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Avery CN, Russell ND, Steely CJ, Hersh AO, Bohnsack JF, Prahalad S, Jorde LB. Shared genomic segments analysis identifies MHC class I and class III molecules as genetic risk factors for juvenile idiopathic arthritis. HGG Adv 2024; 5:100277. [PMID: 38369753 PMCID: PMC10918567 DOI: 10.1016/j.xhgg.2024.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a complex rheumatic disease encompassing several clinically defined subtypes of varying severity. The etiology of JIA remains largely unknown, but genome-wide association studies (GWASs) have identified up to 22 genes associated with JIA susceptibility, including a well-established association with HLA-DRB1. Continued investigation of heritable risk factors has been hindered by disease heterogeneity and low disease prevalence. In this study, we utilized shared genomic segments (SGS) analysis on whole-genome sequencing of 40 cases from 12 multi-generational pedigrees significantly enriched for JIA. Subsets of cases are connected by a common ancestor in large extended pedigrees, increasing the power to identify disease-associated loci. SGS analysis identifies genomic segments shared among disease cases that are likely identical by descent and anchored by a disease locus. This approach revealed statistically significant signals for major histocompatibility complex (MHC) class I and class III alleles, particularly HLA-A∗02:01, which was observed at a high frequency among cases. Furthermore, we identified an additional risk locus at 12q23.2-23.3, containing genes primarily expressed by naive B cells, natural killer cells, and monocytes. The recognition of additional risk beyond HLA-DRB1 provides a new perspective on immune cell dynamics in JIA. These findings contribute to our understanding of JIA and may guide future research and therapeutic strategies.
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Affiliation(s)
- Cecile N Avery
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA.
| | - Nicole D Russell
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Cody J Steely
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Aimee O Hersh
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84112, USA
| | - John F Bohnsack
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84112, USA
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Lynn B Jorde
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA.
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Huang Y, Sompii-Montgomery L, Patti J, Pickering A, Yasin S, Do T, Baker E, Gao D, Abdul-Aziz R, Behrens EM, Canna S, Clark M, Co DO, Collins KP, Eberhard B, Friedman M, Graham TB, Hahn T, Hersh AO, Hobday P, Holland MJ, Huggins J, Lu PY, Mannion ML, Manos CK, Neely J, Onel K, Orandi AB, Ramirez A, Reinhardt A, Riskalla M, Santiago L, Stoll ML, Ting T, Grom AA, Towe C, Schulert GS. Disease Course, Treatments, and Outcomes of Children With Systemic Juvenile Idiopathic Arthritis-Associated Lung Disease. Arthritis Care Res (Hoboken) 2024; 76:328-339. [PMID: 37691306 DOI: 10.1002/acr.25234] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/17/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Systemic juvenile idiopathic arthritis-associated lung disease (SJIA-LD) is a life-threatening disease complication. Key questions remain regarding clinical course and optimal treatment approaches. The objectives of the study were to detail management strategies after SJIA-LD detection, characterize overall disease courses, and measure long-term outcomes. METHODS This was a prospective cohort study. Clinical data were abstracted from the electronic medical record, including current clinical status and changes since diagnosis. Serum biomarkers were determined and correlated with presence of LD. RESULTS We enrolled 41 patients with SJIA-LD, 85% with at least one episode of macrophage activation syndrome and 41% with adverse reactions to a biologic. Although 93% of patients were alive at last follow-up (median 2.9 years), 37% progressed to requiring chronic oxygen or other ventilator support, and 65% of patients had abnormal overnight oximetry studies, which changed over time. Eighty-four percent of patients carried the HLA-DRB1*15 haplotype, significantly more than patients without LD. Patients with SJIA-LD also showed markedly elevated serum interleukin-18 (IL-18), variable C-X-C motif chemokine ligand 9 (CXCL9), and significantly elevated matrix metalloproteinase 7. Treatment strategies showed variable use of anti-IL-1/6 biologics and addition of other immunomodulatory treatments and lung-directed therapies. We found a broad range of current clinical status independent of time from diagnosis or continued biologic treatment. Multidomain measures of change showed imaging features were the least likely to improve with time. CONCLUSION Patients with SJIA-LD had highly varied courses, with lower mortality than previously reported but frequent hypoxia and requirement for respiratory support. Treatment strategies were highly varied, highlighting an urgent need for focused clinical trials.
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Affiliation(s)
- Yannan Huang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Jessica Patti
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Shima Yasin
- University of Iowa Carver College of Medicine, Iowa City
| | - Thuy Do
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth Baker
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Denny Gao
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Rabheh Abdul-Aziz
- University at Buffalo, Oishei Children's Hospital, Buffalo, New York
| | - Edward M Behrens
- The Children's Hospital of Philadelphia and Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Scott Canna
- The Children's Hospital of Philadelphia and Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Matthew Clark
- Prisma Health Children's Hospital Upstate and University of South Carolina School of Medicine-Greenville, Greenville
| | | | - Kathleen P Collins
- University of Tennessee Health Science Center College of Medicine, Memphis
| | | | - Monica Friedman
- Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida
| | - Thomas B Graham
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | - Timothy Hahn
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Aimee O Hersh
- University of Utah School of Medicine, Salt Lake City
| | | | | | - Jennifer Huggins
- Cincinnati Children's Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | - Cynthia K Manos
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | | | - Karen Onel
- Hospital for Special Surgery and Weill Cornell Medical Center, New York City, New York
| | | | | | - Adam Reinhardt
- Boys Town National Research Hospital, Boys Town, Nebraska
| | | | - Laisa Santiago
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | - Tracy Ting
- Cincinnati Children's Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexei A Grom
- Cincinnati Children's Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christopher Towe
- Cincinnati Children's Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
| | - Grant S Schulert
- Cincinnati Children's Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
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Kohli AT, Hersh AO, Ponder L, Chan LHK, Rouster-Stevens KA, Tebo AE, Kugathasan S, Guthery SL, Bohnsack JF, Prahalad S. Prevalence of tissue transglutaminase antibodies and IgA deficiency are not increased in juvenile idiopathic arthritis: a case-control study. Pediatr Rheumatol Online J 2023; 21:110. [PMID: 37798643 PMCID: PMC10557180 DOI: 10.1186/s12969-023-00890-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The prevalence of Celiac Disease (CD) in Juvenile Idiopathic Arthritis (JIA) has been reported to be 0.1-7% in various small studies. As a result of the limited number of research and their inconclusive results there are no clear recommendations for routine CD screening in asymptomatic patients with JIA. Our aim is to estimate the prevalence of IgA deficiency and tissue transglutaminase (tTG) IgA in a cohort of JIA followed in two large academic medical centers. METHODS Serum was collected and stored from all subjects and analyzed in a reference laboratory for total IgA (Quantitative Nephelometry) and tTG IgA antibody levels (Semi-Quantitative Enzyme-Linked Immunosorbent Assay). Fisher's exact tests were performed for statistical significance. Risk estimates (odds ratios) with 95% confidence intervals were calculated. RESULTS 808 JIA cases and 140 controls were analyzed. Majority were non-Hispanic whites (72% vs. 68% p = 0.309). A total of 1.2% of cases were IgA deficient compared to none of the controls (p = 0.373). After excluding IgA deficient subjects, 2% of cases had tTG IgA ≥ 4u/mL compared to 3.6% of controls (p = 0.216) (OR = 0.5; 95% C.I = 0.1-1.4); and 0.8% of cases had tTG IgA > 10u/mL compared to 1.4% of controls (p = 0.627) (OR = 0.5; 95%C.I = 0.1-2.9). CONCLUSIONS Using the largest JIA cohort to date to investigate prevalence of celiac antibodies, the prevalence of positive tTG IgA was 0.8% and of IgA deficiency was 1.2%. The results did not demonstrate a higher prevalence of abnormal tTG IgA in JIA. The study did not support the routine screening of asymptomatic JIA patients for CD.
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Affiliation(s)
- Angela Taneja Kohli
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Aimee O Hersh
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lori Ponder
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lai Hin Kimi Chan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelly A Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Anne E Tebo
- University of Utah, Salt Lake City, UT, USA
- ARUP Laboratories, Salt Lake City, USA
| | - Subra Kugathasan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Stephen L Guthery
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - John F Bohnsack
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Cannon LA, Wenderfer SE, Lewandowski LB, Cooper JC, Goilav B, Knight AM, Hersh AO, Ardoin SP, Sadun RE. Use of EuroLupus Cyclophosphamide Dosing for the Treatment of Lupus Nephritis in Childhood-onset Systemic Lupus Erythematosus in North America. J Rheumatol 2022; 49:607-614. [PMID: 35169053 PMCID: PMC10464387 DOI: 10.3899/jrheum.210428] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Childhood-onset systemic lupus erythematosus (cSLE) has higher rates of lupus nephritis (LN) than adult-onset SLE, often requiring intensive immunosuppression. This study examined North American practices and preferences for the low-dose EuroLupus cyclophosphamide (CYC) protocol, as compared to the high-dose National Institutes of Health (NIH) CYC protocol, to treat LN in cSLE. METHODS A 35-item Web-based survey was distributed to Childhood Arthritis and Rheumatology Research Alliance (CARRA) and Pediatric Nephrology Research Consortium (PNRC) providers. The survey assessed participant demographics, CYC prescribing practices, perceptions of EuroLupus protocol, and LN vignette treatment decisions; 1 vignette was taken from a 2009 CARRA survey and responses were compared. Multivariable logistic regression analyzed provider factors associated with use of low- vs high-dose CYC. RESULTS Responses were provided by 185/421 (44%) pediatric rheumatologists (CARRA) and 40/354 (11%) pediatric nephrologists (PNRC). Among respondents who prescribed CYC for pediatric LN over the past year (n = 135), half reported using EuroLupus. When presented with the same vignette about an adolescent with class IV LN, 32% of pediatric rheumatologists chose EuroLupus dosing in 2020, vs 6% in 2009. Provider factors associated with choosing the low-dose regimen were familiarity with the protocol (OR 4.2, P = 0.006) and greater perceived benefit (OR 1.6, P < 0.0001). Pediatric nephrologists had similar responses to the pediatric rheumatology providers. Overall, 78% of respondents perceived EuroLupus protocol efficacy to be equivalent to the high-dose protocol in cSLE LN. CONCLUSION Pediatric specialists are currently more likely to use low-dose CYC to treat cSLE LN than they were a decade ago. Nevertheless, familiarity with EuroLupus dosing remains low.
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Affiliation(s)
- Laura A Cannon
- L.A. Cannon, MD, Division of Pediatric Rheumatology, Department of Pediatrics, Duke University, Durham, and Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
| | - Scott E Wenderfer
- S.E. Wenderfer, MD, Department of Pediatrics, Baylor College of Medicine; Renal Section, Texas Children's Hospital, Houston, Texas, USA
| | - Laura B Lewandowski
- L.B. Lewandowski, MD, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer C Cooper
- J.C. Cooper, MD, Division of Pediatric Rheumatology, Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Beatrice Goilav
- B. Goilav, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea M Knight
- A.M. Knight, MD, Division of Pediatric Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aimee O Hersh
- A.O. Hersh, MD, Division of Pediatric Rheumatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Stacy P Ardoin
- S.P. Ardoin, MD, Division of Pediatric Rheumatology, Department of Pediatrics, and Division of Rheumatology, Department of Medicine, The Ohio State University, Columbus, Ohio, USA
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Melega S, Brogan P, Cleary G, Hersh AO, Kasapcopur O, Rangaraj S, Yeung RSM, Zeft A, Cooper J, Pordeli P, Kirchner P, Lehane PB. Evaluation of Serious Infection in Pediatric Patients with Low Immunoglobulin Levels Receiving Rituximab for Granulomatosis with Polyangiitis or Microscopic Polyangiitis. Rheumatol Ther 2022; 9:721-734. [PMID: 35279811 PMCID: PMC8964878 DOI: 10.1007/s40744-022-00433-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/10/2022] [Indexed: 10/28/2022] Open
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Wright MA, Trandafir CC, Nelson GR, Hersh AO, Inman CJ, Zielinski BA. Diagnosis and Management of Suspected Pediatric Autoimmune Encephalitis: A Comprehensive, Multidisciplinary Approach and Review of Literature. J Child Neurol 2022; 37:303-313. [PMID: 34927485 DOI: 10.1177/08830738211064673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Autoimmune encephalitis is an increasingly recognized entity in children. When treated promptly, favorable outcomes are seen in a majority of pediatric patients. However, recognition of autoimmune encephalitis in young patients is challenging. Once autoimmune encephalitis is suspected, additional difficulties exist regarding timing of treatment initiation and duration of treatment, as evidence to guide management of these patients is emerging. Here, we review available literature regarding pediatric autoimmune encephalitis and present our institution's comprehensive approach to the evaluation and management of the disease. These guidelines were developed through an iterative process involving both pediatric neurologists and rheumatologists.
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Affiliation(s)
- Melissa A Wright
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - Cristina C Trandafir
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA.,Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, 3989Baylor College of Medicine, Houston, TX, USA
| | - Gary R Nelson
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - Aimee O Hersh
- Division of Pediatric Rheumatology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - C J Inman
- Division of Pediatric Rheumatology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA
| | - Brandon A Zielinski
- Division of Pediatric Neurology, Department of Pediatrics, 14434University of Utah, Salt Lake City, UT, USA.,Department of Neurology, 14434University of Utah, Salt Lake City, UT, USA
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Vazzana KM, Daga A, Goilav B, Ogbu EA, Okamura DM, Park C, Sadun RE, Smitherman EA, Stotter BR, Dasgupta A, Knight AM, Hersh AO, Wenderfer SE, Lewandowski LB. Principles of pediatric lupus nephritis in a prospective contemporary multi-center cohort. Lupus 2021; 30:1660-1670. [PMID: 34219529 PMCID: PMC10461610 DOI: 10.1177/09612033211028658] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lupus nephritis (LN) is a life-threatening manifestation of systemic lupus erythematosus (SLE) and is more common in children than adults. The epidemiology and management of childhood-onset SLE (cSLE) have changed over time, prompting the need to reassess expected outcomes. The purpose of this study is to use the Childhood Arthritis and Rheumatology Research Alliance (CARRA) prospective registry to validate historical principles of LN in a contemporary, real-world cohort. After an extensive literature review, six principles of LN in cSLE were identified. The CARRA registry was queried to evaluate these principles in determining the rate of LN in cSLE, median time from cSLE diagnosis to LN, short-term renal outcomes, and frequency of rituximab as an induction therapy. Of the 677 cSLE patients in the CARRA registry, 32% had documented LN. Decline in kidney function was more common in Black cSLE patients than non-Black patients (p = 0.04). Black race was associated with worse short-term renal outcomes. In short-term follow up, most children with LN had unchanged or improved kidney function, and end stage kidney disease (ESKD) was rare. Ongoing follow-up of cSLE patients in the CARRA registry will be necessary to evaluate long-term outcomes to inform risk, management, and prognosis of LN in cSLE.
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Affiliation(s)
- Kathleen M Vazzana
- Lupus Genomics and Global Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ankana Daga
- Division of Nephrology, Boston Children's Hospital, Boston, MA, USA
| | - Beatrice Goilav
- Division of Nephrology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ekemini A Ogbu
- Department of Pediatrics, 1466Johns Hopkins University, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Daryl M Okamura
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Catherine Park
- Division of Nephrology, Children's National Hospital, Washington, DC, USA
| | | | - Emily A Smitherman
- Division of Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian R Stotter
- Division of Pediatric Nephrology, Hypertension & Pheresis, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Andrea M Knight
- Division of Pediatric Rheumatology, 7979Hospital for Sick Children, Hospital for Sick Children, Toronto, Canada
| | - Aimee O Hersh
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Scott E Wenderfer
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Laura B Lewandowski
- Lupus Genomics and Global Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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9
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Brogan P, Yeung RSM, Cleary G, Rangaraj S, Kasapcopur O, Hersh AO, Li S, Paripovic D, Schikler K, Zeft A, Bracaglia C, Eleftheriou D, Pordeli P, Melega S, Jamois C, Gaudreault J, Michalska M, Brunetta P, Cooper JC, Lehane PB. Phase IIa Global Study Evaluating Rituximab for the Treatment of Pediatric Patients With Granulomatosis With Polyangiitis or Microscopic Polyangiitis. Arthritis Rheumatol 2021; 74:124-133. [PMID: 34164952 PMCID: PMC9299798 DOI: 10.1002/art.41901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 05/17/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
Objective To assess the safety, tolerability, pharmacokinetics, and efficacy of rituximab (RTX) in pediatric patients with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA). Methods The Pediatric Polyangiitis Rituximab Study was a phase IIa, international, open‐label, single‐arm study. During the initial 6‐month remission‐induction phase, patients received intravenous infusions of RTX (375 mg/m2 body surface area) and glucocorticoids once per week for 4 weeks. During the follow‐up period, patients could receive further treatment, including RTX, for GPA or MPA. The safety, pharmacokinetics, pharmacodynamics, and exploratory efficacy outcomes with RTX were evaluated. Results Twenty‐five pediatric patients with new‐onset or relapsing disease were enrolled at 11 centers (19 with GPA [76%] and 6 with MPA [24%]). The median age was 14 years (range 6–17 years). All patients completed the remission‐induction phase. During the overall study period (≤4.5 years), patients received between 4 and 28 infusions of RTX. All patients experienced ≥1 adverse event (AE), mostly grade 1 or grade 2 primarily infusion‐related reactions. Seven patients experienced 10 serious AEs, and 17 patients experienced 31 infection‐related AEs. No deaths were reported. RTX clearance correlated with body surface area. The body surface area–adjusted RTX dosing regimen resulted in similar exposure in both pediatric and adult patients with GPA or MPA. Remission, according to the Pediatric Vasculitis Activity Score, was achieved in 56%, 92%, and 100% of patients by months 6, 12, and 18, respectively. Conclusion In pediatric patients with GPA or MPA, RTX is well tolerated and effective, with an overall safety profile comparable to that observed in adult patients with GPA or MPA who receive treatment with RTX. RTX is associated with a positive risk/benefit profile in pediatric patients with active GPA or MPA.
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Affiliation(s)
- Paul Brogan
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Rae S M Yeung
- Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | | | - Ozgur Kasapcopur
- Istabul University - Cerrahpasa, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Aimee O Hersh
- University of Utah Primary Children's Hospital, Salt Lake City, UT, USA
| | - Suzanne Li
- Hackensack Meridian School of Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
| | | | | | - Andrew Zeft
- The Cleveland Clinic, Center for Pediatric Rheumatology & Immunology, Cleveland, OH, USA
| | | | - Despina Eleftheriou
- UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | | | - Jennifer C Cooper
- Children's Hospital Colorado and University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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10
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Johnson KR, Edens C, Sadun RE, Chira P, Hersh AO, Goh YI, Hui-Yuen J, Singer NG, Spiegel LR, Stinson JN, White PH, Lawson E. Differences in Healthcare Transition Views, Practices, and Barriers Among North American Pediatric Rheumatology Clinicians From 2010 to 2018. J Rheumatol 2021; 48:1442-1449. [PMID: 33526621 DOI: 10.3899/jrheum.200196] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Since 2010, the rheumatology community has developed guidelines and tools to improve healthcare transition. In this study, we aimed to compare current transition practices and beliefs among Childhood Arthritis and Rheumatology Research Alliance (CARRA) rheumatology providers with transition practices from a provider survey published in 2010. METHODS In 2018, CARRA members completed a 25-item online survey about healthcare transition. Got Transition's Current Assessment of Health Care Transition Activities was used to measure clinical transition processes on a scale of 1 (basic) to 4 (comprehensive). Bivariate analyses were used to compare 2010 and 2018 survey findings. RESULTS Over half of CARRA members completed the survey (202/396), including pediatric rheumatologists, adult- and pediatric-trained rheumatologists, pediatric rheumatology fellows, and advanced practice providers. The most common target age to begin transition planning was 15-17 years (49%). Most providers transferred patients prior to age 21 years (75%). Few providers used the American College of Rheumatology transition tools (31%) or have a dedicated transition clinic (23%). Only 17% had a transition policy in place, and 63% did not consistently address healthcare transition with patients. When compared to the 2010 survey, improvement was noted in 3 of 12 transition barriers: availability of adult primary care providers, availability of adult rheumatologists, and pediatric staff transition knowledge and skills (P < 0.001 for each). Nevertheless, the mean current assessment score was < 2 for each measurement. CONCLUSION This study demonstrates improvement in certain transition barriers and practices since 2010, although implementation of structured transition processes remains inconsistent.
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Affiliation(s)
- Kiana R Johnson
- K.R. Johnson, PhD, MSEd, MPH, Department of Pediatrics, East Tennessee State University, Johnson City, Tennessee;
| | - Cuoghi Edens
- C. Edens, MD, Departments of Medicine and Pediatrics, Sections of Rheumatology and Pediatric Rheumatology, University of Chicago, Chicago, Illinois
| | - Rebecca E Sadun
- R.E. Sadun, MD, PhD, Departments of Medicine and Pediatrics, Divisions of Rheumatology, Duke University Medical Center, Durham, North Carolina
| | - Peter Chira
- P. Chira, MD, Pediatric Rheumatology, University of California San Diego, Rady Children's Hospital, San Diego, California
| | - Aimee O Hersh
- A.O. Hersh, MD, Division of Pediatric Rheumatology, University of Utah, Salt Lake City, Utah
| | - Y Ingrid Goh
- Y.I. Goh, BS, Division of Rheumatology/Pediatrics, The Hospital for Sick Children, and Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Joyce Hui-Yuen
- J. Hui-Yuen, MD, MSc, FACR, FAAP, Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, New York
| | - Nora G Singer
- N.G. Singer MD, Departments of Medicine and Pediatrics, Division of Rheumatology, Metrohealth System and Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Lynn R Spiegel
- L.R. Spiegel, MD, FRCPC, Division of Pediatrics/Rheumatology, University of Utah, Salt Lake City, Utah, USA, and Division of Rheumatology/Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer N Stinson
- J.N. Stinson, RN-EC, PhD, CPNP, Division of Rheumatology/Pediatrics, The Hospital for Sick Children, and Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patience H White
- P.H. White, MD, MA, FACP, FAAP, Got Transition, and Department of Medicine, Division of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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11
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Feldman CH, Speyer C, Ashby R, L Bermas B, Bhattacharyya S, Chakravarty E, Everett B, Ferucci E, Hersh AO, Marty FM, Merola JF, Ramsey-Goldman R, Rovin BH, Son MB, Tarter L, Waikar S, Yazdany J, Weissman JS, Costenbader KH. Development of a Set of Lupus-Specific, Ambulatory Care-Sensitive, Potentially Preventable Adverse Conditions: A Delphi Consensus Study. Arthritis Care Res (Hoboken) 2021; 73:146-157. [PMID: 31628721 DOI: 10.1002/acr.24095] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 10/15/2019] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Individuals with systemic lupus erythematosus (SLE) are at high risk for infections and SLE- and medication-related complications. The present study was undertaken to define a set of SLE-specific adverse outcomes that could be prevented, or their complications minimized, if timely, effective ambulatory care had been received. METHODS We used a modified Delphi process beginning with a literature review and key informant interviews to select initial SLE-specific potentially preventable conditions. We assembled a panel of 16 nationally recognized US-based experts from 8 subspecialties. Guided by the RAND-UCLA Appropriateness Method, we held 2 survey rounds with controlled feedback and an interactive webinar to reach consensus regarding preventability and importance on a population level for a set of SLE-specific adverse conditions. In a final round, the panelists endorsed the potentially preventable conditions. RESULTS Thirty-five potential conditions were initially proposed; 62 conditions were ultimately considered during the Delphi process. The response rate was 100% for both survey rounds, 88% for the webinar, and 94% for final approval. The 25 SLE-specific conditions meeting consensus as potentially preventable and important on a population level fell into 4 categories: vaccine-preventable illnesses (6 conditions), medication-related complications (8 conditions), reproductive health-related complications (6 conditions), and SLE-related complications (5 conditions). CONCLUSION We reached consensus on a diverse set of adverse outcomes relevant to SLE patients that may be preventable if patients receive high-quality ambulatory care. This set of outcomes may be studied at the health system level to determine how to best allocate resources and improve quality to reduce avoidable outcomes and disparities among those at highest risk.
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Affiliation(s)
- Candace H Feldman
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Cameron Speyer
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Rachel Ashby
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Brendan Everett
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Francisco M Marty
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Joseph F Merola
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Brad H Rovin
- Ohio State University Wexner Medical Center, Columbus
| | - Mary Beth Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Laura Tarter
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sushrut Waikar
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | - Karen H Costenbader
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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12
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Treemarcki EB, Hersh AO. Health-Related Quality of Life Measures in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:593-607. [PMID: 33091261 DOI: 10.1002/acr.24374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Aimee O Hersh
- University of Utah and Primary Children's Hospital, Salt Lake City
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13
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Haro SL, Lawson EF, Hersh AO. Disease activity and health-care utilization among young adults with childhood-onset lupus transitioning to adult care: data from the Pediatric Lupus Outcomes Study. Lupus 2020; 29:1206-1215. [DOI: 10.1177/0961203320938868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Individuals with childhood-onset systemic lupus erythematosus (cSLE) must transfer from pediatric to adult care. The goal of this study was to examine disease activity and health-care utilization among young adults with cSLE who are undergoing or have recently completed the transfer to adult care. Methods The Pediatric Lupus Outcomes Study (PLOS) is a prospective longitudinal cohort study of young adults aged 18–30 diagnosed with cSLE. We conducted a cross-sectional analysis comparing 47 participants under the care of pediatric rheumatologists to 38 who had completed transfer to adult care. Demographics, disease manifestations, health- care utilization and transition readiness were compared between groups. Results Those in the post-transfer group had significantly lower medication usage and were less likely to have seen a rheumatologist in the past year. Disease manifestations, flare rates, and hospitalizations were similar between groups. Nearly a quarter of patients who had transferred to adult care reported difficulties with the process. Conclusion Post-transfer patients had lower health-care utilization as evidenced by less medication usage and lack of rheumatology follow-up, in spite of the fact that disease activity was similar in both groups. Future studies will assess longitudinal changes in disease activity and damage in this population.
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Affiliation(s)
- Sara L Haro
- Division of Pediatric Rheumatology, University of California, San Francisco, USA
| | - Erica F Lawson
- Division of Pediatric Rheumatology, University of California, San Francisco, USA
| | - Aimee O Hersh
- Division of Pediatric Rheumatology, University of Utah, Salt Lake City, USA
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14
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Ardoin SP, Daly RP, Merzoug L, Tse K, Ardalan K, Arkin L, Knight A, Rubinstein T, Ruth N, Wenderfer SE, Hersh AO. Research priorities in childhood-onset lupus: results of a multidisciplinary prioritization exercise. Pediatr Rheumatol Online J 2019; 17:32. [PMID: 31262324 PMCID: PMC6600895 DOI: 10.1186/s12969-019-0327-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/07/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Childhood-onset systemic erythematosus lupus (cSLE) is characterized by more severe disease, widespread organ involvement and higher mortality compared to adult-onset SLE. However, cSLE is largely underfunded to carry out necessary research to advance the field. Few commonly used SLE medications have been studied in children, and important knowledge gaps exist concerning epidemiology, genetics, pathophysiology and optimal treatments for cSLE. METHODS In order to assess highest cSLE research priority areas, the Lupus Foundation of America (LFA) and Childhood Arthritis and Rheumatology Research Alliance (CARRA) administered a cSLE research prioritization survey to pediatric rheumatologists, dermatologists and nephrologists with expertise in lupus. Members of LFA and CARRA's SLE Committee identified a list of cSLE research domains and developed a 17-item tiered, web-based survey asking respondents to categorize the research domains into high, medium, or low priority areas. For domains identified as high priority, respondents ranked research topics within that category. For example, for the domain of nephritis, respondents ranked importance of: epidemiology, biomarkers, long-term outcomes, quality improvement, etc. The survey was distributed to members of CARRA, Midwestern Pediatric Nephrology Consortium (MWPNC) and Pediatric Dermatology Research Alliance (PeDRA) Connective Tissue Disease group. RESULTS The overall response rate was 256/752 (34%). The highest prioritized research domains were: nephritis, clinical trials, biomarkers, neuropsychiatric disease and refractory skin disease. Notably, nephritis, clinical trials and biomarkers were ranked in the top five by all groups. Within each research domain, all groups showed agreement in identifying the following as important focus areas: determining best treatments, biomarkers/pathophysiology, drug discovery/novel treatments, understanding long term outcomes, and refining provider reported quality measures. CONCLUSION This survey identified the highest cSLE research priorities among leading rheumatology, dermatology and nephrology clinicians and investigators engaged in care of children with lupus. There is a strong need for multidisciplinary collaboration moving forward, which was indicated as highly important among stakeholders involved in the survey. These survey results should be used as a roadmap to guide funding and specific research programs in cSLE to address urgent, unmet needs among this population.
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Affiliation(s)
- Stacy P. Ardoin
- 0000 0004 0392 3476grid.240344.5Division of Pediatric Rheumatology, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205 USA
| | - R Paola Daly
- 0000 0004 0616 4647grid.429277.dLupus Foundation of America, Washington, DC USA
| | - Lyna Merzoug
- 0000 0004 0616 4647grid.429277.dLupus Foundation of America, Washington, DC USA
| | - Karin Tse
- 0000 0004 0616 4647grid.429277.dLupus Foundation of America, Washington, DC USA
| | - Kaveh Ardalan
- 0000 0004 0388 2248grid.413808.6Ann & Robert H. Lurie Children’s Hospital, Chicago, IL USA
| | - Lisa Arkin
- 0000 0001 0701 8607grid.28803.31University of Wisconsin, Madison, WI USA
| | | | - Tamar Rubinstein
- 0000 0004 0566 7955grid.414114.5Children’s Hospital at Montefiore, Bronx, NY USA
| | - Natasha Ruth
- 0000 0001 2189 3475grid.259828.cMedical University of South Carolina, Charleston, SC USA
| | - Scott E. Wenderfer
- 0000 0001 2200 2638grid.416975.8Texas Children’s Hospital, Houston, TX USA
| | - Aimee O. Hersh
- 0000 0001 2193 0096grid.223827.eUniversity of Utah, Salt Lake City, UT USA
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15
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Knight A, Vickery M, Faust L, Muscal E, Davis A, Harris J, Hersh AO, Rodriguez M, Onel K, Rubinstein T, Washington N, Weitzman ER, Conlon H, Woo JMP, Gerstbacher D, von Scheven E. Gaps in Mental Health Care for Youth With Rheumatologic Conditions: A Mixed Methods Study of Perspectives From Behavioral Health Providers. Arthritis Care Res (Hoboken) 2019; 71:591-601. [PMID: 29953741 DOI: 10.1002/acr.23683] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 06/26/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To identify behavioral health provider perspectives on gaps in mental health care for youth with rheumatologic conditions. METHODS Social workers (n = 34) and psychologists (n = 8) at pediatric rheumatology centers in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) completed an online survey assessing current practices and mental health care needs of youth with rheumatologic conditions. Responses were compared to a published survey of CARRA rheumatologists (n = 119). Thematic analysis of 20 semi-structured interviews with behavioral health providers was performed. RESULTS One-third of CARRA centers (n = 100) had no affiliated social worker or psychologist. Only 1 behavioral health provider reported current universal mental health screening at their rheumatology clinic, yet routine depression screening was supported by >85% of behavioral health providers and rheumatologists. Support for anxiety screening was higher among behavioral health providers (90% versus 65%; P < 0.01). Interviews illustrated a need for interventions addressing illness-related anxiety, adjustment/coping/distress, transition, parent/caregiver mental health, and peer support. Limited resources, lack of protocols, and patient cost/time burden were the most frequent barriers to intervention. Inadequate follow-up of mental health referrals was indicated by 52% of providers. More behavioral health providers than rheumatologists favored mental health services in rheumatology settings (55% versus 19%; P < 0.01). Only 7 social workers (21%) provided counseling/therapy, and interviews indicated their perceived underutilization of these services. CONCLUSION Behavioral health providers indicated an unmet need for mental health interventions that address illness-related issues affecting youth with rheumatologic conditions. Implementation of mental health protocols and optimizing utilization of social workers may improve mental health care for these youth.
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Affiliation(s)
- Andrea Knight
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Lauren Faust
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Eyal Muscal
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Alaina Davis
- Monroe Carell Junior Children's Hospital, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Julia Harris
- Children's Mercy Kansas City, University of Missouri, Kansas City
| | | | - Martha Rodriguez
- Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana
| | - Karen Onel
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Tamar Rubinstein
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Nina Washington
- Mississippi Center for Advanced Medicine, Madison, Mississippi
| | - Elissa R Weitzman
- Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts
| | - Hana Conlon
- Columbia University Medical Center, New York, New York
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16
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Heshin-Bekenstein M, Perl L, Hersh AO, von Scheven E, Yelin E, Trupin L, Yazdany J, Lawson EF. Final adult height of patients with childhood-onset systemic lupus erythematosus: a cross sectional analysis. Pediatr Rheumatol Online J 2018; 16:30. [PMID: 29688869 PMCID: PMC5913867 DOI: 10.1186/s12969-018-0239-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/27/2018] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND To compare final height to mid-parental target height among adults with childhood-onset systemic lupus erythematosus (cSLE) versus adult-onset SLE (aSLE), and to evaluate the impact of age at SLE onset on final height. METHODS Data derived from the Lupus Outcomes Study, a longitudinal cohort of adults with SLE, was used for this cross-sectional analysis (N = 728). Participants aged 18-63 years with complete height data were included (N = 566) and were classified as cSLE if age at diagnosis was < 18 years (N = 72). The Tanner formula was used to calculate mid-parental target height. Multivariate linear regression was used to determine mean difference between final height and target height. Multivariate logistic regression was used to compare odds of substantially reduced final height, defined as > 2 SD below target height. Separate analyses were conducted for females and males to account for differences in timing of the pubertal growth spurt for each sex. RESULTS Participants with cSLE were, on average, 2.4 cm shorter than their target height (95% CI -4, - 0.7). The adjusted odds ratio (OR) for substantially reduced final height was 3.9 (95% CI + 2.0, + 7.2, p < 0.001) as compared to participants with aSLE. Females diagnosed between 11 and 13 years were at greatest risk for substantially reduced final height, with adjusted OR of 11.2 (95% CI + 3.4, + 36.3) as compared to participants with aSLE (p < 0.001). CONCLUSIONS cSLE is associated with shorter-than-expected final height. Onset of SLE in the pubertal period, near the time of maximum linear growth, may have a particularly significant impact on final height.
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Affiliation(s)
- Merav Heshin-Bekenstein
- Division of Pediatric Rheumatology, University of California San Francisco, Benioff Children's Hospital, 550 16th Street, 5th Floor, San Francisco, CA, 94143-0632, USA.
| | - Liat Perl
- 0000 0001 2297 6811grid.266102.1Division of Pediatric Endocrinology, University of California San Francisco, San Francisco, CA USA
| | - Aimee O. Hersh
- 0000 0001 2193 0096grid.223827.eDivision of Pediatric Rheumatology, University of Utah, Salt Lake City, UT USA
| | - Emily von Scheven
- 0000 0001 2297 6811grid.266102.1Division of Pediatric Rheumatology, University of California San Francisco, Benioff Children’s Hospital, 550 16th Street, 5th Floor, San Francisco, CA 94143-0632 USA
| | - Ed Yelin
- 0000 0001 2297 6811grid.266102.1Division of Rheumatology, University of California San Francisco, San Francisco, CA USA ,0000 0001 2297 6811grid.266102.1Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA USA
| | - Laura Trupin
- 0000 0001 2297 6811grid.266102.1Division of Rheumatology, University of California San Francisco, San Francisco, CA USA
| | - Jinoos Yazdany
- 0000 0001 2297 6811grid.266102.1Division of Rheumatology, University of California San Francisco, San Francisco, CA USA
| | - Erica F. Lawson
- 0000 0001 2297 6811grid.266102.1Division of Pediatric Rheumatology, University of California San Francisco, Benioff Children’s Hospital, 550 16th Street, 5th Floor, San Francisco, CA 94143-0632 USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Objective Few descriptions of physical disability in childhood-onset SLE (cSLE) exist. We sought to describe disability in a large North American cohort of patients with cSLE and identify predictors of disability. Methods Sociodemographic and clinical data were obtained from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry for patients with cSLE enrolled between May 2010 and October 2014. The Childhood Health Assessment Questionnaire (CHAQ) was used to assess disability and physical functioning. Chi-square tests were used for univariate analyses, and multivariate logistic regression was used to assess predictors of disability. Results We analyzed data for 939 patients with cSLE. The median and mean CHAQ scores were 0 and 0.25, respectively, and 41% of the cohort had at least mild disability. Arthritis and higher pain scores were significantly associated with disability as compared to those without disability ( p < 0.001). In multivariate logistic regression analysis, low annual income, arthritis, and higher pain scores were associated with disability at baseline. Conclusions Disability as measured by baseline CHAQ was fairly common in cSLE patients in the CARRA Legacy Registry, and was associated with low household income, arthritis, and higher pain scores. In addition to optimal disease control, ensuring psychosocial supports and addressing pain may reduce disability in cSLE. Further study is needed of disability in cSLE.
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Affiliation(s)
- A O Hersh
- 1 Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - S M Case
- 2 Department of Pediatrics, Boston Children's Hospital, Boston, MA, USA
| | - M B Son
- 3 Division of Immunology, Boston Children's Hospital, Boston, MA, USA
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Morishita KA, Moorthy LN, Lubieniecka JM, Twilt M, Yeung RSM, Toth MB, Shenoi S, Ristic G, Nielsen SM, Luqmani RA, Li SC, Lee T, Lawson EF, Kostik MM, Klein-Gitelman M, Huber AM, Hersh AO, Foell D, Elder ME, Eberhard BA, Dancey P, Charuvanij S, Benseler SM, Cabral DA. Early Outcomes in Children With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Arthritis Rheumatol 2017; 69:1470-1479. [DOI: 10.1002/art.40112] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/23/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Kimberly A. Morishita
- Kimberly A. Morishita, MD, MHSc, David A. Cabral, MBBS: British Columbia Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | | | | | - Marinka Twilt
- Marinka Twilt, MD, PhD, Susanne M. Benseler, MD, PhD: Alberta Children's Hospital; University of Calgary; Calgary Alberta Canada
| | - Rae S. M. Yeung
- Rae S. M. Yeung, MD, PhD: The Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | | | | | - Goran Ristic
- Mother and Child Health Care Institute of Serbia; Belgrade Serbia
| | | | | | - Suzanne C. Li
- Joseph M. Sanzari Children's Hospital; Hackensack New Jersey
| | - Tzielan Lee
- Tzielan Lee, MD: Stanford Children's Health; Stanford University School of Medicine; Stanford California
| | | | - Mikhail M. Kostik
- Saint-Petersburg State Pediatric Medical University; Saint Petersburg Russia
| | | | - Adam M. Huber
- IWK Health Centre and Dalhousie University; Halifax Nova Scotia Canada
| | | | - Dirk Foell
- University Children's Hospital; Muenster Germany
| | | | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre; St. John's Newfoundland Canada
| | - Sirirat Charuvanij
- Sirirat Charuvanij, MD: Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Susanne M. Benseler
- Marinka Twilt, MD, PhD, Susanne M. Benseler, MD, PhD: Alberta Children's Hospital; University of Calgary; Calgary Alberta Canada
| | - David A. Cabral
- Kimberly A. Morishita, MD, MHSc, David A. Cabral, MBBS: British Columbia Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
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20
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Day RW, Clement PW, Hersh AO, Connors SM, Sumner KL, Best DH, Alashari M. Pulmonary veno-occlusive disease: Two children with gradual disease progression. Respir Med Case Rep 2017; 20:82-86. [PMID: 28070482 PMCID: PMC5219617 DOI: 10.1016/j.rmcr.2016.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 12/27/2016] [Accepted: 12/27/2016] [Indexed: 11/26/2022] Open
Abstract
Pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis are rare forms of pulmonary vascular disease. We report two cases of affected children who had evidence of pulmonary hypertension 3–5 years before developing radiographic findings of pulmonary veno-occlusive disease or pulmonary capillary hemangiomatosis. Both patients experienced a moderate decrease in pulmonary arterial pressure during acute vasodilator testing. Both patients experienced an improvement in six-minute walk performance without an increase in pulmonary edema when treated with targeted therapy for pulmonary hypertension. In some patients, pulmonary veno-occlusive disease and pulmonary capillary hemangiomatosis may progress slowly over a period of months to years. A favorable acute vasodilator response may identify patients who will tolerate, and demonstrate transient clinical improvement with, medical therapy.
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Affiliation(s)
- Ronald W Day
- University of Utah Department of Pediatrics, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Parker W Clement
- University of Utah Department of Pathology, 15 North Medical Drive, Suite 1100, Salt Lake City, UT 84132, USA
| | - Aimee O Hersh
- University of Utah Department of Pediatrics, 81 North Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Susan M Connors
- Vascular Biology Program of Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kelli L Sumner
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT 84108, USA
| | - D Hunter Best
- ARUP Institute for Clinical and Experimental Pathology, 500 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Mouied Alashari
- University of Utah Department of Pathology, 15 North Medical Drive, Suite 1100, Salt Lake City, UT 84132, USA
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Abstract
PURPOSE To describe the treatment and outcomes of a cohort of pediatric intermediate uveitis (IU) patients, with a particular focus on the use of immunomodulatory therapy (IMT). METHODS The disease course, treatment, and outcomes of 39 pediatric IU patients treated in the Uveitis Clinic at the University of Utah from 1999 to 2012 were reviewed, retrospectively. RESULTS Mean age at presentation was 7.7 years (SD 3.1). In total, 95% had bilateral involvement. Out of 77 total eyes involved, the most frequent disease complications were ocular hypertension (0.71 events per person year, PPY), cataracts (events PPY = 0.39), and cystoid macular edema (events PPY = 0.33). A total of 20 patients received IMT; 19/20 were tapered off systemic corticosteroids without a uveitis recurrence; 75% of eyes had inactive disease at final follow-up (mean 37 months). CONCLUSIONS The use of IMT, including biologic therapies, may effectively manage disease inflammation and reduce steroid dosages in pediatric IU patients.
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Affiliation(s)
- Aimee O Hersh
- a Division of Rheumatology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Spencer Cope
- b University of Texas San Antonio, Center for Health Sciences , San Antonio , Texas , USA
| | - John F Bohnsack
- a Division of Rheumatology, Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Akbar Shakoor
- c Department of Ophthalmology , John A. Moran Eye Center, University of Utah School of Medicine , Salt Lake City , Utah , USA
| | - Albert T Vitale
- c Department of Ophthalmology , John A. Moran Eye Center, University of Utah School of Medicine , Salt Lake City , Utah , USA
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Hersh AO, Alarcón GS, Bonetto C, Pernus YB, Kucuku M, Santuccio C, Živković S, Bonhoeffer J. Systemic Lupus Erythematosus: Case definition and guidelines for data collection, analysis, and presentation of immunization safety data. Vaccine 2016; 34:6572-6581. [DOI: 10.1016/j.vaccine.2016.09.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 02/01/2023]
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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24
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Lange L, Thiele GM, McCracken C, Wang G, Ponder LA, Angeles-Han ST, Rouster-Stevens KA, Hersh AO, Vogler LB, Bohnsack JF, Abramowicz S, Mikuls TR, Prahalad S. Symptoms of periodontitis and antibody responses to Porphyromonas gingivalis in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2016; 14:8. [PMID: 26861944 PMCID: PMC4748489 DOI: 10.1186/s12969-016-0068-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/01/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The association between rheumatoid arthritis (RA) and periodontitis is well established. Some children with juvenile idiopathic arthritis (JIA) phenotypically resemble adults with RA, characterized by the presence of anti-cyclic citrullinated peptide (CCP) antibodies. We sought to investigate an association between CCP-positive JIA and symptoms of periodontitis and antibodies to oral microbiota. METHODS Antibodies to oral pathogens Porphyromonas gingivalis, Prevotella intermedia, and Fusobacterium nucleatum were measured using ELISA in 71 children with CCP-positive JIA and 74 children with CCP-negative JIA. Oral health history was collected from 37 children with CCP-positive JIA and 121 children with CCP-negative JIA. T-tests, Chi-square tests, Mann-Whitney U tests, and multivariable regression were used to compare the groups. RESULTS Compared to those with CCP-negative JIA, children with CCP-positive JIA were more likely to be female, older and non-Caucasian. Anti-P. gingivalis (p <0.003) and anti-P. intermedia (p <0.008) IgG antibody titers were higher in the CCP-positive cohort. Differences in P. gingivalis antibody titers remained significant after adjusting for age (p = 0.007). Children with CCP-positive JIA more likely reported tender/bleeding gums (43 % vs. 24 %, p < 0.02) compared to children with CCP-negative JIA. After controlling for age at collection, the odds of having tender/bleeding gums were 2.2 times higher in the CCP-positive group compared (95 % CI 0.98 - 4.83; p = 0.056). CONCLUSIONS Children with CCP-positive JIA have higher antibody titers to P. gingivalis and more symptoms of poor oral health, supporting a possible role for periodontitis in the etiology of CCP-positive JIA.
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Affiliation(s)
- Lauren Lange
- Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
| | - Geoffrey M. Thiele
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE USA
| | - Courtney McCracken
- Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA.
| | - Gabriel Wang
- Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA.
| | | | - Sheila T. Angeles-Han
- Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA 30322 USA ,Children’s Healthcare of Atlanta, Atlanta, GA USA
| | - Kelly A. Rouster-Stevens
- Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA 30322 USA ,Children’s Healthcare of Atlanta, Atlanta, GA USA
| | - Aimee O. Hersh
- University of Utah School of Medicine, Salt Lake City, UT USA
| | - Larry B. Vogler
- Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA 30322 USA ,Children’s Healthcare of Atlanta, Atlanta, GA USA
| | | | - Shelly Abramowicz
- Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA. .,Children's Healthcare of Atlanta, Atlanta, GA, USA. .,Department of Surgery, Division of Oral and Maxillofacial Surgery, Emory University School of Medicine, Atlanta, GA, USA.
| | - Ted R. Mikuls
- VA Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, NE USA
| | - Sampath Prahalad
- Department of Pediatrics Emory University School of Medicine, 1760 Haygood Dr. NE, Atlanta, GA, 30322, USA. .,Children's Healthcare of Atlanta, Atlanta, GA, USA. .,Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA.
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Smits-Seemann RR, Kaul S, Hersh AO, Fluchel MN, Boucher KM, Kirchhoff AC, Smits-Seemann RR, Kaul S, Hersh AO, Fluchel MN, Boucher KM, Kirchhoff AC. ReCAP: Gaps in Insurance Coverage for Pediatric Patients With Acute Lymphoblastic Leukemia. J Oncol Pract 2016; 12:175-6; e207-14. [DOI: 10.1200/jop.2015.005686] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
QUESTION ASKED: We sought to determine the likelihood that pediatric and adolescent acute lymphoblastic leukemia (ALL) patients experience a gap in health insurance coverage in the first 2 years of therapy. SUMMARY ANSWER: We found that 12% of patients with ALL in our sample who had insurance at diagnosis experienced a gap in insurance coverage during the first 2 years of therapy; that is, they had one or more clinic encounter at which they did not have insurance. Patients with public insurance at diagnosis were more likely to experience an insurance gap than those with private insurance at diagnosis, and those diagnosed in more recent years were less likely to experience a gap. METHODS/APPROACH: We determined insurance status at all clinic encounters at a tertiary children’s hospital within 2 years of diagnosis for patients diagnosed with ALL between 1998 and 2010, and calculated the odds of a gap occurring on the basis of demographic and diagnostic variables. BIAS, CONFOUNDING FACTOR(S), DRAWBACKS: Our assessment is from years before the roll-out of key Patient Protection and Affordable Care Act provisions, which should improve insurance coverage for pediatric and adolescent patients with ALL. In addition, we lacked information on patient or caregiver socioeconomic status, which may be important for explaining insurance gaps. Finally, our assessment is based on a single institution. REAL-LIFE IMPLICATIONS: Gaps in health insurance may exacerbate the financial and emotional burden associated with pediatric and adolescent cancer. Understanding the likelihood that these gaps will occur, as well as predictors of insurance gaps, will allow social workers and other providers to help families manage anticipated changes in insurance, with the goal of reducing unnecessary burden. [Figure: see text]
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Affiliation(s)
- Rochelle R. Smits-Seemann
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Sapna Kaul
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Aimee O. Hersh
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Mark N. Fluchel
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Kenneth M. Boucher
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Anne C. Kirchhoff
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children’s Hospital, Salt Lake City, UT
| | - Rochelle R. Smits-Seemann
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Sapna Kaul
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Aimee O. Hersh
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Mark N. Fluchel
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Kenneth M. Boucher
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
| | - Anne C. Kirchhoff
- University of Utah; Huntsman Cancer Institute, University of Utah; and Primary Children's Hospital, Salt Lake City, UT
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Abstract
Juvenile idiopathic arthritis (JIA) is the most common chronic inflammatory arthropathy of childhood. Juvenile idiopathic arthritis is believed to be a complex genetic trait influenced by both genetic and environmental factors. Twin and family studies suggest a substantial role for genetic factors in the predisposition to JIA. Describing the genetics is complicated by the heterogeneity of JIA; the International League of Associations for Rheumatology (ILAR) has defined seven categories of JIA based on distinct clinical and laboratory features. Utilizing a variety of techniques including candidate gene studies, the use of genotyping arrays such as Immunochip, and genome wide association studies (GWAS), both human leukocyte antigen (HLA) and non-HLA susceptibility loci associated with JIA have been described. Several of these polymorphisms (e.g. HLA class II, PTPN22, STAT4) are shared with other common autoimmune conditions; other novel polymorphisms that have been identified may be unique to JIA. Associations with oligoarticular and RF-negative polyarticular JIA are the best characterized. A strong association between HLA DRB1:11:03/04 and DRB1:08:01, and a protective effect of DRB1:15:01 have been described. HLA DPB1:02:01 has also been associated with oligoarticular and RF-negative polyarticular JIA. Besides PTPN22, STAT4 and PTPN2 variants, IL2, IL2RA, IL2RB, as well as IL6 and IL6R loci also harbor variants associated with oligoarticular and RF-negative polyarticular JIA. RF-positive polyarticular JIA is associated with many of the shared epitope encoding HLA DRB1 alleles, as well as PTPN22, STAT4 and TNFAIP3 variants. ERA is associated with HLA B27. Most other associations between JIA categories and HLA or non-HLA variants need confirmation. The formation of International Consortia to ascertain and analyze large cohorts of JIA categories, validation of reported findings in independent cohorts, and functional studies will enhance our understanding of the genetic underpinnings of JIA.
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Affiliation(s)
- Aimee O Hersh
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Sampath Prahalad
- Departments of Pediatrics and Human Genetics, Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA.
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27
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Affiliation(s)
- Aimee O Hersh
- Department of Pediatrics, Division of Allergy, Immunology and Rheumatology, University of Utah, Salt Lake City, Utah, USA.
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Lawson EF, Hersh AO, Trupin L, von Scheven E, Okumura MJ, Yazdany J, Yelin EH. Educational and vocational outcomes of adults with childhood- and adult-onset systemic lupus erythematosus: nine years of followup. Arthritis Care Res (Hoboken) 2014; 66:717-24. [PMID: 24877200 DOI: 10.1002/acr.22228] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare educational and vocational outcomes among adults with childhood-onset systemic lupus erythematosus (SLE) and adult-onset SLE. METHODS We used data derived from the 2002–2010 cycles of the Lupus Outcomes Study, a longitudinal cohort of 1,204 adult subjects with SLE. Subjects ages 18–60 years living in the US (n = 929) were included in the analysis and were classified as childhood-onset SLE if age at diagnosis was <18 years (n = 115). Logistic regression was used to assess the unadjusted and adjusted effect of childhood-onset SLE, sex, race/ethnicity, baseline age, urban or rural location, and US region on the likelihood of completing a bachelor's degree. Generalized estimating equations were used to assess the effect of childhood-onset SLE, demographics, education, and disease-related factors on the odds of employment, accounting for multiple observations over the study period. RESULTS Subjects with childhood-onset SLE were on average younger (mean ± SD 29 ± 10 years versus 44 ± 9 years), with longer disease duration (mean ± SD 15 ± 10 years versus 11 ± 8 years). Subjects with adult-onset SLE and childhood-onset SLE subjects were equally likely to complete a bachelor's degree. However, subjects with childhood-onset SLE were significantly less likely to be employed, independent of demographic and disease characteristics (odds ratio 0.62, 95% confidence interval 0.42–0.91). CONCLUSION While subjects with SLE are just as likely as those with adult-onset SLE to complete college education, childhood-onset SLE significantly increases the risk of not working in adulthood, even when controlling for disease and demographic factors. Exploring reasons for low rates of employment and providing vocational support may be important to maximize long-term functional outcomes in patients with childhood-onset SLE.
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Lawson EF, Trupin L, Hersh AO, Scheven EV, Yelin EH, Yazdany J. A168: Systemic Lupus Erythematosus In-Hospital Mortality Risk Across Ages: A National Estimate. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38594] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | - Laura Trupin
- University of California; San Francisco, San Francisco CA
| | | | | | | | - Jinoos Yazdany
- University of California; San Francisco, San Francisco CA
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Angeles-Han ST, McCracken C, Pichavant M, Jenkins K, Ponder L, Myoung E, Stevens KR, Vogler LB, Kennedy C, Yeh S, Cope S, Bohnsack JF, Hersh AO, Thompson SD, Prahalad S. A123: HLA Associations in a Matched Cohort of Juvenile Idiopathic Arthritis Children With and Without Uveitis. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | | | - Lori Ponder
- Children's Healthcare of Atlanta; Atlanta GA
| | | | | | | | | | - Steven Yeh
- Emory University School of Medicine; Atlanta GA
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Hersh AO, Son MB, von Scheven E. A85: Effect of Childhood-Onset Systemic Lupus Erythematosus on Linear Height and Body Mass Index. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
OBJECTIVE Disparities in outcomes among adults with systemic lupus erythematosus (SLE) have been documented. We investigated associations between sociodemographic factors and volume of annual inpatient hospital admissions with hospitalization characteristics and poor outcomes among patients with childhood-onset SLE. METHODS By using the Pediatric Health Information System, we analyzed admissions for patients aged 3 to <18 years at index admission with ≥ 1 International Classification of Diseases, Ninth Revision code for SLE from January 2006 to September 2011. Summary statistics and univariable analyses were used to examine demographic characteristics of hospital admissions, readmissions, and lengths of stay. We used multivariable logistic regression analyses, controlling for patient gender, age, race, ethnicity, insurance type, hospital volume, US census region, and severity of illness, to examine risk factors for poor outcomes. RESULTS A total of 10,724 admissions occurred among 2775 patients over the study period. Hispanic patients had longer lengths of stay, more readmissions, and higher in-hospital mortality. In multivariable analysis, African American race was significantly associated with ICU admission. African American race and Hispanic ethnicity were associated with end-stage renal disease and death. Volume of patients with SLE per hospital and hospital location were not significantly associated with outcomes. CONCLUSIONS In this cohort of hospitalized children with SLE, race and ethnicity were associated with outcomes. Further studies are needed to elucidate the relationship between sociodemographic factors and poor outcomes in patients with childhood-onset SLE.
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Affiliation(s)
- Mary Beth F. Son
- Division of Immunology and,Departments of Pediatrics and,Address correspondence to Mary Beth F. Son, MD, Division of Immunology, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail:
| | - Victor M. Johnson
- Department of Anesthesiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Aimee O. Hersh
- Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Mindy S. Lo
- Division of Immunology and,Departments of Pediatrics and
| | - Karen H. Costenbader
- Medicine, Harvard Medical School, Boston, Massachusetts;,Department of Rheumatology, Brigham & Women’s Hospital, Boston, Massachusetts
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Bennett TD, Fluchel M, Hersh AO, Hayward KN, Hersh AL, Brogan TV, Srivastava R, Stone BL, Korgenski EK, Mundorff MB, Casper TC, Bratton SL. Macrophage activation syndrome in children with systemic lupus erythematosus and children with juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2013; 64:4135-42. [PMID: 22886474 DOI: 10.1002/art.34661] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 07/31/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To describe patient demographics, interventions, and outcomes in hospitalized children with macrophage activation syndrome (MAS) complicating systemic lupus erythematosus (SLE) or juvenile idiopathic arthritis (JIA). METHODS We performed a retrospective cohort study using data recorded in the Pediatric Health Information System (PHIS) database from October 1, 2006 to September 30, 2010. Participants had International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis codes for MAS and either SLE or JIA. The primary outcome was hospital mortality (for the index admission). Secondary outcomes included intensive care unit (ICU) admission, critical care interventions, and medication use. RESULTS A total of 121 children at 28 children's hospitals met the inclusion criteria, including 19 children with SLE and 102 children with JIA. The index admission mortality rate was 7% (8 of 121 patients). ICU admission (33%), mechanical ventilation (26%), and inotrope/vasopressor therapy (26%) were common. Compared to children with JIA, those with SLE had a similar mortality rate (6% versus 11%, respectively; exact P = 0.6). More patients with SLE than those with JIA received ICU care (63% versus 27%; P = 0.002), received mechanical ventilation (53% versus 21%; P = 0.003), and had cardiovascular dysfunction (47% versus 23% received inotrope/vasopressor therapy; P = 0.02). Children with SLE and those with JIA received cyclosporine at similar rates, but more children with SLE received cyclophosphamide and mycophenolate mofetil, and more children with JIA received interleukin-1 antagonists. CONCLUSION Organ system dysfunction is common in children with rheumatic diseases complicated by MAS, and more organ system support is required in children with underlying SLE than in children with JIA. Current treatment of pediatric MAS varies based on the underlying rheumatic disease.
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Affiliation(s)
- Tellen D Bennett
- Pediatric Critical Care, University of Utah, Salt Lake City, UT 84158-1289, USA.
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Morishita K, Guzman J, Chira P, Muscal E, Zeft A, Klein-Gitelman M, Uribe AG, Abramson L, Benseler SM, Eberhard A, Ede K, Hashkes PJ, Hersh AO, Higgins G, Imundo LF, Jung L, Kim S, Kingsbury DJ, Lawson EF, Lee T, Li SC, Lovell DJ, Mason T, McCurdy D, O'Neil KM, Punaro M, Ramsey SE, Reiff A, Rosenkranz M, Schikler KN, Scuccimarri R, Singer NG, Stevens AM, van Mater H, Wahezi DM, White AJ, Cabral DA. Do adult disease severity subclassifications predict use of cyclophosphamide in children with ANCA-associated vasculitis? An analysis of ARChiVe study treatment decisions. J Rheumatol 2012; 39:2012-20. [PMID: 22859342 DOI: 10.3899/jrheum.120299] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether adult disease severity subclassification systems for antineutrophil cytoplasmic antibody-associated vasculitis (AAV) are concordant with the decision to treat pediatric patients with cyclophosphamide (CYC). METHODS We applied the European Vasculitis Study (EUVAS) and Wegener's Granulomatosis Etanercept Trial (WGET) disease severity subclassification systems to pediatric patients with AAV in A Registry for Childhood Vasculitis (ARChiVe). Modifications were made to the EUVAS and WGET systems to enable their application to this cohort of children. Treatment was categorized into 2 groups, "cyclophosphamide" and "no cyclophosphamide." Pearson's chi-square and Kendall's rank correlation coefficient statistical analyses were used to determine the relationship between disease severity subgroup and treatment at the time of diagnosis. RESULTS In total, 125 children with AAV were studied. Severity subgroup was associated with treatment group in both the EUVAS (chi-square 45.14, p < 0.001, Kendall's tau-b 0.601, p < 0.001) and WGET (chi-square 59.33, p < 0.001, Kendall's tau-b 0.689, p < 0.001) systems; however, 7 children classified by both systems as having less severe disease received CYC, and 6 children classified as having severe disease by both systems did not receive CYC. CONCLUSION In this pediatric AAV cohort, the EUVAS and WGET adult severity subclassification systems had strong correlation with physician choice of treatment. However, a proportion of patients received treatment that was not concordant with their assigned severity subclass.
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Mina R, von Scheven E, Ardoin SP, Eberhard BA, Punaro M, Ilowite N, Hsu J, Klein-Gitelman M, Moorthy LN, Muscal E, Radhakrishna SM, Wagner-Weiner L, Adams M, Blier P, Buckley L, Chalom E, Chédeville G, Eichenfield A, Fish N, Henrickson M, Hersh AO, Hollister R, Jones O, Jung L, Levy D, Lopez-Benitez J, McCurdy D, Miettunen PM, Quintero-del Rio AI, Rothman D, Rullo O, Ruth N, Schanberg LE, Silverman E, Singer NG, Soep J, Syed R, Vogler LB, Yalcindag A, Yildirim-Toruner C, Wallace CA, Brunner HI. Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2012. [PMID: 22162255 DOI: 10.1002/acr.21558.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To formulate consensus treatment plans (CTPs) for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (SLE). METHODS A structured consensus formation process was employed by the members of the Childhood Arthritis and Rheumatology Research Alliance after considering the existing medical evidence and current treatment approaches. RESULTS After an initial Delphi survey (response rate = 70%), a 2-day consensus conference, and 2 followup Delphi surveys (response rates = 63-79%), consensus was achieved for a limited set of CTPs addressing the induction therapy of proliferative LN. These CTPs were developed for prototypical patients defined by eligibility characteristics, and included immunosuppressive therapy with either mycophenolic acid orally twice per day, or intravenous cyclophosphamide once per month at standardized dosages for 6 months. Additionally, the CTPs describe 3 options for standardized use of glucocorticoids, including a primarily oral, a mixed oral/intravenous, and a primarily intravenous regimen. There was consensus on measures of effectiveness and safety of the CTPs. The CTPs were well accepted by the pediatric rheumatology providers treating children with LN, and up to 300 children per year in North America are expected to be candidates for the treatment with the CTPs. CONCLUSION CTPs for induction therapy of proliferative LN in juvenile SLE based on the available scientific evidence and pediatric rheumatology group experience have been developed. Consistent use of the CTPs may improve the prognosis of proliferative LN, and support the conduct of comparative effectiveness studies aimed at optimizing therapeutic strategies for proliferative LN in juvenile SLE.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Mina R, von Scheven E, Ardoin SP, Eberhard BA, Punaro M, Ilowite N, Hsu J, Klein-Gitelman M, Moorthy LN, Muscal E, Radhakrishna SM, Wagner-Weiner L, Adams M, Blier P, Buckley L, Chalom E, Chédeville G, Eichenfield A, Fish N, Henrickson M, Hersh AO, Hollister R, Jones O, Jung L, Levy D, Lopez-Benitez J, McCurdy D, Miettunen PM, Quintero-del Rio AI, Rothman D, Rullo O, Ruth N, Schanberg LE, Silverman E, Singer NG, Soep J, Syed R, Vogler LB, Yalcindag A, Yildirim-Toruner C, Wallace CA, Brunner HI. Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2012; 64:375-83. [PMID: 22162255 DOI: 10.1002/acr.21558] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To formulate consensus treatment plans (CTPs) for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (SLE). METHODS A structured consensus formation process was employed by the members of the Childhood Arthritis and Rheumatology Research Alliance after considering the existing medical evidence and current treatment approaches. RESULTS After an initial Delphi survey (response rate = 70%), a 2-day consensus conference, and 2 followup Delphi surveys (response rates = 63-79%), consensus was achieved for a limited set of CTPs addressing the induction therapy of proliferative LN. These CTPs were developed for prototypical patients defined by eligibility characteristics, and included immunosuppressive therapy with either mycophenolic acid orally twice per day, or intravenous cyclophosphamide once per month at standardized dosages for 6 months. Additionally, the CTPs describe 3 options for standardized use of glucocorticoids, including a primarily oral, a mixed oral/intravenous, and a primarily intravenous regimen. There was consensus on measures of effectiveness and safety of the CTPs. The CTPs were well accepted by the pediatric rheumatology providers treating children with LN, and up to 300 children per year in North America are expected to be candidates for the treatment with the CTPs. CONCLUSION CTPs for induction therapy of proliferative LN in juvenile SLE based on the available scientific evidence and pediatric rheumatology group experience have been developed. Consistent use of the CTPs may improve the prognosis of proliferative LN, and support the conduct of comparative effectiveness studies aimed at optimizing therapeutic strategies for proliferative LN in juvenile SLE.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Lawson EF, Hersh AO, Trupin L, Von Scheven E, Yelin EH. Long-term education and employment outcomes in pediatric-onset systemic lupus erythematosus. Pediatr Rheumatol Online J 2012. [PMCID: PMC3402994 DOI: 10.1186/1546-0096-10-s1-a105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Uribe AG, Huber AM, Kim S, O'Neil KM, Wahezi DM, Abramson L, Baszis K, Benseler SM, Bowyer SL, Campillo S, Chira P, Hersh AO, Higgins GC, Eberhard A, Ede K, Imundo LF, Jung L, Kingsbury DJ, Klein-Gitelman M, Lawson EF, Li SC, Lovell DJ, Mason T, McCurdy D, Muscal E, Nassi L, Rabinovich E, Reiff A, Rosenkranz M, Schikler KN, Singer NG, Spalding S, Stevens AM, Cabral DA. Increased sensitivity of the European medicines agency algorithm for classification of childhood granulomatosis with polyangiitis. J Rheumatol 2012; 39:1687-97. [PMID: 22589257 DOI: 10.3899/jrheum.111352] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Granulomatosis with polyangiitis (Wegener's; GPA) and other antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) are rare in childhood and are sometimes difficult to discriminate. We compared use of adult-derived classification schemes for GPA against validated pediatric criteria in the ARChiVe (A Registry for Childhood Vasculitis e-entry) cohort, a Childhood Arthritis and Rheumatology Research Alliance initiative. METHODS Time-of-diagnosis data for children with physician (MD) diagnosis of AAV and unclassified vasculitis (UCV) from 33 US/Canadian centers were analyzed. The European Medicines Agency (EMA) classification algorithm and European League Against Rheumatism/Paediatric Rheumatology International Trials Organisation/Paediatric Rheumatology European Society (EULAR/PRINTO/PRES) and American College of Rheumatology (ACR) criteria for GPA were applied to all patients. Sensitivity and specificity were calculated (MD-diagnosis as reference). RESULTS MD-diagnoses for 155 children were 100 GPA, 25 microscopic polyangiitis (MPA), 6 ANCA-positive pauciimmune glomerulonephritis, 3 Churg-Strauss syndrome, and 21 UCV. Of these, 114 had GPA as defined by EMA, 98 by EULAR/PRINTO/PRES, and 87 by ACR. Fourteen patients were identified as GPA by EULAR/PRINTO/PRES but not by ACR; 3 were identified as GPA by ACR but not EULAR/PRINTO/PRES. Using the EMA algorithm, 135 (87%) children were classifiable. The sensitivity of the EMA algorithm, the EULAR/PRINTO/PRES, and ACR criteria for classifying GPA was 90%, 77%, and 69%, respectively, with specificities of 56%, 62%, and 67%. The relatively poor sensitivity of the 2 criteria related to their inability to discriminate patients with MPA. CONCLUSION EULAR/PRINTO/PRES was more sensitive than ACR criteria in classifying pediatric GPA. Neither classification system has criteria for MPA; therefore usefulness in discriminating patients in ARChiVe was limited. Even when using the most sensitive EMA algorithm, many children remained unclassified.
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Affiliation(s)
- América G Uribe
- Division of Rheumatology, BC Children's Hospital, Vancouver, BC V6H 3V4, Canada
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Morishita K, Li SC, Muscal E, Spalding S, Guzman J, Uribe A, Abramson L, Baszis K, Benseler S, Bowyer S, Campillo S, Chira P, Hersh AO, Higgins G, Eberhard A, Ede K, Imundo L, Jung L, Kim S, Kingsbury DJ, Klein-Gitelman M, Lawson EF, Lovell DJ, Mason T, McCurdy D, Nanda K, Nassi L, O'Neil KM, Rabinovich E, Ramsey SE, Reiff A, Rosenkranz M, Schikler K, Stevens A, Wahezi D, Cabral DA. Assessing the performance of the Birmingham Vasculitis Activity Score at diagnosis for children with antineutrophil cytoplasmic antibody-associated vasculitis in A Registry for Childhood Vasculitis (ARChiVe). J Rheumatol 2012; 39:1088-94. [PMID: 22337238 DOI: 10.3899/jrheum.111030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE There are no validated tools for measuring disease activity in pediatric vasculitis. The Birmingham Vasculitis Activity Score (BVAS) is a valid disease activity tool in adult vasculitis. Version 3 (BVAS v.3) correlates well with physician's global assessment (PGA), treatment decision, and C-reactive protein in adults. The utility of BVAS v.3 in pediatric vasculitis is not known. We assessed the association of BVAS v.3 scores with PGA, treatment decision, and erythrocyte sedimentation rate (ESR) at diagnosis in pediatric antineutrophil cytoplasmic antibody-associated vasculitis (AAV). METHODS Children with AAV diagnosed between 2004 and 2010 at all ARChiVe centers were eligible. BVAS v.3 scores were calculated with a standardized online tool (www.vasculitis.org). Spearman's rank correlation coefficient (r(s)) was used to test the strength of association between BVAS v.3 and PGA, treatment decision, and ESR. RESULTS A total of 152 patients were included. The physician diagnosis of these patients was predominantly granulomatosis with polyangiitis (n = 99). The median BVAS v.3 score was 18.0 (range 0-40). The BVAS v.3 correlations were r(s) = 0.379 (95% CI 0.233 to 0.509) with PGA, r(s) = 0.521 (95% CI 0.393 to 0.629) with treatment decision, and r(s) = 0.403 (95% CI 0.253 to 0.533) with ESR. CONCLUSION Applied to children with AAV, BVAS v.3 had a weak correlation with PGA and moderate correlation with both ESR and treatment decision. Prospective evaluation of BVAS v.3 and/or pediatric-specific modifications to BVAS v.3 may be required before it can be formalized as a disease activity assessment tool in pediatric AAV.
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Affiliation(s)
- Kimberly Morishita
- British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
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Lawson EF, Hersh AO, Applebaum MA, Yelin EH, Okumura MJ, von Scheven E. Self-management skills in adolescents with chronic rheumatic disease: A cross-sectional survey. Pediatr Rheumatol Online J 2011; 9:35. [PMID: 22145642 PMCID: PMC3254592 DOI: 10.1186/1546-0096-9-35] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Accepted: 12/06/2011] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND For adolescents with a diagnosis of lifelong chronic illness, mastery of self-management skills is a critical component of the transition to adult care. This study aims to examine self-reported medication adherence and self-care skills among adolescents with chronic rheumatic disease. METHODS Cross-sectional survey of 52 adolescent patients in the Pediatric Rheumatology Clinic at UCSF. Outcome measures were self-reported medication adherence, medication regimen knowledge and independence in health care tasks. Predictors of self-management included age, disease perception, self-care agency, demographics and self-reported health status. Bivariate associations were assessed using the Student's t-test, Wilcoxon rank sum test and Fisher exact test as appropriate. Independence in self-management tasks were compared between subjects age 13-16 and 17-20 using the chi-squared test. RESULTS Subjects were age 13-20 years (mean 15.9); 79% were female. Diagnoses included juvenile idiopathic arthritis (44%), lupus (35%), and other rheumatic conditions (21%). Mean disease duration was 5.3 years (SD 4.0). Fifty four percent reported perfect adherence to medications, 40% reported 1-2 missed doses per week, and 6% reported missing 3 or more doses. The most common reason for missing medications was forgetfulness. Among health care tasks, there was an age-related increase in ability to fill prescriptions, schedule appointments, arrange transportation, ask questions of doctors, manage insurance, and recognize symptoms of illness. Ability to take medications as directed, keep a calendar of appointments, and maintain a personal medical file did not improve with age. CONCLUSIONS This study suggests that adolescents with chronic rheumatic disease may need additional support to achieve independence in self-management.
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Affiliation(s)
- Erica F Lawson
- Department of Pediatrics, Division of Rheumatology & Immunology, University of California, San Francisco, 533 Parnassus, Rm U-127, Box 0107, San Francisco, CA 94143, USA.
| | - Aimee O Hersh
- Department of Pediatrics, Division of Allergy, Immunology & Rheumatology, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Mark A Applebaum
- Department of Pediatrics, Division of Rheumatology & Immunology, University of California, San Francisco, 533 Parnassus, Rm U-127, Box 0107, San Francisco, CA 94143, USA
| | - Edward H Yelin
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, 3333 California Street, Suite 270, San Francisco, CA 94143-0920, USA
| | - Megumi J Okumura
- Department of Pediatrics, Division of General Pediatrics, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA 94118, USA
| | - Emily von Scheven
- Department of Pediatrics, Division of Rheumatology & Immunology, University of California, San Francisco, 533 Parnassus, Rm U-127, Box 0107, San Francisco, CA 94143, USA
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Hersh AO, Trupin L, Yazdany J, Panopalis P, Julian L, Katz P, Criswell LA, Yelin E. Childhood-onset disease as a predictor of mortality in an adult cohort of patients with systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62:1152-9. [PMID: 20235215 PMCID: PMC3755501 DOI: 10.1002/acr.20179] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine childhood-onset disease as a predictor of mortality in a cohort of adult patients with systemic lupus erythematosus (SLE). METHODS Data were derived from the University of California Lupus Outcomes Study, a longitudinal cohort of 957 adult subjects with SLE that includes 98 subjects with childhood-onset SLE. Baseline and followup data were obtained via telephone interviews conducted in 2002-2007. The number of deaths during 5 years of followup was determined and standardized mortality ratios (SMRs) for the cohort, and across age groups, were calculated. Kaplan-Meier life table analysis was used to compare mortality rates between childhood- (defined as SLE diagnosis at <18 years of age) and adult-onset SLE. Multivariate Cox proportional hazard models were used to determine predictors of mortality. RESULTS During the median followup period of 48 months, 72 deaths (7.5% of subjects) occurred, including 9 deaths (12.5%) in subjects with childhood-onset SLE. The overall SMR was 2.5 (95% confidence interval [95% CI] 2.0-3.2). In Kaplan-Meier survival analysis, after adjusting for age, childhood-onset subjects were at increased risk for mortality throughout the followup period (P< 0.0001). In a multivariate model adjusting for age, disease duration, and other covariates, childhood-onset SLE was independently associated with an increased mortality risk (hazard ratio [HR] 3.1, 95% CI 1.3-7.3), as was low socioeconomic status measured by education (HR 1.9, 95% CI 1.1-3.2), and end stage renal disease (HR 2.1, 95% CI 1.1-4.0). CONCLUSION Childhood-onset SLE was a strong predictor of mortality in this cohort. Interventions are needed to prevent early mortality in this population.
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Affiliation(s)
- Aimee O Hersh
- University of California, San Francisco, 94143, USA.
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Yazdany J, Tonner C, Trupin L, Panopalis P, Gillis JZ, Hersh AO, Julian LJ, Katz PP, Criswell LA, Yelin EH. Provision of preventive health care in systemic lupus erythematosus: data from a large observational cohort study. Arthritis Res Ther 2010; 12:R84. [PMID: 20462444 PMCID: PMC2911868 DOI: 10.1186/ar3011] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 04/16/2010] [Accepted: 05/12/2010] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Cancer and infections are leading causes of mortality in systemic lupus erythematosus (SLE) after diseases of the circulatory system, and therefore preventing these complications is important. In this study, we examined two categories of preventive services in SLE: cancer surveillance (cervical, breast, and colon) and immunizations (influenza and pneumococcal). We compared the receipt of these services in SLE to the general population, and identified subgroups of patients who were less likely to receive these services. METHODS We compared preventive services reported by insured women with SLE enrolled in the University of California, San Francisco Lupus Outcomes Study (n=685) to two representative samples derived from a statewide health interview survey, a general population sample (n=18,013) and a sample with non-rheumatic chronic conditions (n=4,515). In addition, using data from the cohort in both men and women (n=742), we applied multivariate regression analyses to determine whether characteristics of individuals (for example, sociodemographic and disease factors), health systems (for example, number of visits, involvement of generalists or rheumatologists in care, type of health insurance) or neighborhoods (neighborhood poverty) influenced the receipt of services. RESULTS The receipt of preventive care in SLE was similar to both comparison samples. For cancer surveillance, 70% of eligible respondents reported receipt of cervical cancer screening and mammography, and 62% reported colon cancer screening. For immunizations, 59% of eligible respondents reported influenza immunization, and 60% reported pneumococcal immunization. In multivariate regression analyses, several factors were associated with a lower likelihood of receiving preventive services, including younger age and lower educational attainment. We did not observe any effects by neighborhood poverty. A higher number of physician visits and involvement of generalist providers in care was associated with a higher likelihood of receiving most services. CONCLUSIONS Although receipt of cancer screening procedures and immunizations in our cohort was comparable to the general population, we observed significant variability by sociodemographic factors such as age and educational attainment. Further research is needed to identify the physician, patient or health system factors contributing to this observed variation in order to develop effective quality improvement interventions.
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Affiliation(s)
- Jinoos Yazdany
- Division of Rheumatology, University of California, San Francisco, UCSF Box 0920, San Francisco, CA 94143-0920, USA
| | - Chris Tonner
- Division of Rheumatology, University of California, San Francisco, UCSF Box 0920, San Francisco, CA 94143-0920, USA
| | - Laura Trupin
- Division of Rheumatology, University of California, San Francisco, UCSF Box 0920, San Francisco, CA 94143-0920, USA
| | - Pantelis Panopalis
- Division of Rheumatology, McGill University Health Center 1, 650 Cedar Avenue, Room A6-123, Montreal, QC H3G 1A4, Canada
| | - Joann Z Gillis
- Division of Rheumatology, National Jewish Hospital, 1400 Jackson?Street, Denver, CO 80206, USA
| | - Aimee O Hersh
- Division of Pediatric Rheumatology, University of California, San Francisco, 533 Parnassus Avenue, San Francisco, CA 94143 - 0107, USA
| | - Laura J Julian
- Division of Rheumatology, University of California, San Francisco, UCSF Box 0920, San Francisco, CA 94143-0920, USA
| | - Patricia P Katz
- Division of Rheumatology, University of California, San Francisco, UCSF Box 0920, San Francisco, CA 94143-0920, USA
| | - Lindsey A Criswell
- Division of Rheumatology, University of California, San Francisco, 374 Parnassus Avenue, San Francisco, CA 94143 - 0500, USA
| | - Edward H Yelin
- Division of Rheumatology, University of California, San Francisco, UCSF Box 0920, San Francisco, CA 94143-0920, USA
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Cabral DA, Uribe AG, Benseler S, O'Neil KM, Hashkes PJ, Higgins G, Zeft AS, Lovell DJ, Kingsbury DJ, Stevens A, McCurdy D, Chira P, Abramson L, Arkachaisri T, Campillo S, Eberhard A, Hersh AO, Huber AM, Kim S, Klein-Gitelman M, Levy DM, Li SC, Mason T, Dewitt EM, Muscal E, Nassi L, Reiff A, Schikler K, Singer NG, Wahezi D, Woodward A. Classification, presentation, and initial treatment of Wegener's granulomatosis in childhood. ACTA ACUST UNITED AC 2010; 60:3413-24. [PMID: 19877069 DOI: 10.1002/art.24876] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare the criteria for Wegener's granulomatosis (WG) of the American College of Rheumatology (ACR) with those of the European League Against Rheumatism/Pediatric Rheumatology European Society (EULAR/PRES) in a cohort of children with WG and other antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAVs), and to describe the interval to diagnosis, presenting features, and initial treatment for WG. METHODS Eligible patients had been diagnosed by site rheumatologists (termed the "MD diagnosis") since 2004. This diagnosis was used as a reference standard for sensitivity and specificity testing of the 2 WG classification criteria. Descriptive analyses were confined to ACR-classified WG patients. RESULTS MD diagnoses of 117 patients (82 of whom were female) were WG (n = 76), microscopic polyangiitis (n = 17), ANCA-positive pauci-immune glomerulonephritis (n = 5), Churg-Strauss syndrome (n = 2), and unclassified vasculitis (n = 17). The sensitivities of the ACR and EULAR/PRES classification criteria for WG among the spectrum of AAVs were 68.4% and 73.6%, respectively, and the specificities were 68.3% and 73.2%, respectively. Two more children were identified as having WG by the EULAR/PRES criteria than by the ACR criteria. For the 65 ACR-classified WG patients, the median age at diagnosis was 14.2 years (range 4-17 years), and the median interval from symptom onset to diagnosis was 2.7 months (range 0-49 months). The most frequent presenting features by organ system were constitutional (89.2%), pulmonary (80.0%), ear, nose, and throat (80.0%), and renal (75.4%). Fifty-four patients (83.1%) commenced treatment with the combination of corticosteroids and cyclophosphamide, with widely varying regimens; the remainder received methotrexate alone (n = 1), corticosteroids alone (n = 4), or a combination (n = 6). CONCLUSION The EULAR/PRES criteria minimally improved diagnostic sensitivity and specificity for WG among a narrow spectrum of children with AAVs. Diagnostic delays may result from poor characterization of childhood WG. Initial therapy varied considerably among participating centers.
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Affiliation(s)
- David A Cabral
- Division of Rheumatology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Hersh AO, von Scheven E, Yazdany J, Panopalis P, Trupin L, Julian L, Katz P, Criswell LA, Yelin E. Differences in long-term disease activity and treatment of adult patients with childhood- and adult-onset systemic lupus erythematosus. ACTA ACUST UNITED AC 2009; 61:13-20. [PMID: 19116979 DOI: 10.1002/art.24091] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare differences in long-term outcome between adults with childhood-onset (age at diagnosis <18 years) systemic lupus erythematosus (SLE) and with adult-onset SLE. METHODS Data were derived from the University of California Lupus Outcomes Study, a longitudinal cohort of 885 adult subjects with SLE (90 childhood-onset [cSLE], 795 adult-onset [aSLE]). Baseline and 1-year followup data were obtained via structured 1-hour telephone interviews conducted between 2002 and 2006. Using self-report data, differences in organ involvement and disease morbidity, current disease status and activity, past and current medication use, and number of physician visits were compared, based on age at diagnosis of SLE. RESULTS Average disease duration for the cSLE and aSLE subgroups was 16.5 and 13.4 years, respectively, and mean age at followup was 30.5 and 49.9 years, respectively. When compared with aSLE subjects, cSLE subjects had a higher frequency of SLE-related renal disease, whereas aSLE subjects were more likely to report a history of pulmonary disease. Rates of clotting disorders, seizures, and myocardial infarction were similar between the 2 groups. At followup, cSLE subjects had lower overall disease activity, but were more likely to be taking steroids and other immunosuppressive therapies. The total number of yearly physician visits was similar between the 2 groups, although cSLE subjects had a higher number of nephrology visits. CONCLUSION This study demonstrates important differences in the outcomes of patients with cSLE and aSLE, and provides important prognostic information about long-term SLE disease activity and treatment.
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Panopalis P, Yazdany J, Gillis JZ, Julian L, Trupin L, Hersh AO, Criswell LA, Katz P, Yelin E. Health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus. ACTA ACUST UNITED AC 2009; 59:1788-95. [PMID: 19035422 DOI: 10.1002/art.24063] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To estimate health care costs and costs associated with changes in work productivity among persons with systemic lupus erythematosus (SLE) in the US. METHODS Data were derived from the University of California, San Francisco Lupus Outcomes Study. Participants provided information on their health care resource use and employment. Cost estimates were derived for both direct health care costs and costs related to changes in work productivity. Direct health care costs included costs for hospitalizations, emergency department services, physician visits, outpatient surgical procedures, dialysis, and medications. Productivity costs were estimated by measuring changes in hours of work productivity since diagnosis of SLE; these estimates were also compared with normal US population data. RESULTS For the total population of participants, the mean annual direct cost was $12,643 (2004 US dollars). The mean annual productivity cost for subjects of employment age (>or=18 and <65 years) was $8,659. The mean annual total cost (direct and productivity) for subjects of employment age was $20,924. Regression results showed that greater disease activity, longer disease duration, and worse physical and mental health were significant predictors of higher direct costs; older age predicted lower direct costs. Older age, greater disease activity, and worse physical and mental health status were significant predictors of higher costs due to changes in work productivity. CONCLUSION Both direct health care costs and costs associated with changes in work productivity are substantial and both represent important contributors to the total costs associated with SLE.
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