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Güngörer V, Çelikel E, Ekici Tekin Z, Polat MC, Öner N, Kurt T, Kaplan MM, Sezer M, Tekgöz N, Karagöl C, Coşkun S, Çelikel Acar B. Biological Agent Switching in Patients With Juvenile Idiopathic Arthritis: A Tertiary Center Experience. J Clin Rheumatol 2023; 29:255-261. [PMID: 37068267 DOI: 10.1097/rhu.0000000000001974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
OBJECTIVE The purpose of this study is to investigate the causes and outcomes of switching biological agents in juvenile idiopathic arthritis (JIA) patients using biological agents and compare the characteristics of patients whose biological agents are switched and those whose are not. METHODS This medical records review study was conducted with 128 patients who were diagnosed with JIA at our clinic between January 2009 and January 2022 and were receiving biologic agents. Factors affecting the biologic agent switching were investigated. RESULTS The JIA subtype with the most frequent switching in biological agents was systemic JIA (n = 13, 40.6%). Systemic JIA was followed by rheumatoid factor-negative polyarticular JIA and persistent oligoarticular JIA with 5 patients (15.6%), extended oligoarticular JIA and enthesitis-related JIA with 3 patients (9.3%), rheumatoid factor-positive polyarticular JIA with 2 patients (6.2%), and undifferentiated JIA with 1 patient (3.1%). Among the patients, 32 (25%) patients had their biological agent switched once, and 5 (3.9%) had theirs switched twice. The most frequently used biological agent was etanercept (n = 76, 59.3%), whereas the most frequently observed cases of biological agent switching were from an anti-TNF agent to another anti-TNF agent (40.6%). The reason for switching was unresponsiveness to the agent in 22 patients (68.8%), adverse effects in 6 patients (18.7%), drug intolerance in 1 patient (3.1%), and other reasons in 3 patients (9.3%). CONCLUSIONS The most frequently used biological agent was etanercept; the most frequent cases of biological agents switching were from an anti-TNF agent to another anti-TNF agent.
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Affiliation(s)
- Vildan Güngörer
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Li J, Ver Berne J, Shujaat S, Shaheen E, Politis C, Jacobs R. Influence of systemic comorbidities on the complications of orthognathic surgery: A scoping review. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e956-e961. [PMID: 35760309 DOI: 10.1016/j.jormas.2022.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/09/2022] [Accepted: 06/22/2022] [Indexed: 11/17/2022]
Abstract
The potential impact of systemic comorbidities has not yet been thoroughly explored in orthognathic surgery. Therefore, the following scoping review was conducted to accumulate evidence on the possible impact of systemic comorbidities on the orthognathic surgery complications. PubMed, Embase, Cochrane, and Web of Science databases were searched up to April 2022 to identify studies about patients with systemic comorbidities who underwent orthognathic surgery. A total of 12,938 articles were screened, and seven articles met the inclusion criteria. Only one study had control group, other six articles had a non-comparative study design. The current evidence suggests a high impact of rheumatic diseases and neuromuscular disorders on the surgery- and patient-related postoperative complications following orthognathic surgery. At the same instance, the findings of the review should be interpreted with caution due to a lack of substantial evidence for extrapolating the findings to a contemporary surgical practice.
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Affiliation(s)
- Jiqing Li
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium.
| | - Jonas Ver Berne
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Sohaib Shujaat
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Eman Shaheen
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Constantinus Politis
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS IMPATH research group, Department of Imaging & Pathology, Faculty of Medicine, KU Leuven and Department of Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
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Muzaffer MA, Abdelgalil AA. Tocilizumab in management of refractory juvenile idiopathic arthritis, 10 years of experience at tertiary university hospital. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00074-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Juvenile idiopathic arthritis (JIA) is the most prevalent pediatric rheumatic disorder. Progress in modalities of therapy improves the disease outcome. We aimed to determine the efficacy and safety of tocilizumab (TCZ) in the management of systemic (sJIA) and polyarticular (pJIA) in children who are resistant to conventional as well as other biological therapies. In this retrospective study, we selected JIA patients according to the International League of Association for Rheumatology (ILAR) criteria and were treated with TCZ. Response to TCZ was assessed using Juvenile Arthritis Disease Activity Score-10 (JADAS-10) and also outcomes were assessed according to the American College of Rheumatology (ACR) remission criteria. Safety of the drug was assessed by documenting possibly related adverse effects (AE). Statistical analysis using SPSS version 25 with statistical significance is considered if p ≤ 0.05. We included 16 JIA patients aged ≤ 18 years but 2 of them were excluded as they developed severe reaction during the TCZ 1st dose, so finally, 14 patients were included.
Results
The median age of our patients was 12 years. Of these 14 patients, 9 (64.3%) had sJIA and 5 (35.7%) had pJIA. TCZ use led to significant improvement in the JADAS-10 from mean 22.4 (± 7.9) when it was initially assessed and then 3, 6, 12, and 24 months after TCZ initiation with means 5.7 (± 3.9), 4.4 (± 3.7), 3.5 (± 3.1), and 2.7 (± 2.2), (P = 0.001, 0.001, 0.005, 0.012), respectively. Five patients exhibited TCZ possibly expected side effects. Neutropenia and infusion-related reactions were the most frequent AE.
Conclusions
Tocilizumab seems to be generally effective and safe drug in the management of sJIA and pJIA especially in cases refractory to conventional as well as other biologic agents.
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Alzyoud RM, Alsuweiti MO, Almaaitah HQ, Aladaileh BN, Alnoubani MK, Alwahadneh AM. Juvenile idiopathic arthritis in Jordan: single center experience. Pediatr Rheumatol Online J 2021; 19:90. [PMID: 34118940 PMCID: PMC8196540 DOI: 10.1186/s12969-021-00572-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 05/20/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a heterogeneous group of disorders, including all forms of arthritis, which develops in children who are less than 16 years old. This study aimed to evaluate the clinical and laboratory features of JIA in a single center in Jordan. METHODS A retrospective analysis of the electronic medical records of Pediatric patients diagnosed with JIA based on the International League of Associations for Rheumatology (ILAR) criteria during the period from 2015 to 2019 at the Pediatric Rheumatology Clinic in the Queen Rania Children's Hospital. All patients were below the age of 14 years at the time of diagnosis and followed for at least 6 months. Collected data consisted of age, gender, age at initial presentation and diagnosis, JIA subtype, laboratory data, treatment options, and outcome. RESULTS A total of 210 patients were included in this cohort (94 males and 116 females) with the mean age at diagnosis and mean age at onset of 5.33 ± 3.40 years and 5.08 ± 3.40 years (range: 7 months - 14 years), respectively. Oligoarticular JIA was the commonest subtype (54.7%), followed by systemic arthritis (17.1%) and polyarticular arthritis (12.3%). ANA was positive in 70 patients (33.6%). Uveitis occurred in 30 (14.2%) patients. CONCLUSION To the best of our knowledge, this study on this cohort is the first report on JIA in Jordan, in comparison with other regionally and internationally published reports. Oligoarticular JIA was found to be the most common subtype. For detailed knowledge on JIA characteristics and patterns, a population-based, rather than a single center study, should be conducted in Jordan.
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Affiliation(s)
- Raed M Alzyoud
- Pediatric Immunology, Allergy and Rheumatology Division, Queen Rania Children's Hospital, Royal Medical Services, King Abdullah II St 226, P. O Box 11855, Amman, Jordan.
| | - Motasem O Alsuweiti
- Pediatric Immunology, Allergy and Rheumatology Division, Queen Rania Children's Hospital, Royal Medical Services, King Abdullah II St 226, P. O Box 11855, Amman, Jordan
| | - Heba Q Almaaitah
- Pediatric Immunology, Allergy and Rheumatology Division, Queen Rania Children's Hospital, Royal Medical Services, King Abdullah II St 226, P. O Box 11855, Amman, Jordan
| | - Bushra N Aladaileh
- Pediatric Immunology, Allergy and Rheumatology Division, Queen Rania Children's Hospital, Royal Medical Services, King Abdullah II St 226, P. O Box 11855, Amman, Jordan
| | - Mohammad K Alnoubani
- Pediatric Immunology, Allergy and Rheumatology Division, Queen Rania Children's Hospital, Royal Medical Services, King Abdullah II St 226, P. O Box 11855, Amman, Jordan
| | - Adel M Alwahadneh
- Pediatric Immunology, Allergy and Rheumatology Division, Queen Rania Children's Hospital, Royal Medical Services, King Abdullah II St 226, P. O Box 11855, Amman, Jordan
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Tarakcı E, Kısa EP, Arman N, Albayrak A. Physical activity and exercise in patients with pediatric rheumatic disease: A systematic search and review. Turk Arch Pediatr 2021; 56:179-186. [PMID: 34104906 DOI: 10.5152/turkarchpediatr.2021.21034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 02/15/2021] [Indexed: 01/20/2023]
Abstract
Childhood rheumatic diseases are a group of diseases that can affect many organs and systems, resulting in pain, joint stiffness, muscle atrophy and weakness. Physical inactivity has been reported in many childhood rheumatic diseases. There are many studies in the literature comparing the effectiveness of exercise programs in children with juvenile idiopathic arthritis. Exercise and physical activity are considered major parts of the treatment of children with rheumatic disease. The aim of this review is to systematically present studies on physical activity and exercise programs in children with rheumatism from the last 5 years. An internet-based search of three databases-PubMed, PEDro and Medline- was conducted to find relevant studies. Two reviewers individually identified studies on the basis of their title, abstract or full text-as necessary-to determine their eligibility. Differences of opinion between the two examiners were resolved by discussion. Scientific studies of children with different rheumatic diagnoses have shown that physical activity and exercise have a significant effect on reducing the symptoms of the disease. However, the duration, frequency, method and evaluation of the exercises are still being discussed in the literature.
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Affiliation(s)
- Ela Tarakcı
- Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa Faculty of Health Science, Istanbul, Turkey
| | - Eylül Pınar Kısa
- Division of Physiotherapy and Rehabilitation, Biruni University, Faculty of Health Science, Istanbul, Turkey.,Division of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nilay Arman
- Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpasa Faculty of Health Science, Istanbul, Turkey
| | - Asya Albayrak
- Division of Physiotherapy and Rehabilitation, Institute of Graduate Studies, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Karadağ ŞG, Demirkan FG, Koç R, Çakmak F, Sönmez HE, Aktay Ayaz N. Approach to switching biologics in juvenile idiopathic arthritis: a real-life experience. Rheumatol Int 2021; 42:141-147. [PMID: 33846863 DOI: 10.1007/s00296-021-04854-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 03/30/2021] [Indexed: 11/30/2022]
Abstract
The primary aim of the treatment of juvenile idiopathic arthritis (JIA) is complete remission and minimizing the development of complications. Though biologic agents (BAs) provide better disease control, data related to BA switching patterns in JIA patients are scarce. This study aimed to determine the BA switching patterns in JIA patients. The study included children with JIA that received ≥ 1 BAs. Disease activity was evaluated based on the juvenile arthritis disease activity score 71 (JADAS71). Demographic data, clinical and laboratory findings, BA switching patterns, and the rationales for BA switching were recorded. The study included 177 (82 female and 95 male) JIA patients that received ≥ 1 BAs. Mean age at diagnosis of JIA was 9.1 ± 4.9 years. BAs were prescribed a median of 14 months (range: 3-66 months) after diagnosis. Among the 177 patients, 31 (17.5%) required BA switching a median 10.5 months (range: 3-38 months) after initiation of the first BA. Among all the BAs that were switched to after administration of the first BA, tocilizumab was the most commonly switched (n = 15). The most common reason for BA switching was inadequate response (n = 29). BAs were switched 2 times in 5 patients and 3 times in 1 patient. When patients that switched BAs 1 time were compared to those that switched 2 and 3 times there were not any differences in terms of JIA types, whereas those that switched 2 and 3 times had a higher active joint count and JADAS71 score after 6 months of initiation of the first BA. As some of the JIA patients could not achieve remission despite using the prescribed BA, BA switching was required. Herein, we provide data on both BA switching patterns and requirements, which may improve the management of JIA patients.
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Affiliation(s)
- Şerife Gül Karadağ
- Department of Pediatric Rheumatology, University of Health Sciences, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul University Medical School, Fatih, Istanbul, Turkey
| | - Rahime Koç
- Department of Pediatric Rheumatology, University of Health Sciences, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul University Medical School, Fatih, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli Faculty of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul University Medical School, Fatih, Istanbul, Turkey.
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Makalish TP, Golovkin IO, Oberemok VV, Laikova KV, Temirova ZZ, Serdyukova OA, Novikov IA, Rosovskyi RA, Gordienko AI, Zyablitskaya EY, Gafarova EA, Yurchenko KA, Fomochkina II, Kubyshkin AV. Anti-Rheumatic Effect of Antisense Oligonucleotide Cytos-11 Targeting TNF-α Expression. Int J Mol Sci 2021; 22:ijms22031022. [PMID: 33498456 PMCID: PMC7864158 DOI: 10.3390/ijms22031022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 02/06/2023] Open
Abstract
The urgency of the search for inexpensive and effective drugs with localized action for the treatment of rheumatoid arthritis continues unabated. In this study, for the first time we investigated the Cytos-11 antisense oligonucleotide suppression of TNF-α gene expression in a rat model of rheumatoid arthritis induced by complete Freund’s adjuvant. Cytos-11 has been shown to effectively reduce peripheral blood concentrations of TNF-α, reduce joint inflammation, and reduce pannus development. The results achieved following treatment with the antisense oligonucleotide Cytos-11 were similar to those of adalimumab (Humira®); they also compared favorably with those results, which provides evidence of the promise of drugs based on antisense technologies in the treatment of this disease.
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Affiliation(s)
- Tatyana P. Makalish
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Ilya O. Golovkin
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
- Correspondence: (I.O.G); (V.V.O.); Tel.: +7-978-814-68-66 (V.V.O.)
| | - Volodymyr V. Oberemok
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
- Nikita Botanical Gardens—National Scientific Centre Russian Academy of Sciences, 298648, Simferopol, Russia
- Correspondence: (I.O.G); (V.V.O.); Tel.: +7-978-814-68-66 (V.V.O.)
| | - Kateryna V. Laikova
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
- Research Institute of Agriculture of Crimea, 295005 Simferopol, Russia
| | - Zenure Z. Temirova
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Olesya A. Serdyukova
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
| | - Ilya A. Novikov
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
- Research Institute of Agriculture of Crimea, 295005 Simferopol, Russia
| | - Roman A. Rosovskyi
- Taurida Academy, V.I. Vernadsky Crimean Federal University, Vernadsky Av. 4, 295007 Simferopol, Russia; (K.V.L.); (O.A.S.); (I.A.N.); (R.A.R.)
| | - Andrey I. Gordienko
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Evgeniya Yu. Zyablitskaya
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Elvina A. Gafarova
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Kseniya A. Yurchenko
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Iryna I. Fomochkina
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
| | - Anatoly V. Kubyshkin
- Medical Academy Named after S.I. Georgievsky, V.I. Vernadsky Crimean Federal University, Lenin Boulevard 5/7, 295051 Simferopol, Russia; (T.P.M.); (Z.Z.T.); (A.I.G.); (E.Y.Z.); (E.A.G.); (K.A.Y.); (I.I.F.); (A.V.K.)
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Adrovic A, Yildiz M, Köker O, Şahin S, Barut K, Kasapçopur Ö. Biologics in juvenile idiopathic arthritis-main advantages and major challenges: A narrative review. Arch Rheumatol 2020; 36:146-157. [PMID: 34046584 PMCID: PMC8140868 DOI: 10.46497/archrheumatol.2021.7953] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/04/2020] [Indexed: 12/26/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood. The disease is divided in different subtypes based on main clinical features and disease course. Emergence of biological agents targeting specific pro-inflammatory cytokines responsible for the disease pathogenesis represents the revolution in the JIA treatment. Discovery and widespread usage of biological agents have led to significant improvement in JIA patients’ treatment, with evidently increased functionality and decreased disease sequel. Increased risk of infections remains the main discussion topic for years. Despite the slightly increased frequency of upper respiratory tract infections reported in some studies, the general safety of drugs is acceptable with rare reports of severe adverse effects (SAEs). Tuberculosis (TBC) represents the important threat in regions with increased TBC prevalence. Therefore, routine screening for TBC should not be neglected when prescribing and during the follow-up of biological treatment. Malignancy represents a hypothetical complication that sometimes causes hesitations for physicians and patients in its prescription and usage. On the other hand, current reports from the literature do not support the increased risk for malignancy among JIA patients treated with biological agents. A multidisciplinary approach including a pediatric rheumatologist and an infectious disease specialist is mandatory in the follow- up of JIA patients. Although the efficacy and safety of biological agents have been proven in different studies, there is still a need for long-term, multicentric evaluation providing relevant data.
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Affiliation(s)
- Amra Adrovic
- Department of Pediatrics, Division of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Mehmet Yildiz
- Department of Pediatrics, Division of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Oya Köker
- Department of Pediatrics, Division of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Sezgin Şahin
- Department of Pediatrics, Division of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Kenan Barut
- Department of Pediatrics, Division of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatrics, Division of Pediatric Rheumatology, Istanbul University-Cerrahpasa, Cerrahpasa Medical School, Istanbul, Turkey
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9
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Barut K, Adrovic A, Sahin S, Tarcin G, Tahaoglu G, Koker O, Yildiz M, Kasapcopur O. Prognosis, complications and treatment response in systemic juvenile idiopathic arthritis patients: A single-center experience. Int J Rheum Dis 2019; 22:1661-1669. [PMID: 31273940 DOI: 10.1111/1756-185x.13649] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 05/15/2019] [Accepted: 06/13/2019] [Indexed: 02/06/2023]
Abstract
AIM Systemic juvenile idiopathic arthritis (sJIA) is a distinctive subtype of JIA characterized by systemic features and poor outcome. We aimed to investigate demographic and clinical features, long-term treatment response and disease complications in a large sJIA cohort. METHODS Patients diagnosed with sJIA followed up at a pediatric rheumatology outpatient department from January 2003 to December 2017 were included. Demographic and clinical features, long-term treatment response and disease complications were retrospectively collected. RESULTS A total of 168 sJIA patients (51.8% female, 48.2% male) were included: 31.5% with monocyclic, 13.7% polycyclic and 54.8% with persistent clinical course. Corticosteroids were initially used in all patients. Methotrexate was used in 75% and cyclosporine A was used in 17.3% patients. Biological drugs were used in 42.8% patients; etanercept in 29.7%, anakinra in 16%, canakinumab in 16%, tocilizumab in 10% patients. Remission off medication was achieved in 82 (48.8%). Macrophage activation syndrome (MAS) was present in 11.9%, growth retardation in 11.3% patients. Eight percent (4/50) of patients had low bone mineral density. Three patients (1.78%) died due to MAS secondary multiorgan insufficiency and infection. CONCLUSION The disease is characterized with diverse clinical presentation and possibly severe complications. MAS complicated with multiorgan insufficiency is the major mortality factor. Corticosteroids represent the mainstay of the initial treatment. In patients resistant to classic treatment, biological drugs should be timely introduced.
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Affiliation(s)
- Kenan Barut
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gurkan Tarcin
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Gulberk Tahaoglu
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Oya Koker
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
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10
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Nanda S, De Bedout V, Gru A, Zlotoff B. Recurrent fevers and a diffuse, evanescent papular rash. Pediatr Dermatol 2019; 36:535-537. [PMID: 31290601 DOI: 10.1111/pde.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sonali Nanda
- Department of Dermatology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Valeria De Bedout
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Alejandro Gru
- Department of Dermatology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Barrett Zlotoff
- Department of Dermatology, University of Virginia School of Medicine, Charlottesville, Virginia
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11
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Chen YC, Chang YW, Tan KP, Shen YS, Wang YH, Chang CH. Can mesenchymal stem cells and their conditioned medium assist inflammatory chondrocytes recovery? PLoS One 2018; 13:e0205563. [PMID: 30462647 PMCID: PMC6248915 DOI: 10.1371/journal.pone.0205563] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 09/27/2018] [Indexed: 12/29/2022] Open
Abstract
Osteoarthritis (OA), one of the most common joint disease, affects more than 80% of the population aged 70 or over. Mesenchymal stem cells (MSCs) show multi-potent differentiation and self-renewal capability, and, after exposure to an inflammatory environment, also exhibit immunosuppressive properties. In this study, we have used a model of lipopolysaccharide (LPS)-stimulated chondrocytes to evaluate MSC anti-inflammatory efficacy. The anti-inflammatory mechanism was tested in two cell-contained culture systems: (i) MSC-chondrocyte indirect contact system and (ii) MSC-chondrocyte direct contact system, and one cytokine-only culture system: MSC-conditioned medium (CM) system. Results showed that MSCs reduced chondrocyte inflammation through both paracrine secretion and cell-to-cell contact. The inflammation-associated, and free-radical-related genes were down-regulated significantly in the direct contact system on 24 h, however, the TNF-α. IL-6 were upregulated and aggrecan, COLII were downregulated on 72 h in direct contact system. Moreover, we found CM produced by MSC possess well therapeutic effect on inflammatory chondorcyte, and the 10-fold concentrated MSC-conditioned medium could down-regulated chondorcyte synthesis inflammation-associated, and free-radical-related genes, such as TNF-α, IL-1β, IL-6 and iNOS even treated for 72 h. In conclusion, MSC-CM showed great potential for MSC-based therapy for OA.
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Affiliation(s)
- Yu-Chun Chen
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
- College of General Studies, Yuan Ze University, Taoyuan City, Taiwan, R.O.C
| | - Yu-Wei Chang
- Department of Surgery, Memorial Mackay Hospital, Taipei, Taiwan, R.O.C
| | - Kinn Poay Tan
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
| | - Yi-Shan Shen
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan, R.O.C
| | - Yao-Horng Wang
- Department of Nursing, Yuanpei University of Medical Technology, Hsinchu, Taiwan, R.O.C
| | - Chih-Hung Chang
- Department of Orthopedic Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C
- Graduate School of Biotechnology and Bioengineering, Yuan Ze University, Taoyuan City, Taiwan, R.O.C
- * E-mail:
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12
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Escárcega RO, Lipinski MJ, García-Carrasco M, Mendoza-Pinto C, Galvez-Romero JL, Cervera R. Inflammation and atherosclerosis: Cardiovascular evaluation in patients with autoimmune diseases. Autoimmun Rev 2018; 17:703-708. [DOI: 10.1016/j.autrev.2018.01.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/31/2018] [Indexed: 01/13/2023]
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13
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Abstract
Juvenile idiopathic arthritis is the most common chronic rheumatic disease of unknown aetiology in childhood and predominantly presents with peripheral arthritis. The disease is divided into several subgroups, according to demographic characteristics, clinical features, treatment modalities and disease prognosis. Systemic juvenile idiopathic arthritis, which is one of the most frequent disease subtypes, is characterized by recurrent fever and rash. Oligoarticular juvenile idiopathic arthritis, common among young female patients, is usually accompanied by anti-nuclear antibodie positivity and anterior uveitis. Seropositive polyarticular juvenile idiopathic arthritis, an analogue of adult rheumatoid arthritis, is seen in less than 10% of paediatric patients. Seronegative polyarticular juvenile idiopathic arthritis, an entity more specific for childhood, appears with widespread large- and small-joint involvement. Enthesitis-related arthritis is a separate disease subtype, characterized by enthesitis and asymmetric lower-extremity arthritis. This disease subtype represents the childhood form of adult spondyloarthropathies, with human leukocyte antigen-B27 positivity and uveitis but commonly without axial skeleton involvement. Juvenile psoriatic arthritis is characterized by a psoriatic rash, accompanied by arthritis, nail pitting and dactylitis. Disease complications can vary from growth retardation and osteoporosis secondary to treatment and disease activity, to life-threatening macrophage activation syndrome with multi-organ insufficiency. With the advent of new therapeutics over the past 15 years, there has been a marked improvement in juvenile idiopathic arthritis treatment and long-term outcome, without any sequelae. The treatment of juvenile idiopathic arthritis patients involves teamwork, including an experienced paediatric rheumatologist, an ophthalmologist, an orthopaedist, a paediatric psychiatrist and a physiotherapist. The primary goals of treatment are to eliminate active disease, to normalize joint function, to preserve normal growth and to prevent long-term joint damage. Timely and aggressive treatment is important to provide early disease control. The first-line treatment includes disease-modifying anti-rheumatic drugs (methotrexate, sulphasalazine, leflunomide) in combination with corticosteroids, used in different dosages and routes (oral, intravenous, intra-articular). Intra-articular application of steroids seems to be an effective treatment modality, especially in monoarthritis. Biological agents should be added in the treatment of unresponsive patients. Anti-tumour necrosis factor agents (etanercept, infliximab, adalimumab), anti-interleukin-1 agents (anakinra, canakinumab), anti- interleukin-6 agents (tocilizumab) and T-cell regulatory agents (abatacept) have been shown to be safe and effective in childhood patients. Recent studies reported sustained reduction in joint damage with even complete clinical improvement in paediatric patients, compared to previous data.
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Affiliation(s)
- Kenan Barut
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Sezgin Şahin
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, İstanbul University Cerrahpaşa Medical School, İstanbul, Turkey
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14
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The Assessment of Serum Endocan Levels in Children With Juvenile Idiopathic Arthritis. Arch Rheumatol 2017; 33:168-173. [PMID: 30207559 DOI: 10.5606/archrheumatol.2018.6528] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 08/31/2017] [Indexed: 02/03/2023] Open
Abstract
Objectives This study aims to evaluate the levels of serum endocan in children with juvenile idiopathic arthritis (JIA). Patients and methods Sixty-seven children with JIA (30 males, 37 females; mean age 10.4±4.9 years; range 2 to 18 years) and a sex- and age- matched healthy control group of 39 children (16 males, 23 females; mean age 9.3±4.1 years; range 1 to 17 years) were recruited. Patients with JIA were divided into two groups as the clinically active JIA group (n=27) and inactive JIA group (n=40). Results The median serum endocan level in patients with JIA was significantly higher than in the control group (633.75 ng/L vs. 379.76 ng/L, p<0.01). Comparison between patients with active JIA and inactive JIA was not significant in terms of endocan levels (618.70 ng/L vs. 687.36 ng/L, p=0.34). There was a weak negative correlation between Childhood Health Assessment Questionnaire scores of patients with JIA and serum endocan levels. Conclusion The high level of serum endocan highlighted the endothelial damage in patients with JIA.
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15
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Cai RA, Beste D, Chaplin H, Varakliotis S, Suffield L, Josephs F, Sen D, Wedderburn LR, Ioannou Y, Hailes S, Eleftheriou D. Developing and Evaluating JIApp: Acceptability and Usability of a Smartphone App System to Improve Self-Management in Young People With Juvenile Idiopathic Arthritis. JMIR Mhealth Uhealth 2017; 5:e121. [PMID: 28811270 PMCID: PMC5575419 DOI: 10.2196/mhealth.7229] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 03/13/2017] [Accepted: 04/14/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Flare-ups in juvenile idiopathic arthritis (JIA) are characterized by joint pain and swelling and often accompanied with fatigue, negative emotions, and reduced participation in activities. To minimize the impact of JIA on the physical and psychosocial development and well-being of young people (YP), it is essential to regularly monitor disease activity and side effects, as well as to support self-management such as adherence to treatment plans and engagement in general health-promoting behaviors. Smartphone technology has the potential to engage YP with their health care through convenient self-monitoring and easy access to information. In addition, having a more accurate summary of self-reported fluctuations in symptoms, behaviors, and psychosocial problems can help both YP and health care professionals (HCPs) better understand the patient's condition, identify barriers to self-management, and assess treatment effectiveness and additional health care needs. No comprehensive smartphone app has yet been developed in collaboration with YP with JIA, their parents, and HCPs involved in their care. OBJECTIVES The objective of this study was to design, develop, and evaluate the acceptability and usability of JIApp, a self-management smartphone app system for YP with JIA and HCPs. METHODS We used a qualitative, user-centered design approach involving YP, parents, and HCPs from the rheumatology team. The study was conducted in three phases: (1) phase I focused on developing consensus on the features, content, and design of the app; (2) phase II was used for further refining and evaluating the app prototype; and (3) phase III focused on usability testing of the app. The interview transcripts were analyzed using qualitative content analysis. RESULTS A total of 29 YP (aged 10-23, median age 17) with JIA, 7 parents, and 21 HCPs were interviewed. Major themes identified as the ones that helped inform app development in phase I were: (1) remote monitoring of symptoms, well-being, and activities; (2) treatment adherence; and (3) education and support. During phase II, three more themes emerged that informed further refinement of the app prototype. These included (4) adapting a reward system to motivate end users for using the app; (5) design of the app interface; and (6) clinical practice integration. The usability testing during phase III demonstrated high rates of overall satisfaction and further affirmed the content validity of the app. CONCLUSIONS We present the development and evaluation of a smartphone app to encourage self-management and engagement with health care for YP with JIA. The app was found to have high levels of acceptability and usability among YP and HCPs and has the potential to improve health care and outcomes for this age group. Future feasibility testing in a prospective study will firmly establish the reliability, efficacy, and cost-effectiveness of such an app intervention for patients with arthritis.
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Affiliation(s)
- Ran A Cai
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Dominik Beste
- Department of Computer Science, University College London, London, United Kingdom
| | - Hema Chaplin
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Socrates Varakliotis
- Department of Computer Science, University College London, London, United Kingdom
| | - Linda Suffield
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Francesca Josephs
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom
| | - Debajit Sen
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,University College London Hospitals NHS Foundation Trust, Adolescent Rheumatology, London, United Kingdom
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Infection, Immunity, Inflammation, and Physiological Medicine, London, United Kingdom
| | - Yiannakis Ioannou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,University College London Hospitals NHS Foundation Trust, Adolescent Rheumatology, London, United Kingdom
| | - Stephen Hailes
- Department of Computer Science, University College London, London, United Kingdom
| | - Despina Eleftheriou
- Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, United Kingdom.,UCL Great Ormond Street Institute of Child Health, Infection, Immunity, Inflammation, and Physiological Medicine, London, United Kingdom
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16
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Mori M, Sugiyama N, Morishima Y, Sugiyama N, Kokubo T, Takei S, Yokota S. Safety and effectiveness of etanercept for treatment of juvenile idiopathic arthritis: Results from a postmarketing surveillance. Mod Rheumatol 2017; 28:101-107. [PMID: 28448193 DOI: 10.1080/14397595.2017.1310704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The objectives of this surveillance were to determine safety and effectiveness of etanercept in patients with juvenile idiopathic arthritis (JIA). METHODS In this postmarketing surveillance, patients aged 5-16 years with active polyarthritis JIA were treated with etanercept at the doses approved in the Japanese package insert. The occurrence and seriousness of adverse events (AEs) were assessed using the Japanese Medical Dictionary for Regulatory Activities version 15.1. Effectiveness was determined as the improvement from baseline in disease activity score in 28 joints (DAS28)-erythrocyte sedimentation rate (ESR), remission, and physician's assessment of overall improvement. The number of responders was expressed as a percentage. The last observation carried forward method was used to impute missing data. RESULTS Safety analysis included 102 patients; 22 patients experienced 36 treatment-related AEs, three of which were unexpected. None of the AEs were deemed to need special safety warnings. Effectiveness analysis included 87 patients. At 24 weeks, 29/46 (63.0%) patients demonstrated either good or moderate response in DAS28-4/ESR and treatment was assessed to be markedly effective or effective by physicians in 79/83 (95.2%) patients. CONCLUSIONS These data are consistent with earlier reports showing that etanercept was effective and demonstrated no safety signals in patients with JIA.
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Affiliation(s)
- Masaaki Mori
- a Department of Lifetime Clinical Immunology , Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University , Tokyo , Japan
| | | | | | | | | | - Syuji Takei
- c Department of Maternal and Child Health Nursing , School of Health Sciences, Faculty of Medicine, Kagoshima University , Kagoshima , Japan
| | - Shumpei Yokota
- d Fuji Toranomon Orthopedics Hospital , Shizuoka , Japan
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17
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Kellen R, Silverberg NB, Lebwohl M. Efficacy and safety of ustekinumab in adolescents. Pediatric Health Med Ther 2016; 7:109-120. [PMID: 29388600 PMCID: PMC5683279 DOI: 10.2147/phmt.s75836] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The biologic agent ustekinumab is a human monoclonal antibody that binds to the p40 subunit shared by interleukins (ILs) 12 and 23. The antibody is able to prevent binding of cytokines to the IL-12Rβ1 cell surface receptor and therefore may prevent IL-23 driven activation of the IL-23/Th 17 axis of inflammation. The anti-inflammatory activity has been beneficial in adult psoriasis. Ustekinumab has been approved in the United States for the treatment of adults with psoriasis and psoriatic arthritis. Approval in children and adolescents has not been granted by the US Food and Drug Administration. Subcutaneous injections of ustekinumab are administered at baseline, week 4 and every 12 weeks thereafter, a regimen that is particularly appealing to young patients who do not like more frequent injections at home. The product is attractive because, although it works through an immune system mechanism, the selective activity is such that the drug has not been associated with many of the side effects attributed to other immunosuppressive medications. Case reports of ustekinumab for pediatric psoriasis have shown promising results, and the recent Phase III CADMUS trial tested the agent in adolescents aged 12-17 years with psoriasis, using standard dose 0.75 mg/kg (≤60 kg), 45 mg (>60-≤100 kg), and 90 mg (>100 kg) or half-standard dosing 0.375 mg/kg (≤60 kg), 22.5 mg (>60-≤100 kg), and 45 mg (>100 kg) with a loading dosage at week 0 and week 4. Psoriasis area and severity index-75 was achieved in more than three-quarters of patients in full and half dosing by 12 weeks, and psoriasis area and severity index-90 in 54.1% and 61.1% of half and full dosage by 12 weeks, respectively. Ustekinumab was generally well tolerated in adolescents, with some patients developing antibodies, and nasopharyngitis being the major adverse event. Ustekinumab is a promising agent in adolescent psoriasis that appears to be well tolerated. The best monitoring plan and usage in younger patients still remain to be defined.
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Affiliation(s)
- Roselyn Kellen
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nanette B Silverberg
- Department of Dermatology, Mount Sinai St Luke’s-Roosevelt Hospital, New York, NY, USA
- Beth Israel Medical Centers, New York, NY, USA
| | - Mark Lebwohl
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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18
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Doğruel D, Yılmaz M, Bingöl G, Altıntaş DU, Güneşer Kendirli S. Fraction of exhaled nitric oxide as a predictor in juvenile idiopathic arthritis progression. Clin Rheumatol 2016; 36:541-546. [PMID: 27511473 DOI: 10.1007/s10067-016-3371-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 07/18/2016] [Accepted: 07/29/2016] [Indexed: 01/25/2023]
Abstract
In this study, the relation between the nitric oxide (NO) levels in the serum and fraction of exhaled nitric oxide (FENO) in children with juvenile idiopathic arthritis (JIA) and the activation criteria of the disease has been investigated. The study group consisted of 35 JIA-diagnosed patients and 18 healthy children. According to the clinical and laboratory findings, the patients with JIA were divided into two groups, active (group I) and in remission (group II). The healthy children were classified as group III. The activation criteria of the disease were determined for each patient. The serum NO level and FENO level were measured in all the patients. In the group with JIA, correlation was detected between FENO level and number of involved joints and number of joints with limited motion. In addition, correlation was determined between the FENO level and number of involved joints in group I and the serum NO level and activity score in group II. However, it was seen that there is no statistical difference in the serum NO level and FENO level of the patients with JIA and the control group and groups I and II. This study demonstrated the correlation between FENO level and number of involved joints and number of joints with limited motion in patients with JIA. Our results matter in terms of FENO being a noninvasive laboratory marker in following the progression of the disease.
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Affiliation(s)
- Dilek Doğruel
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey.
| | - Mustafa Yılmaz
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Gülbin Bingöl
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Derya Ufuk Altıntaş
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
| | - Seval Güneşer Kendirli
- Department of Pediatric Allergy and Immunology, Çukurova University Faculty of Medicine, Adana, Turkey
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19
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Liang QQ, Shi Q, Wood RW, Xing LP, Wang YJ. Peri-articular lymphatic system and "Bi" theory of Chinese medicine in the pathogenesis and treatment of arthritis. Chin J Integr Med 2015; 21:648-55. [PMID: 26432788 DOI: 10.1007/s11655-015-2305-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Indexed: 12/11/2022]
Abstract
Rheumatoid arthritis (RA) and osteoarthritis (OA) are the two most common joint diseases, and they have characterization of synovial inflammation and cartilage destruction, associated with the accumulation of numerous catabolic mediators and inflammatory cells in the synovial space and surrounding soft tissues. How these factors are cleared and if the "clearance" process contributes to pathogenesis of arthritis are not known. Recently, we found the existence of the peri-articular lymphatic system in mouse joints. The blockade of lymphangiogenesis and lymphatic draining function accelerates while stimulation of lymphatic function attenuates the severity of joint tissue lesions in mouse models of RA and OA. More importantly, we noticed the similarity between the dysfunction of lymphatic drainage in arthritic joints and "Bi" theory of Chinese medicine (CM), and demonstrated that several Bi disease-treated herbal drugs directly affect the function of lymphatic endothelial cells. Here we review the advances about the interactions between joint inflammation and changes in the peri-articular lymphatic system and discuss our view of linking "Bi" theory of CM to lymphatic dysfunction in arthritis.
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Affiliation(s)
- Qian-Qian Liang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Qi Shi
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China
| | - Ronald W Wood
- Department of Obstetrics and Gynecology, Urology, and Neurobiology and Anatomy, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Lian-Ping Xing
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, 14642, USA. .,Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, 14642, USA.
| | - Yong-Jun Wang
- Department of Orthopaedics, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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