, Via Giustiniani 2, 35128 Padova, Italy
| | - Rui Xiao
- grid.25879.310000 0004 1936 8972Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine at the University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104 USA
| | - Timothy G. Brandon
- grid.239552.a0000 0001 0680 8770Department of Pediatrics, Division of Rheumatology at the Children’s Hospital of Philadelphia, Wood Bldg 1st foor, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Jon M. Burnham
- grid.25879.310000 0004 1936 8972Department of Pediatrics, Division of Rheumatology at the Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Wood Bldg 1st foor, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Joyce C. Chang
- grid.25879.310000 0004 1936 8972Department of Pediatrics, Division of Rheumatology at the Children’s Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Wood Bldg 1st foor, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA
| | - Pamela F. Weiss
- grid.25879.310000 0004 1936 8972Department of Pediatrics, Division of Rheumatology at the Children’s Hospital of Philadelphia and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Wood Bldg 1st foor, 3401 Civic Center Blvd, Philadelphia, PA 19104 USA ,grid.239552.a0000 0001 0680 8770The Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 11121, Philadelphia, PA 19104 USA
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15
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Marino A, De Souza M, Giani T, Cimaz R. Pharmacotherapy for juvenile spondyloarthritis: an overview of the available therapies. Expert Opin Pharmacother 2020; 21:2161-2168. [PMID: 32726179 DOI: 10.1080/14656566.2020.1796970] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Spondyloarthropathies (SpA) represent a heterogeneous group of inflammatory arthritides with autoimmune pathogenesis that can affect both adults and children with peculiar features such as enthesitis, sacroiliac joint, and axial involvement. Since juvenile onset of SpA (JSpA) is not well codified by the current juvenile idiopathic arthritis classification, studies in this field are restricted to single categories and therefore cannot be exhaustive. This review aims to report recent advances in the treatment of JSpA. AREAS COVERED In order to assess the available therapies for JSpA, the authors have analyzed data obtained from retrospective and prospective studies, case reports, and case series, as well as from controlled trials. EXPERT OPINION Given the challenging classification of JSpA, research in this field has been restricted to single subcategories. Little is known of which patients are more likely to develop axial involvement leading to severe spinal damage. Whether TNF inhibitors are capable to prevent or stop disease progression, once started, is yet to be ascertained with structural damage still a matter for research. Therefore, trials on the efficacy of TNF inhibitors in JSpA are strongly advocated since they may help to elucidate their place as a treatment option.
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Affiliation(s)
- Achille Marino
- Department of Pediatrics, Desio's Hospital, ASST Monza, Desio, Italy
| | - Mirian De Souza
- Rheumatology, ASST G.Pini-CTO, University of Milan , Milan, Italy
| | - Teresa Giani
- Department of Medical Biotechnology, University of Siena , Siena, Italy.,Pediatric Rheumatology, Meyer Children's Hospital, Florence, Italy
| | - Rolando Cimaz
- Pediatric Rheumatology, ASST G.Pini-CTO , Milan, Italy.,Department of Clinical Sciences and Community Health, and Research Center for Adult and Pediatric Rheumatic Diseases, University of Milan , Milan, Italy
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16
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Meneghetti TC, Padilha TMH, Azevedo VF, Cat MNL, Sarolli BMS, de Carvalho VO. The musculoskeletal impairment negatively impacts the quality of life of children and adolescents with psoriasis. Adv Rheumatol 2020; 60:33. [PMID: 32552795 DOI: 10.1186/s42358-020-00136-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 06/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The severity of nail disease, the presence of arthralgia and fatigue are predictors of development of psoriatic arthritis (PsA) in patients with psoriasis (Pso). In children, little is known about the musculoskeletal (MSK) impairment in patients with Pso and its effect on health-related quality of life (HRQoL). OBJECTIVES To determine the frequencies of pain and MSK inflammation (i.e., arthritis, enthesitis, and sacroiliitis) among children and adolescents with Pso and its relationship to HRQoL and fatigue. METHODS Pediatric patients with Pso underwent a rheumatologic physical examination to evaluate synovitis, enthesalgia, sacroiliac joint (SIJ) pain and tender points of fibromyalgia. The core set of domains recommended by the GRAPPA - OMERACT to be measured in PsA studies was assessed. Ultrasound (US) was performed in clinical cases of enthesitis, and magnetic resonance imaging (MRI) was performed in cases of SIJ pain. RESULTS Forty-three participants (10 ± 2.9 years old) were evaluated. Pain on palpation of the entheses was observed in 10 (23.2%) patients and pain on SIJ palpation was observed in 3 (7%). No patient presented with synovitis; one presented with enthesitis on US, but MRI did not confirm sacroiliitis in any case. Patients with MSK pain had greater skin disease severity (PASI 5.4 vs. 2, p < 0.01), worse fatigue, and lower HRQoL scores on all instruments used. The estimated risk of HRQoL impairment was eight times higher in the presence of MSK pain, which was an independent predictive factor. With a NAPSI greater than 30, the probability of pain was greater than 80%. CONCLUSION MSK pain is frequent among children with Pso, related to the severity of skin and nail disease, and negatively affects HRQoL. The typically used complementary exams might not detect the inflammatory process caused by Pso.
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Affiliation(s)
- Thaís Cugler Meneghetti
- Pediatric Rheumatology, Unit of Pediatrics at Clinics Hospital, Federal University of Paraná, R. Gen. Carneiro, 181 - Alto da Glória, Curitiba, PR, 80060-900, Brazil.
| | | | - Valderílio Feijó Azevedo
- Rheumatology Division of the Department of Internal Medicine, Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Mônica Nunes Lima Cat
- Statistics Unit of the Department of Pediatrics, Federal University of Paraná, Curitiba, Paraná, Brazil
| | | | - Vânia Oliveira de Carvalho
- Pediatric Dermatology Division of the Department of Pediatrics, Federal University of Paraná, Curitiba, Paraná, Brazil
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17
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Rumsey DG, Guzman J, Rosenberg AM, Huber AM, Scuccimarri R, Shiff NJ, Bruns A, Feldman BM, Eurich DT, Benseler S, Berard R, Boire G, Bolaria R, Cabral D, Cameron B, Campillo S, Chan M, Chédeville G, Chetaille A, Dancey P, Dorval J, Duffy C, Ellsworth J, Feldman D, Gross K, Haddad E, Houghton K, Johnson N, Jurencak R, Lang B, Larché M, Laxer R, LeBlanc C, Levy D, Luca N, Miettunen P, Morishita K, Oen K, Petty R, Ramsey S, Roth J, Saint‐Cyr C, Schmeling H, Schneider R, Silverman E, Spiegel L, Stringer E, Tse S, Tucker L, Turvey S, Watanabe Duffy K, Yeung R. Worse Quality of Life, Function, and Pain in Children With Enthesitis, Irrespective of Their Juvenile Arthritis Category. Arthritis Care Res (Hoboken) 2020; 72:441-446. [DOI: 10.1002/acr.23844] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/05/2019] [Indexed: 11/07/2022]
Affiliation(s)
| | - Jaime Guzman
- University of British Columbia Vancouver British Columbia Canada
| | | | | | | | | | | | - Brian M. Feldman
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
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18
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Learoyd AE, Sen D, Fitzgerald M. The pain trajectory of juvenile idiopathic arthritis (JIA): translating from adolescent patient report to behavioural sensitivity in a juvenile animal model. Pediatr Rheumatol Online J 2019; 17:60. [PMID: 31455369 PMCID: PMC6712651 DOI: 10.1186/s12969-019-0360-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/07/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND While pain is a common symptom in JIA patients, it remains unclear why some JIA patients develop ongoing or persistent pain. Complex clinical and social settings confound analysis of individual factors that may contribute to this pain. To address this, we first undertook a retrospective analysis of pain reports in a JIA patient cohort with the aim of identifying potential factors contributing to persistent pain. We then carried out an experimental laboratory study, using joint inflammatory pain behaviour in rodents, to validate the role of these factors in the onset of persistent pain under controlled conditions. METHODS Patients: Retrospective analysis of anonymised pain visual analogue scale (VAS) scores and accompanying clinical scores from 97 JIA patients aged 13-19 (mean: 16.40 ± 1.21) collected over 50 weeks. Rats: Experimental study of pain behaviour following intra-articular microinjection of complete Freund's adjuvant (CFA) in adolescents (n = 25) and young adults (n = 43). Some animals (n = 21) had been previously exposed to joint inflammation in infancy or adolescence. RESULTS Patients: Cluster analysis of patient pain VAS scores revealed three trajectories over 50 weeks: consistently low pain (n = 45), variable pain (n = 30) and persistently high pain (n = 22). Number of actively inflamed joints did not differ in the three groups. High pain at a single visit correlated with greater physician global assessment of disease activity, while a high pain trajectory over 50 weeks was associated with more limited joints but fewer actively inflamed joints. Rats: Rodents administered ankle joint CFA also exhibit low, medium and high joint pain sensitivities, independent of joint inflammation. Prolonged inflammatory pain behaviour was associated with high background pain sensitivity, following joint inflammation at an earlier stage in life. CONCLUSIONS Both JIA patients and rodents differ in their individual pain sensitivity independent of the concurrent joint inflammation. Using experimental animal models allows us to isolate physiological factors underlying these differences, independently of social or clinical factors. The results suggest that a history of prior arthritic activity/joint inflammation may contribute to high pain sensitivity in adolescents with JIA.
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Affiliation(s)
- Annastazia E. Learoyd
- 0000000121901201grid.83440.3bDepartment of Neuroscience, Physiology & Pharmacology, University College London, London, UK
| | - Debajit Sen
- 0000000121901201grid.83440.3bArthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, UK.
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19
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Buckley L, Ware E, Kreher G, Wiater L, Mehta J, Burnham JM. Outcome Monitoring and Clinical Decision Support in Polyarticular Juvenile Idiopathic Arthritis. J Rheumatol 2019; 47:273-281. [PMID: 31308202 DOI: 10.3899/jrheum.190268] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Inconsistent assessment and treatment may impair juvenile idiopathic arthritis (JIA) outcomes. We aimed to improve polyarticular JIA (rheumatoid factor-positive and -negative) outcomes by standardizing point-of-care disease activity monitoring and implementing clinical decision support (CDS) to reduce treatment variation. METHODS We performed a quality improvement initiative in an outpatient pediatric rheumatology practice. The interventions, implemented from April to November 2016, included standardized disease activity measurement, disease activity target review, and phased introduction of polyarticular JIA CDS to guide medication selection, dosing, treatment duration, and tapering. Process measures included visit-level target attestation (goal: 50%) and CDS use (goal: 15%). Our goal was to reduce the polyarticular JIA clinical Juvenile Arthritis Disease Activity Score (cJADAS-10) by at least 10%. Included patients had at least 2 visits from April 2016 through July 2017, and were classified as having early (≤ 6 mos) or established disease (> 6 mos). RESULTS Patients with polyarticular JIA (n = 97; 81% established disease) were observed for 10.3 months (interquartile range: 6.4-12.3). Target attestation and CDS use occurred in a mean of 77% and 45% of polyarticular JIA visits, respectively. The median cJADAS-10 decreased significantly in both early (16.5 to 2.7, p < 0.001) and established polyarticular JIA (2.1 to 1.0, p = 0.01). A high proportion of patients with early disease received biologic therapy (73.7%). In established disease, although prescription of nonbiologic and biologic disease-modifying antirheumatic drugs remained similar overall, adalimumab prescribing increased (12.8% to 23.1%, p = 0.008). CONCLUSION Implementation of structured disease activity monitoring and CDS in polyarticular JIA was associated with significant reductions in disease activity scores in both early and established disease.
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Affiliation(s)
- Lisa Buckley
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Eileen Ware
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Genna Kreher
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Lisa Wiater
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Jay Mehta
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia
| | - Jon M Burnham
- From the Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA. .,L. Buckley, MD, Fellow, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; E. Ware, RN, BSN, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; G. Kreher, MPH, Office of Clinical Quality Improvement, Children's Hospital of Philadelphia; L. Wiater, RN, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J. Mehta, MD, Associate Professor, Department of Pediatrics, Division of Rheumatology, Children's Hospital of Philadelphia; J.M. Burnham, MD, MSCE, Associate Professor, Department of Pediatrics, Division of Rheumatology, and the Office of Clinical Quality Improvement, Children's Hospital of Philadelphia.
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Participation in school and physical education in juvenile idiopathic arthritis in a Nordic long-term cohort study. Pediatr Rheumatol Online J 2019; 17:44. [PMID: 31307487 PMCID: PMC6631827 DOI: 10.1186/s12969-019-0341-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 06/12/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The aim of the study was to describe school attendance and participation in physical education in school among children with juvenile idiopathic arthritis (JIA). METHODS Consecutive cases of JIA from defined geographical areas of Finland, Sweden and Norway with disease onset in 1997 to 2000 were followed for 8 years in a multi-center cohort study, aimed to be as close to population-based as possible. Clinical characteristics and information on school attendance and participation in physical education (PE) were registered. RESULTS Participation in school and in PE was lowest initially and increased during the disease course. Eight years after disease onset 228/274 (83.2%) of the children reported no school absence due to JIA, while 16.8% reported absence during the last 2 months due to JIA. Full participation in PE was reported by 194/242 (80.2%), partly by 16.9%, and none by 2.9%. Lowest participation in PE was found among children with ERA and the undifferentiated categories. Absence in school and PE was associated with higher disease activity measures at the 8-year visit. School absence > 1 day at baseline predicted use of disease-modifying anti-rheumatic drugs, including biologics (DMARDs) (OR 1.2 (1.1-1.5)), and non-remission off medication (OR 1.4 (1.1-1.7) 8 years after disease onset. CONCLUSION School absence at baseline predicted adverse long-term outcome. In children and adolescents with JIA participation in school activities is mostly high after 8 years of disease. For the minority with low participation, special attention is warranted to promote their full potential of social interaction and improve long-term outcome.
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Trajectories of pain severity in juvenile idiopathic arthritis: results from the Research in Arthritis in Canadian Children Emphasizing Outcomes cohort. Pain 2019; 159:57-66. [PMID: 28937578 DOI: 10.1097/j.pain.0000000000001064] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We studied children enrolled within 90 days of juvenile idiopathic arthritis diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) prospective inception cohort to identify longitudinal trajectories of pain severity and features that may predict pain trajectory at diagnosis. A total of 1062 participants were followed a median of 24.3 months (interquartile range = 16.0-37.1 months). Latent trajectory analysis of pain severity, measured in a 100-mm visual analogue scale, identified 5 distinct trajectories: (1) mild-decreasing pain (56.2% of the cohort); (2) moderate-decreasing pain (28.6%); (3) chronically moderate pain (7.4%); (4) minimal pain (4.0%); and (5) mild-increasing pain (3.7%). Mean disability and quality of life scores roughly paralleled the pain severity trajectories. At baseline, children with chronically moderate pain, compared to those with moderate-decreasing pain, were older (mean 10.0 vs 8.5 years, P = 0.01) and had higher active joint counts (mean 10.0 vs 7.2 joints, P = 0.06). Children with mild-increasing pain had lower joint counts than children with mild-decreasing pain (2.3 vs 5.2 joints, P < 0.001). Although most children with juvenile idiopathic arthritis in this cohort had mild or moderate initial levels of pain that decreased quickly, about 1 in 10 children had concerning pain trajectories (chronically moderate pain and mild-increasing pain). Systematic periodic assessment of pain severity in the months after diagnosis may help identify these concerning pain trajectories early and lay out appropriate pain management plans. Focused research into the factors leading to these concerning trajectories may help prevent them.
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Mistry RR, Patro P, Agarwal V, Misra DP. Enthesitis-related arthritis: current perspectives. Open Access Rheumatol 2019; 11:19-31. [PMID: 30774484 PMCID: PMC6354696 DOI: 10.2147/oarrr.s163677] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
In this narrative review, we overview the recent literature on enthesitis-related arthritis (ERA). For the purpose of our review, we searched Scopus for recent articles on this subject from 2013 onward, including some classic older articles for perspective. ERA is a juvenile idiopathic arthritis (JIA) subtype more common in males, associated in a majority with human leucocyte antigen B27. Such children generally present with asymmetric oligoarthritis or polyarthritis, predominantly of lower limb joints, associated with enthesitis or sacroiliitis. While diagnosis remains clinical, ultrasound is being increasingly used to detect subclinical enthesitis and for guiding entheseal site injections. Spine MRI can help detect sacroiliitis, inflammatory spinal changes, and pelvic sites of enthesitis in such patients. The recent juvenile spondyloarthropathy disease activity index recognizes the key clinical features of ERA, viz enthesitis and inflammatory back pain, which other disease activity indices used in JIA did not include. Management includes NSAIDs with physical therapy. Conventional disease-modifying agents like sulfasalazine and methotrexate may be used to minimize duration of NSAID use and in those with high inflammatory burden. In patients refractory to these drugs, biologics such as antitumor necrosis factor alpha agents have proven useful, based on evidences from randomized controlled trials and retrospective registry analyses. Factors predicting a poorer outcome in such children include hip or ankle involvement or restricted spinal mobility. Considering that children with ERA have overall poorer long-term outcomes than other subtypes of JIA, there is a need to further optimize therapeutic strategies for such patients.
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Affiliation(s)
- Rutviz Rajendra Mistry
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Pallavi Patro
- Department of Pharmacology, Sriram Chandra Bhanja (SCB) Medical College, Cuttack, India
| | - Vikas Agarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
| | - Durga Prasanna Misra
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India,
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23
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van Dijkhuizen EHP, Aidonopoulos O, Ter Haar NM, Pires Marafon D, Magni-Manzoni S, Ioannidis YE, Putignani L, Vastert SJ, Malattia C, De Benedetti F, Martini A. Prediction of inactive disease in juvenile idiopathic arthritis: a multicentre observational cohort study. Rheumatology (Oxford) 2018; 57:1752-1760. [PMID: 29931340 DOI: 10.1093/rheumatology/key148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 12/13/2022] Open
Abstract
Objectives To predict the occurrence of inactive disease in JIA in the first 2 years of disease. Methods An inception cohort of 152 treatment-naïve JIA patients with disease duration <6 months was analysed. Potential predictors were baseline clinical variables, joint US, gut microbiota composition and a panel of inflammation-related compounds in blood plasma. Various algorithms were employed to predict inactive disease according to Wallace criteria at 6-month intervals in the first 2 years. Performance of the models was evaluated using the split-cohort technique. The cohort was analysed in its entirety, and separate models were developed for oligoarticular patients, polyarticular RF negative patients and ANA positive patients. Results All models analysing the cohort as a whole showed poor performance in test data [area under the curve (AUC): <0.65]. The subgroup models performed better. Inactive disease was predicted by lower baseline juvenile arthritis DAS (JADAS)-71 and lower relative abundance of the operational taxonomic unit Mogibacteriaceae for oligoarticular patients (AUC in test data: 0.69); shorter duration of morning stiffness, higher haemoglobin and lower CXCL-9 levels at baseline for polyarticular RF negative patients (AUC in test data: 0.69); and shorter duration of morning stiffness and higher baseline haemoglobin for ANA positive patients (AUC in test data: 0.72). Conclusion Inactive disease could not be predicted with satisfactory accuracy in the whole cohort, likely due to disease heterogeneity. Interesting predictors were found in more homogeneous subgroups. These need to be validated in future studies.
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Affiliation(s)
- Evert H Pieter van Dijkhuizen
- Wilhelmina Children's Hospital, Department of Paediatric Rheumatology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Paediatric Rheumatology, Istituto Giannina Gaslini, Genoa, Italy
| | - Orfeas Aidonopoulos
- Institute for the Management of Information Systems, Athena Research and Innovation Centre, Athens, Greece
| | - Nienke M Ter Haar
- Wilhelmina Children's Hospital, Department of Paediatric Rheumatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | | | - Yannis E Ioannidis
- Department of Informatics and Telecommunications, University of Athens, Athens, Greece
| | | | - Sebastiaan J Vastert
- Wilhelmina Children's Hospital, Department of Paediatric Rheumatology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Clara Malattia
- Paediatric Rheumatology, Istituto Giannina Gaslini, Genoa, Italy.,DINOGMI (Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili), Università degli studi di Genova, Genoa, Italy
| | | | - Alberto Martini
- Paediatric Rheumatology, Istituto Giannina Gaslini, Genoa, Italy.,DINOGMI (Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili), Università degli studi di Genova, Genoa, Italy
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24
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Listing M, Mönkemöller K, Liedmann I, Niewerth M, Sengler C, Listing J, Foell D, Heiligenhaus A, Klein A, Horneff G, Ganser G, Haas JP, Klotsche J, Minden K. The majority of patients with newly diagnosed juvenile idiopathic arthritis achieve a health-related quality of life that is similar to that of healthy peers: results of the German multicenter inception cohort (ICON). Arthritis Res Ther 2018; 20:106. [PMID: 29848349 PMCID: PMC5977761 DOI: 10.1186/s13075-018-1588-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 04/04/2018] [Indexed: 11/10/2022] Open
Abstract
Background Achieving the best possible health-related quality of life (HRQoL) for a patient is an important treatment goal in juvenile idiopathic arthritis (JIA). We investigated the 36-month trajectories of HRQoL in children with JIA compared with healthy peers and identified the predictors of an unfavorable HRQoL. Methods Patients with a recent JIA diagnosis were enrolled in the German inception cohort study ICON. As a peer group, friends of patients of the same age and sex were asked to cooperate. Children were prospectively followed and regularly questioned about their HRQoL using the Pediatric Quality of Life Inventory 4.0 (PedsQL). Disease activity was assessed by the clinical Juvenile Arthritis Disease Activity Score (cJADAS-10), and the burden of the child’s chronic illness on their family was assessed by the Family Burden Questionnaire (FaBel). Linear mixed models were used to compare the HRQoL of the patients and their peers. Associations between the health status of a patient at enrollment and an unfavorable HRQoL (PedsQL total < 79.3) at their 3-year follow-up (FU) were analyzed by logistic regression. Results Data from 953 patients (median symptom duration 6 months, mean age 7.9 years) and 491 healthy peers (aged 8.4 years) were analyzed. During 3 years of FU, the disease activity and HRQoL of the patients improved significantly (cJADAS-10 from 9.8 (6.2) to 2.7 (3.6) and PedsQL total score from 71.7 (18.2) to 87.3 (13.9)). While the HRQoL of the patients varied among the several JIA categories at the time of enrollment, no significant differences were found at the 3-year FU. After 36 months, the HRQoL of the patients had largely converged with that of their healthy peers. JIA patients had a psychosocial health status comparable with their healthy peers, whereas a small significant mean difference remained in physical health (5.8, 95% confidence interval (CI) 4.1–7.6). Up to the 36-month FU, three-quarters of JIA patients attained a favorable HRQoL (PedsQL ≥ 79.3) which was achieved by 90% of the peers. A higher family burden, higher pain level, and lower well-being at enrollment were associated with an unfavorable HRQoL. Conclusions Under current therapeutic conditions, an HRQoL corresponding with that of healthy children is a realistic treatment goal in JIA.
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Affiliation(s)
- Miriam Listing
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany.
| | - Kirsten Mönkemöller
- Kinderkrankenhaus Amsterdamer Straße, Kliniken der Stadt Köln gGmbH, Köln, Germany
| | - Ina Liedmann
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Martina Niewerth
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Claudia Sengler
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Joachim Listing
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University of Münster, Münster, Germany
| | - Arnd Heiligenhaus
- Department of Ophthalmology at St. Franziskus Hospital Münster, University of Duisburg-Essen, Duisburg, Germany
| | - Ariane Klein
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Gerd Horneff
- Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
| | - Gerd Ganser
- St. Josef-Stift Sendenhorst, Sendenhorst, Germany
| | - Johannes-Peter Haas
- Deutsches Zentrum für Kinder- und Jugendrheumatologie, Garmisch-Partenkirchen, Germany
| | - Jens Klotsche
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany
| | - Kirsten Minden
- Deutsches Rheuma-Forschungszentrum Berlin, Epidemiology Unit, Charitéplatz 1, 10117, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Rheumatology and Clinical Immunology, Berlin, Germany
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25
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Relas H, Luosujärvi R, Kosola S. Outcome of transition phase patients with juvenile idiopathic arthritis. Mod Rheumatol 2018; 28:832-837. [DOI: 10.1080/14397595.2017.1416890] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Heikki Relas
- Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Riitta Luosujärvi
- Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Silja Kosola
- Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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26
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Weitzman ER, Wisk LE, Salimian PK, Magane KM, Dedeoglu F, Hersh AO, Kimura Y, Mandl KD, Ringold S, Natter M. Adding patient-reported outcomes to a multisite registry to quantify quality of life and experiences of disease and treatment for youth with juvenile idiopathic arthritis. J Patient Rep Outcomes 2018; 2:16. [PMID: 29645010 PMCID: PMC5891162 DOI: 10.1186/s41687-017-0025-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/14/2017] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Children with Juvenile Idiopathic Arthritis (JIA) often have poor health-related quality of life (HRQOL) despite advances in treatment. Patient-centered research may shed light on how patient experiences of treatment and disease contribute to HRQOL, pinpointing directions for improving care and enhancing outcomes. METHODS Parent proxies of youth enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry shared patient-reported outcomes about their child's HRQOL and experiences of disease and treatment burden (pain interference, morning stiffness, history of medication side effects and methotrexate intolerance). Contributions of these measures to HRQOL were estimated using generalized estimating equations accounting for site and patient demographics. RESULTS Patients (N = 180) were 81.1% white non-Hispanic and 76.7% female. Mean age was 11.8 (SD = 3.6) years, mean disease duration was 7.7 years (SD = 3.5). Mean Total Pediatric Quality of Life was 76.7 (SD = 18.2). Mean pain interference score was 50.1 (SD = 11.1). Nearly one-in-five (17.8%) youth experienced >15 min of morning stiffness on a typical day, more than one quarter (26.7%) reported ≥1 serious medication side effect and among 90 methotrexate users, 42.2% met criteria for methotrexate intolerance. Measures of disease and treatment burden were independently negatively associated with HRQOL (all p-values <0.01). Negative associations among measures of treatment burden and HRQOL were attenuated after controlling for disease burden and clinical characteristics but remained significant. CONCLUSIONS For youth with JIA, HRQOL is multidimensional, reflecting disease as well as treatment factors. Adverse treatment experiences undermine HRQOL even after accounting for disease symptoms and disease activity and should be assessed routinely to improve wellbeing.
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Affiliation(s)
- Elissa R. Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, Boston, 02115 USA
- Computational Health Informatics Program, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Lauren E. Wisk
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, Boston, 02115 USA
| | - Parissa K. Salimian
- Division of Developmental Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Kara M. Magane
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Fatma Dedeoglu
- Rheumatology Program, Division of Immunology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
| | - Aimee O. Hersh
- Division of Pediatric Rheumatology, University of Utah School of Medicine and Primary Children’s Medical Center, Salt Lake City, UT 84113 USA
| | - Yukiko Kimura
- Division of Pediatric Rheumatology, Hackensack University Medical Center, Hackensack, NJ 07601 USA
| | - Kenneth D. Mandl
- Department of Pediatrics, Harvard Medical School, Boston, 02115 USA
- Computational Health Informatics Program, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
- Department of Biomedical Informatics, Harvard Medical School, Boston, 02115 USA
| | - Sarah Ringold
- Division of Rheumatology, Seattle Children’s Hospital, Seattle, WA 98105 USA
| | - Marc Natter
- Department of Pediatrics, Harvard Medical School, Boston, 02115 USA
- Computational Health Informatics Program, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115 USA
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27
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Polachek A, Li S, Chandran V, Gladman DD. Clinical Enthesitis in a Prospective Longitudinal Psoriatic Arthritis Cohort: Incidence, Prevalence, Characteristics, and Outcome. Arthritis Care Res (Hoboken) 2017; 69:1685-1691. [PMID: 27998023 DOI: 10.1002/acr.23174] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/13/2016] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the incidence, prevalence, characteristics, disease associations, risk factors, and outcome of clinical enthesitis in patients with psoriatic arthritis (PsA). METHODS The study included patients with PsA followed prospectively. Enthesitis was defined as the presence of at least 1 tender enthesis at 1 of the 18 entheseal sites of the Spondyloarthritis Research Consortium of Canada enthesitis index. RESULTS Between 2008 and 2014, 281 of 803 patients had enthesitis, providing a prevalence of 35%. A total of 192 patients developed enthesitis during the course of followup, with an annual incidence of 0.9%. Most of the patients had 1 (48.4%) or 2 (32.2%) tender entheseal sites, and the mean ± SD number of sites per visit was 2.03 ± 1.6. The 3 most common sites were at the insertions of the Achilles tendon, plantar fascia on the calcaneus, and the lateral epicondyles (24.2%, 20.8%, and 17.2%, respectively). More active disease (higher actively inflamed joint count, tenosynovitis, and dactylitis), more pain, and less clinical damage were associated with enthesitis. Higher body mass index, more actively inflamed joints, and younger age were risk factors for developing this condition. Enthesitis resolved in most patients without changing treatment. CONCLUSION Clinical enthesitis is common, with a period prevalence of 35% of PsA patients. It usually involves only 1 or 2 sites simultaneously. The most common tender sites are at the insertions of the Achilles tendon, plantar fascia, and the lateral epicondyles. More active disease and more pain are associated with enthesitis.
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Affiliation(s)
- Ari Polachek
- University of Toronto, Toronto Western Hospital, and Centre for Prognosis Studies in the Rheumatic Diseases, Toronto, Ontario, Canada
| | - Suzanne Li
- Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and University Health Network, Toronto, Ontario, Canada
| | - Vinod Chandran
- University of Toronto, Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, and University Health Network, Toronto, Ontario, Canada
| | - Dafna D Gladman
- University of Toronto, Krembil Research Institute, Center for Prognosis Studies in the Rheumatic Diseases, and Toronto Western Hospital, Toronto, Ontario, Canada
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Abstract
PURPOSE OF REVIEW This review provides a detailed update regarding the genetics, pathogenesis, disease phenotype evaluation, therapies and expected outcomes for children with enthesitis-related arthritis (ERA). RECENT FINDINGS Recent studies evaluated human leukocyte antigen (HLA)-B27 subtypes and non-major histocompatibility complex genes including toll like receptor 4, NLRP3, CXCR4 and PTPN12 in children with ERA. The microbiome and γδ-T cells have also been an area of active investigation. Several studies focus on the imaging phenotype of children with ERA, including the use of ultrasonography and MRI. MRI techniques studied in this population include dedicated MRI, whole-body MRI and diffusion-weighted imaging. Conventional and biologic disease-modifying agents continue to be the mainstay of therapy, though the past 2 years have witnessed several greatly needed randomized controlled trials to study the efficacy of these medications in ERA. Finally, long-term effectiveness studies of biologics in children with ERA have helped inform provider and patient expectations of disease response and prognosis. SUMMARY Further evaluation of the role of the microbiome and the interleukin 17/interleukin 23 axis, techniques to optimize evaluation of disease features, and efficacy and effectiveness of newer medications are greatly needed in this understudied population of children.
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29
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Brandon TG, Becker BD, Bevans KB, Weiss PF. Patient-Reported Outcomes Measurement Information System Tools for Collecting Patient-Reported Outcomes in Children With Juvenile Arthritis. Arthritis Care Res (Hoboken) 2017; 69:393-402. [PMID: 27159889 DOI: 10.1002/acr.22937] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 04/22/2016] [Accepted: 05/03/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the precision and construct validity of pediatric Patient-Reported Outcomes Measurement Information System (PROMIS) instruments in a population of juvenile idiopathic arthritis (JIA) patients and parent proxies. METHODS A convenience sample of JIA patients and parents of JIA patients completed PROMIS instruments for 8 domains: anger, anxiety, depressive symptoms, fatigue, mobility, pain interference, peer relationships, and upper-extremity function. Short form and computerized adaptive test (CAT) scores were derived from item bank responses. Raw scores were translated to standardized T scores with corresponding SEs. Discrimination between inactive versus active disease was evaluated as an indicator of each measure's construct validity. SEs were plotted to evaluate each instrument's relative precision. Patient-parent concordance was assessed using intraclass correlations (ICCs). RESULTS A total of 228 patients and 223 parents participated, providing 71-78 responses per domain. Patient- and parent-reported anger, fatigue, mobility, and pain interference scores significantly differed between those with inactive and active disease. Anxiety, depressive symptoms, and peer relationships differed by disease activity levels for parent-report only. Short forms and CATs provided comparable reliability to the full item banks across the full range of each outcome. Patient-parent agreement ranged from ICC 0.3 to 0.8. CATs did not reduce the number of items for any domain compared to the short form. CONCLUSION Precision and discriminatory abilities of PROMIS instruments depend on health domain and report type (self-report versus parent proxy-report) for children with JIA. Varying levels of patient-parent concordance reinforces the importance of considering both perspectives in comprehensive health outcomes assessments.
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Affiliation(s)
| | | | | | - Pamela F Weiss
- University of Pennsylvania Perelman School of Medicine, Philadelphia
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30
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Hersh AO, Salimian PK, Weitzman ER. Using Patient-Reported Outcome Measures to Capture the Patient's Voice in Research and Care of Juvenile Idiopathic Arthritis. Rheum Dis Clin North Am 2016; 42:333-46. [PMID: 27133493 PMCID: PMC4853816 DOI: 10.1016/j.rdc.2016.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Patient-reported outcome (PRO) measures provide a valuable window into how patients with juvenile idiopathic arthritis and their parents perceive their functioning, quality of life, and medication side effects in the context of their disease and treatment. Momentum behind adoption of PRO measures is increasing as these patient-relevant tools capture information pertinent to taking a patient-centered approach to health care and research. This article reviews the clinical and research utility of obtaining PROs across domains applicable to the experience of juvenile idiopathic arthritis and summarizes available self-report and parent-proxy PRO measures. Current challenges and limitations of PRO usage are discussed.
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Affiliation(s)
- Aimee O Hersh
- Pediatric Rheumatology, University of Utah, 81 Mario Capecchi Way, 4th Floor, Salt Lake City, UT 84113, USA.
| | - Parissa K Salimian
- Division of Developmental Medicine, Boston Children's Hospital, 300 Longwood Avenue BCH3185, Boston, MA 02115, USA
| | - Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, 300 Longwood Avenue BCH3187, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 300 Longwood Avenue BCH3187, Boston, MA 02115, USA; Computational Health Informatics Program, Boston Children's Hospital, 300 Longwood Avenue BCH3187, Boston, MA 02115, USA
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