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Kim H, Saygin D, Douglas C, Wilkerson J, Erman B, Pistorio A, McGrath JA, Reed AM, Oddis CV, Bracaglia C, van Royen-Kerkhof A, Bica B, Dolezalova P, Ferriani VPL, Flato B, Bernard-Medina AG, Herlin T, Miller FW, Vencovsky J, Ruperto N, Aggarwal R, Rider LG. Performance of the 2016 ACR-EULAR myositis response criteria in juvenile dermatomyositis therapeutic trials and consensus profiles. Rheumatology (Oxford) 2023; 62:3680-3689. [PMID: 36929918 PMCID: PMC10629769 DOI: 10.1093/rheumatology/kead111] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/11/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES The 2016 ACR-EULAR Response Criteria for JDM was developed as a composite measure with differential weights of six core set measures (CSMs) to calculate a Total Improvement Score (TIS). We assessed the contribution of each CSM, representation of muscle-related and patient-reported CSMs towards improvement, and frequency of CSM worsening across myositis response criteria (MRC) categories in validation of MRC. METHODS Data from JDM patients in the Rituximab in Myositis trial (n = 48), PRINTO JDM trial (n = 139), and consensus patient profiles (n = 273) were included. Observed vs expected CSM contributions were compared using Sign test. Characteristics of MRC categories were compared by Wilcoxon tests with Bonferroni adjustment. Spearman correlation of changes in TIS and individual CSMs were examined. Agreement between physician-assessed change and MRC categories was evaluated by weighted Cohen's kappa. RESULTS Of 457 JDM patients with IMACS CSMs and 380 with PRINTO CSMs, 9-13% had minimal, 19-23% had moderate and 41-50% had major improvement. The number of improved and absolute percentage change of CSMs increased by MRC improvement level. Patients with minimal improvement by MRC had a median of 0-1 CSM worsened, and those with moderate/major improvement had a median of zero worsening CSMs. Of patients improved by MRC, 94-95% had improvement in muscle strength and 93-95% had improvement in ≥1 patient-reported CSM. IMACS and PRINTO CSMs performed similarly. Physician-rated change and MRC improvement categories had moderate-to-substantial agreement (Kappa 0.5-0.7). CONCLUSION The ACR-EULAR MRC perform consistently across multiple studies, supporting its further use as an efficacy end point in JDM trials.
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Affiliation(s)
- Hanna Kim
- Juvenile Myositis Pathogenesis and Therapeutics Unit, National Institute of Arthritis Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Didem Saygin
- Section of Rheumatology, Department of Medicine, University of Chicago, Chicago, IL, USA
- School of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Brian Erman
- Social & Scientific Systems, Inc, Durham, NC, USA
| | - Angela Pistorio
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | | | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Chester V Oddis
- School of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Claudia Bracaglia
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Annet van Royen-Kerkhof
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Blanca Bica
- Section of Rheumatology, Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Pavla Dolezalova
- General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Virginia P L Ferriani
- Department of Pediatrics; Division of Rheumatology, Ribeirao Preto Medical School- Sao Paulo University, Ribeirao Preto, Brazil
| | - Berit Flato
- Department of Rheumatology, Oslo University Hospital, Norway and Institute of clinical medicine, University of Oslo, Oslo, Norway
| | | | - Troels Herlin
- Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
| | - Jiri Vencovsky
- Institute of Rheumatology, Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Nicolino Ruperto
- UOSID Centro Trial, PRINTO, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Rohit Aggarwal
- School of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, NIH, Bethesda, MD, USA
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Lakshminrusimha S, Reed AM, Cheng TL, Cunningham JM, Devaskar SU. An Approach to Compensation Plans for Physician Faculty in Academic Pediatric Departments. J Pediatr 2023; 262:113511. [PMID: 37244572 DOI: 10.1016/j.jpeds.2023.113511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Affiliation(s)
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC
| | - Tina L Cheng
- Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - John M Cunningham
- Department of Pediatrics and Comer Children's Hospital, University of Chicago, Chicago, IL
| | - Sherin U Devaskar
- Department of Pediatrics, David Geffen School of Medicine at UCLA and the UCLA Mattel Children's Hospital, Los Angeles, CA
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Kline S, Reed AM, McCarty L, Brown D, Fuste A, Kirstein K, Pak G, Jain L, Gessouroun M. Two Steps Forward, One Step Back: The Complexity of Accurately Defining and Measuring Clinical Activity in Academic Pediatrics. J Pediatr 2023; 259:113446. [PMID: 37120130 DOI: 10.1016/j.jpeds.2023.113446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Affiliation(s)
- Susan Kline
- Department of Pediatrics, Duke University, Durham, NC
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC.
| | - Liz McCarty
- Department of Pediatrics, Emory University, Atlanta, GA
| | - Desiree Brown
- Department of Pediatrics, University of South Florida, Tampa, FL
| | - Angela Fuste
- Department of Pediatrics, University of Miami, Miami, FL
| | - Kristine Kirstein
- Department of Pediatrics. All Children's Hospital, St Petersburg, FL
| | - Gil Pak
- Department of Pediatrics, Penn State, Hershey, PA
| | - Lucky Jain
- Department of Pediatrics, Emory University, Atlanta, GA
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Lin C, Bier B, Reed AM, Paat JJ, Tu P. Changes in Confidence, Feelings, and Perceived Necessity Concerning COVID-19 Booster. Vaccines (Basel) 2023; 11:1244. [PMID: 37515059 PMCID: PMC10383837 DOI: 10.3390/vaccines11071244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/08/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 booster first became available to all adults in the U.S. in November 2021 and a bivalent version in September 2022, but a large population remains booster-hesitant; only 17% of Americans have obtained the updated vaccine as of June 2023. We conducted two cross-sectional surveys in 2021 and 2022 (n = 1889 and 1319) to determine whether changes in booster-related feelings or perceptions had occurred and whether they altered vaccination rates over time. We found that both positive and negative emotions had grown stronger between the two years, with the prevalence of annoyance increasing the most (21.5% to 39.7%). The impact of trust on booster intention more than doubled (OR = 7.46 to 16.04). Although perceived risk of infection decreased, more participants in 2022 indicated uncertainty or unwillingness to obtain a new booster than in 2021, while the proportion refusing a booster remained constant at 22.5%. Confidence in the COVID-19 vaccine and feelings of hope from the booster motivated acceptance; both were stronger predictors of booster receptivity than prior vaccination history. Our findings signal a need to rebuild trust by informing people of their continued risk and appealing to positive, especially optimistic emotions to encourage booster uptake. Future research should explore longitudinal trends in behavior and feelings toward new booster doses and the impact of prolonged vaccine hesitancy on infection rates.
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Affiliation(s)
- Cheryl Lin
- Policy and Organizational Management Program, Duke University, Durham, NC 27708, USA
| | - Brooke Bier
- Policy and Organizational Management Program, Duke University, Durham, NC 27708, USA
| | - Ann M Reed
- School of Medicine, Duke University, Durham, NC 27708, USA
| | - John J Paat
- School of Medicine, Duke University, Durham, NC 27708, USA
| | - Pikuei Tu
- Policy and Organizational Management Program, Duke University, Durham, NC 27708, USA
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Rothwell S, Amos CI, Miller FW, Rider LG, Lundberg IE, Gregersen PK, Vencovsky J, McHugh N, Limaye V, Selva‐O'Callaghan A, Hanna MG, Machado PM, Pachman LM, Reed AM, Molberg Ø, Benveniste O, Mathiesen P, Radstake T, Doria A, De Bleecker JL, De Paepe B, Maurer B, Ollier WE, Padyukov L, O'Hanlon TP, Lee A, Wedderburn LR, Chinoy H, Lamb JA. Identification of Novel Associations and Localization of Signals in Idiopathic Inflammatory Myopathies Using Genome-Wide Imputation. Arthritis Rheumatol 2023; 75:1021-1027. [PMID: 36580032 PMCID: PMC10238560 DOI: 10.1002/art.42434] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/07/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The idiopathic inflammatory myopathies (IIMs) are heterogeneous diseases thought to be initiated by immune activation in genetically predisposed individuals. We imputed variants from the ImmunoChip array using a large reference panel to fine-map associations and identify novel associations in IIM. METHODS We analyzed 2,565 Caucasian IIM patient samples collected through the Myositis Genetics Consortium (MYOGEN) and 10,260 ethnically matched control samples. We imputed 1,648,116 variants from the ImmunoChip array using the Haplotype Reference Consortium panel and conducted association analysis on IIM and clinical and serologic subgroups. RESULTS The HLA locus was consistently the most significantly associated region. Four non-HLA regions reached genome-wide significance, SDK2 and LINC00924 (both novel) and STAT4 in the whole IIM cohort, with evidence of independent variants in STAT4, and NAB1 in the polymyositis (PM) subgroup. We also found suggestive evidence of association with loci previously associated with other autoimmune rheumatic diseases (TEC and LTBR). We identified more significant associations than those previously reported in IIM for STAT4 and DGKQ in the total cohort, for NAB1 and FAM167A-BLK loci in PM, and for CCR5 in inclusion body myositis. We found enrichment of variants among DNase I hypersensitivity sites and histone marks associated with active transcription within blood cells. CONCLUSION We found novel and strong associations in IIM and PM and localized signals to single genes and immune cell types.
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Affiliation(s)
- Simon Rothwell
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | | | - Frederick W. Miller
- Environmental Autoimmunity GroupNational Institute of Environmental Health Sciences, NIHBethesdaMaryland
| | - Lisa G. Rider
- Environmental Autoimmunity GroupNational Institute of Environmental Health Sciences, NIHBethesdaMaryland
| | - Ingrid E. Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Peter K. Gregersen
- The Robert S. Boas Center for Genomics and Human GeneticsThe Feinstein InstituteManhassetNew York
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, First Medical FacultyCharles UniversityPragueCzech Republic
| | - Neil McHugh
- Department of Pharmacy and PharmacologyUniversity of BathBathUK
| | - Vidya Limaye
- Rheumatology Unit, Royal Adelaide Hospital and Discipline of MedicineAdelaide UniversityAdelaideAustralia
| | - Albert Selva‐O'Callaghan
- Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Michael G. Hanna
- Department of Neuromuscular Diseases, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Pedro M. Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, and Centre for Rheumatology, UCL Division of MedicineUniversity College LondonLondonUK
| | - Lauren M. Pachman
- Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Ann M. Reed
- Department of PediatricsDuke UniversityDurhamNorth Carolina
| | - Øyvind Molberg
- Department of RheumatologyOslo University HospitalOsloNorway
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié‐Salpêtrière HospitalParisFrance
| | - Pernille Mathiesen
- Paediatric Department, Slagelse Hospital and Paediatric Rheumatology Unit, RigshospitaletCopenhagenDenmark
| | - Timothy Radstake
- Department of Rheumatology and Clinical ImmunologyUniversity Medical CenterUtrechtthe Netherlands
| | - Andrea Doria
- Rheumatology Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | | | | | - Britta Maurer
- Department of Rheumatology and ImmunologyUniversity HospitalBernSwitzerland
| | - William E. Ollier
- Manchester Metropolitan University, School of Healthcare SciencesManchesterUK
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Solna, Karolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Terrance P. O'Hanlon
- Environmental Autoimmunity GroupNational Institute of Environmental Health Sciences, NIHBethesdaMaryland
| | - Annette Lee
- The Robert S. Boas Center for Genomics and Human GeneticsThe Feinstein InstituteManhassetNew York
| | - Lucy R. Wedderburn
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, and Arthritis Research UK Centre for Adolescent Rheumatology, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK, and Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK, and Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of ManchesterManchesterUK
| | - Janine A. Lamb
- Epidemiology and Public Health Group, Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
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6
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Bode SM, Hoffman BD, Chapman SH, Kaczorowski JM, Best DL, Shah AN, Nerlinger AL, Barnard JA, Loud KJ, Brophy P, Reed AM, Braner D. Academic Careers in Advocacy: Aligning Institutional Values Through Use of an Advocacy Portfolio. Pediatrics 2022; 150:188322. [PMID: 35734955 DOI: 10.1542/peds.2021-055014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/24/2022] Open
Abstract
Academic children's hospitals must embrace advocacy as a central component of their missions to discover new knowledge and improve the health of the communities and patients they serve. To do so, they must ensure faculty have both the tools and the opportunities to develop and articulate the work of advocacy as an academic endeavor. This can be accomplished by integrating the work of advocacy at the community and policy-change levels into the traditional value systems of academic medicine, especially the promotions process, to establish its legitimacy. Academic pediatric institutions can support this transformation through robust training and professional development programs and establishing opportunities, resources, and leadership positions in advocacy. The adoption of an advocacy portfolio can be used to align these activities and accomplishments to institutional values and promotion. This alignment is crucial to supporting the advocacy work of pediatricians at a time in which community engagement and systems and policy change must be added to professional activities to ensure optimal outcomes for all children.
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Affiliation(s)
- Sara M Bode
- Nationwide Children's Hospital, Columbus, Ohio
| | | | - Steven H Chapman
- Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | | | - Debra L Best
- Duke Children's Hospital and Health Center, Durham, North Carolina
| | - Anita N Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Keith J Loud
- Children's Hospital at Dartmouth-Hitchcock, Lebanon, New Hampshire
| | | | - Ann M Reed
- Duke Children's Hospital and Health Center, Durham, North Carolina
| | - Dana Braner
- Doernbecher Children's Hospital, Portland, Oregon
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7
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Stingl C, Dvergsten JA, Eng SWM, Yeung RSM, Fritzler MJ, Mason T, Crowson C, Voora D, Reed AM. Gene Expression Profiles of Treatment Response and Non-Response in Children With Juvenile Dermatomyositis. ACR Open Rheumatol 2022; 4:671-681. [PMID: 35616642 PMCID: PMC9374052 DOI: 10.1002/acr2.11445] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 01/26/2022] [Accepted: 02/01/2022] [Indexed: 12/26/2022] Open
Abstract
Objective The study objective was to identify differences in gene expression between treatment responders (TRs) and treatment non‐responders (TNRs) diagnosed with juvenile dermatomyositis (JDM). Methods Gene expression analyses were performed using whole blood messenger RNA sequencing in patients with JDM (n = 17) and healthy controls (HCs; n = 10). Four analyses were performed (A1‐4) comparing differential gene expression and pathways analysis exploiting the timing of sample acquisition and the treatments received to perform these comparative analyses. Analyses were done at diagnosis and follow‐up, which averaged 7 months later in the cohort. Results At diagnosis, the expression of 10 genes differed between TRs and TNRs. Hallmark and canonical pathway analysis revealed 11 and 60 pathways enriched in TRs and 3 and 21 pathways enriched in TNRs, respectively. Pathway enrichment at diagnosis in TRs was strongest in pathways involved in metabolism, complement activation, and cell signaling as mediated by IL‐8, p38/microtubule associated protein kinases (MAPK)/extracellular signal‐regulated kinases (ERK), Phosphatidylinositol 3 Kinase Gamma (PI3Kγ), and the B cell receptor. Follow‐up hallmark and canonical pathway analysis showed that 2 and 14 pathways were enriched in TRs, whereas 24 and 123 pathways were enriched in treatment TNRs, respectively. Prior treatment with glucocorticoids significantly altered expression of 13 genes in the analysis of subjects at diagnosis with JDM as compared with HCs. Conclusion Numerous genes and pathways differ between TRs and TNRs at diagnosis and follow‐up. Prior treatment with glucocorticoids prior to specimen acquisition had a small effect on the performed analyses.
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Affiliation(s)
| | | | - Simon W M Eng
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rae S M Yeung
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Deakin CT, Bowes J, Rider LG, Miller FW, Pachman LM, Sanner H, Rouster-Stevens K, Mamyrova G, Curiel R, Feldman BM, Huber AM, Reed AM, Schmeling H, Cook CG, Marshall LR, Wilkinson MGL, Eyre S, Raychaudhuri S, Wedderburn LR. Association with HLA-DRβ1 position 37 distinguishes juvenile Dermatomyositis from adult-onset myositis. Hum Mol Genet 2022; 31:2471-2481. [PMID: 35094092 PMCID: PMC9307311 DOI: 10.1093/hmg/ddac019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 09/10/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Juvenile dermatomyositis (JDM) is a rare, severe autoimmune disease and the most common idiopathic inflammatory myopathy (IIM) of children. JDM and adult-onset dermatomyositis (DM) have similar clinical, biological and serological features, although these features differ in prevalence between childhood-onset and adult-onset disease, suggesting age of disease onset may influence pathogenesis. Therefore, a JDM-focused genetic analysis was performed using the largest collection of JDM samples to date.
Methods
Caucasian JDM samples (n = 952) obtained via international collaboration were genotyped using the Illumina HumanCoreExome chip. Additional non-assayed HLA loci and genome-wide SNPs were imputed.
Results
HLA-DRB1*03:01 was confirmed as the classical HLA allele most strongly associated with JDM (OR 1.66; 95% CI 1.46, 1.89; P = 1.4 × 10−14), with an independent association at HLA-C*02:02 (OR = 1.74; 95% CI 1.42, 2.13, P = 7.13 × 10−8). Analyses of amino acid positions within HLA-DRB1 indicated the strongest association was at position 37 (omnibus P = 3.3 × 10−19), with suggestive evidence this association was independent of position 74 (omnibus P = 5.1 × 10−5), the position most strongly associated with adult-onset DM. Conditional analyses also suggested the association at position 37 of HLA-DRB1 was independent of some alleles of the Caucasian HLA 8.1 ancestral haplotype (AH8.1) such as HLA-DQB1*02:01 (OR = 1.62; 95% CI 1.36, 1.93; P = 8.70 × 10−8), but not HLA-DRB1*03:01 (OR = 1.49; 95% CR 1.24, 1.80; P = 2.24 × 10−5). No associations outside the HLA region were identified.
Conclusions
Our findings confirm previous associations with AH8.1 and HLA-DRB1*03:01, HLA-C*02:02 and identify a novel association with amino acid position 37 within HLA-DRB1 which may distinguish JDM from adult DM.
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Affiliation(s)
- Claire T Deakin
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospital and Great Ormond Street Hospital, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Lauren M Pachman
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Helga Sanner
- Department of Rheumatology, University of Oslo, Oslo, Norway
- Oslo New University College, Oslo, Norway
| | | | - Gulnara Mamyrova
- Division of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rodolfo Curiel
- Division of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Brian M Feldman
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ann M Reed
- Pediatrics, Duke University, Durham, North Carolina, USA
| | - Heinrike Schmeling
- Alberta Children's Hospital and Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Charlotte G Cook
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lucy R Marshall
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospital and Great Ormond Street Hospital, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Meredyth G Ll Wilkinson
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospital and Great Ormond Street Hospital, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Stephen Eyre
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Soumya Raychaudhuri
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospital and Great Ormond Street Hospital, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
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9
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Dvergsten JA, Reed AM, Landerman L, Pisetsky DS, Ilkayeva O, Huffman KM. Metabolomics Analysis Identifies a Lipidomic Profile in Treatment Naïve Juvenile Dermatomyositis Patients versus Healthy Control Subjects. Rheumatology (Oxford) 2021; 61:1699-1708. [PMID: 34185053 PMCID: PMC8996785 DOI: 10.1093/rheumatology/keab520] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objectives To perform an exploratory study to identify a JDM serum metabolic profile that differs from healthy controls (HCs) and responds to immunosuppressive treatment. Methods Blood was collected from 9 HCs and 10 patients diagnosed with probable (n = 4) or definite (n = 6) JDM based on the criteria of Bohan and Peter for myositis, with 7 of the 10 providing longitudinal samples following initiation of treatment; these patients comprised the treatment-naïve cohort. Sera underwent mass spectroscopy–based measurements of targeted metabolic intermediates, including 15 amino acids, 45 acylcarnitines (ACs), 15 ceramides and 29 sphingomyelins. Principal components analysis reduced metabolites into smaller sets of factors each comprised of correlated metabolic intermediates. Factor scores and metabolite concentrations were compared with HCs using two-sample t-tests while treatment effects were evaluated using paired t-tests. Results Of eight principal components analysis–derived metabolite factors (one AC, two amino acids, three sphingosine and two ceramide), two were significantly associated with JDM: one AC factor containing mostly long-chain ACs (P = 0.049) and one ceramide factor (P < 0.01). For 12 individual ACs, mostly long chain, and three ceramides, concentrations were significantly greater for JDM than HCs. Factors based on these individual metabolites showed decreasing scores with treatment (P = 0.03 and P < 0.01, respectively). Conclusion While additional validation is needed, these lipids have potential as JDM serum diagnostic and/or treatment biomarkers. Additionally, the significant association of long-chain ACs and ceramides with JDM offers insights regarding pathogenesis, implicating dysregulation of mitochondrial fatty acid β-oxidation.
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Affiliation(s)
- Jeffrey A Dvergsten
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
| | - Ann M Reed
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
| | - Lawrence Landerman
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
| | - David S Pisetsky
- Department of Medicine and Immunology, Duke University Medical Center and Research Service, Durham VA Medical Center, Durham, NC, USA
| | - Olga Ilkayeva
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
| | - Kim M Huffman
- Department of Medicine, Duke Molecular Physiology Institute, Duke School of Medicine, Durham, NC, USA
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10
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Liu K, Tomlinson G, Reed AM, Huber AM, Saarela O, Bout-Tabaku SM, Curran M, Dvergsten JA, Eberhard BA, Jung LK, Kim S, Ringold S, Rouster-Steven KA, Tesher M, Wahezi DM, Feldman BM. Pilot Study of the Juvenile Dermatomyositis Consensus Treatment Plans: A CARRA Registry Study. J Rheumatol 2020; 48:114-122. [PMID: 32238513 DOI: 10.3899/jrheum.190494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 02/10/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To determine the feasibility of comparing the Childhood Arthritis and Rheumatology ResearchAlliance (CARRA) consensus treatment plans (CTP) in treating moderate new-onset juvenile dermatomyositis (JDM) using the CARRA registry, and to establish appropriate analytic methods to control for confounding by indication and missing data. METHODS A pilot cohort of 39 patients with JDM from the CARRA registry was studied. Patients were assigned by the treating physician, considering patient/family preferences, to 1 of 3 CTP: methotrexate (MTX) and prednisone (MP); intravenous (IV) methylprednisolone, MTX, and prednisone (MMP); or IV methylprednisolone, MTX, prednisone, and IV immunoglobulin (MMPI). The primary outcome was the proportion of patients achieving moderate improvement at 6 months under each CTP. Statistical methods including multiple imputation and inverse probability of treatment weighting were used to handle missing data and confounding by indication. RESULTS Patients received MP (n = 13), MMP (n = 18) and MMPI (n = 8). Patients in all CTP had significant improvement in disease activity. Of the 36 patients who remained in our pilot study at 6 months, 16 (44%) of them successfully achieved moderate improvement at 6 months (6/13, 46% for MP; 7/15, 47% for MMP; 3/8, 38% for MMPI). After correcting for confounding, there were no statistically significant pairwise differences between the CTP (P = 0.328-0.88). CONCLUSION We gained valuable experience and insight from our pilot study that can be used to guide the design and analysis of comparative effectiveness studies using the CARRA registry CTP approach. Our analytical methods can be adopted for future comparative effectiveness studies and applied to other rare disease observational studies.
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Affiliation(s)
- Kuan Liu
- K. Liu, MMath, B.M. Feldman, MD, MSc, FRCPC, The Hospital for Sick Children, Toronto, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - George Tomlinson
- G. Tomlinson, PhD, Department of Medicine, University Health Network, Toronto, Ontario, Canada.,G. Tomlinson, PhD, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Ann M Reed
- A.M. Reed, MD, Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Adam M Huber
- A.M. Huber, MD, MSc, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Olli Saarela
- O. Saarela, PhD, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sharon M Bout-Tabaku
- S.M. Bout-Tabaku, MD, MSCE, Department of Pediatric Medicine, Sidra Medicine, Doha, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Megan Curran
- M.L. Curran, MD, Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Jeffrey A Dvergsten
- J.A. Dvergsten, MD, Department of Pediatrics, Duke University Medical Center, Durham, and Department of Pediatrics, Duke Children's Hospital, Durham, North Carolina, USA
| | - Barbara A Eberhard
- B.A. Eberhard, MBBS, MS, Division of Pediatric Rheumatology, Steven and Alexandra Cohen Children's Medical Center of New York, Lake Success, New York, and Department of Pediatrics, Hofstra Northwell School of Medicine, Hempstead, New York, USA
| | - Lawrence K Jung
- L.K. Jung, MD, Division of Rheumatology, Children's National Health System, Washington, D.C., USA
| | - Susan Kim
- S. Kim, MD, MMSc, Department of Pediatrics, University of California San Francisco, San Francisco, California, USA
| | - Sarah Ringold
- S. Ringold, MD, Seattle Children's Hospital and Research Institute, Seattle, Washington, USA
| | - Kelly A Rouster-Steven
- K.A. Rouster-Steven, MD, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Melissa Tesher
- M. Tesher, MD, Comer Children's Hospital, University of Chicago Medical Center, Chicago, Illinois, USA
| | - Dawn M Wahezi
- D.M. Wahezi, MD, Msc, Division of Pediatric Rheumatology, the Children's Hospital at Montefiore, Bronx, New York, USA
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11
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Eng SWM, Olazagasti JM, Goldenberg A, Crowson CS, Oddis CV, Niewold TB, Yeung RSM, Reed AM. A Clinically and Biologically Based Subclassification of the Idiopathic Inflammatory Myopathies Using Machine Learning. ACR Open Rheumatol 2020; 2:158-166. [PMID: 32039563 PMCID: PMC7077789 DOI: 10.1002/acr2.11115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 08/15/2019] [Accepted: 12/10/2019] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE Published predictive models of disease outcomes in idiopathic inflammatory myopathies (IIMs) are sparse and of limited accuracy due to disease heterogeneity. Computational methods may address this heterogeneity by partitioning patients based on clinical and biological phenotype. METHODS To identify new patient groups, we applied similarity network fusion (SNF) to clinical and biological data from 168 patients with myositis (64 adult polymyositis [PM], 65 adult dermatomyositis [DM], and 39 juvenile DM [JDM]) in the Rituximab in Myositis trial. We generated a sparse proof-of-concept bedside classifier using multinomial regression and identified characteristics that distinguished these groups. We conducted χ2 tests to link new patient groups with the myositis subtypes. RESULTS SNF identified five patient groups in the discovery cohort that subdivided the myositis subtypes. The sparse multinomial regressor to predict patient group assignments (areas under the receiver operating characteristic curve = [0.78, 0.97]; areas under the precision-recall curve = [0.55, 0.96]) found that autoantibody enrichment defined four of these groups: anti-Mi-2, anti-signal recognition peptide (SRP), anti-nuclear matrix protein 2 (NXP2), and anti-synthetase (Syn). Depletion of immunoglobulin M (IgM) defined the fifth group. Each group was associated with one subtype, with adult DM being associated with anti-Mi-2 and anti-Syn autoantibodies, JDM being associated with anti-NXP2 autoantibodies, and adult PM being associated with IgM depletion and anti-SRP autoantibodies. These associations enabled us to further resolve the current myositis subtypes. CONCLUSION Using unsupervised machine learning, we identified clinically and biologically homogeneous groups of patients with IIMs, forming the basis of an integrated disease classification based on both clinical and biological phenotype, thus validating other approaches and what has been previously described.
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Affiliation(s)
- Simon W M Eng
- Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| | | | - Anna Goldenberg
- Hospital for Sick Children (SickKids), Vector Institute, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Rae S M Yeung
- Hospital for Sick Children (SickKids), University of Toronto, Toronto, Ontario, Canada
| | - Ann M Reed
- Duke University School of Medicine, Durham, North Carolina
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12
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Wu JQ, Lu MP, Reed AM. Juvenile dermatomyositis: advances in clinical presentation, myositis-specific antibodies and treatment. World J Pediatr 2020; 16:31-43. [PMID: 31556011 DOI: 10.1007/s12519-019-00313-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Received: 08/05/2019] [Accepted: 08/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Juvenile dermatomyositis (JDM) is a chronic autoimmune disease characteristic by inflammation of small vessels within the skin, muscle and vital organs. But the clinical features and treatment of JDM have not been fully clarified. DATA SOURCES Databases underwent through PubMed for articles about the clinical features, myositis-specific antibodies of JDM and its treatment, and we selected publications written in English which were relevant to the topic of this review. RESULTS Clinical features and myositis-specific antibodies may predict the severity and prognosis of disease. Although the mortality rate has been lower with traditional treatments, such as corticosteroid, intravenous immunoglobulin, and disease-modifying anti-rheumatic drugs such as methotrexate, their usages are variable. Novel biological therapies seem to be effective for refractory JDM patients, but more clinical trials are necessary. CONCLUSIONS JDM is a sever disease of childhood. We need to better understand recent advances of JDM in the context of clinical features including skin manifestations, muscle weakness and organ damage, myositis-specific antibodies and their associated outcomes and the treatment of disease.
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Affiliation(s)
- Jian-Qiang Wu
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Mei-Ping Lu
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, China
| | - Ann M Reed
- Department of Pediatrics, Division of Pediatric Rheumatology, Duke University School of Medicine, Durham, 27710, USA.
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13
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Hurst JH, Barrett KJ, Kelly MS, Staples BB, McGann KA, Cunningham CK, Reed AM, Gbadegesin RA, Permar SR. Cultivating Research Skills During Clinical Training to Promote Pediatric-Scientist Development. Pediatrics 2019; 144:e20190745. [PMID: 31363070 PMCID: PMC6855830 DOI: 10.1542/peds.2019-0745] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 11/24/2022] Open
Abstract
Physician-scientists represent a critical component of the biomedical and health research workforce. However, the proportion of physicians who spend a significant amount of effort on scientific research has declined over the past 40 years. This trend has been particularly noticeable in pediatrics despite recent scientific work revealing that early life influences, exposures, and health status play a significant role in lifelong health and disease. To address this problem, the Duke University Department of Pediatrics developed the Duke Pediatric Research Scholars Program for Physician-Scientist Development (DPRS). The DPRS is focused on research training during pediatric residency and fellowship. We aim to provide sufficient research exposure and support to help scholars develop a research niche and scholarly products as well as identify the career pathways that will enable them to achieve their research goals. Herein, we describe the DPRS's organizational structure, core components, recruitment strategies, and initial results, and we discuss implementation challenges and solutions. Additionally, we detail the program's integration with the department's residency and fellowship training programs (with particular reference to the challenges of integrating research into small- to medium-sized residency programs) and describe the development and integration of related initiatives across Duke University School of Medicine. The program served as the basis for 2 successful National Institutes of Health Stimulating Access to Research in Residency (R38) applications, and we hope it will serve as a model to integrate formalized research training for residents and fellows who wish to pursue research careers in academic medicine.
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Affiliation(s)
- Jillian H. Hurst
- Duke Pediatric Research Scholars Program for Physician-Scientist Development and
- Clinical and Translational Sciences Institute
- Office of Physician-Scientist Development, Duke University, Durham, North Carolina; and
- Department of Pediatrics, Children’s Health and Discovery Institute, Durham, North Carolina
| | - Katherine J. Barrett
- Duke Pediatric Research Scholars Program for Physician-Scientist Development and
- Office of Physician-Scientist Development, Duke University, Durham, North Carolina; and
| | - Matthew S. Kelly
- Duke Pediatric Research Scholars Program for Physician-Scientist Development and
- Divisions of Infectious Diseases and
| | | | | | | | | | - Rasheed A. Gbadegesin
- Duke Pediatric Research Scholars Program for Physician-Scientist Development and
- Nephrology
- Duke Molecular Physiology Institute
- Office of Physician-Scientist Development, Duke University, Durham, North Carolina; and
| | - Sallie R. Permar
- Duke Pediatric Research Scholars Program for Physician-Scientist Development and
- Divisions of Infectious Diseases and
- Duke Human Vaccine Institute, and
- Office of Physician-Scientist Development, Duke University, Durham, North Carolina; and
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14
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Rothwell S, Chinoy H, Lamb JA, Miller FW, Rider LG, Wedderburn LR, McHugh NJ, Mammen AL, Betteridge ZE, Tansley SL, Bowes J, Vencovský J, Deakin CT, Dankó K, Vidya L, Selva-O'Callaghan A, Pachman LM, Reed AM, Molberg Ø, Benveniste O, Mathiesen PR, Radstake TRDJ, Doria A, de Bleecker J, Lee AT, Hanna MG, Machado PM, Ollier WE, Gregersen PK, Padyukov L, O'Hanlon TP, Cooper RG, Lundberg IE. Focused HLA analysis in Caucasians with myositis identifies significant associations with autoantibody subgroups. Ann Rheum Dis 2019; 78:996-1002. [PMID: 31138531 PMCID: PMC6585280 DOI: 10.1136/annrheumdis-2019-215046] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/14/2019] [Accepted: 03/30/2019] [Indexed: 12/23/2022]
Abstract
Objectives Idiopathic inflammatory myopathies (IIM) are a spectrum of rare autoimmune diseases characterised clinically by muscle weakness and heterogeneous systemic organ involvement. The strongest genetic risk is within the major histocompatibility complex (MHC). Since autoantibody presence defines specific clinical subgroups of IIM, we aimed to correlate serotype and genotype, to identify novel risk variants in the MHC region that co-occur with IIM autoantibodies. Methods We collected available autoantibody data in our cohort of 2582 Caucasian patients with IIM. High resolution human leucocyte antigen (HLA) alleles and corresponding amino acid sequences were imputed using SNP2HLA from existing genotyping data and tested for association with 12 autoantibody subgroups. Results We report associations with eight autoantibodies reaching our study-wide significance level of p<2.9×10–5. Associations with the 8.1 ancestral haplotype were found with anti-Jo-1 (HLA-B*08:01, p=2.28×10–53 and HLA-DRB1*03:01, p=3.25×10–9), anti-PM/Scl (HLA-DQB1*02:01, p=1.47×10–26) and anti-cN1A autoantibodies (HLA-DRB1*03:01, p=1.40×10–11). Associations independent of this haplotype were found with anti-Mi-2 (HLA-DRB1*07:01, p=4.92×10–13) and anti-HMGCR autoantibodies (HLA-DRB1*11, p=5.09×10–6). Amino acid positions may be more strongly associated than classical HLA associations; for example with anti-Jo-1 autoantibodies and position 74 of HLA-DRB1 (p=3.47×10–64) and position 9 of HLA-B (p=7.03×10–11). We report novel genetic associations with HLA-DQB1 anti-TIF1 autoantibodies and identify haplotypes that may differ between adult-onset and juvenile-onset patients with these autoantibodies. Conclusions These findings provide new insights regarding the functional consequences of genetic polymorphisms within the MHC. As autoantibodies in IIM correlate with specific clinical features of disease, understanding genetic risk underlying development of autoantibody profiles has implications for future research.
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Affiliation(s)
- Simon Rothwell
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK
| | - Janine A Lamb
- Centre for Epidemiology, The University of Manchester, Manchester, UK
| | - Frederick W Miller
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Lucy R Wedderburn
- NIHR Great Ormond Street Biomedical Research Centre, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Neil J McHugh
- Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Andrew L Mammen
- Muscle Disease Unit, Laboratory of Muscle Stem Cells and Gene Regulation, National Institute of Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA.,Departments of Neurology and Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | - Sarah L Tansley
- Pharmacy and Pharmacology, University of Bath, Bath, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - John Bowes
- Arthritis Research UK Centre for Genetics and Genomics, The University of Manchester, Manchester, UK
| | - Jiří Vencovský
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Claire T Deakin
- NIHR Great Ormond Street Biomedical Research Centre, University College London, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, London, UK
| | - Katalin Dankó
- Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Limaye Vidya
- Rheumatology Unit, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Albert Selva-O'Callaghan
- Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Lauren M Pachman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann M Reed
- Pediatrics, Duke University, Durham, North Carolina, USA
| | - Øyvind Molberg
- Department of Rheumatology, University of Oslo, Oslo, Norway
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié-Salpêtrière University Hospital, France, France
| | - Pernille R Mathiesen
- Department of Paediatrics and Adolescent Medicine, Rigshospitalet, Copenhagen, Denmark
| | - Timothy R D J Radstake
- Department of Rheumatology and Clinical Immunology, Utrecht Medical Center, Utrecht, The Netherlands
| | - Andrea Doria
- Division of Rheumatology, University of Padova, Padova, Italy
| | | | - Annette T Lee
- Robert S. Boas Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, Department of Neuromuscular Diseases, University College London Institute of Neurology, London, UK
| | - Pedro M Machado
- Department of Rheumatology, University College London Hospital NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - William E Ollier
- Centre for Epidemiology, The University of Manchester, Manchester, UK.,School of Healthcare Sciences, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Peter K Gregersen
- Center for Genomics and Human Genetics, The Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Terrance P O'Hanlon
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Robert G Cooper
- MRC/ARUK Centre for Integrated Research into Musculoskeletal Ageing, University of Liverpool, Liverpool, Merseyside, UK
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden
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15
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Crowson CS, Hein MS, Pendegraft RS, Strausbauch MA, Niewold TB, Ernste FC, Dvergsten J, Amin S, Wampler Muskardin TL, Peterson E, Baechler EC, Reed AM. Interferon Chemokine Score and Other Cytokine Measures Track With Changes in Disease Activity in Patients With Juvenile and Adult Dermatomyositis. ACR Open Rheumatol 2019; 1:83-89. [PMID: 31777784 PMCID: PMC6857969 DOI: 10.1002/acr2.1011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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] [Indexed: 01/16/2023] Open
Abstract
Objective Our aim was to identify cytokines and chemokines in patients with adult dermatomyositis (DM) and juvenile dermatomyositis (JDM) that predict changes in disease activity. Methods Multiplexed immunoassays (Meso Scale Discovery) enabled simultaneous measurement of interferon (IFN)‐regulated chemokines and other pro‐ and anti‐inflammatory cytokines specific to differentiation of specific T‐cell and innate pathways. Cytokine scores were computed for IFNCK (IP‐10, MCP‐1), Th1 (IFNɣ, TNFα, and IL2), Th2 (IL4, IL10, IL12, and IL 13), Th17 (IL6, IL17, IL1β), macrophage (MIP‐1α, MIP‐1β, IL8), and regulatory (IL10, TNFα) factors. Spearman correlation and mixed models were used to examine whether cytokines at a previous visit predict change in disease activity at the next visit. Results The study included 36 patients (16 DM and 20 JDM) with at least two visits (87 patient intervals between two visits). Mean age (SD) at inclusion was 56.9 (18.4) years for DM and 10.8 (6.6) years in JDM, 67% of patients were female, 89% Caucasian. The mean (SD) physician global, muscle and extra‐muscular disease activity Visual Analog Scale scores at inclusion were 41 (26), 36 (30), and 34 (21) mm, respectively. The change in IFN score from one visit to the next was associated with the change in physician global (P = 0.010) and extramuscular (P < 0.001) disease activity scores. Preliminary results revealed significant correlations of previous IFNCK score and IL‐6 with subsequent disease activity measures, but after adjustment for multiple visits per patient, these associations did not reach statistical significance. Conclusion There is a potential relationship between IFNCK and other cytokine scores seen in adult and juvenile DM with future disease states.
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Affiliation(s)
| | - Molly S Hein
- Mayo Clinic College of Medicine Rochester Minnesota
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16
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Houtman M, Ekholm L, Hesselberg E, Chemin K, Malmström V, Reed AM, Lundberg IE, Padyukov L. T-cell transcriptomics from peripheral blood highlights differences between polymyositis and dermatomyositis patients. Arthritis Res Ther 2018; 20:188. [PMID: 30157932 PMCID: PMC6116372 DOI: 10.1186/s13075-018-1688-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 05/26/2018] [Accepted: 07/29/2018] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Polymyositis (PM) and dermatomyositis (DM) are two distinct subgroups of idiopathic inflammatory myopathies, a chronic inflammatory disorder clinically characterized by muscle weakness and inflammatory cell infiltrates in muscle tissue. In PM, a major component of inflammatory cell infiltrates is CD8+ T cells, whereas in DM, CD4+ T cells, plasmacytoid dendritic cells, and B cells predominate. In this study, with the aim to differentiate involvement of CD4+ and CD8+ T-cell subpopulations in myositis subgroups, we investigated transcriptomic profiles of T cells from peripheral blood of patients with myositis. METHODS Total RNA was extracted from CD4+ T cells (PM = 8 and DM = 7) and CD8+ T cells (PM = 4 and DM = 5) that were isolated from peripheral blood mononuclear cells via positive selection using microbeads. Sequencing libraries were generated using the Illumina TruSeq Stranded Total RNA Kit and sequenced on an Illumina HiSeq 2500 platform, yielding about 50 million paired-end reads per sample. Differential gene expression analyses were conducted using DESeq2. RESULTS In CD4+ T cells, only two genes, ANKRD55 and S100B, were expressed significantly higher in patients with PM than in patients with DM (false discovery rate [FDR] < 0.05, model adjusted for age, sex, HLA-DRB1*03 status, and RNA integrity number [RIN]). On the contrary, in CD8+ T cells, 176 genes were differentially expressed in patients with PM compared with patients with DM. Of these, 44 genes were expressed significantly higher in CD8+ T cells from patients with PM, and 132 genes were expressed significantly higher in CD8+ T cells from patients with DM (FDR < 0.05, model adjusted for age, sex, and RIN). Gene Ontology analysis showed that genes differentially expressed in CD8+ T cells are involved in lymphocyte migration and regulation of T-cell differentiation. CONCLUSIONS Our data strongly suggest that CD8+ T cells represent a major divergence between PM and DM patients compared with CD4+ T cells. These alterations in the gene expression in T cells from PM and DM patients might advocate for distinct immune mechanisms in these subphenotypes of myositis.
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Affiliation(s)
- Miranda Houtman
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
| | - Louise Ekholm
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Espen Hesselberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Karine Chemin
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Vivianne Malmström
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ann M Reed
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, USA
| | - Ingrid E Lundberg
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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17
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Abstract
The adult and juvenile myositis syndromes, commonly referred to collectively as idiopathic inflammatory myopathies (IIMs), are systemic autoimmune diseases with the hallmarks of muscle weakness and inflammation. Validated, well-standardized measures to assess disease activity, known as core set measures, were developed by international networks of myositis researchers for use in clinical trials. Composite response criteria using weighted changes in the core set measures of disease activity were developed and validated for adult and juvenile patients with dermatomyositis and adult patients with polymyositis, with different thresholds for minimal, moderate and major improvement in adults and juveniles. Additional measures of muscle strength and function are being validated to improve content validity and sensitivity to change. A health-related quality of life measure, which incorporates patient input, is being developed for adult patients with IIM. Disease state criteria, including criteria for inactive disease and remission, are being used as secondary end points in clinical trials. MRI of muscle and immunological biomarkers are promising approaches to discriminate between disease activity and damage and might provide much-needed objective outcome measures. These advances in the assessment of outcomes for myositis treatment, along with collaborations between international networks, should facilitate further development of new therapies for patients with IIM.
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Affiliation(s)
- Lisa G. Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Rohit Aggarwal
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA
| | - Pedro M. Machado
- Centre for Rheumatology & MRC Centre for Neuromuscular Diseases, University College London, London, UK
| | | | - Ann M. Reed
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Lisa Christopher-Stine
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Nicolino Ruperto
- Istituto Giannina Gaslini, Clinica Pediatria e Reumatologia, PRINTO, Genoa, Italy
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18
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Hinks A, Marion MC, Cobb J, Comeau ME, Sudman M, Ainsworth HC, Bowes J, Becker ML, Bohnsack JF, Haas JP, Lovell DJ, Mellins ED, Nelson JL, Nordal E, Punaro M, Reed AM, Rose CD, Rosenberg AM, Rygg M, Smith SL, Stevens AM, Videm V, Wallace CA, Wedderburn LR, Yarwood A, Yeung RSM, Langefeld CD, Thompson SD, Thomson W, Prahalad S. Brief Report: The Genetic Profile of Rheumatoid Factor-Positive Polyarticular Juvenile Idiopathic Arthritis Resembles That of Adult Rheumatoid Arthritis. Arthritis Rheumatol 2018; 70:957-962. [PMID: 29426059 PMCID: PMC5984672 DOI: 10.1002/art.40443] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 08/01/2017] [Accepted: 02/01/2018] [Indexed: 02/03/2023]
Abstract
Objective Juvenile idiopathic arthritis (JIA) comprises 7 heterogeneous categories of chronic childhood arthritides. Approximately 5% of children with JIA have rheumatoid factor (RF)–positive arthritis, which phenotypically resembles adult rheumatoid arthritis (RA). Our objective was to compare and contrast the genetics of RF‐positive polyarticular JIA with those of RA and selected other JIA categories, to more fully understand the pathophysiologic relationships of inflammatory arthropathies. Methods Patients with RF‐positive polyarticular JIA (n = 340) and controls (n = 14,412) were genotyped using the Immunochip array. Single‐nucleotide polymorphisms were tested for association using a logistic regression model adjusting for admixture proportions. We calculated weighted genetic risk scores (wGRS) of reported RA and JIA risk loci, and we compared the ability of these wGRS to predict RF‐positive polyarticular JIA. Results As expected, the HLA region was strongly associated with RF‐positive polyarticular JIA (P = 5.51 × 10−31). Nineteen of 44 RA risk loci and 6 of 27 oligoarticular/RF‐negative polyarticular JIA risk loci were associated with RF‐positive polyarticular JIA (P < 0.05). The RA wGRS predicted RF‐positive polyarticular JIA (area under the curve [AUC] 0.71) better than did the oligoarticular/RF‐negative polyarticular JIA wGRS (AUC 0.59). The genetic profile of patients with RF‐positive polyarticular JIA was more similar to that of RA patients with age at onset 16–29 years than to that of RA patients with age at onset ≥70 years. Conclusion RF‐positive polyarticular JIA is genetically more similar to adult RA than to the most common JIA categories and thus appears to be a childhood‐onset presentation of autoantibody‐positive RA. These findings suggest common disease mechanisms, which could lead to novel therapeutic targets and shared treatment strategies.
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Affiliation(s)
- Anne Hinks
- University of Manchester, Manchester, UK
| | - Miranda C Marion
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Joanna Cobb
- University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Mary E Comeau
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Marc Sudman
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Hannah C Ainsworth
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - John Bowes
- University of Manchester, Manchester, UK
| | | | | | | | - Johannes-Peter Haas
- German Centre for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - J Lee Nelson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle
| | - Ellen Nordal
- University Hospital of North Norway and UIT The Arctic University of Norway, Tromsø, Norway
| | - Marilynn Punaro
- Arthritis Clinic Texas Scottish Rite Hospital for Children and University of Texas Southwestern Medical Center, Dallas
| | - Ann M Reed
- Duke University School of Medicine, Durham, North Carolina
| | | | | | - Marite Rygg
- Norwegian University of Science and Technology and St. Olav's University Hospital, Trondheim, Norway
| | | | - Anne M Stevens
- Seattle Children's Research Institute and University of Washington, Seattle
| | - Vibeke Videm
- Norwegian University of Science and Technology and St. Olav's University Hospital, Trondheim, Norway
| | - Carol A Wallace
- Seattle Children's Hospital and Research Institute, Seattle, Washington
| | - Lucy R Wedderburn
- University College London and NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | | | - Rae S M Yeung
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Carl D Langefeld
- Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | | | - Wendy Thomson
- University of Manchester and Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Sampath Prahalad
- Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
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Challa D, Crowson CS, Niewold TB, Reed AM. Predictors of changes in disease activity among children with juvenile dermatomyositis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry. Clin Rheumatol 2017; 37:1011-1015. [PMID: 29170979 DOI: 10.1007/s10067-017-3901-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 10/26/2017] [Accepted: 10/29/2017] [Indexed: 01/25/2023]
Abstract
Determinants of changes in disease activity among patients with juvenile dermatomyositis (JDM) are unknown. Our objective was to develop predictive models to predict changes in disease activity using the CARRA Legacy Registry. The CARRA Legacy Registry included 658 subjects with definite or probably JDM with 297 subjects with a one follow-up visit after baseline, and we studied the 65 subjects with active disease at baseline. Linear regression models were used to build risk scores for changes in disease activity adjusted for baseline disease activity, age, sex, and disease duration. Disease activity improved from baseline to 6-month follow-up as measured by patient/parent global health score (median 4; p = 0.008), patient pain score (median 2; p = 0.014), physician global (median 4; p < 0.001), and Childhood Myositis Assessment Scale (CMAS) (median 41, p < 0.001). Anti-nuclear antibodies (p = 0.013) and hydroxychloroquine use (p = 0.045) were significant predictors of less improvement in patient/parent global and baseline patient/parent global. Anti-nuclear antibodies (p = 0.001) and V/shawl sign (p = 0.005) were significant predictors of less improvement in patient pain (R-square improved from 0.29 for adjustors alone to 0.46 for the full model). Small joint arthritis (p < 0.01) predicted less improvement and dysphagia/dysphonia (p = 0.033) predicted greater improvement in CMAS and baseline CMAS (R-square improved from 0.73 for adjustors alone to 0.86 for the full model). Disease characteristics can help identify patients who are less likely to improve over time. Risk scores to predict future changes in disease activity could be used to trigger more aggressive treatment earlier in the disease course.
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Affiliation(s)
- Divya Challa
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.,Department of Health Science Research, Mayo Clinic, Rochester, MN, USA
| | - Timothy B Niewold
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.,Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Ann M Reed
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Box 3352, Durham, NC, 27710, USA.
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20
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Bottai M, Tjärnlund A, Santoni G, Werth VP, Pilkington C, de Visser M, Alfredsson L, Amato AA, Barohn RJ, Liang MH, Singh JA, Aggarwal R, Arnardottir S, Chinoy H, Cooper RG, Danko K, Dimachkie MM, Feldman BM, García-De La Torre I, Gordon P, Hayashi T, Katz JD, Kohsaka H, Lachenbruch PA, Lang BA, Li Y, Oddis CV, Olesinka M, Reed AM, Rutkowska-Sak L, Sanner H, Selva-O’Callaghan A, Wook Song Y, Vencovsky J, Ytterberg SR, Miller FW, Rider LG, Lundberg IE. EULAR/ACR classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups: a methodology report. RMD Open 2017; 3:e000507. [PMID: 29177080 PMCID: PMC5687535 DOI: 10.1136/rmdopen-2017-000507] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [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: 06/01/2017] [Revised: 09/25/2017] [Accepted: 10/21/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To describe the methodology used to develop new classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIMs) and their major subgroups. METHODS An international, multidisciplinary group of myositis experts produced a set of 93 potentially relevant variables to be tested for inclusion in the criteria. Rheumatology, dermatology, neurology and paediatric clinics worldwide collected data on 976 IIM cases (74% adults, 26% children) and 624 non-IIM comparator cases with mimicking conditions (82% adults, 18% children). The participating clinicians classified each case as IIM or non-IIM. Generally, the classification of any given patient was based on few variables, leaving remaining variables unmeasured. We investigated the strength of the association between all variables and between these and the disease status as determined by the physician. We considered three approaches: (1) a probability-score approach, (2) a sum-of-items approach criteria and (3) a classification-tree approach. RESULTS The approaches yielded several candidate models that were scrutinised with respect to statistical performance and clinical relevance. The probability-score approach showed superior statistical performance and clinical practicability and was therefore preferred over the others. We developed a classification tree for subclassification of patients with IIM. A calculator for electronic devices, such as computers and smartphones, facilitates the use of the European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria. CONCLUSIONS The new EULAR/ACR classification criteria provide a patient's probability of having IIM for use in clinical and research settings. The probability is based on a score obtained by summing the weights associated with a set of criteria items.
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Affiliation(s)
- Matteo Bottai
- Unit of Biostatistics, Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anna Tjärnlund
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Giola Santoni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Victoria P Werth
- Department of Dermatology, Philadelphia VAMC and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clarissa Pilkington
- Department of Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Marianne de Visser
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lars Alfredsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anthony A Amato
- Department of Neurology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Matthew H Liang
- Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, and Section of Rheumatology, Boston VA Healthcare System, Boston, Massachusetts, USA
| | - Jasvinder A Singh
- University of Alabama at Birmingham (UAB) and Birmingham VA Medical, Birmingham, Alabama, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Hector Chinoy
- National Institute of Health Research, Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Robert G Cooper
- MRC/ARUK Institute of Ageing and Chronic Disease, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - Katalin Danko
- Division of Immunology, 3rd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brian M Feldman
- Department of Pediatrics, Division of Rheumatology, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Ignacio García-De La Torre
- Department of Immunology and Rheumatology, Hospital General de Occidente, Secretaría de Salud, and University of Guadalajara, Guadalajara, Mexico
| | - Patrick Gordon
- Department of Rheumatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Taichi Hayashi
- Clinical Immunology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - James D Katz
- US Department of Health and Human Services, National Institutes of Health, Bethesda, Maryland, USA
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Peter A Lachenbruch
- Department of Public Health, Oregon State University, Corvallis, Oregon, USA
| | - Bianca A Lang
- Department of Pediatrics, Division of Rheumatology, IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Yuhui Li
- Department of Rheumatology and Immunology, People’s Hospital of Beijing University, Beijing, China
| | - Chester V Oddis
- Division of Rheumatology and Clinical Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marzena Olesinka
- Connective Tissue Diseases Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Lidia Rutkowska-Sak
- Paediatric Clinic of Rheumatology, Institute of Rheumatology, Warsaw, Poland
| | - Helga Sanner
- Section of Rheumatology, Oslo University Hospital–Rikshospitalet, Oslo, Norway
| | | | - Yeong Wook Song
- Department of Internal Medicine, Medical Research Center, Clinical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, US Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, US Department of Health and Human Services, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden
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21
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Rider LG, Ruperto N, Pistorio A, Erman B, Bayat N, Lachenbruch PA, Rockette H, Feldman BM, Huber AM, Hansen P, Oddis CV, Lundberg IE, Amato AA, Chinoy H, Cooper RG, Chung L, Danko K, Fiorentino D, García-De la Torre I, Reed AM, Wook Song Y, Cimaz R, Cuttica RJ, Pilkington CA, Martini A, van der Net J, Maillard S, Miller FW, Vencovsky J, Aggarwal R. 2016 ACR-EULAR adult dermatomyositis and polymyositis and juvenile dermatomyositis response criteria-methodological aspects. Rheumatology (Oxford) 2017; 56:1884-1893. [PMID: 28977549 DOI: 10.1093/rheumatology/kex226] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
Objective The objective was to describe the methodology used to develop new response criteria for adult DM/PM and JDM. Methods Patient profiles from prospective natural history data and clinical trials were rated by myositis specialists to develop consensus gold-standard ratings of minimal, moderate and major improvement. Experts completed a survey regarding clinically meaningful improvement in the core set measures (CSM) and a conjoint-analysis survey (using 1000Minds software) to derive relative weights of CSM and candidate definitions. Six types of candidate definitions for response criteria were derived using survey results, logistic regression, conjoint analysis, application of conjoint-analysis weights to CSM and published definitions. Sensitivity, specificity and area under the curve were defined for candidate criteria using consensus patient profile data, and selected definitions were validated using clinical trial data. Results Myositis specialists defined the degree of clinically meaningful improvement in CSM for minimal, moderate and major improvement. The conjoint-analysis survey established the relative weights of CSM, with muscle strength and Physician Global Activity as most important. Many candidate definitions showed excellent sensitivity, specificity and area under the curve in the consensus profiles. Trial validation showed that a number of candidate criteria differentiated between treatment groups. Top candidate criteria definitions were presented at the consensus conference. Conclusion Consensus methodology, with definitions tested on patient profiles and validated using clinical trials, led to 18 definitions for adult PM/DM and 14 for JDM as excellent candidates for consideration in the final consensus on new response criteria for myositis.
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Affiliation(s)
- Lisa G Rider
- Environmental Autoimmunity Group, NIEHS, National Institutes of Health, Bethesda, MD, USA
| | | | - Angela Pistorio
- Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy
| | - Brian Erman
- Social and Scientific Systems, Inc., Durham, NC
| | - Nastaran Bayat
- Environmental Autoimmunity Group, NIEHS, National Institutes of Health, Bethesda, MD, USA
| | - Peter A Lachenbruch
- Environmental Autoimmunity Group, NIEHS, National Institutes of Health, Bethesda, MD, USA
| | - Howard Rockette
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, PA, USA
| | - Brian M Feldman
- Division of Rheumatology, Hospital for Sick Children, Toronto, Ontario
| | - Adam M Huber
- Rheumatology Department, Izaak Walton Killam Health Centre, Halifax, Nova Scotia, Canada
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Chester V Oddis
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Ingrid E Lundberg
- Rheumatology Unit, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden
| | - Anthony A Amato
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Hector Chinoy
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust.,Manchester Academic Health Science Centre, The University of Manchester, Manchester
| | - Robert G Cooper
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Lorinda Chung
- Division of Rheumatology, Stanford University, Redwood City, CA, USA
| | - Katalin Danko
- 3rd Department of Internal Medicine, Division of Immunology, University of Debrecen, Debrecen, Hungary
| | - David Fiorentino
- Department of Dermatology, Stanford University, Redwood City, CA, USA
| | | | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC, USA
| | - Yeong Wook Song
- Department of Molecular Medicine and Biopharmaceutical Sciences, Medical Research Center, Seoul National University, Seoul, Korea
| | - Rolando Cimaz
- Pediatric Rheumatology, Azienda Ospedaliero Universitaria Meyer, University of Florence, Florence, Italy
| | - Rubén J Cuttica
- Department of Pediatric Rheumatology, Hospital de Niños Pedro de Elizalde, University of Buenos Aires, Buenos Aires, Argentina
| | - Clarissa A Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Alberto Martini
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO.,Università degli Studi di Genova, Dipartimento di Pediatria, Genoa, Italy
| | - Janjaap van der Net
- Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Susan Maillard
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Frederick W Miller
- Environmental Autoimmunity Group, NIEHS, National Institutes of Health, Bethesda, MD, USA
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, Charles University, Prague, Czech Republic
| | - Rohit Aggarwal
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
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22
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McCann LJ, Pilkington CA, Huber AM, Ravelli A, Appelbe D, Kirkham JJ, Williamson PR, Aggarwal A, Christopher-Stine L, Constantin T, Feldman BM, Lundberg I, Maillard S, Mathiesen P, Murphy R, Pachman LM, Reed AM, Rider LG, van Royen-Kerkof A, Russo R, Spinty S, Wedderburn LR, Beresford MW. Development of a consensus core dataset in juvenile dermatomyositis for clinical use to inform research. Ann Rheum Dis 2017; 77:241-250. [PMID: 29084729 PMCID: PMC5816738 DOI: 10.1136/annrheumdis-2017-212141] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [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: 07/27/2017] [Revised: 09/23/2017] [Accepted: 10/01/2017] [Indexed: 01/07/2023]
Abstract
Objectives This study aimed to develop consensus on an internationally agreed dataset for juvenile dermatomyositis (JDM), designed for clinical use, to enhance collaborative research and allow integration of data between centres. Methods A prototype dataset was developed through a formal process that included analysing items within existing databases of patients with idiopathic inflammatory myopathies. This template was used to aid a structured multistage consensus process. Exploiting Delphi methodology, two web-based questionnaires were distributed to healthcare professionals caring for patients with JDM identified through email distribution lists of international paediatric rheumatology and myositis research groups. A separate questionnaire was sent to parents of children with JDM and patients with JDM, identified through established research networks and patient support groups. The results of these parallel processes informed a face-to-face nominal group consensus meeting of international myositis experts, tasked with defining the content of the dataset. This developed dataset was tested in routine clinical practice before review and finalisation. Results A dataset containing 123 items was formulated with an accompanying glossary. Demographic and diagnostic data are contained within form A collected at baseline visit only, disease activity measures are included within form B collected at every visit and disease damage items within form C collected at baseline and annual visits thereafter. Conclusions Through a robust international process, a consensus dataset for JDM has been formulated that can capture disease activity and damage over time. This dataset can be incorporated into national and international collaborative efforts, including existing clinical research databases.
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Affiliation(s)
- Liza J McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Clarissa A Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, University College London Hospital, London, UK
| | - Adam M Huber
- Division of Pediatric Rheumatology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Angelo Ravelli
- Division of Rheumatology, Università degli Studi di Genova and Istituto Giannina Gaslini Pediatria II-Reumatologia, Genoa, Italy
| | - Duncan Appelbe
- Department of Biostatistics, MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Jamie J Kirkham
- Department of Biostatistics, MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Department of Biostatistics, MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Tamas Constantin
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Brian M Feldman
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ingrid Lundberg
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sue Maillard
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pernille Mathiesen
- Department of Paediatrics and Adolescent Medicine, Naestved Hospital, Region Zeeland, Naestved, Denmark
| | - Ruth Murphy
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, UK
| | - Lauren M Pachman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Centre for Clinical Immunology, The Stanley Manne Children's Research Centre, Chicago, Illinois, USA
| | - Ann M Reed
- Department of Paediatrics, Duke University, Durham, North Carolina, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Annet van Royen-Kerkof
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Ricardo Russo
- Department of Paediatric Immunology and Rheumatology, Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Stefan Spinty
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy R Wedderburn
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, University College London Hospital, London, UK.,Infection, Immunology, and Rheumatology Section, UCL GOS Institute of Child Health, University College London, London, UK.,NIHR-Biomedical Research Centre at GOSH, London, UK
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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23
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Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, Visser MD, Alfredsson L, Amato AA, Barohn RJ, Liang MH, Singh JA, Aggarwal R, Arnardottir S, Chinoy H, Cooper RG, Dankó K, Dimachkie MM, Feldman BM, Torre IGDL, Gordon P, Hayashi T, Katz JD, Kohsaka H, Lachenbruch PA, Lang BA, Li Y, Oddis CV, Olesinska M, Reed AM, Rutkowska-Sak L, Sanner H, Selva-O'Callaghan A, Song YW, Vencovsky J, Ytterberg SR, Miller FW, Rider LG. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. Ann Rheum Dis 2017; 76:1955-1964. [PMID: 29079590 DOI: 10.1136/annrheumdis-2017-211468] [Citation(s) in RCA: 621] [Impact Index Per Article: 88.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/23/2017] [Accepted: 07/26/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop and validate new classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIM) and their major subgroups. METHODS Candidate variables were assembled from published criteria and expert opinion using consensus methodology. Data were collected from 47 rheumatology, dermatology, neurology and paediatric clinics worldwide. Several statistical methods were used to derive the classification criteria. RESULTS Based on data from 976 IIM patients (74% adults; 26% children) and 624 non-IIM patients with mimicking conditions (82% adults; 18% children), new criteria were derived. Each item is assigned a weighted score. The total score corresponds to a probability of having IIM. Subclassification is performed using a classification tree. A probability cut-off of 55%, corresponding to a score of 5.5 (6.7 with muscle biopsy) 'probable IIM', had best sensitivity/specificity (87%/82% without biopsies, 93%/88% with biopsies) and is recommended as a minimum to classify a patient as having IIM. A probability of ≥90%, corresponding to a score of ≥7.5 (≥8.7 with muscle biopsy), corresponds to 'definite IIM'. A probability of <50%, corresponding to a score of <5.3 (<6.5 with muscle biopsy), rules out IIM, leaving a probability of ≥50 to <55% as 'possible IIM'. CONCLUSIONS The European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for IIM have been endorsed by international rheumatology, dermatology, neurology and paediatric groups. They employ easily accessible and operationally defined elements, and have been partially validated. They allow classification of 'definite', 'probable' and 'possible' IIM, in addition to the major subgroups of IIM, including juvenile IIM. They generally perform better than existing criteria.
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Affiliation(s)
- Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anna Tjärnlund
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Matteo Bottai
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Victoria P Werth
- Department of Dermatology, Philadelphia VAMC and Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Clarissa Pilkington
- Department of Rheumatology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Marianne de Visser
- Department of Neurology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Lars Alfredsson
- Institute for Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anthony A Amato
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Richard J Barohn
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Matthew H Liang
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Section of Rheumatology, Boston VA Healthcare, Boston, Massachusetts, USA
| | - Jasvinder A Singh
- Mayo Clinic College of Medicine, Rochester, Minnesota, USA.,University of Alabama and Birmingham VA Medical Center, Birmingham, USA
| | - Rohit Aggarwal
- Division of Rheumatology and Clinical Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | - Hector Chinoy
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | - Robert G Cooper
- MRC/ARUK Institute of Ageing and Chronic Disease, Faculty of Health & Life Sciences, University of Liverpool, Liverpool, UK
| | - Katalin Dankó
- Division of Immunology, 3rd Department of Internal Medicine, Medical and Health Science Center, University of Debrecen, Debrecen, Hungary
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brian M Feldman
- Division of Rheumatology, Department of Pediatrics, University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Ignacio Garcia-De La Torre
- Department of Immunology and Rheumatology, Hospital General de Occidente, Secretaría de Salud, and University of Guadalajara, Guadalajara, Jalisco, Mexico
| | - Patrick Gordon
- Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Taichi Hayashi
- Clinical Immunology, Doctoral Program in Clinical Sciences, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan
| | - James D Katz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, US Department of Health and Human Services, Bethesda, Maryland, USA
| | - Hitoshi Kohsaka
- Department of Rheumatology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Peter A Lachenbruch
- Department of Public Health, Oregon State University, Corvallis, Oregon, USA
| | - Bianca A Lang
- Division of Rheumatology, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Yuhui Li
- Department of Rheumatology and Immunology, People's Hospital of Beijing University, Beijing, China
| | - Chester V Oddis
- Division of Rheumatology and Clinical Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Marzena Olesinska
- Connective Tissue Diseases Department, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Lidia Rutkowska-Sak
- Paediatric Clinic of Rheumatology, Institute of Rheumatology, Warsaw, Poland
| | - Helga Sanner
- Section of Rheumatology, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | | | - Yeong-Wook Song
- Department of Internal Medicine, Medical Research Center, Clinical Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jiri Vencovsky
- Department of Rheumatology, Institute of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Steven R Ytterberg
- Division of Rheumatology, Mayo Clinic College of Medicine, Rochester, New York, USA
| | - Frederick W Miller
- US Department of Health and Human Services, Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Lisa G Rider
- US Department of Health and Human Services, Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
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Lundberg IE, Tjärnlund A, Bottai M, Werth VP, Pilkington C, de Visser M, Alfredsson L, Amato AA, Barohn RJ, Liang MH, Singh JA, Aggarwal R, Arnardottir S, Chinoy H, Cooper RG, Dankó K, Dimachkie MM, Feldman BM, Garcia-De La Torre I, Gordon P, Hayashi T, Katz JD, Kohsaka H, Lachenbruch PA, Lang BA, Li Y, Oddis CV, Olesinska M, Reed AM, Rutkowska-Sak L, Sanner H, Selva-O'Callaghan A, Song YW, Vencovsky J, Ytterberg SR, Miller FW, Rider LG. 2017 European League Against Rheumatism/American College of Rheumatology Classification Criteria for Adult and Juvenile Idiopathic Inflammatory Myopathies and Their Major Subgroups. Arthritis Rheumatol 2017; 69:2271-2282. [PMID: 29106061 DOI: 10.1002/art.40320] [Citation(s) in RCA: 338] [Impact Index Per Article: 48.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/26/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To develop and validate new classification criteria for adult and juvenile idiopathic inflammatory myopathies (IIM) and their major subgroups. METHODS Candidate variables were assembled from published criteria and expert opinion using consensus methodology. Data were collected from 47 rheumatology, dermatology, neurology, and pediatric clinics worldwide. Several statistical methods were utilized to derive the classification criteria. RESULTS Based on data from 976 IIM patients (74% adults; 26% children) and 624 non-IIM patients with mimicking conditions (82% adults; 18% children), new criteria were derived. Each item is assigned a weighted score. The total score corresponds to a probability of having IIM. Subclassification is performed using a classification tree. A probability cutoff of 55%, corresponding to a score of 5.5 (6.7 with muscle biopsy) "probable IIM," had best sensitivity/specificity (87%/82% without biopsies, 93%/88% with biopsies) and is recommended as a minimum to classify a patient as having IIM. A probability of ≥90%, corresponding to a score of ≥7.5 (≥8.7 with muscle biopsy), corresponds to "definite IIM." A probability of <50%, corresponding to a score of <5.3 (<6.5 with muscle biopsy), rules out IIM, leaving a probability of ≥50-<55% as "possible IIM." CONCLUSION The European League Against Rheumatism/American College of Rheumatology (EULAR/ACR) classification criteria for IIM have been endorsed by international rheumatology, dermatology, neurology, and pediatric groups. They employ easily accessible and operationally defined elements, and have been partially validated. They allow classification of "definite," "probable," and "possible" IIM, in addition to the major subgroups of IIM, including juvenile IIM. They generally perform better than existing criteria.
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Affiliation(s)
- Ingrid E Lundberg
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Anna Tjärnlund
- Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | - Victoria P Werth
- Philadelphia VA Medical Center and Hospital of the University of Pennsylvania, Philadelphia
| | | | | | | | - Anthony A Amato
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Matthew H Liang
- Brigham and Women's Hospital and Boston VA Healthcare, Boston, Massachusetts
| | - Jasvinder A Singh
- Mayo Clinic College of Medicine, Rochester, Minnesota, and University of Alabama and Birmingham VA Medical Center, Birmingham, Alabama
| | - Rohit Aggarwal
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Hector Chinoy
- Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, UK
| | | | | | | | - Brian M Feldman
- University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Patrick Gordon
- King's College Hospital NHS Foundation Trust, London, UK
| | | | - James D Katz
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | - Bianca A Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Yuhui Li
- People's Hospital of Beijing University, Beijing, China
| | - Chester V Oddis
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Marzena Olesinska
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | | | | | - Helga Sanner
- Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | | | - Yeong-Wook Song
- Seoul National University College of Medicine, Seoul, Republic of Korea
| | | | | | - Frederick W Miller
- National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
| | - Lisa G Rider
- National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
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25
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Rider LG, Aggarwal R, Pistorio A, Bayat N, Erman B, Feldman BM, Huber AM, Cimaz R, Cuttica RJ, de Oliveira SK, Lindsley CB, Pilkington CA, Punaro M, Ravelli A, Reed AM, Rouster-Stevens K, van Royen-Kerkhof A, Dressler F, Saad Magalhaes C, Constantin T, Davidson JE, Magnusson B, Russo R, Villa L, Rinaldi M, Rockette H, Lachenbruch PA, Miller FW, Vencovsky J, Ruperto N. 2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Juvenile Dermatomyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Ann Rheum Dis 2017; 76:782-791. [PMID: 28385804 DOI: 10.1136/annrheumdis-2017-211401] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [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: 03/01/2017] [Indexed: 11/04/2022]
Abstract
To develop response criteria for juvenile dermatomyositis (DM). We analysed the performance of 312 definitions that used core set measures from either the International Myositis Assessment and Clinical Studies Group (IMACS) or the Paediatric Rheumatology International Trials Organisation (PRINTO) and were derived from natural history data and a conjoint analysis survey. They were further validated using data from the PRINTO trial of prednisone alone compared to prednisone with methotrexate or cyclosporine and the Rituximab in Myositis (RIM) trial. At a consensus conference, experts considered 14 top candidate criteria based on their performance characteristics and clinical face validity, using nominal group technique. Consensus was reached for a conjoint analysis-based continuous model with a total improvement score of 0-100, using absolute per cent change in core set measures of minimal (≥30), moderate (≥45), and major (≥70) improvement. The same criteria were chosen for adult DM/polymyositis, with differing thresholds for improvement. The sensitivity and specificity were 89% and 91-98% for minimal improvement, 92-94% and 94-99% for moderate improvement, and 91-98% and 85-86% for major improvement, respectively, in juvenile DM patient cohorts using the IMACS and PRINTO core set measures. These criteria were validated in the PRINTO trial for differentiating between treatment arms for minimal and moderate improvement (p=0.009-0.057) and in the RIM trial for significantly differentiating the physician's rating for improvement (p<0.006). The response criteria for juvenile DM consisted of a conjoint analysis-based model using a continuous improvement score based on absolute per cent change in core set measures, with thresholds for minimal, moderate, and major improvement.
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Affiliation(s)
| | | | - Angela Pistorio
- Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy
| | | | - Brian Erman
- Social and Scientific Systems, Inc., Durham, North Carolina, USA
| | | | | | | | - Rubén J Cuttica
- Hospital de Niños Pedro de Elizalde, University of Buenos Aires, Buenos Aires, Argentina
| | | | - Carol B Lindsley
- University of Kansas City Medical Center, Kansas City, Kansas, USA
| | | | - Marilynn Punaro
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Angelo Ravelli
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, and Università degli Studi di Genova, Genoa, Italy
| | - Ann M Reed
- Duke University, Durham, North Carolina, USA
| | | | | | | | | | | | - Joyce E Davidson
- Royal Hospital for Sick Children, Glasgow, UK.,Royal Hospital for Sick Children, Edinburgh, UK
| | - Bo Magnusson
- Karolinska University Hospital, Stockholm, Sweden
| | - Ricardo Russo
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Luca Villa
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO, Genoa, Italy
| | - Mariangela Rinaldi
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO, Genoa, Italy
| | | | | | | | | | - Nicolino Ruperto
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO, Genoa, Italy
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26
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Rider LG, Aggarwal R, Pistorio A, Bayat N, Erman B, Feldman BM, Huber AM, Cimaz R, Cuttica RJ, de Oliveira SK, Lindsley CB, Pilkington CA, Punaro M, Ravelli A, Reed AM, Rouster-Stevens K, van Royen-Kerkhof A, Dressler F, Magalhaes CS, Constantin T, Davidson JE, Magnusson B, Russo R, Villa L, Rinaldi M, Rockette H, Lachenbruch PA, Miller FW, Vencovsky J, Ruperto N. 2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Juvenile Dermatomyositis: An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol 2017; 69:911-923. [PMID: 28382778 DOI: 10.1002/art.40060] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 01/31/2017] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To develop response criteria for juvenile dermatomyositis (DM). METHODS We analyzed the performance of 312 definitions that used core set measures from either the International Myositis Assessment and Clinical Studies Group (IMACS) or the Paediatric Rheumatology International Trials Organisation (PRINTO) and were derived from natural history data and a conjoint analysis survey. They were further validated using data from the PRINTO trial of prednisone alone compared to prednisone with methotrexate or cyclosporine and the Rituximab in Myositis (RIM) trial. At a consensus conference, experts considered 14 top candidate criteria based on their performance characteristics and clinical face validity, using nominal group technique. RESULTS Consensus was reached for a conjoint analysis-based continuous model with a total improvement score of 0-100, using absolute percent change in core set measures of minimal (≥30), moderate (≥45), and major (≥70) improvement. The same criteria were chosen for adult DM/polymyositis, with differing thresholds for improvement. The sensitivity and specificity were 89% and 91-98% for minimal improvement, 92-94% and 94-99% for moderate improvement, and 91-98% and 85-86% for major improvement, respectively, in juvenile DM patient cohorts using the IMACS and PRINTO core set measures. These criteria were validated in the PRINTO trial for differentiating between treatment arms for minimal and moderate improvement (P = 0.009-0.057) and in the RIM trial for significantly differentiating the physician's rating for improvement (P < 0.006). CONCLUSION The response criteria for juvenile DM consisted of a conjoint analysis-based model using a continuous improvement score based on absolute percent change in core set measures, with thresholds for minimal, moderate, and major improvement.
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Affiliation(s)
| | | | - Angela Pistorio
- Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy
| | | | - Brian Erman
- Social and Scientific Systems, Inc., Durham, North Carolina
| | | | | | | | - Rubén J Cuttica
- Hospital de Niños Pedro de Elizalde, University of Buenos Aires, Buenos Aires, Argentina
| | | | | | | | | | - Angelo Ravelli
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, and Università degli Studi di Genova, Genoa, Italy
| | | | | | | | | | | | | | - Joyce E Davidson
- Royal Hospital for Sick Children, Glasgow, UK, and Royal Hospital for Sick Children, Edinburgh, UK
| | - Bo Magnusson
- Karolinska University Hospital, Stockholm, Sweden
| | - Ricardo Russo
- Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Luca Villa
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO, Genoa, Italy
| | - Mariangela Rinaldi
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO, Genoa, Italy
| | | | | | | | | | - Nicolino Ruperto
- Istituto Giannina Gaslini, Pediatria II - Reumatologia, PRINTO, Genoa, Italy
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27
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Smith PB, Benjamin DK, Reed AM. The Role of a Division of Quantitative Sciences Division in Enhancing Academic Productivity of a Department of Pediatrics. J Pediatr 2017; 180:4-5. [PMID: 27742124 PMCID: PMC5183483 DOI: 10.1016/j.jpeds.2016.09.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- P Brian Smith
- Department of Pediatrics, Duke University, Durham, NC.
| | | | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, NC
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28
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Aggarwal R, Loganathan P, Koontz D, Qi Z, Reed AM, Oddis CV. Cutaneous improvement in refractory adult and juvenile dermatomyositis after treatment with rituximab. Rheumatology (Oxford) 2016; 56:247-254. [PMID: 27837048 DOI: 10.1093/rheumatology/kew396] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/03/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The aim was to assess the efficacy of rituximab for the cutaneous manifestations of adult DM and JDM. METHODS Patients with refractory adult DM (n = 72) and JDM (n = 48) were treated with rituximab in a randomized placebo-phase-controlled trial [either rituximab early drug (week 0/1) or rituximab late arms (week 8/9), such that all subjects received study drug]. Stable concomitant therapy was allowed. Cutaneous disease activity was assessed using the Myositis Disease Activity Assessment Tool, which grades cutaneous disease activity on a visual analog scale. A myositis damage assessment tool, termed the Myositis Damage Index, was used to assess cutaneous damage. Improvement post-rituximab was evaluated in individual rashes as well as in cutaneous disease activity and damage scores. The χ2 test, Student's paired t-test and Wilcoxon test were used for analysis. RESULTS There were significant improvements in cutaneous disease activity from baseline to the end of the trial after rituximab administration in both adult DM and JDM subsets. The cutaneous visual analog scale activity improved in adult DM (3.22-1.72, P = 0.0002) and JDM (3.26-1.56, P <0.0001), with erythroderma, erythematous rashes without secondary changes of ulceration or necrosis, heliotrope, Gottron sign and papules improving most significantly. Adult DM subjects receiving rituximab earlier in the trial demonstrated a trend for faster cutaneous response (20% relative improvement from baseline) compared with those receiving B cell depletion later (P = 0.052). CONCLUSION Refractory skin rashes in adult DM and JDM showed improvement after the addition of rituximab to the standard therapy in a clinical trial.
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Affiliation(s)
- Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Priyadarshini Loganathan
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Diane Koontz
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Zengbiao Qi
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Ann M Reed
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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29
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Huber AM, Kim S, Reed AM, Carrasco R, Feldman BM, Hong SD, Kahn P, Rahimi H, Robinson AB, Vehe RK, Weiss JE, Spencer C. Childhood Arthritis and Rheumatology Research Alliance Consensus Clinical Treatment Plans for Juvenile Dermatomyositis with Persistent Skin Rash. J Rheumatol 2016; 44:110-116. [PMID: 27803135 DOI: 10.3899/jrheum.160688] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [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: 09/14/2016] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Juvenile dermatomyositis (JDM) is the most common form of idiopathic inflammatory myopathy in children. While outcomes are generally thought to be good, persistence of skin rash is a common problem. The goal of this study was to describe the development of clinical treatment plans (CTP) for children with JDM characterized by persistent skin rash despite complete resolution of muscle involvement. METHODS The Childhood Arthritis and Rheumatology Research Alliance, a North American consortium of pediatric rheumatologists and other healthcare providers, used a combination of Delphi surveys and nominal group consensus meetings to develop CTP that reflected consensus on typical treatments for patients with JDM with persistent skin rash. RESULTS Consensus was reached on patient characteristics and outcome assessment. Patients should have previously received corticosteroids and methotrexate (MTX). Three consensus treatment plans were developed. Plan A added intravenous immunoglobulin (IVIG) if it was not already being used. Plan B added mycophenolate mofetil, while Plan C added cyclosporine. Continuation of previous treatments, including corticosteroids, MTX, and IVIG, was permitted in plans B and C. CONCLUSION Three consensus CTP were developed for use in children with JDM and persistent skin rash despite complete resolution of muscle disease. These CTP reflect typical treatment approaches and are not to be considered treatment recommendations or standard of care. Using prospective data collection and statistical methods to account for nonrandom treatment assignment, it is expected that these CTP will be used to allow treatment comparisons, and ultimately determine the best treatment for these patients.
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Affiliation(s)
- Adam M Huber
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA. .,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University.
| | - Susan Kim
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Ann M Reed
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Ruy Carrasco
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Brian M Feldman
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Sandy D Hong
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Philip Kahn
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Homaira Rahimi
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Angela Byun Robinson
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Richard K Vehe
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Jennifer E Weiss
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
| | - Charles Spencer
- From the IWK Health Centre; Dalhousie University, Halifax, Nova Scotia; Hospital for Sick Children, Toronto; University of Toronto, Toronto, Ontario, Canada; Boston Children's Hospital, Boston; Harvard University, Cambridge, Massachusetts; Duke University School of Medicine, Durham, North Carolina; Seattle Children's Hospital; University of Washington, Seattle, Washington; Dell Children's Medical Center of Central Texas, Austin; University of Texas at Austin, Austin, Texas; University of Iowa Children's Hospital and University of Iowa, Iowa City, Iowa; New York Langone Medical Center; New York University, New York; University of Rochester Medical Center; University of Rochester, Rochester, New York; Rainbow Babies and Children's Hospital, Cleveland; Case Western Reserve University, Cleveland; Nationwide Children's Hospital, Columbus; Ohio State University, Columbus, Ohio; University of Minnesota Masonic Children's Hospital, University of Minnesota, Minneapolis, Minnesota; Hackensack University Medical Center, Hackensack; University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.,A.M. Huber, MSc, MD, IWK Health Centre, and Dalhousie University; S. Kim, MD, MMSc, Boston Children's Hospital, and Harvard University; A.M. Reed, MD, Duke University School of Medicine; R. Carrasco, MD, Dell Children's Medical Center of Central Texas, and University of Texas at Austin; B.M. Feldman, MD, MSc, Hospital for Sick Children, and University of Toronto; S.D. Hong, MD, University of Iowa Children's Hospital, and University of Iowa; P. Kahn, MD, New York Langone Medical Center, and New York University; H. Rahimi, MD, MTR, University of Rochester Medical Center, University of Rochester; A.B. Robinson, MD, Rainbow Babies and Children's Hospital, and Case Western Reserve University; R.K. Vehe, MD, University of Minnesota Masonic Children's Hospital, and University of Minnesota; J.E. Weiss, MD, Hackensack University Medical Center, and University of Medicine and Dentistry of New Jersey; C. Spencer, MD, Nationwide Children's Hospital, and Ohio State University
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López De Padilla CM, Crowson CS, Hein MS, Pendegraft RS, Strausbauch MA, Niewold TB, Ernste FC, Peterson E, Baechler EC, Reed AM. Gene Expression Profiling in Blood and Affected Muscle Tissues Reveals Differential Activation Pathways in Patients with New-onset Juvenile and Adult Dermatomyositis. J Rheumatol 2016; 44:117-124. [PMID: 27803134 DOI: 10.3899/jrheum.160293] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [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: 09/30/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To identify shared and differential molecular pathways in blood and affected muscle between adult dermatomyositis (DM) and juvenile DM, and their association with clinical disease activity measures. METHODS Gene expression of transcription factors and cytokines involved in differentiation and effector function of T cell subsets, regulatory T cells and follicular Th cells, were analyzed in the blood from 21 newly diagnosed adult and 26 juvenile DM subjects and in 15 muscle specimens (7 adult and 8 juvenile DM) using a custom RT2 Profiler PCR Array. Disease activity was determined and measured by established disease activity tools. RESULTS The most prominent finding was the higher blood expression of Th17-related cytokines [retinoic acid-related orphan receptor-γ, interferon regulatory factor 4, interleukin (IL)-23A, IL-6, IL-17F, and IL-21] in juvenile DM at baseline. In contrast, adult patients with DM showed increased blood levels of STAT3 and BCL6 compared with juvenile DM. In muscle, GATA3, IL-13, and STAT5B were found at higher levels in juvenile patients with DM compared with adult DM. Among 25 patients (11 adult and 14 juvenile DM) who had blood samples at baseline and at 6 months, increased expression of IL-1β, STAT3, STAT6, STAT5B, and BCL6 was associated with an improvement in global extramuscular disease activity. CONCLUSION We observed differences in gene expression profiling in blood and muscle between new-onset adult and juvenile DM. Cytokine expression in the blood of juvenile patients with new-onset DM was dominated by Th17-related cytokines compared with adult patients with DM. This may reflect the activation of different Th pathways between muscle and blood.
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Affiliation(s)
- Consuelo M López De Padilla
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Cynthia S Crowson
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Molly S Hein
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Richard S Pendegraft
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Michael A Strausbauch
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Timothy B Niewold
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Floranne C Ernste
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Erik Peterson
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Emily C Baechler
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA.,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center
| | - Ann M Reed
- From the Division of Rheumatology, Department of Pediatrics, Mayo Clinic; Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; Department of Surgical Research, Mayo Clinic; Division of Rheumatology and Department of Immunology, Mayo Clinic; Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine, Rochester; Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota, Minneapolis, Minnesota; Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, North Carolina, USA. .,C.M. López De Padilla, MD, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; C.S. Crowson, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.S. Hein, BS, Division of Rheumatology, Department of Pediatrics, Mayo Clinic; R.S. Pendegraft, MS, Division of Rheumatology and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic; M.A. Strausbauch, MS, Department of Surgical Research, Mayo Clinic; T.B. Niewold, MD, Division of Rheumatology and Department of Immunology, Mayo Clinic; F.C. Ernste, MD, Division of Rheumatology, Department of Internal Medicine and Department of Pediatrics, Mayo Clinic College of Medicine; E. Peterson, MD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; E.C. Baechler, PhD, Division of Rheumatic and Autoimmune diseases, Department of Medicine, University of Minnesota; A.M. Reed, MD, Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center.
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Stevens AM, Kanaan SB, Torok KS, Medsger TA, Mayes MD, Reveille JD, Klein-Gitelman M, Reed AM, Lee T, Li SC, Henstorf G, Luu C, Aydelotte T, Nelson JL. Brief Report: HLA-DRB1, DQA1, and DQB1 in Juvenile-Onset Systemic Sclerosis. Arthritis Rheumatol 2016; 68:2772-2777. [PMID: 27214100 DOI: 10.1002/art.39765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 05/19/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Systemic sclerosis (SSc) is a rare disease that is particularly uncommon in children. Specific HLA alleles have been associated with SSc in adults. This study was undertaken to investigate HLA class II alleles in juvenile-onset SSc. METHODS DRB1, DQA1, and DQB1 alleles were determined by DNA-based HLA typing. Analyses were conducted comparing Caucasian patients with juvenile-onset SSc (n = 76) to healthy Caucasian controls (n = 581). RESULTS Initial analyses focused on HLA class II associations previously reported in adult Caucasian patients with SSc. The frequency of DRB1*11 was not significantly increased in juvenile-onset SSc (22.4% of patients with juvenile-onset SSc versus 17.6% of controls; odds ratio [OR] 1.35, P = 0.34), nor were the specific DRB1*11:01 or *11:04 alleles. DQA1*05, a risk factor previously identified in adult men with SSc, was increased in patients with juvenile-onset SSc versus controls (57.9% versus 44.1%; OR 1.76, P = 0.027), as was DRB1*03 (34.2% versus 22.5%; OR 1.79, P = 0.031). Secondary analyses of all DRB1 allele groups revealed an association with DRB1*10 (10.5% of patients with juvenile-onset SSc versus 1.5% of controls; OR 7.48, P = 0.0002). As this is a new observation, correction was made for multiple comparisons of 13 different DRB1 allele groups; results nevertheless remained significant (P = 0.003). Also, a lower frequency of DRB1*01 was observed in patients with juvenile-onset SSc who were younger at disease onset (OR 0.06, P = 0.01) and in those with antibodies to topoisomerase (OR 0.14, P = 0.024). CONCLUSION Associations of HLA alleles with juvenile-onset SSc differed from associations with SSc in women, but were similar to associations with SSc in men. Additionally, a novel association with DRB1*10 was observed in children. The greatest proportion of genetic risk of SSc is contributed by the HLA complex, and the current study reveals the importance of the association of HLA class II genes in juvenile-onset SSc.
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Affiliation(s)
- Anne M Stevens
- Seattle Children's Research Institute and University of Washington, Seattle.
| | - Sami B Kanaan
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kathryn S Torok
- University of Pittsburgh and Children's Hospital of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | | | | | | | - Marisa Klein-Gitelman
- Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ann M Reed
- Duke University School of Medicine, Durham, North Carolina
| | - Tzielan Lee
- Stanford University, Stanford, California and Lucile Packard Children's Hospital, Palo Alto, California
| | - Suzanne C Li
- Hackensack University Medical Center, Hackensack, New Jersey
| | | | - Christine Luu
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - J Lee Nelson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle
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Aggarwal R, Oddis CV, Goudeau D, Koontz D, Qi Z, Reed AM, Ascherman DP, Levesque MC. Autoantibody levels in myositis patients correlate with clinical response during B cell depletion with rituximab. Rheumatology (Oxford) 2016; 55:1710. [PMID: 27383242 DOI: 10.1093/rheumatology/kew275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
| | - Danielle Goudeau
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
| | - Diane Koontz
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
| | - Zengbiao Qi
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
| | - Ann M Reed
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Dana P Ascherman
- Division of Rheumatology and Immunology, University of Miami Department of Medicine, Miami, FL, USA
| | - Marc C Levesque
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
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33
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Gonzalez Santiago TM, Zavialov A, Saarela J, Seppanen M, Reed AM, Abraham RS, Gibson LE. Dermatologic Features of ADA2 Deficiency in Cutaneous Polyarteritis Nodosa. JAMA Dermatol 2016; 151:1230-4. [PMID: 26131734 DOI: 10.1001/jamadermatol.2015.1635] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Mutations in the CERC1 gene associated with deficiency in the ADA2 protein (DADA2) have been implicated in the pathogenesis of cutaneous polyarteritis nodosa (cPAN) and early-onset vasculopathy. DADA2 is not only limited to cPAN and vasculopathy but also includes immunodeficiency that affects several cellular compartments, including B cells; however, some patients appear to have a more indolent, skin-limited disease. OBSERVATIONS In this report, we describe 2 white siblings (female and male) with a history of cPAN with DADA2 as a result of novel compound heterozygous mutations inherited in trans in the CECR1 gene (c.37_39del [p.K13del] and c.1159C>A [p.N328K]). The onset of disease was earlier in the female sibling than the male sibling although both were diagnosed as having cPAN in early childhood. The disease is associated with a more significant immunodeficiency and other systemic symptoms in the female than the male sibling. CONCLUSIONS AND RELEVANCE These findings suggest a genetic cause of cPAN in some patients. Therefore, DADA2 should be considered in patients with cPAN, specifically in those whose conditions are diagnosed at an early age, regardless of their ethnicity, presence or absence of systemic symptoms, or a family history of the disease.
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Affiliation(s)
| | - Andrey Zavialov
- Turku Center for Biotechnology, University of Turku, Turku, Finland
| | - Janna Saarela
- Institute for Molecular Medicine Finland, University of Helsinki, Helsinki
| | - Mikko Seppanen
- Immunodeficiency Unit, Inflammation Center, Helsinki University, Helsinki University Hospital, Helsinki, Finland
| | - Ann M Reed
- Rheumatology Division, Department of Internal Medicine and Pediatrics, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Roshini S Abraham
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Lawrence E Gibson
- Department of Dermatology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota
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Aggarwal R, Oddis CV, Goudeau D, Koontz D, Qi Z, Reed AM, Ascherman DP, Levesque MC. Autoantibody levels in myositis patients correlate with clinical response during B cell depletion with rituximab. Rheumatology (Oxford) 2016; 55:991-9. [PMID: 26888854 DOI: 10.1093/rheumatology/kev444] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To determine the longitudinal trends in serum levels of four myositis-associated autoantibodies: anti-Jo-1, -transcription intermediary factor 1 γ (TIF1-γ), -signal recognition particle (SRP) and -Mi-2, after B cell depletion with rituximab, and to determine the longitudinal association of these autoantibody levels with disease activity as measured by myositis core-set measures (CSMs). METHODS Treatment-resistant adult and pediatric myositis subjects (n = 200) received rituximab in the 44-week Rituximab in Myositis Trial. CSMs [muscle enzymes, manual muscle testing (MMT), physician and patient global disease activity, HAQ, and extramuscular disease activity] were evaluated monthly and anti-Jo-1 (n = 28), -TIF1-γ (n = 23), -SRP (n = 25) and -Mi-2 (n = 26) serum levels were measured using validated quantitative ELISAs. Temporal trends and the longitudinal relationship between myositis-associated autoantibodies levels and CSM were estimated using linear mixed models. RESULTS Following rituximab, anti-Jo-1 levels decreased over time (P < 0.001) and strongly correlated with all CSMs (P < 0.008). Anti-TIF1-γ levels also decreased over time (P < 0.001) and were only associated with HAQ, MMT and physician and patient global disease activity. Anti-SRP levels did not change significantly over time, but were significantly associated with serum muscle enzymes. Anti-Mi-2 levels significantly decreased over time and were associated with muscle enzymes, MMT and the physician global score. CONCLUSION Anti-Jo-1, anti-TIF1-γ and anti-Mi-2 levels in myositis subjects decreased after B cell depletion and were correlated with changes in disease activity, whereas anti-SRP levels were only associated with longitudinal muscle enzyme levels. The strong association of anti-Jo-1 levels with clinical outcomes suggests that anti-Jo-1 autoantibodies may be a good biomarker for disease activity.
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Affiliation(s)
- Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA,
| | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
| | - Danielle Goudeau
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
| | - Diane Koontz
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
| | - Zengbiao Qi
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
| | - Ann M Reed
- Department of Pediatrics, Duke University School of Medicine, Durham, NC and
| | - Dana P Ascherman
- Division of Rheumatology and Immunology, University of Miami Department of Medicine, Miami, FL, USA
| | - Marc C Levesque
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh Department of Medicine, Pittsburgh, PA
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Anderson JH, Anderson KR, Aulie HA, Crowson CS, Mason TG, Ardoin SP, Reed AM, Flatø B. Juvenile idiopathic arthritis and future risk for cardiovascular disease: a multicenter study. Scand J Rheumatol 2016; 45:299-303. [PMID: 26854592 DOI: 10.3109/03009742.2015.1126345] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To evaluate the frequency of cardiovascular disease (CVD) and CVD risk factor development in adult patients previously diagnosed with juvenile idiopathic arthritis (JIA). METHOD A cohort study was conducted utilizing patients at two academic institutions (cohorts 1 and 2). Each institution evaluated the common endpoint of CVD outcomes and CVD risk factor development in adults aged ≥ 30 years and at the 29-year follow-up from disease onset in cohorts 1 and 2, respectively, with comparison to control groups of similar age and sex. RESULTS Cohort 1 included 41 patients with JIA and follow-up ≥ 30 years of age with comparison to 41 controls. Three patients (7%) had CVD, compared to one control (2%; p = 0.31). Cohort 2 included 170 patients with JIA and a median of 29 years of follow-up from disease onset with comparison to 91 controls. Two patients (2%) had CVD, compared to none of the controls (p = 0.29). The presence of CVD risk factors was found to be increased in the JIA group compared to the controls in three categories: family history of CVD (cohort 1), hypertension (cohort 2), and ever smokers (cohorts 2). CONCLUSIONS There is no increase in CVD events in patients with JIA 29 years following disease onset when compared to the general population. As these cohorts age, it will be informative to evaluate whether this baseline risk remains present or a trend towards increasing CVD emerges. Continued longitudinal follow-up of these cohorts and larger population-based studies are needed to establish a definitive relationship between JIA and CVD.
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Affiliation(s)
- J H Anderson
- a Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology , Mayo Clinic , Rochester , MN , USA
| | - K R Anderson
- b Department of Dermatology/Division of Pediatric Dermatology , Mayo Clinic , Rochester , MN , USA
| | - H A Aulie
- c Department of Rheumatology , Oslo University Hospital, Rikshospitalet , Oslo , Norway
| | - C S Crowson
- d Department of Biomedical Statistics and Informatics , Mayo Clinic , Rochester , MN , USA.,e Department of Internal Medicine/Division of Rheumatology , Mayo Clinic , Rochester , MN , USA
| | - T G Mason
- e Department of Internal Medicine/Division of Rheumatology , Mayo Clinic , Rochester , MN , USA.,f Department of Pediatric and Adolescent Medicine/Division of Pediatric Rheumatology , Mayo Clinic , Rochester , MN , USA
| | - S P Ardoin
- g Department of Internal Medicine/Division of Rheumatology and Immunology , Ohio State University , Columbus , OH , USA
| | - A M Reed
- f Department of Pediatric and Adolescent Medicine/Division of Pediatric Rheumatology , Mayo Clinic , Rochester , MN , USA
| | - B Flatø
- c Department of Rheumatology , Oslo University Hospital, Rikshospitalet , Oslo , Norway.,h Medical Faculty , Institute of Clinical Medicine, University of Oslo , Oslo , Norway
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Schmeling H, Mahler M, Levy DM, Moore K, Stevens AM, Wick J, McMillan JD, Horneff G, Assassi S, Charles J, Salazar G, Mayes MD, Silverman ED, Klien-Gitelman M, Lee T, Brunner HI, Reed AM, Fritzler MJ. Autoantibodies to Dense Fine Speckles in Pediatric Diseases and Controls. J Rheumatol 2015; 42:2419-26. [PMID: 26472409 DOI: 10.3899/jrheum.150567] [Citation(s) in RCA: 28] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Autoantibodies to the dense fine speckled 70 kDa antigen (DFS70) are reported to be more common in individuals who do not have an antinuclear antibody (ANA)-associated rheumatic disease (AARD) than in patients with AARD. The frequency of anti-DFS70 antibodies has been thoroughly studied in adult but not in pediatric populations. The primary objective of this observational study was to determine the frequency of anti-DFS70 in pediatric AARD and reference cohorts. METHODS Sera from 743 children with AARD and related conditions, and 345 samples from reference cohorts (healthy children and those being investigated for AARD) were studied for anti-DFS70 autoantibodies as measured by a chemiluminescence immunoassay. A de-identified administrative database was used to retrieve demographic, serologic, and clinical data. RESULTS Anti-DFS70 antibodies were seen in 2.1% of healthy children and in 4.5% of sera from pediatric individuals referred for ANA testing. The frequency of anti-DFS70 was highest in juvenile localized scleroderma (LS; 4/29, 13.8%), juvenile dermatomyositis (JDM; 2/11, 18.2%), childhood systemic lupus erythematosus (cSLE; 19/331, 5.7%), diffuse cutaneous systemic sclerosis (1/22, 4.5%), celiac disease (2/49, 4.1%), and juvenile idiopathic arthritis (JIA; 5/202, 2.5%). Of note, anti-DFS70 antibodies were observed in 3/26 children (11.5%) with uveitis and JIA-associated uveitis. CONCLUSION The frequency of anti-DFS70 autoantibodies in healthy pediatric subjects is within the lower range of that reported in adults. Anti-DFS70 antibodies can be found in childhood SSc and cSLE, but has a remarkably high frequency in children with LS, JDM, and uveitis.
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Affiliation(s)
- Heinrike Schmeling
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Michael Mahler
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Deborah M Levy
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Katharine Moore
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Anne M Stevens
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - James Wick
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Jacob D McMillan
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Gerd Horneff
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Shervin Assassi
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Julio Charles
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Gloria Salazar
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Maureen D Mayes
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Earl D Silverman
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Marissa Klien-Gitelman
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Tzelan Lee
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Hermine I Brunner
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Ann M Reed
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Marvin J Fritzler
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
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Miller FW, Chen W, O’Hanlon TP, Cooper RG, Vencovsky J, Rider LG, Danko K, Wedderburn LR, Lundberg IE, Pachman LM, Reed AM, Ytterberg SR, Padyukov L, Selva-O’Callaghan A, Radstake TR, Isenberg DA, Chinoy H, Ollier WE, Scheet P, Peng B, Lee A, Byun J, Lamb JA, Gregersen PK, Amos CI. Genome-wide association study identifies HLA 8.1 ancestral haplotype alleles as major genetic risk factors for myositis phenotypes. Genes Immun 2015; 16:470-80. [PMID: 26291516 PMCID: PMC4840953 DOI: 10.1038/gene.2015.28] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [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] [Received: 02/28/2015] [Revised: 06/15/2015] [Accepted: 06/18/2015] [Indexed: 02/06/2023]
Abstract
Autoimmune muscle diseases (myositis) comprise a group of complex phenotypes influenced by genetic and environmental factors. To identify genetic risk factors in patients of European ancestry, we conducted a genome-wide association study (GWAS) of the major myositis phenotypes in a total of 1710 cases, which included 705 adult dermatomyositis, 473 juvenile dermatomyositis, 532 polymyositis and 202 adult dermatomyositis, juvenile dermatomyositis or polymyositis patients with anti-histidyl-tRNA synthetase (anti-Jo-1) autoantibodies, and compared them with 4724 controls. Single-nucleotide polymorphisms showing strong associations (P<5×10(-8)) in GWAS were identified in the major histocompatibility complex (MHC) region for all myositis phenotypes together, as well as for the four clinical and autoantibody phenotypes studied separately. Imputation and regression analyses found that alleles comprising the human leukocyte antigen (HLA) 8.1 ancestral haplotype (AH8.1) defined essentially all the genetic risk in the phenotypes studied. Although the HLA DRB1*03:01 allele showed slightly stronger associations with adult and juvenile dermatomyositis, and HLA B*08:01 with polymyositis and anti-Jo-1 autoantibody-positive myositis, multiple alleles of AH8.1 were required for the full risk effects. Our findings establish that alleles of the AH8.1 comprise the primary genetic risk factors associated with the major myositis phenotypes in geographically diverse Caucasian populations.
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Affiliation(s)
- Frederick W. Miller
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Wei Chen
- M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Terrance P. O’Hanlon
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Robert G. Cooper
- MRC/ARUK Institute for Ageing and Chronic Disease, University of Liverpool, United Kingdom, L69 3GA
| | - Jiri Vencovsky
- Institute of Rheumatology, Charles University, Prague, Czech Republic; Na Slupi, 12850 Prague
| | - Lisa G. Rider
- National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland 20892
| | - Katalin Danko
- 3 Department of Internal Medicine, Division of Immunology University of Debrecen, Debrecen, Hungary H-4032
| | - Lucy R. Wedderburn
- Institute of Child Health, University College London, London, United Kingdom, WC1N 1EH
| | - Ingrid E. Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden SE-171 77
| | - Lauren M. Pachman
- Department of Pediatric Rheumatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611
| | | | | | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Solna, Karolinska Institutet, Stockholm, Sweden SE-171 77
| | | | - Timothy R. Radstake
- Department of Rheumatology and Clinical Immunology, Laboratory for Translational Immunology, Utrecht University Medical Center; and Nijmegen Center for Molecular Life Sciences, Nijmegen, The Netherlands 6500.HB
| | - David A. Isenberg
- Division of Medicine, University College London, London, United Kingdom WC1E63T
| | - Hector Chinoy
- The National Institute for Health Research Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, University of Manchester, Manchester, United Kingdom M139PT
| | - William E.R. Ollier
- Centre for Integrated Genomic Medical Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom M13 9PT
| | - Paul Scheet
- M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Bo Peng
- M.D. Anderson Cancer Center, Houston, Texas 77030
| | - Annette Lee
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York 11030
| | - Jinyoung Byun
- Department of Community and Family Medicine, Dartmouth College, Hanover, New Hampshire 03755
| | - Janine A. Lamb
- Centre for Integrated Genomic Medical Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom M13 9PT
| | - Peter K. Gregersen
- Robert S. Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York 11030
| | - Christopher I. Amos
- Department of Community and Family Medicine, Dartmouth College, Hanover, New Hampshire 03755
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Rothwell S, Cooper RG, Lundberg IE, Miller FW, Gregersen PK, Bowes J, Vencovsky J, Danko K, Limaye V, Selva-O'Callaghan A, Hanna MG, Machado PM, Pachman LM, Reed AM, Rider LG, Cobb J, Platt H, Molberg Ø, Benveniste O, Mathiesen P, Radstake T, Doria A, De Bleecker J, De Paepe B, Maurer B, Ollier WE, Padyukov L, O'Hanlon TP, Lee A, Amos CI, Gieger C, Meitinger T, Winkelmann J, Wedderburn LR, Chinoy H, Lamb JA. Dense genotyping of immune-related loci in idiopathic inflammatory myopathies confirms HLA alleles as the strongest genetic risk factor and suggests different genetic background for major clinical subgroups. Ann Rheum Dis 2015; 75:1558-66. [PMID: 26362759 DOI: 10.1136/annrheumdis-2015-208119] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/28/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of rare autoimmune diseases characterised by muscle weakness and extramuscular manifestations such as skin rashes and interstitial lung disease. We genotyped 2566 IIM cases of Caucasian descent using the Immunochip; a custom array covering 186 established autoimmune susceptibility loci. The cohort was predominantly comprised of patients with dermatomyositis (DM, n=879), juvenile DM (JDM, n=481), polymyositis (PM, n=931) and inclusion body myositis (n=252) collected from 14 countries through the Myositis Genetics Consortium. RESULTS The human leucocyte antigen (HLA) and PTPN22 regions reached genome-wide significance (p<5×10(-8)). Nine regions were associated at a significance level of p<2.25×10(-5), including UBE2L3, CD28 and TRAF6, with evidence of independent effects within STAT4. Analysis of clinical subgroups revealed distinct differences between PM, and DM and JDM. PTPN22 was associated at genome-wide significance with PM, but not DM and JDM, suggesting this effect is driven by PM. Additional suggestive associations including IL18R1 and RGS1 in PM and GSDMB in DM were identified. HLA imputation confirmed that alleles HLA-DRB1*03:01 and HLA-B*08:01 of the 8.1 ancestral haplotype (8.1AH) are most strongly associated with IIM, and provides evidence that amino acids within the HLA, such as HLA-DQB1 position 57 in DM, may explain part of the risk in this locus. Associations with alleles outside the 8.1AH reveal differences between PM, DM and JDM. CONCLUSIONS This work represents the largest IIM genetic study to date, reveals new insights into the genetic architecture of these rare diseases and suggests different predominating pathophysiology in different clinical subgroups.
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Affiliation(s)
- Simon Rothwell
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Robert G Cooper
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter K Gregersen
- The Robert S Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - John Bowes
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katalin Danko
- Division of Clinical Immunology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Vidya Limaye
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | | | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Lauren M Pachman
- Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Joanna Cobb
- Arthritis Research UK, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Hazel Platt
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | | | | | - Timothy Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea Doria
- Department of Medicine, University of Padova, Padova, Italy
| | - Jan De Bleecker
- Department of Neurology, Neuromuscular Reference Centre, Ghent University Hospital, Ghent, Belgium
| | - Boel De Paepe
- Department of Neurology, Neuromuscular Reference Centre, Ghent University Hospital, Ghent, Belgium
| | - Britta Maurer
- Department of Rheumatology and Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - William E Ollier
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Terrance P O'Hanlon
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Annette Lee
- The Robert S Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Christopher I Amos
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Christian Gieger
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Neuherberg, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Technische Universität München, Munich, Germany Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Juliane Winkelmann
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, and Institute of Child Health, University College London, London, UK
| | - Hector Chinoy
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Janine A Lamb
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
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López De Padilla CM, Crowson CS, Hein MS, Strausbauch MA, Aggarwal R, Levesque MC, Ascherman DP, Oddis CV, Reed AM. Interferon-regulated chemokine score associated with improvement in disease activity in refractory myositis patients treated with rituximab. Clin Exp Rheumatol 2015; 33:655-663. [PMID: 26446265] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 03/13/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate whether serum interferon (IFN)-regulated chemokine and distinct cytokine response profiles are associated with clinical improvement in patients with refractory inflammatory myopathy treated with rituximab. METHODS In a randomised, placebo-phase trial Rituximab in Myositis Trial (RIM), 200 refractory adult and paediatric myositis subjects received rituximab. Following rituximab, clinical response and disease activity were assessed. Serum samples and clinical data were collected at baseline and several time-points after rituximab treatment. Multiplexed sandwich immunoassays quantified serum levels of IFN-regulated chemokines and other pro-inflammatory cytokines. Composite IFN-regulated chemokine and Th1, Th2, Th17 and regulatory cytokine scores were computed. RESULTS Baseline IFN-regulated chemokine, Th1, Th2, Th17 and regulatory cytokine scores correlated with baseline physician global VAS, whereas the baseline Th1, Th2 and Th17 cytokine scores correlated with baseline muscle VAS. We also found baseline IFN-regulated chemokine scores correlated with specific non-muscular targets such as baseline cutaneous (r=0.29; p=0.002) and pulmonary (r=0.18; p=0.02) VAS scores. Among all cytokine/chemokines examined, the baseline score of IFN-regulated chemokines demonstrated the best correlation with changes in muscle VAS at 8 (r=-0.19; p=0.01) and 16 weeks (r=-0.17; p=0.03) following rituximab and physician global VAS at 16 weeks (r=-0.16; p=0.04). In vitro experiments showed increased levels of IL-8 (p=0.04), MCP-1 (p=0.04), IL-6 (p=0.03), IL-1β (p=0.04), IL-13 (p=0.04), IL-10 (p=0.02), IL-2 (p=0.04) and IFN-γ (p=0.02) in supernatants of TLR-3 stimulated PBMCs from non-responder compared to patients responders to rituximab. CONCLUSIONS IFN-regulated chemokines before treatment is associated with improvement in disease activity measures in refractory myositis patients treated with rituximab.
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Affiliation(s)
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Pediatrics; and Division of Biomedical Statistics and Informatics, Department of Health Science Research, Mayo Clinic, Rochester, USA
| | - Molly S Hein
- Division of Rheumatology, Department of Pediatrics, Mayo Clinic, Rochester, USA
| | | | - Rohit Aggarwal
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Marc C Levesque
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - Chester V Oddis
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Ann M Reed
- Department of Pediatrics, Duke Children's Hospital, Duke University Medical Center, Durham, NC, USA
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Olazagasti JM, Hein M, Crowson CS, de Padilla CL, Peterson E, Baechler EC, Reed AM. Adipokine gene expression in peripheral blood of adult and juvenile dermatomyositis patients and their relation to clinical parameters and disease activity measures. J Inflamm (Lond) 2015; 12:29. [PMID: 25918482 PMCID: PMC4410479 DOI: 10.1186/s12950-015-0075-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/29/2015] [Indexed: 11/23/2022]
Abstract
Objective Recently adipokines have been implicated in the regulation of immune and inflammatory responses in autoimmune disease. To investigate the role of adipokines in adult and pediatric patients with newly diagnosed dermatomyositis (DM), we analyzed peripheral blood and skeletal muscle gene expression of four adipokines: visfatin, leptin, adiponectin and resistin. Methods Peripheral blood mononuclear cells (PBMCs) were collected for 21 adult DM, 26 juvenile DM, 5 non-disease adult controls, and 6 non-disease pediatric controls at two time points: baseline and 6 months. Muscle biopsies from 5 adult DM patients and 5 non-disease adult controls were collected at baseline. Similarly, muscle biopsies from 7 juvenile DM patients and 5 non-disease pediatric controls were collected at baseline. The gene expression levels of leptin, adiponectin, resistin, visfatin and related inflammatory cytokines, IL-6, TNF- α, and housekeeping genes GAPDH, B2M, and ACTB were generated using a custom RT2 Profiler PCR Array. Results Visfatin gene expression levels in peripheral blood were significantly higher in newly diagnosed adult DM cases compared to non-disease controls (P = 0.004) and these levels correlated with baseline clinical parameters such as age (r = 0.34, P = 0.020), male sex (r = −0.35, P = 0.017), prednisone use (r = −0.42, P = 0.006), and DMARD use (r = 0.35, P = 0.025). No significant association was found between change in visfatin gene expression levels and change in disease activity measures. While visfatin gene expression was significantly up-regulated in muscle tissue of juvenile DM patients (P = 0.028), in adult DM patients only a trend towards significance was observed (P = 0.08). Also, muscle gene expression levels of resistin were significantly elevated in both adult and juvenile DM patients compared respectively to non-disease adult and pediatric controls. Furthermore, an association between peripheral blood resistin gene expression and DM disease activity, including global, muscle, and extra-skeletal disease activity was also observed. Conclusion Peripheral blood visfatin gene expression and muscle resistin gene expression are significantly increased in newly diagnosed adult DM patients. Further longitudinal studies should explore the possibility of using gene expression levels of adipokines such as visfatin and resistin as novel clinical diagnostic biomarkers in DM.
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Affiliation(s)
| | - Molly Hein
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, MN USA ; Department of Health Sciences Research, Mayo Clinic, Rochester, MN USA
| | | | - Erik Peterson
- Department of Medicine, Division of Rheumatic and Autoimmune Diseases, and Center for Immunology, University of Minnesota, Minneapolis, MN USA
| | - Emily C Baechler
- Department of Medicine, Division of Rheumatic and Autoimmune Diseases, and Center for Immunology, University of Minnesota, Minneapolis, MN USA
| | - Ann M Reed
- Department of Pediatrics, Duke University School of Medicine, 201 Trent Drive, Durham, NC 27710 USA
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Affiliation(s)
| | - Margot S. Peters
- Department of Dermatology; Mayo Clinic; Rochester MN USA
- Division of Anatomic Pathology; Mayo Clinic; Rochester MN USA
| | - Ann M. Reed
- Division of Rheumatology; Mayo Clinic; Rochester MN USA
- Department of Pediatric and Adolescent Medicine; Mayo Clinic; Rochester MN USA
| | - Megha M. Tollefson
- Department of Dermatology; Mayo Clinic; Rochester MN USA
- Department of Pediatric and Adolescent Medicine; Mayo Clinic; Rochester MN USA
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Aggarwal R, Bandos A, Reed AM, Ascherman DP, Barohn RJ, Feldman BM, Miller FW, Rider LG, Harris-Love MO, Levesque MC, Oddis CV. Predictors of clinical improvement in rituximab-treated refractory adult and juvenile dermatomyositis and adult polymyositis. Arthritis Rheumatol 2014; 66:740-9. [PMID: 24574235 DOI: 10.1002/art.38270] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 11/05/2013] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To identify the clinical and laboratory predictors of clinical improvement in a cohort of myositis patients treated with rituximab. METHODS We analyzed data for 195 patients with myositis (75 with adult polymyositis [PM], 72 with adult dermatomyositis [DM], and 48 with juvenile DM) in the Rituximab in Myositis trial. Clinical improvement was defined as 20% improvement in at least 3 of the following 6 core set measures of disease activity: physician's and patient's/parent's global assessment of disease activity, manual muscle testing, physical function, muscle enzymes, and extramuscular disease activity. We analyzed the association of the following baseline variables with improvement: myositis clinical subgroup, demographics, myositis damage, clinical and laboratory parameters, core set measures, rituximab treatment, and myositis autoantibodies (antisynthetase, anti-Mi-2, anti-signal recognition particle, anti-transcription intermediary factor 1γ [TIF-1γ], anti-MJ, other autoantibodies, and no autoantibodies). All measures were univariately assessed for association with improvement using time-to-event analyses. A multivariable time-dependent proportional hazards model was used to evaluate the association of individual predictive factors with improvement. RESULTS In the final multivariable model, the presence of an antisynthetase, primarily anti-Jo-1 (hazard ratio [HR] 3.08, P < 0.01), anti-Mi-2 (HR 2.5, P < 0.01), or other autoantibody (HR 1.4, P = 0.14) predicted a shorter time to improvement compared to the absence of autoantibodies. A lower physician's global assessment of damage (HR 2.32, P = 0.02) and juvenile DM (versus adult myositis) (HR 2.45, P = 0.01) also predicted improvement. Unlike autoantibody status, the predictive effect of physician's global assessment of damage and juvenile DM diminished by week 20. Rituximab treatment did not affect these associations. CONCLUSION Our findings indicate that the presence of antisynthetase and anti-Mi-2 autoantibodies, juvenile DM subset, and lower disease damage strongly predict clinical improvement in patients with refractory myositis.
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Robinson AB, Hoeltzel MF, Wahezi DM, Becker ML, Kessler EA, Schmeling H, Carrasco R, Huber AM, Feldman BM, Reed AM. Clinical characteristics of children with juvenile dermatomyositis: the Childhood Arthritis and Rheumatology Research Alliance Registry. Arthritis Care Res (Hoboken) 2014; 66:404-10. [PMID: 23983017 DOI: 10.1002/acr.22142] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 08/13/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate aspects of juvenile dermatomyositis (DM), including disease characteristics and treatment, through a national multicenter registry. METHODS Subjects meeting the modified Bohan and Peter criteria for definite juvenile DM were analyzed from the cross-sectional Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry between 2010 and 2012 from 55 US pediatric rheumatology centers. Demographics, disease characteristics, diagnostic assessments, and medication exposure data were collected at enrollment. RESULTS A total of 384 subjects met the criteria for analysis. At enrollment, the median Childhood Myositis Assessment Scale score was 51 (interquartile range [IQR] 46-52), the median Childhood Health Assessment Questionnaire score was 0 (IQR 0-0.5), and the median physician and subject global assessment scores were 1 (IQR 0-2) and 1 (IQR 0-3), respectively, out of a maximum of 10. Of the diagnostic assessments, magnetic resonance imaging was more likely than electromyography or muscle biopsy to show abnormalities. A total of 329 subjects had ≥2 diagnostic studies performed, and >34% of these subjects reported ≥1 negative study. Ninety-five percent had been treated with corticosteroids and 92% with methotrexate, suggesting that these medications were almost universally prescribed for juvenile DM in the US. CONCLUSION In 2 years, the ongoing CARRA Registry has collected clinical data on 384 children with juvenile DM and has the potential to become one of the largest juvenile DM cohorts in the world. More research is needed about prognostic factors in juvenile DM, and differences in therapy based on manifestations of disease need to be explored by practitioners. This registry provides the infrastructure needed to advance clinical and translational research and represents a major step toward improving outcomes of children with juvenile DM.
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Prahalad S, Marion MC, Cobb J, Sudman M, Hinks A, Pichavant M, Ponder L, Reed AM, Wallace C, Becker ML, Yeung RSM, Rosenberg AM, Punaro MG, Mellins ED, Nelson JL, Videm V, Rygg M, Nordal E, Brown MA, Cutler D, Bohnsack JF, Thomson W, Thompson SD, Langefeld CD. A159: The Autoimmune Genetic Architecture of Childhood Onset Rheumatoid Arthritis. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38585] [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]
Affiliation(s)
| | | | - Joanna Cobb
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, Institute of Inflammation and Repair, The University of Manchester; Manchester United Kingdom
| | - Marc Sudman
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | - Anne Hinks
- The University of Manchester; Manchester United Kingdom
| | | | - Lori Ponder
- Children's Healthcare of Atlanta; Atlanta GA
| | | | - Carol Wallace
- Seattle Children's Hospital, University of Washington; Seattle WA
| | | | - Rae S. M. Yeung
- The Hospital for Sick Children and University of Toronto; Toronto ON
| | | | | | | | | | - Vibeke Videm
- Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, and Department of Immunology and Transfusion Medicine, Trondheim University Hospital; Trondheim Norway
| | - Marite Rygg
- St Olav University Hospital; Trondheim Norway
| | - Ellen Nordal
- University Hospital of North Norway; Tromso Norway
| | - Matthew A. Brown
- University of Queensland Diamantina Institute; Brisbane Australia
| | | | | | - Wendy Thomson
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester Academic Health Science Centre; Manchester United Kingdom
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Fischer PR, Driscoll DJ, Reed AM, Moir C. Pediatrics practice at Mayo Clinic - a historical vignette. Mayo Clin Proc 2014; 89:e23-5. [PMID: 24582204 DOI: 10.1016/j.mayocp.2014.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 01/28/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Philip R Fischer
- Division of General Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN.
| | | | - Ann M Reed
- Division of Pediatric Rheumatology, Mayo Clinic, Rochester, MN
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Miller FW, Cooper RG, Vencovský J, Rider LG, Danko K, Wedderburn LR, Lundberg IE, Pachman LM, Reed AM, Ytterberg SR, Padyukov L, Selva-O'Callaghan A, Radstake TRDJ, Isenberg DA, Chinoy H, Ollier WER, O'Hanlon TP, Peng B, Lee A, Lamb JA, Chen W, Amos CI, Gregersen PK. Genome-wide association study of dermatomyositis reveals genetic overlap with other autoimmune disorders. ACTA ACUST UNITED AC 2014; 65:3239-47. [PMID: 23983088 DOI: 10.1002/art.38137] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 08/13/2013] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To identify new genetic associations with juvenile and adult dermatomyositis (DM). METHODS We performed a genome-wide association study (GWAS) of adult and juvenile DM patients of European ancestry (n = 1,178) and controls (n = 4,724). To assess genetic overlap with other autoimmune disorders, we examined whether 141 single-nucleotide polymorphisms (SNPs) outside the major histocompatibility complex (MHC) locus, and previously associated with autoimmune diseases, predispose to DM. RESULTS Compared to controls, patients with DM had a strong signal in the MHC region consisting of GWAS-level significance (P < 5 × 10(-8)) at 80 genotyped SNPs. An analysis of 141 non-MHC SNPs previously associated with autoimmune diseases showed that 3 SNPs linked with 3 genes were associated with DM, with a false discovery rate (FDR) of <0.05. These genes were phospholipase C-like 1 (PLCL1; rs6738825, FDR = 0.00089), B lymphoid tyrosine kinase (BLK; rs2736340, FDR = 0.0031), and chemokine (C-C motif) ligand 21 (CCL21; rs951005, FDR = 0.0076). None of these genes was previously reported to be associated with DM. CONCLUSION Our findings confirm the MHC as the major genetic region associated with DM and indicate that DM shares non-MHC genetic features with other autoimmune diseases, suggesting the presence of additional novel risk loci. This first identification of autoimmune disease genetic predispositions shared with DM may lead to enhanced understanding of pathogenesis and novel diagnostic and therapeutic approaches.
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Affiliation(s)
- Frederick W Miller
- National Institute of Environmental Health Sciences, NIH, Bethesda, Maryland
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Dvergsten JA, Mueller RG, Griffin P, Abedin S, Pishko A, Michel JJ, Rosenkranz ME, Reed AM, Kietz DA, Vallejo AN. Premature cell senescence and T cell receptor-independent activation of CD8+ T cells in juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2013; 65:2201-10. [PMID: 23686519 DOI: 10.1002/art.38015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 05/07/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE CD8+ T cells lacking CD28 were originally reported to be a characteristic feature of juvenile idiopathic arthritis (JIA), but the relevance of these unusual cells to this disease remains to be elucidated. Because of recent evidence that loss of CD28 cells is typical of terminally differentiated lymphocytes, the aim of this study was to examine functional subsets of CD8+ T cells in patients with JIA. METHODS Blood and/or waste synovial fluid samples were collected from children with a definite diagnosis of JIA (n = 98). Deidentified peripheral blood (n = 33) and cord blood (n = 13) samples from healthy donors were also collected. CD8+ and CD4+ T cells were screened for novel receptors, and where indicated, bioassays were performed to determine the functional relevance of the identified receptor. RESULTS JIA patients had a naive T cell compartment with shortened telomeres, and their entire T cell pool had reduced proliferative capacity. They had an overabundance of CD31+CD28(null) CD8+ T cells, which was a significant feature of oligoarticular JIA (n = 62) as compared to polyarticular JIA (n = 36). CD31+ CD28(null) CD8+ T cells had limited mitotic capacity and expressed high levels of the senescence antigens histone γH2AX and/or p16. Ligation of CD31, which was independent of the T cell receptor (TCR), sufficiently induced tyrosine phosphorylation, vesicle exocytosis, and production of interferon-γ and interleukin-10. CONCLUSION These data provide the first evidence of cell senescence, as represented by CD31+CD28(null) CD8+ T cells, in the pathophysiology of JIA. Activation of these unusual cells in a TCR-independent manner suggests that they are maladaptive and could be potential targets for immunotherapy.
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Affiliation(s)
- Jeffrey A Dvergsten
- Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
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Prahalad S, Conneely KN, Jiang Y, Sudman M, Wallace CA, Brown MR, Ponder LA, Rohani-Pichavant M, Zwick ME, Cutler DJ, Angeles-Han ST, Vogler LB, Kennedy C, Rouster-Stevens K, Wise CA, Punaro M, Reed AM, Mellins ED, Bohnsack JF, Glass DN, Thompson SD. Susceptibility to childhood-onset rheumatoid arthritis: investigation of a weighted genetic risk score that integrates cumulative effects of variants at five genetic loci. Arthritis Rheum 2013; 65:1663-7. [PMID: 23450725 PMCID: PMC3683854 DOI: 10.1002/art.37913] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 02/19/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Children with childhood-onset rheumatoid arthritis (RA) include those with rheumatoid factor or anti-citrullinated protein antibody-positive juvenile idiopathic arthritis. To test the hypothesis that adult-onset RA-associated variants are also associated with childhood-onset RA, we investigated RA-associated variants at 5 loci in a cohort of patients with childhood-onset RA. We also assessed the cumulative association of these variants in susceptibility to childhood-onset RA using a weighted genetic risk score (wGRS). METHODS A total of 155 children with childhood-onset RA and 684 healthy controls were genotyped for 5 variants in the PTPN22, TRAF1/C5, STAT4, and TNFAIP3 loci. High-resolution HLA-DRB1 genotypes were available for 149 cases and 373 controls. We tested each locus for association with childhood-onset RA via logistic regression. We also computed a wGRS for each subject, with weights based on the natural log of the published odds ratios (ORs) for the alleles investigated, and used logistic regression to test the wGRS for association with childhood-onset RA. RESULTS Childhood-onset RA was associated with TNFAIP3 rs10499194 (OR 0.60 [95% confidence interval 0.44-0.83]), PTPN22 rs2476601 (OR 1.61 [95% confidence interval 1.11-2.31]), and STAT4 rs7574865 (OR 1.41 [95% confidence interval 1.06-1.87]) variants. The wGRS was significantly different between cases and controls (P < 2 × 10(-16) ). Individuals in the third to fifth quintiles of wGRS had a significantly increased disease risk compared to baseline (individuals in the first quintile). Higher wGRS was associated with increased risk of childhood-onset RA, especially among males. CONCLUSION The magnitude and direction of the association between TNFAIP3, STAT4, and PTPN22 variants and childhood-onset RA are similar to those observed in RA, suggesting that adult-onset RA and childhood-onset RA share common genetic risk factors. Using a wGRS, we have demonstrated the cumulative association of RA-associated variants with susceptibility to childhood-onset RA.
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Affiliation(s)
- Sampath Prahalad
- Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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Ernste FC, Crowson CS, de Padilla CL, Hein MS, Reed AM. Longitudinal Peripheral Blood Lymphocyte Subsets Correlate with Decreased Disease Activity in Juvenile Dermatomyositis. J Rheumatol 2013; 40:1200-11. [DOI: 10.3899/jrheum.121031] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective:To determine the clinical characteristics and subsets of peripheral blood lymphocytes (PBL), which correlate with decreased disease activity in patients with juvenile dermatomyositis (JDM).Methods.Peripheral blood mononuclear cells from 24 patients with JDM were collected at Mayo Clinic Rochester between 2007 and 2011. These were analyzed using fluorescence-activated cell sorting and flow cytometry. Clinical disease activity was determined by visual analog scales (VAS) collected in 2 consecutive visits and correlated with PBL subsets.Results.The change in CD3+CD69+ T cells correlated with the change in global VAS scores. The change in HLA-DR- CD11c+ myeloid dendritic cells also correlated with the change in extramuscular VAS scores. There were trends toward decreased levels of HLA-DR- CD11c+ cells with decreased muscle and global VAS scores, but these did not reach significance. The change in HLA-DR- CD123+ plasmacytoid dendritic cells negatively correlated with the change in muscle VAS scores. Although not statistically significant, decreased levels of CD3-CD16- CD56+ natural killer (NK) cells and HLA-DR- CD86+ myeloid dendritic cells, and increased levels of CD16+CD56- NK cells, correlated with decreased VAS scores.Conclusion.Changes in CD3+CD69+ T cells, HLA-DR- CD11c+ myeloid dendritic cells, and HLA-DR- CD123+ plasmacytoid dendritic cells are associated with improved clinical course in JDM and could be used as markers for disease activity, but findings need to be verified in a larger, independent cohort. Lack of significant differences among most of our PBL subsets suggests that lymphocyte phenotyping may be difficult to definitively correlate with disease activity in JDM.
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