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Li SC, Rabinovich CE, Becker ML, Torok KS, Ferguson PJ, Dedeoglu F, Hong S, Sivaraman V, Laxer RM, Stewart K, Ibarra MF, Mason T, Higgins G, Pope E, Li X, Lozy T, Fuhlbrigge RC. Capturing the Range of Disease Involvement in Localized Scleroderma: The Localized Scleroderma Total Severity Scale. Arthritis Care Res (Hoboken) 2024; 76:616-626. [PMID: 38148547 DOI: 10.1002/acr.25281] [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: 04/10/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 12/28/2023]
Abstract
OBJECTIVE Juvenile localized scleroderma (jLS) is a chronic autoimmune disease commonly associated with poor outcomes, including contractures, hemiatrophy, uveitis, and seizures. Despite improvements in treatment, >25% of patients with jLS have functional impairment. To improve patient evaluation, our workgroup developed the Localized scleroderma Total Severity Scale (LoTSS), an overall disease severity measure. METHODS LoTSS was developed as a weighted measure by a consensus process involving literature review, surveys, case vignettes, and multicriteria decision analysis. Feasibility was assessed in larger Childhood Arthritis and Rheumatology Research Alliance groups. Construct validity with physician assessment and inter-rater reliability was assessed using case vignettes. Additional evaluation was performed in a prospective patient cohort initiating treatment. RESULTS LoTSS severity items were organized into modules that reflect jLS disease patterns, with modules for skin, extracutaneous, and craniofacial manifestations. Construct validity of LoTSS was supported by a strong positive correlation with the Physician Global Assessment (PGA) of severity and damage and weak positive correlation with PGA-Activity, as expected. LoTSS was responsive, with a small effect size identified. Moderate-to-excellent inter-rater reliability was demonstrated. LoTSS was able to discriminate between patient subsets, with higher scores identified in those with greater disease burden and functional limitation. CONCLUSION We developed a new LS measure for assessing cutaneous and extracutaneous severity and have shown it to be reliable, valid, and responsive. LoTSS is the first measure that assesses and scores all the major extracutaneous manifestations in LS. Our findings suggest LoTSS could aid assessment and management of patients and facilitate outcome evaluation in treatment studies.
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Affiliation(s)
- Suzanne C Li
- Joseph M. Sanzari Children's Hospital, Hackensack, and Hackensack Meridian School of Medicine, Nutley, New Jersey
| | | | - Mara L Becker
- Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Sandy Hong
- University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Vidya Sivaraman
- The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Ronald M Laxer
- Temerty Faculty of Medicine, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Katie Stewart
- Texas Children's Hospital and Baylor College of Medicine, Austin, Texas
| | | | | | - Gloria Higgins
- The Ohio State University and Nationwide Children's Hospital, Columbus, Ohio
| | - Elena Pope
- Temerty Faculty of Medicine, University of Toronto, and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Xiaohu Li
- Stevens Institute of Technology, Hoboken, New Jersey
| | - Tara Lozy
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, New Jersey
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging. Arthritis Care Res (Hoboken) 2022; 74:505-520. [PMID: 35233989 DOI: 10.1002/acr.24839] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Recommendations in this guideline include the use of physical therapy and occupational therapy interventions; a healthy, well-balanced, age-appropriate diet; specific laboratory monitoring for medications; widespread use of immunizations; and shared decision-making with patients/caregivers. Disease management for all patients with JIA is addressed with respect to nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis, and a concurrent 2021 guideline on oligoarthritis, temporomandibular arthritis, and systemic JIA. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Recommendations for Nonpharmacologic Therapies, Medication Monitoring, Immunizations, and Imaging. Arthritis Rheumatol 2022; 74:570-585. [PMID: 35233961 PMCID: PMC10127939 DOI: 10.1002/art.42036] [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] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide recommendations for the management of juvenile idiopathic arthritis (JIA) with a focus on nonpharmacologic therapies, medication monitoring, immunizations, and imaging, irrespective of JIA phenotype. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Recommendations in this guideline include the use of physical therapy and occupational therapy interventions; a healthy, well-balanced, age-appropriate diet; specific laboratory monitoring for medications; widespread use of immunizations; and shared decision-making with patients/caregivers. Disease management for all patients with JIA is addressed with respect to nonpharmacologic therapies, medication monitoring, immunizations, and imaging. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis, and a concurrent 2021 guideline on oligoarthritis, temporomandibular arthritis, and systemic JIA. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2022; 74:521-537. [PMID: 35233986 PMCID: PMC10124899 DOI: 10.1002/acr.24853] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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5
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Onel KB, Horton DB, Lovell DJ, Shenoi S, Cuello CA, Angeles-Han ST, Becker ML, Cron RQ, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Kimura Y, Lee T, Murphy K, Nigrovic PA, Ombrello MJ, Rabinovich CE, Tesher M, Twilt M, Klein-Gitelman M, Barbar-Smiley F, Cooper AM, Edelheit B, Gillispie-Taylor M, Hays K, Mannion ML, Peterson R, Flanagan E, Saad N, Sullivan N, Szymanski AM, Trachtman R, Turgunbaev M, Veiga K, Turner AS, Reston JT. 2021 American College of Rheumatology Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Oligoarthritis, Temporomandibular Joint Arthritis, and Systemic Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2022; 74:553-569. [PMID: 35233993 PMCID: PMC10161784 DOI: 10.1002/art.42037] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/29/2021] [Accepted: 11/23/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To provide updated guidelines for pharmacologic management of juvenile idiopathic arthritis (JIA), focusing on treatment of oligoarthritis, temporomandibular joint (TMJ) arthritis, and systemic JIA with and without macrophage activation syndrome. Recommendations regarding tapering and discontinuing treatment in inactive systemic JIA are also provided. METHODS We developed clinically relevant Patient/Population, Intervention, Comparison, and Outcomes questions. After conducting a systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation approach was used to rate the quality of evidence (high, moderate, low, or very low). A Voting Panel including clinicians and patients/caregivers achieved consensus on the direction (for or against) and strength (strong or conditional) of recommendations. RESULTS Similar to those published in 2019, these JIA recommendations are based on clinical phenotypes of JIA, rather than a specific classification schema. This guideline provides recommendations for initial and subsequent treatment of JIA with oligoarthritis, TMJ arthritis, and systemic JIA as well as for tapering and discontinuing treatment in subjects with inactive systemic JIA. Other aspects of disease management, including factors that influence treatment choice and medication tapering, are discussed. Evidence for all recommendations was graded as low or very low in quality. For that reason, more than half of the recommendations are conditional. CONCLUSION This clinical practice guideline complements the 2019 American College of Rheumatology JIA and uveitis guidelines, which addressed polyarthritis, sacroiliitis, enthesitis, and uveitis. It serves as a tool to support clinicians, patients, and caregivers in decision-making. The recommendations take into consideration the severity of both articular and nonarticular manifestations as well as patient quality of life. Although evidence is generally low quality and many recommendations are conditional, the inclusion of caregivers and patients in the decision-making process strengthens the relevance and applicability of the guideline. It is important to remember that these are recommendations. Clinical decisions, as always, should be made by the treating clinician and patient/caregiver.
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Affiliation(s)
- Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Daniel B Horton
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Susan Shenoi
- Seattle Children's Hospital and Research Center and University of Washington, Seattle
| | | | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | | | | | | | | | - Harry Gewanter
- Children's Hospital of Richmond at VCU, Richmond, Virginia
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Yukiko Kimura
- Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | - Peter A Nigrovic
- Boston Children's Hospital and Brigham and Women's Hospital, Boston, Massachusetts
| | | | | | | | - Marinka Twilt
- University of Calgary and Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Marisa Klein-Gitelman
- Ann & Robert Lurie Children's Hospital of Chicago and Northwestern University, Chicago, Illinois
| | | | | | | | | | - Kimberly Hays
- Penn State Health Children's Hospital, Hershey, Pennsylvania
| | | | | | | | | | | | | | | | | | - Keila Veiga
- Maria Fareri Children's Hospital, Valhalla, New York
| | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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Li SC, Higgins GC, Chen M, Torok KS, Rabinovich CE, Stewart K, Laxer RM, Pope E, Haines KA, Punaro M, O'Neil KM. Extracutaneous involvement is common and associated with prolonged disease activity and greater impact in juvenile localized scleroderma. Rheumatology (Oxford) 2021; 60:5724-5733. [PMID: 33711155 DOI: 10.1093/rheumatology/keab238] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 02/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate factors associated with extracutaneous involvement (ECI) in juvenile localized scleroderma (jLS). METHODS A prospective, multicentre, 6-month observational study was performed. The data collected included disease features, global assessments, and subject symptoms. Bivariate and linear multilevel regression analyses were performed. RESULTS A total of 86 jLS subjects (80% female, 80% Caucasian), median age of disease onset 7.7 years, were evaluated. Most had linear scleroderma or mixed morphea. Of the 86 subjects, 49 (57%) had 125 extracutaneous problems {median 2 [interquartile range (IQR) 1, 3] per subject} from nine organ systems. Most of these subjects had multiple musculoskeletal problems. ECI was associated with more extensive cutaneous involvement, higher number of symptoms, family history of autoimmunity, and ANA and RF positivity. Subjects with ECI had higher scores for physician global assessment of damage (PGA-D), and parental global assessment of disease impact, but not baseline physician global assessment of disease activity (PGA-A). Although subjects with ECI received more MTX and glucocorticoid treatment, they had a slower reduction in PGA-A scores and symptoms over time, suggesting a poorer response to treatment. In logistic regression modelling, female sex had the largest effect on parental impact scores. CONCLUSION ECI occurred in the majority of subjects with jLS, and was associated with more medication use, longer treatment duration, higher PGA-D scores, and higher parental assessment of disease impact. Our findings suggest that jLS subjects with ECI have greater overall disease burden, both cutaneous and extracutaneous, and poorer response to treatment. More study of the treatment needs of this population is warranted.
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Affiliation(s)
- Suzanne C Li
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Gloria C Higgins
- Department of Pediatrics, The Ohio State University and Nationwide Children's Hospital, Columbus, OH
| | - Mallory Chen
- Department of Psychology, Williams College, Williamstown, MA
| | - Kathryn S Torok
- Department of Pediatrics, University of Pittsburgh Clinical and Translational Science Institute, Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | - Katie Stewart
- Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, TX, USA
| | | | - Elena Pope
- Department of Pediatrics, The University of Toronto, The Hospital for Sick Kids, Toronto, Canada
| | - Kathleen A Haines
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Marilynn Punaro
- Department of Pediatrics, Texas Scottish Rite Hospital, Dallas, TX, USA
| | - Kathleen M O'Neil
- Department of Pediatrics, University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
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Li SC, Torok KS, Ishaq SS, Buckley M, Edelheit B, Ede KC, Liu C, Rabinovich CE. Preliminary evidence on abatacept safety and efficacy in refractory juvenile localized scleroderma. Rheumatology (Oxford) 2021; 60:3817-3825. [PMID: 33369667 DOI: 10.1093/rheumatology/keaa873] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 11/30/2020] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate the safety and efficacy of abatacept treatment for refractory juvenile localized scleroderma (jLS) in a retrospective study. METHODS A multicentre cohort study was performed to evaluate jLS subjects treated with abatacept with follow-up for 12 months to maximum of 24 months. Assessments at 6-month intervals included skin activity measures and physician global assessment of activity (PGA-A). Descriptive statistical analysis was performed. RESULTS Eighteen subjects were studied with median age of 13.4 years, the majority had linear scleroderma subtype, and musculoskeletal involvement. All had previously failed MTX and/or mycophenolate mofetil treatment and glucocorticoids. Abatacept was added to the subject's maintenance DMARD treatment; 13 also received glucocorticoids at start of abatacept. No serious adverse events occurred. Skin activity and PGA-A scores declined in nearly all by 6 months and continued to improve from 6 to 12 months. At 12 months, 15 (83%) subjects were considered responders, two (11%) treatment failures, and one dropped out for adverse event. Response was sustained for 11 (61%) subjects to 18 months and eight (44%) to 24 months. Overall, four (22%) subjects were treatment failures and three (16.7%) discontinued abatacept for adverse event. Active musculoskeletal problems improved in most affected subjects. Ten subjects were able to discontinue initial glucocorticoid and six concomitant DMARD treatment. CONCLUSION Abatacept was found to be safe and effective for jLS subjects refractory to standard of care treatment. Subjects experienced improvement in both skin and musculoskeletal activity. Prospective studies should be performed to more fully evaluate abatacept's efficacy.
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Affiliation(s)
- Suzanne C Li
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ, USA
| | - Kathryn S Torok
- Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Sarah S Ishaq
- Department of Biochemistry, Montclair State University, Montclair, NJ, USA
| | - Mary Buckley
- Department of Pediatrics, Duke Children's Hospital and Health Center, Duke University School of Medicine, Durham, NC, USA
| | - Barbara Edelheit
- Department of Pediatrics, Connecticut Children's Medical Center, Hartford, CT, USA
| | - Kaleo C Ede
- Department of Pediatrics, Phoenix Children's Hospital, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Christopher Liu
- Department of Biochemistry, Montclair State University, Montclair, NJ, USA
| | - C Egla Rabinovich
- Department of Pediatrics, Duke Children's Hospital and Health Center, Duke University School of Medicine, Durham, NC, USA
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Brunner HI, Nanda K, Toth M, Foeldvari I, Bohnsack J, Milojevic D, Rabinovich CE, Kingsbury DJ, Marzan K, Chalom E, Horneff G, Kuester RM, Dare JA, Trachana M, Jung LK, Olson J, Minden K, Quartier P, Bereswill M, Kalabic J, Kupper H, Lovell DJ, Martini A, Ruperto N. Safety and Effectiveness of Adalimumab in Patients With Polyarticular Course of Juvenile Idiopathic Arthritis: STRIVE Registry Seven-Year Interim Results. Arthritis Care Res (Hoboken) 2020; 72:1420-1430. [PMID: 31421019 PMCID: PMC7589221 DOI: 10.1002/acr.24044] [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: 03/26/2019] [Accepted: 08/13/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To evaluate safety and effectiveness of adalimumab (ADA) in polyarticular-course juvenile idiopathic arthritis (JIA) in the STRIVE registry. METHODS STRIVE enrolled patients with polyarticular-course JIA into 2 arms based on treatment with methotrexate (MTX) alone or ADA with/without MTX (ADA ± MTX). Adverse events (AEs) per 100 patient-years of observation time were analyzed by registry arm. Patients who entered the registry within 4 weeks of starting MTX or ADA ± MTX, defined as new users, were evaluated for change in disease activity assessed by the 27-joint Juvenile Arthritis Disease Activity Score with the C-reactive protein level (JADAS-27CRP ). RESULTS At the 7-year cutoff date (June 1, 2016), data from 838 patients were available (MTX arm n = 301, ADA ± MTX arm n = 537). The most common AEs were nausea (10.3%), sinusitis (4.7%), and vomiting (4.3%) in the MTX arm and arthritis (3.9%), upper respiratory tract infection (3.5%), sinusitis, tonsillitis, and injection site pain (3.0% each) in the ADA ± MTX arm. Rates of serious infection were 1.5 events/100 patient-years in the MTX arm and 2.0 events/100 patient-years in the ADA ± MTX arm. AE and serious AE rates were similar in patients receiving ADA with versus without MTX. No deaths or malignancies were reported. New users in the ADA ± MTX arm showed a trend toward lower mean JADAS-27CRP compared with new users in the MTX arm in the first year of STRIVE. CONCLUSION The STRIVE registry 7-year interim results support the idea that ADA ± MTX is well tolerated by most children. Registry median ADA exposure was 2.47 (interquartile range 1.0-3.6) years, with 42% of patients continuing ADA at the 7-year cutoff date.
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Affiliation(s)
- Hermine I Brunner
- Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Kabita Nanda
- University of Washington School of Medicine and Seattle Children's Hospital, Seattle
| | - Mary Toth
- Nemours Children's Hospital, Orlando, Florida
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology, Hamburg, Germany
| | | | - Diana Milojevic
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | | | | | | | - Elizabeth Chalom
- Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Gerd Horneff
- Asklepios Klinik Sankt Augustin, Sankt Augustin, and University Hospital of Cologne, Cologne, Germany
| | | | - Jason A Dare
- Arkansas Children's Hospital, Little Rock, Arkansas
| | - Maria Trachana
- Hippokration General Hospital, Thessaloniki University School of Medicine, Thessaloniki, Greece
| | | | | | - Kirsten Minden
- Charite University Medicine Berlin and German Rheumatism Research Center, Berlin, Germany
| | - Pierre Quartier
- Université Paris-Descartes, Institut IMAGINE and Centre de Référence RAISE, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | | | - Hartmut Kupper
- AbbVie Deutschland GmbH and Co. KG, Ludwigshafen, Germany
| | - Daniel J Lovell
- Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alberto Martini
- Istituto Giannina Gaslini Clinica Pediatrica e Reumatologia-PRINTO, Genova, Italy
| | - Nicolino Ruperto
- Istituto Giannina Gaslini Clinica Pediatrica e Reumatologia-PRINTO, Genova, Italy
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Li SC, Torok KS, Rabinovich CE, Dedeoglu F, Becker ML, Ferguson PJ, Hong SD, Ibarra MF, Stewart K, Pope E, Higgins GC, Laxer RM, Mason T, Fuhlbrigge RC, Andrews T. Initial Results from a Pilot Comparative Effectiveness Study of 3 Methotrexate-based Consensus Treatment Plans for Juvenile Localized Scleroderma. J Rheumatol 2019; 47:1242-1252. [DOI: 10.3899/jrheum.190311] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/27/2022]
Abstract
Objective.To perform a comparative effectiveness feasibility study in juvenile localized scleroderma (LS), using standardized treatment regimens (consensus treatment plans; CTP).Methods.A prospective, multicenter 1-year pilot observational cohort study was performed by Childhood Arthritis and Rheumatology Research Alliance (CARRA) LS workgroup members. Patients with active, moderate to severe juvenile LS were treated with one of 3 CTP: methotrexate alone, or in combination with intravenous (30 mg/kg/dose for 3 mos) or oral corticosteroids (2 mg/kg/day tapered by 48 weeks).Results.Fifty patients, with demographics typical for juvenile LS, were enrolled, and 44 (88%) completed the study. Most had extracutaneous involvement. Patients improved in all 3 CTP, with > 75% having a major or moderate level of improvement compared to baseline. Damage accrued in some patients. Major deviations from prescribed regimen resulted from medication intolerance (n = 6; 14%) or treatment failure (n = 11; 25%); failures occurred in all 3 CTP. Significant responses to treatment were demonstrated by LS skin scoring measures and overall physician assessments, with differences in response level identified in some patient subsets. Response differences were associated with baseline disease activity level, LS subtype, skin disease extent, and extracutaneous involvement.Conclusion.This study demonstrates the feasibility of conducting juvenile LS comparative effectiveness studies. The CTP were found to be safe, effective, and tolerable. Our assessments performed well. Because damage is common and may progress despite effective control of activity, we recommend initial treatment efficacy be evaluated primarily by activity measures. Potential confounders for response were identified that warrant further study.
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10
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Li SC, Fuhlbrigge RC, Laxer RM, Pope E, Ibarra MF, Stewart K, Mason T, Becker ML, Hong S, Dedeoglu F, Torok KS, Rabinovich CE, Ferguson PJ, Punaro M, Feldman BM, Andrews T, Higgins GC. Developing comparative effectiveness studies for a rare, understudied pediatric disease: lessons learned from the CARRA juvenile localized scleroderma consensus treatment plan pilot study. Pediatr Rheumatol Online J 2019; 17:43. [PMID: 31307476 PMCID: PMC6632199 DOI: 10.1186/s12969-019-0350-5] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/08/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND We designed and initiated a pilot comparative effectiveness study for juvenile localized scleroderma (jLS), for which there is limited evidence on best therapy. We evaluated the process we used, in relation to the specific protocol and to the general task of identifying strategies for implementing studies in rare pediatric diseases. METHODS This was a prospective, multi-center, observational cohort study of 50 jLS patients initiating treatment, designed and conducted by the jLS group of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) from 2012 to 2015. A series of virtual and physical meetings were held to design the study, standardize clinical assessments, generate and refine disease activity and damage measures, and monitor the study. Patients were initiated on one of three standardized methotrexate-based treatment regimens (consensus treatment plans, CTPs) and monitored for 1 year. An optional bio-banking sub-study was included. RESULTS The target enrollment of 50 patients was achieved over 26 months at 10 sites, with patients enrolled into all CTPs. Enrolled patients were typical for jLS. Study eligibility criteria were found to perform well, capturing patients thought appropriate for treatment studies. Minor modifications to the eligibility criteria, primarily to facilitate recruitment for future studies, were discussed with consensus agreement reached on them by the jLS group. There were marked differences in site preferences for specific CTPs, with half the sites treating all their patients with the same CTP. Most patients (88%) completed the study, and 68% participated in the bio-banking substudy. CONCLUSIONS We demonstrate the feasibility of our approach for conducting comparative effectiveness research in a rare pediatric disease. Multi-center collaboration by dedicated investigators who met regularly was a key factor in the success of this project. Other factors that facilitate these studies include having a sufficient number of investigators to enroll in each regimen, and streamlining study approval and management.
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Affiliation(s)
- Suzanne C. Li
- Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, Imus PC337, 30 Prospect Ave, Hackensack, NJ 07061 USA
- Hackensack Meridian School of Medicine at Seton Hall University, Clifton, NJ USA
| | | | - Ronald M. Laxer
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Elena Pope
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | | | - Katie Stewart
- Texas Scottish Rite Hospital and UT Southwestern, Dallas, TX USA
| | | | | | - Sandy Hong
- University of Iowa Stead Family Children’s Hospital, Iowa City, IA USA
| | | | | | | | | | - Marilynn Punaro
- Texas Scottish Rite Hospital and UT Southwestern, Dallas, TX USA
| | - Brian M. Feldman
- University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Tracy Andrews
- Rutgers School of Public Health, Rutgers University, Newark, NJ USA
| | - Gloria C. Higgins
- The Ohio State University and Nationwide Children’s Hospital, Columbus, OH USA
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11
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Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Holland GN, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Sen HN, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Care Res (Hoboken) 2019; 71:703-716. [PMID: 31021540 DOI: 10.1002/acr.23871] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. CONCLUSION This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.
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Affiliation(s)
- Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gary N Holland
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Rayfel Schneider
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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12
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Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Rheumatol 2019; 71:846-863. [PMID: 31021537 DOI: 10.1002/art.40884] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
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Affiliation(s)
| | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Rayfel Schneider
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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13
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Angeles-Han ST, Ringold S, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Holland GN, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Sen HN, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. Arthritis Rheumatol 2019; 71:864-877. [PMID: 31021511 DOI: 10.1002/art.40885] [Citation(s) in RCA: 46] [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: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. CONCLUSION This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.
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Affiliation(s)
- Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gary N Holland
- UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - H Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Rayfel Schneider
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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Ringold S, Angeles-Han ST, Beukelman T, Lovell D, Cuello CA, Becker ML, Colbert RA, Feldman BM, Ferguson PJ, Gewanter H, Guzman J, Horonjeff J, Nigrovic PA, Ombrello MJ, Passo MH, Stoll ML, Rabinovich CE, Schneider R, Halyabar O, Hays K, Shah AA, Sullivan N, Szymanski AM, Turgunbaev M, Turner A, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken) 2019; 71:717-734. [PMID: 31021516 DOI: 10.1002/acr.23870] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 02/27/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
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Affiliation(s)
| | - Sheila T Angeles-Han
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
| | | | | | | | - Brian M Feldman
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | - Harry Gewanter
- Children's Hospital of Richmond, Virginia Commonwealth University, Richmond
| | - Jaime Guzman
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Peter A Nigrovic
- Brigham & Women's Hospital and Boston Children's Hospital, Boston, Massachusetts
| | | | | | | | | | - Rayfel Schneider
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | - Amy Turner
- American College of Rheumatology, Atlanta, Georgia
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Wu EY, Li SC, Torok KS, Virkud YV, Fuhlbrigge RC, Rabinovich CE. Baseline Description of the Juvenile Localized Scleroderma Subgroup From the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry. ACR Open Rheumatol 2019; 1:119-124. [PMID: 31777788 PMCID: PMC6858014 DOI: 10.1002/acr2.1019] [Citation(s) in RCA: 23] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Localized scleroderma (LS) is a chronic inflammatory and fibrosing skin disorder. We present baseline data on the juvenile LS (jLS) cohort from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry, a multicenter observational registry of pediatric rheumatologic disorders. Methods This is a cross-sectional analysis of children with jLS enrolled in the CARRA Legacy Registry between May 2010 and April 2014. Descriptive statistics were used for demographic, clinical, and laboratory features. Data analysis included two-sample t test, χ2 test, Fisher's exact test, linear/logistic regression, and analysis of variance. Results Of 381 children with jLS, 76% were female and 80% Caucasian. Mean onset age was 8.2 years, with 17% having a 2-year or greater delay to first pediatric rheumatology (PRH) visit. Linear scleroderma was the most common subtype (54%). Antinuclear antibody (ANA) positivity was associated with joint contracture (P = 0.04), muscle atrophy (P = 0.014), and extremity shortening (P = 0.007). Elevated aldolase was associated with joint contracture (P = 0.008) and elevated creatine kinase (CK) with muscle atrophy (P = 0.028) and extremity shortening (P = 0.016). Children with functional limitation (27%) had earlier first PRH visit compared with those without (P = 0.01). Poorer function correlated with muscle atrophy, joint contracture, and extremity shortening (P < 0.001). Methotrexate (97%) and corticosteroids (68%) were the most common medications used. Conclusion Children with jLS without joint limitation are referred later, highlighting the insidious onset and need for educating referring providers. Poorer function correlated with muscle atrophy, joint contracture, and limb shortening. ANA positivity and elevated CK or aldolase were associated with muscle atrophy, joint contracture, and/or limb shortening, suggesting predictors of muscle involvement.
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Affiliation(s)
| | - Suzanne C Li
- Hackensack University Medical Center Hackensack New Jersey
| | - Kathryn S Torok
- Children's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania
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Angeles-Han ST, Lo MS, Henderson LA, Lerman MA, Abramson L, Cooper AM, Parsa MF, Zemel LS, Ronis T, Beukelman T, Cox E, Sen HN, Holland GN, Brunner HI, Lasky A, Rabinovich CE. Childhood Arthritis and Rheumatology Research Alliance Consensus Treatment Plans for Juvenile Idiopathic Arthritis-Associated and Idiopathic Chronic Anterior Uveitis. Arthritis Care Res (Hoboken) 2019; 71:482-491. [PMID: 29806733 PMCID: PMC6261704 DOI: 10.1002/acr.23610] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 05/22/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Systemic immunosuppressive treatment of pediatric chronic anterior uveitis (CAU), both juvenile idiopathic arthritis-associated and idiopathic anterior uveitis, varies, making it difficult to identify best treatments. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed consensus treatment plans (CTPs) for CAU for the purpose of reducing practice variability and allowing future comparison of treatments using comparative effectiveness analysis techniques. METHODS A core group of pediatric rheumatologists, ophthalmologists with uveitis expertise, and a lay advisor comprised the CARRA uveitis workgroup that performed a literature review on pharmacologic treatments, held teleconferences, and developed a case-based survey administered to the CARRA membership to delineate treatment practices. We held 3 face-to-face consensus meetings using nominal group technique to develop CTPs. RESULTS The survey identified areas of treatment practice variability. We developed 2 CTPs for the treatment of CAU, case definitions, and monitoring parameters. The first CTP is directed at children who are naive to steroid-sparing medication, and the second at children initiating biologic therapy, with options for methotrexate, adalimumab, and infliximab. We defined a core data set and outcome measures, with data collection at 3 and 6 months after therapy initiation. The CARRA membership voted to accept the CTPs with a >95% approval (n = 233). CONCLUSION Using consensus methodology, 2 standardized CTPs were developed for systemic immunosuppressive treatment of CAU. These CTPs are not meant as treatment guidelines, but are designed for further pragmatic research within the CARRA research network. Use of these CTPs in a prospective comparison effectiveness study should improve outcomes by identifying best practice options.
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Affiliation(s)
- Sheila T. Angeles-Han
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Mindy S. Lo
- Division of Immunology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA
| | - Lauren A. Henderson
- Division of Immunology, Boston Children’s Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Leslie Abramson
- Vermont Children’s Hospital at University of Vermont Medical Center, Burlington, VT
| | | | | | | | - Tova Ronis
- Children’s National Health System, Washington, DC
| | | | | | - H. Nida Sen
- National Eye Institute, National Institutes of Health, Bethesda, Maryland
| | - Gary N. Holland
- UCLA Stein Eye Institute and David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA
| | - Hermine I. Brunner
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Andrew Lasky
- Randall Children’s Hospital at Legacy Emmanuel, Portland, OR
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17
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Stevens BE, Torok KS, Li SC, Hershey N, Curran M, Higgins GC, Moore KF, Egla Rabinovich C, Dodson S, Stevens AM. Clinical Characteristics and Factors Associated With Disability and Impaired Quality of Life in Children With Juvenile Systemic Sclerosis: Results From the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry. Arthritis Care Res (Hoboken) 2018; 70:1806-1813. [PMID: 29457372 DOI: 10.1002/acr.23547] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 02/13/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To investigate clinical manifestations of juvenile systemic sclerosis (SSc; scleroderma), including disease characteristics and patient quality of life, using the multinational Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry. METHODS Patients with juvenile SSc were prospectively enrolled between 2010 and 2013. The diagnosis of juvenile SSc was determined by the enrolling pediatric rheumatologist, with the requirement for disease onset prior to age 18 years. Collected data included demographics, disease characteristics, medication exposure, and quality of life metrics. RESULTS In total, 64 patients with juvenile SSc were enrolled a median of 3.6 years after disease onset, which occurred at a median age of 10.3 years. The most common organ manifestations were dermatologic and vascular, followed by musculoskeletal, gastrointestinal, and pulmonary; in 38% of patients, ≥4 organ systems were affected. Patients with juvenile SSc had significantly more disability at enrollment compared with CARRA Legacy Registry patients with juvenile idiopathic arthritis, dermatomyositis, or systemic lupus erythematosus. Although physician-reported measures correlated most closely with arthritis, dermatologic manifestations, and pulmonary manifestations, poor patient-reported measures were associated with gastrointestinal involvement. During >50 person-years of follow-up, most organ manifestations remained stable, and no mortality or development of new solid organ involvement after enrollment was reported. CONCLUSION In the first multicenter prospective cohort of patients with juvenile SSc in North America, the disease burden was high: multiorgan manifestations were common, and functional disability was greater than that observed in patients with other childhood-onset rheumatic diseases. Gastrointestinal involvement had the greatest impact on quality of life.
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Affiliation(s)
- Brandi E Stevens
- Riley Hospital for Children at Indiana University Health, Indianapolis, and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kathryn S Torok
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Suzanne C Li
- Hackensack University Medical Center, Hackensack Meridian Health, Hackensack, New Jersey
| | - Nicole Hershey
- University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Megan Curran
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Gloria C Higgins
- Ohio State University and Nationwide Children's Hospital, Columbus
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18
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Li SC, Li X, Pope E, Stewart K, Higgins GC, Rabinovich CE, O’Neil KM, Haines KA, Laxer RM, Punaro M, Jacobe H, Andrews T, Wittkowski K, Nyirenda T, Foeldvari I, Torok KS. New Features for Measuring Disease Activity in Pediatric Localized Scleroderma. J Rheumatol 2018; 45:1680-1688. [DOI: 10.3899/jrheum.171381] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/22/2022]
Abstract
Objective.To identify clinical features that define disease activity in pediatric localized scleroderma (LS), and determine their specificity and importance.Methods.We conducted a multicenter prospective study of patients with active and inactive LS skin lesions. A standardized evaluation of a single designated study lesion per subject was performed at 3 visits. We evaluated the pattern and correlation between assessed features and physician’s global assessments of activity (PGA-A).Results.Ninety of 103 subjects had evaluable data; 66 had active and 24 inactive disease. Subjects had similar age of onset, sex, and disease patterns. Linear scleroderma was the most common subtype. Features specific for active disease included erythema, violaceous color, tactile warmth, abnormal skin texture, and disease extension. Scores for these variables changed over time and correlated with PGA-A of the lesion. Active and inactive lesions could not be distinguished by the presence or level of skin thickening, either of lesion edge or center. However, in active lesions, skin thickening scores did correlate with PGA–A scores. Regression analysis identified the combination of erythema, disease extension, violaceous color, skin thickening, and abnormal texture as predictive of PGA-A at study entry. Damage features were common irrespective of activity status.Conclusion.We identified variables strongly associated with disease activity, expanding upon those used in current measures, and determined their relative importance in physician activity scoring. Skin thickening was found to lack specificity for disease activity. These results will help guide development of a sensitive, responsive activity tool to improve care of patients with LS.
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19
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Abstract
Objective Cutaneous manifestations of pediatric systemic lupus erythematosus cause significant morbidity. Lenalidomide, a thalidomide analogue, has shown promise treating cutaneous lupus erythematosus in adults. Our objective was to evaluate lenalidomide's efficacy and safety in treating refractory cutaneous manifestations of pediatric systemic lupus erythematosus. Methods We performed a retrospective chart review of 10 adolescents who received lenalidomide for recalcitrant cutaneous lupus erythematosus. Information was gathered at drug initiation and 6-month follow-up. The Wilcoxon matched-pairs signed-rank test was used to assess change in quantitative parameters of disease activity. Results Nine subjects were girls and six were African-American. Indications for lenalidomide treatment included alopecia, nasal and oral ulcers, extensive malar rash, discoid lesions, bullous lesions, panniculitis, cutaneous vasculitis, and Raynaud's phenomenon with digital ulcerations. Within 6 months, all patients demonstrated complete or near resolution based on physician report. Prednisone dose decreased from a mean 23.5 mg (SD± 13.3) to 12.25 mg (SD± 9.2) ( P= 0.008). Sedimentation rate decreased from a mean 29 mm/hour (SD± 31.5) to 17 mm/hour (SD± 18.1) ( P= 0.004). Lenalidomide was well tolerated. Conclusion Lenalidomide is an effective and safe treatment for a spectrum of dermatological conditions in pediatric systemic lupus erythematosus. Its use may allow a reduction in prednisone dose and decreased disfigurement. Prospective study is needed to clarify lenalidomide's role in treating cutaneous manifestations of systemic lupus erythematosus.
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Affiliation(s)
- E Y Wu
- 1 Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - L E Schanberg
- 2 Department of Pediatrics, Duke University Medical Center, Durham, USA
| | - E C Wershba
- 3 Phoenix Children's Medical Group, Phoenix, USA
| | - C E Rabinovich
- 2 Department of Pediatrics, Duke University Medical Center, Durham, USA
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20
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Abstract
Uveitis refers to the presence of intraocular inflammation, and as a strict definition compromises the iris and ciliary body anteriorly and the choroid posteriorly (the uvea). Untreated, uveitis can lead to visual loss or blindness. The etiology of uveitis can include both infectious and noninfectious (usually immune-mediated) causes, the latter of which are often mediated predominantly by Th1 CD4+ T-cells that secrete proinflammatory cytokines. Tumor necrosis factor-alpha (TNF-α) is a proinflammatory cytokine involved in the pathogenesis of uveitis, which at high concentrations can cause excess inflammation and tissue damage. Adalimumab is a recombinant human IgG1 monoclonal antibody specific for human TNF-α. Historically, corticosteroids and methotrexate were used to treat uveitis; however, newer biologic agents such as adalimumab have revolutionized therapy for noninfectious uveitis. Adalimumab has shown efficacy in treating refractory uveitis in multiple settings, including idiopathic disease, juvenile idiopathic arthritis, sarcoidosis, Behçets disease, and uveitis secondary to spondyloarthropathies, among several other noninfectious uveitis conditions. In this paper, we will review the profile of adalimumab, the role of TNF-α in uveitis, discuss safety data, and summarize key articles evaluating the efficacy of adalimumab in treating uveitis secondary to the most commonly associated autoimmune diseases.
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Affiliation(s)
- Stephen J Balevic
- Department of Pediatric Rheumatology, Duke University Medical Center, Durham, NC, USA
| | - C Egla Rabinovich
- Department of Pediatric Rheumatology, Duke University Medical Center, Durham, NC, USA
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21
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Fotis L, Shaikh N, Baszis K, French A, Tarr P, Grevich S, Lee P, Ringold S, Leroux B, Leahey H, Yuasa M, Foster J, Sokolove J, Lahey L, Robinson W, Newsom J, Stevens A, Karasawa R, Tamaki M, Tanaka M, Sato T, Yudoh K, Jarvis JN, Moncrieffe H, Bennett MF, Tsoras M, Luyrink L, Xu H, Prahalad S, Morris P, Dare J, Nigrovic PA, Rosenkranz M, Becker M, O’Neil KM, Griffin T, Lovell DJ, Grom AA, Medvedovic M, Thompson SD, Zhu L, Jiang K, Wong L, Buck MJ, Chen Y, Moncrieffe H, Brungs L, Liu T, Wang T, Jarvis JN, Alsaeid K, Alfailakawi J, Alenezi H, Alsaeed H, Beukelman T, Natter M, Ilowite N, Mieszkalski K, Burrell G, Best B, Bristow H, Carr S, Dennos A, Kaufmann R, Kimura Y, Schanberg L, Blier PR, Boneparth A, Wenderfer SE, Moorthy LN, Radhakrishna SM, Sagcal-Gironella ACP, von Scheven E, Gedik KC, Siddique S, Aguiar CL, Erkan D, Cohen E, Lee Y, Dossett M, Mehta D, Davis R, Gilbert M, Goilav B, Meidan E, Hsu J, Boneparth A, Chua A, Ardoin S, Wenderfer SE, Von Scheven E, Ruth NM, Hui-Yuen J, Gedik KC, Bermudez L, Cook A, Imundo L, Starr A, Eichenfield A, Askanase A, Janow G, Schanberg LE, Setoguchi S, Hasselblad V, Mellins ED, Schneider R, Kimura Y, Kimura Y, Grevich S, Beukelman T, Morgan E, Graham TB, Ibarra M, Ruas YS, Klein-Gitelman M, Onel K, Prahalad S, Punaro M, Ringold S, Toib D, Van Mater H, Weiss JE, Weiss PF, Mieszkalski K, Schanberg LE, Kwok TSH, Bisaillon J, Smith C, Brosseau L, Stinson J, Huber AM, Duffy CM, April KT, Lewandowski LB, Scott C, Li SC, Torok KS, Rabinovich CE, Hong SD, Becker ML, Dedeoglu F, Ibarra MF, Ferguson PJ, Fuhbrigge RC, Stewart KG, Pope E, Laxer RM, Mason TG, Higgins GC, Li X, Punaro MG, Tomlinson G, Pullenayegum E, Matelski J, Schanberg L, Feldman BM, Manthiram K, Correa H, Edwards K, Oberle EJ, Bayer M, Co DO, Baris HE, Chiu Y, Huber A, Kim S, Oberle EJ, Beukelman T, Orandi AB, Baszis KW, Dharnidharka V, Hoeltzel MF, Reed A, Huber A, Tomlinson G, Pullenayegum E, Matelski J, Goh YI, Schanberg L, Feldman BM, Schnabel A, Range U, Hahn G, Siepmann T, Berner R, Hedrich CM, Stevens B, Torok KS, Li S, Hershey N, Curran M, Higgins G, Moore K, Rabinovich E, Stevens AM, Stinson J, Connelly M, Huber A, Luca N, Spiegel L, Tsimicalis A, Luca S, Tajuddin N, Berard R, Barsalou J, Campillo S, Dancey P, Duffy C, Feldman B, Johnson N, McGrath P, Shiff N, Tse S, Tucker L, Victor C, Stinson J, Lalloo C, Harris L, Cafazzo J, Spiegel L, Feldman B, Luca N, Laxer R, Bullock DR, Vehe RK, Zhang L, Correll CK, Ganguli S, Shenberger M, Korumilli R, Gottlieb B, Rodriguez M, de Ranieri D, Onel K, Wagner-Weiner L, Tesher M, Wojcicki ER, Maletta KL, Co DO, Malloy M, Thomson S, Olson JC, Wenderfer SE, Gilbert M, Hsu J, Sule S, Rubinstein TB, Goilav B, Okamura DM, Chua A, Greenbaum LA, Lane JC, von Scheven E, Ardoin SP, Ruth NM, Woo JMP, Malloy MM, Jegers JA, Hahn DJ, Hintermeyer MK, Martinetti SM, Heckel GR, Roth-Wojcicki EL, Co DO. Proceedings of the 2016 Childhood Arthritis and Rheumatology Research Alliance (CARRA) Scientific Meeting : Toronto, Canada. 14-17 April 2016. Pediatr Rheumatol Online J 2016; 14 Suppl 1:41. [PMID: 27409414 PMCID: PMC4943514 DOI: 10.1186/s12969-016-0098-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
P1 Serologic evidence of gut-driven systemic inflammation in juvenile idiopathic arthritis Lampros Fotis, Nur Shaikh, Kevin Baszis, Anthony French, Phillip Tarr P2 Oral health and anti-citrullinated peptide antibodies (ACPA) in juvenile idiopathic arthritis Sriharsha Grevich, Peggy Lee, Sarah Ringold, Brian Leroux, Hannah Leahey, Megan Yuasa, Jessica Foster, Jeremy Sokolove, Lauren Lahey, William Robinson, Joshua Newsom, Anne Stevens P3 Novel autoantigens for endothelial cell antibodies in pediatric rheumatic diseases identified by proteomics Rie Karasawa, Mayumi Tamaki, Megumi Tanaka, Toshiko Sato, Kazuo Yudoh, James N. Jarvis P4 Transcriptional profiling reveals monocyte signature associated with JIA patient poor response to methotrexate Halima Moncrieffe, Mark F. Bennett, Monica Tsoras, Lorie Luyrink, Huan Xu, Sampath Prahalad, Paula Morris, Jason Dare, Peter A. Nigrovic, Margalit Rosenkranz, Mara Becker, Kathleen M. O’Neil, Thomas Griffin, Daniel J. Lovell, Alexei A. Grom, Mario Medvedovic, Susan D. Thompson P5 A multi-dimensional genomic map for polyarticular juvenile idiopathic arthritis Lisha Zhu, Kaiyu Jiang, Laiping Wong, Michael J Buck, Yanmin Chen, Halima Moncrieffe, Laura Brungs, Tao Liu, Ting Wang, James N Jarvis P6 Tocilizumab for treatment of children with refractory JIA Khaled Alsaeid, Jasim Alfailakawi, Hamid Alenezi, Hazim Alsaeed P7 Clinical characteristics of the initial patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry Tim Beukelman, Marc Natter, Norm Ilowite, Kelly Mieszkalski, Grendel Burrell, Brian Best, Helen Bristow, Shannon Carr, Anne Dennos, Rachel Kaufmann, Yukiko Kimura, Laura Schanberg P8 Comparative performance of small and large clinical centers in a comprehensive pediatric rheumatology disease registry Peter R Blier P9 Clinical characteristics of children with membranous lupus nephritis: The Childhood Arthritis and Rheumatology Research Alliance Legacy Registry Alexis Boneparth, Scott E. Wenderfer, L. Nandini Moorthy, Suhas M. Radhakrishna, Anna Carmela P. Sagcal-Gironella, Emily von Scheven P10 Rituximab use in pediatric lupus anticoagulant hypoprothrombinemia syndrome - a two center experience Kader Cetin Gedik, Salma Siddique, Cassyanne L. Aguiar, Doruk Erkan P11 Predictors of complementary and alternative medicine use and response in children with musculoskeletal conditions Ezra Cohen, Yvonne Lee, Michelle Dossett, Darshan Mehta, Roger Davis P12 Comparison of pediatric rheumatology and nephrology survey results for the treatment of refractory proliferative lupus nephritis and renal flare in juvenile SLE Mileka Gilbert, Beatrice Goilav, Esra Meidan, Joyce Hsu, Alexis Boneparth, Anabelle Chua, Stacy Ardoin, Scott E. Wenderfer, Emily Von Scheven, Natasha M. Ruth P13 Transitioning lupus patients from pediatric to adult rheumatology Joyce Hui-Yuen, Kader Cetin Gedik, Liza Bermudez, Ashlea Cook, Lisa Imundo, Amy Starr, Andrew Eichenfield, Anca Askanase P14 The systemic juvenile idiopathic arthritis cohort of the Childhood Arthritis & Rheumatology Research Alliance Registry Ginger Janow, Laura E. Schanberg, Soko Setoguchi, Victor Hasselblad, Elizabeth D. Mellins, Rayfel Schneider, Yukiko Kimura, The CARRA Legacy Registry Investigators P15 Results of the pilot study of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans for new-onset systemic juvenile idiopathic arthritis Yukiko Kimura, Sriharsha Grevich, Timothy Beukelman, Esi Morgan, T Brent Graham, Maria Ibarra, Yonit Sterba Ruas, Marisa Klein-Gitelman, Karen Onel, Sampath Prahalad, Marilynn Punaro, Sarah Ringold, Dana Toib, Heather Van Mater, Jennifer E. Weiss, Pamela F. Weiss, Kelly Mieszkalski, Laura E. Schanberg P16 A systemic review of pain relief modalities in juvenile idiopathic arthritis: First step in developing a novel decision support intervention Timothy S. H. Kwok, Jacinthe Bisaillon, Christine Smith, Lucie Brosseau, Jennifer Stinson, Adam M. Huber, Ciaran M. Duffy, Karine Toupin April P17 Barriers and facilitators to care retention for pediatric systemic lupus erythematous patients in South Africa: A qualitative study Laura B Lewandowski, Christiaan Scott P18 Evaluating the feasibility of conducting comparative effectiveness studies in juvenile Localized Scleroderma (jLS) Suzanne C. Li, Kathryn S. Torok, C. Egla Rabinovich, Sandy D. Hong, Mara L Becker, Fatma Dedeoglu, Maria F. Ibarra, Polly J Ferguson, Rob C. Fuhbrigge, Katie G. Stewart, Elena Pope, Ronald M. Laxer, Thomas G. Mason, Gloria C. Higgins, Xiaohu Li, Marilynn G. Punaro, George Tomlinson, Eleanor Pullenayegum, John Matelski, Laura Schanberg, Brian M. Feldman P19 Tonsillar histology in patients with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome Kalpana Manthiram, Hernan Correa, Kathryn Edwards P20 Clinical course of juvenile dermatomyositis presenting as skin predominant disease Edward J. Oberle, Michelle Bayer, Dominic O. Co, Hatice Ezgi Baris, Yvonne Chiu, Adam Huber, Susan Kim P21 A Survey of musculoskeletal ultrasound practices of pediatric rheumatologists in North America Edward J Oberle, Timothy Beukelman P22 Assessment, classification and treatment of calcinosis as a complication of juvenile dermatomyositis: A survey of pediatric rheumatologists by the Childhood Arthritis and Rheumatology Research Alliance Amir B. Orandi, Kevin W. Baszis, Vikas Dharnidharka, Mark F. Hoeltzel, for the CARRA JDM Committee P23 CARRA dermatomyositis CTP pilot study Ann Reed, Adam Huber, George Tomlinson, Eleanor Pullenayegum, John Matelski, Y. Ingrid Goh, Laura Schanberg, Brian M. Feldman P24 Unexpectedly high incidences and prolonged disease activity in children with chronic non-bacterial osteomyelitis (CNO) as compared to bacterial osteomyelitis Anja Schnabel, Ursula Range, Gabriele Hahn, Timo Siepmann, Reinhard Berner, Christian Michael Hedrich P25 Juvenile systemic sclerosis cohort within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry: Follow up characteristics Brandi Stevens, Kathryn S. Torok, Suzanne Li, Nicole Hershey, Megan Curran, Gloria Higgins, Katharine Moore, Egla Rabinovich, Anne M. Stevens, for the CARRA Registry Investigators P26 Development and usability testing of an iPad and desktop psycho-educational game for children with Juvenile Idiopathic Arthritis and their parents Jennifer Stinson, Mark Connelly, Adam Huber, Nadia Luca, Lynn Spiegel, Argerie Tsimicalis, Stephanie Luca, Naweed Tajuddin, Roberta Berard, Julia Barsalou, Sarah Campillo, Paul Dancey, Ciaran Duffy, Brian Feldman, Nicole Johnson, Patrick McGrath, Natalie Shiff, Shirley Tse, Lori Tucker, Charles Victor P27 iCanCopeTM: User-centred design and development of a smartphone app to support self-management for youth with arthritis pain Jennifer Stinson, Chitra Lalloo, Lauren Harris, Joseph Cafazzo, Lynn Spiegel, Brian Feldman, Nadia Luca, Ronald Laxer P28 Accessing pediatric rheumatology care: Despite barriers, few parents prefer telemedicine Danielle R. Bullock, Richard K. Vehe, Lei Zhang, Colleen K. Correll1 P29 Exploration of factors contributing to time to achieve clinically inactive disease (CID) in juvenile idiopathic arthritis (JIA): A preliminary report Suhas Ganguli, Max Shenberger, Ritesh Korumilli, Beth Gottlieb P30 Pediatric rheumatology referral patterns: Presenting complaints of new patients at a large, urban academic center Martha Rodriguez, Deirdre de Ranieri, Karen Onel, Linda Wagner-Weiner, Melissa Tesher P31 Quality improvement (QI) initiatives in childhood systemic lupus erythematosus (cSLE) Elizabeth Roth Wojcicki, Kristyn L. Maletta, Dominic O. Co, Marsha Malloy, Sarah Thomson, Judyann C. Olson P32 Proliferative lupus nephritis in juvenile SLE: Support from the pediatric nephrology community for the definitions of responsiveness and flare in the 2012 consensus treatment plans Scott E. Wenderfer, Mileka Gilbert, Joyce Hsu, Sangeeta Sule, Tamar B. Rubinstein, Beatrice Goilav, Daryl M. Okamura, Annabelle Chua, Laurence A. Greenbaum, Jerome C. Lane, Emily von Scheven, Stacy P. Ardoin, Natasha M. Ruth P33 The steroid taper app: Making of a mobile app Jennifer M. P. Woo, Marsha M. Malloy, James A. Jegers, Dustin J. Hahn, Mary K. Hintermeyer, Stacey M. Martinetti, Gretchen R. Heckel, Elizabeth L. Roth-Wojcicki, Dominic O. Co
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Affiliation(s)
- Lampros Fotis
- Washington University School of Medicine, St Louis, Missouri USA
| | - Nur Shaikh
- Washington University School of Medicine, St Louis, Missouri USA
| | - Kevin Baszis
- Washington University School of Medicine, St Louis, Missouri USA
| | - Anthony French
- Washington University School of Medicine, St Louis, Missouri USA
| | - Phillip Tarr
- Washington University School of Medicine, St Louis, Missouri USA
| | - Sriharsha Grevich
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA USA
| | - Peggy Lee
- Department of Oral Medicine, University of Washington, Seattle, WA USA
| | - Sarah Ringold
- Department of Rheumatology, Seattle Children’s Hospital, Seattle, WA USA
| | - Brian Leroux
- Department of Oral Health Sciences, University of Washington, Seattle, WA USA
| | | | | | | | - Jeremy Sokolove
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University, Stanford, CA USA
| | - Lauren Lahey
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University, Stanford, CA USA
| | - William Robinson
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University, Stanford, CA USA
| | | | - Anne Stevens
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA USA ,Seattle Children’s Research Institute, Seattle, WA USA
| | - Rie Karasawa
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mayumi Tamaki
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Megumi Tanaka
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshiko Sato
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuo Yudoh
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - James N. Jarvis
- University at Buffalo, State University of New York, Buffalo, NY USA
| | - Halima Moncrieffe
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,University of Cincinnati, Cincinnati, OH USA
| | | | - Monica Tsoras
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Lorie Luyrink
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Huan Xu
- University of Cincinnati, Cincinnati, OH USA
| | | | - Paula Morris
- Arkansas Children’s Hospital Research Institute, Little Rock, AR USA
| | - Jason Dare
- Arkansas Children’s Hospital Research Institute, Little Rock, AR USA
| | | | | | - Mara Becker
- Children’s Mercy Hospital, Kansas City, MO USA
| | | | | | - Daniel J. Lovell
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Alexei A. Grom
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | | | - Susan D. Thompson
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,University of Cincinnati, Cincinnati, OH USA
| | - Lisha Zhu
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Kaiyu Jiang
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Laiping Wong
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Michael J Buck
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Yanmin Chen
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | | | | | - Tao Liu
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Ting Wang
- Washington University, St. Louis, MO USA
| | - James N Jarvis
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Khaled Alsaeid
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait ,Mubarak Hospital, Jabriya, Kuwait
| | | | | | | | - Tim Beukelman
- University of Alabama at Birmingham, Birmingham, AL USA
| | - Marc Natter
- Tufts University, Medford, MA USA ,Harvard University, Boston, MA USA
| | - Norm Ilowite
- The Children’s Hospital at Montefiore, Bronx, NY USA
| | | | | | | | | | | | | | | | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ USA
| | | | - Peter R. Blier
- Baystate Children’s Hospital, Springfield, MA USA ,Tufts University School of Medicine, Boston, MA USA
| | - Alexis Boneparth
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | | | | | | | | | | | | | - Salma Siddique
- Hospital for Special Surgery-Weill Cornell Medical Center, New York, NY USA
| | | | - Doruk Erkan
- Hospital for Special Surgery-Weill Cornell Medical Center, New York, NY USA
| | - Ezra Cohen
- Boston Children’s Hospital, Boston, MA USA
| | - Yvonne Lee
- Brigham and Women’s Hospital, Boston, MA USA
| | | | | | | | - Mileka Gilbert
- Medical University of South Carolina, Charleston, SC USA
| | | | | | - Joyce Hsu
- Stanford University, Stanford, CA USA
| | | | | | - Stacy Ardoin
- Nationwide Children’s Hospital, Columbus, OH USA
| | | | | | | | - Joyce Hui-Yuen
- Division of Pediatric Rheumatology, Cohen Children’s Medical Center, New Hyde Park, NY USA
| | - Kader Cetin Gedik
- Division of Pediatric Rheumatology, Cohen Children’s Medical Center, New Hyde Park, NY USA
| | - Liza Bermudez
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Ashlea Cook
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Lisa Imundo
- Division of Adult Rheumatology, Columbia University Medical Center, New York, NY USA
| | - Amy Starr
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Andrew Eichenfield
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Anca Askanase
- Division of Adult Rheumatology, Columbia University Medical Center, New York, NY USA
| | - Ginger Janow
- Pediatrics, Joseph M Sanzari Children’s Hospital, Hackensack, NJ USA
| | - Laura E. Schanberg
- Pediatrics, Duke University, Durham, NC USA ,Duke Clinical Research Institute, Durham, NC USA
| | | | | | | | - Rayfel Schneider
- Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Yukiko Kimura
- Pediatrics, Joseph M Sanzari Children’s Hospital, Hackensack, NJ USA
| | | | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ USA
| | | | | | - Esi Morgan
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | | | | | | | | | - Karen Onel
- Comer Children’s Hospital of Chicago, Chicago, IL USA
| | | | | | | | - Dana Toib
- St. Christopher’s Hospital for Children, Philadelphia, PA USA
| | | | | | | | | | | | - Timothy S. H. Kwok
- Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Jacinthe Bisaillon
- School of Nursing Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Christine Smith
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Lawrence S. Bloomberg Faculty of Nursing University of Toronto, Toronto, Ontario Canada
| | - Adam M. Huber
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia Canada
| | - Ciaran M. Duffy
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario Canada
| | - Karine Toupin April
- Department of Pediatrics, Children’s Hospital of Eastern Ontario Research Institute, Faculty of Medicine, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Laura B. Lewandowski
- Pediatric Rheumatology, Duke University Medical Center, Durham, NC USA ,Duke Global Health Institute, Duke University, Durham, NC USA ,Paediatric Rheumatology, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa ,National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, Bethesda, MD USA
| | - Christiaan Scott
- Paediatric Rheumatology, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
| | - Suzanne C. Li
- Hackensack University Medical Center, Hackensack, NJ USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xiaohu Li
- Stevens Institute of Technology, Hoboken, NJ USA
| | | | | | | | | | | | | | - Kalpana Manthiram
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Hernan Correa
- Department of Pathology, Immunology, and Microbiology, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Kathryn Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Edward J. Oberle
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH USA
| | - Michelle Bayer
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | - Dominic O. Co
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | | | - Yvonne Chiu
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | - Adam Huber
- IWK Health Centre, Dalhousie University, Halifax, NS Canada
| | - Susan Kim
- Boston Children’s Hospital, Boston, MA USA ,Harvard Medical School, Boston, MA USA
| | - Edward J. Oberle
- Nationwide Children’s Hospital, Columbus, OH USA ,The Ohio State University, Columbus, OH USA
| | | | - Amir B. Orandi
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Kevin W. Baszis
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Vikas Dharnidharka
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Mark F. Hoeltzel
- Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor, MI USA
| | | | | | - Adam Huber
- Dalhousie University, Halifax, NS Canada
| | | | | | | | | | | | | | - Anja Schnabel
- Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Hahn
- Department of Radiology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Reinhard Berner
- Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Michael Hedrich
- Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Brandi Stevens
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA USA
| | | | - Suzanne Li
- Hackensack University Medical Center, Hackensack, NJ USA
| | - Nicole Hershey
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA USA
| | - Megan Curran
- Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | | | | | | | - Anne M. Stevens
- Seattle Children’s Research Institute, University of Washington, Seattle, WA USA
| | | | - Jennifer Stinson
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mark Connelly
- University of Kansas Medical Center, Kansas City, MO USA
| | - Adam Huber
- IWK Health Centre, Halifax, Nova Scotia Canada
| | - Nadia Luca
- Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Lynn Spiegel
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Stephanie Luca
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Naweed Tajuddin
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | | | | | - Paul Dancey
- Memorial University of Newfoundland, Newfoundland, Canada
| | - Ciaran Duffy
- Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Brian Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | | | | | - Shirley Tse
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lori Tucker
- British Columbia Children’s Hospital, Vancouver, British Columbia Canada
| | | | | | | | - Lauren Harris
- The Hospital for Sick Children, Toronto, Canada ,University of Toronto, Toronto, Canada ,Centre for Global eHealth Innovation, Toronto, Canada
| | | | | | | | - Nadia Luca
- Alberta Children’s Hospital, Calgary, Alberta Canada
| | | | - Danielle R. Bullock
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Richard K. Vehe
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Lei Zhang
- Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN USA
| | - Colleen K. Correll
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Suhas Ganguli
- Pediatric Rheumatology, Cohen Children’s Medical Center, New York, NY 11040 USA
| | - Max Shenberger
- Pediatric Rheumatology, Cohen Children’s Medical Center, New York, NY 11040 USA
| | - Ritesh Korumilli
- Pediatrics, Flushing Hospital Medical Center, New York, NY 11355 USA
| | - Beth Gottlieb
- Pediatric Rheumatology, Cohen Children’s Medical Center, New York, NY 11040 USA
| | - Martha Rodriguez
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | - Deirdre de Ranieri
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | - Karen Onel
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | | | - Melissa Tesher
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | | | | | | | | | | | | | | | - Mileka Gilbert
- Medical University of South Carolina, Charleston, SC USA
| | - Joyce Hsu
- Stanford University, Stanford, CA USA
| | - Sangeeta Sule
- Johns Hopkins Children’s Hospital, Baltimore, MD USA
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Henderson LA, Zurakowski D, Angeles-Han ST, Lasky A, Rabinovich CE, Lo MS. Medication use in juvenile uveitis patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2016; 14:9. [PMID: 26879972 PMCID: PMC4755024 DOI: 10.1186/s12969-016-0069-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 02/04/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND There is not yet a commonly accepted, standardized approach in the treatment of juvenile idiopathic uveitis when initial steroid therapy is insufficient. We sought to assess current practice patterns within a large cohort of children with juvenile uveitis. METHODS This is a cross-sectional cohort study of patients with uveitis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRAnet) registry. Clinical information including, demographic information, presenting features, disease complications, and medications were collected. Chi-square and Fisher's exact tests were used to assess for associations between medications and clinical characteristics. RESULTS Ninety-two children with idiopathic and 656 with juvenile idiopathic arthritis (JIA)-associated uveitis were identified. Indication (arthritis or uveitis) for medication use was not available for JIA patients; therefore, detailed analysis was limited to children with idiopathic uveitis. In this group, 94 % had received systemic steroids. Methotrexate (MTX) was used in 76 % of patients, with oral and subcutaneous forms given at similar rates. In multivariable analysis, non-Caucasians were more likely to be treated initially with subcutaneous MTX (P = 0.003). Of the 53 % of patients treated with a biologic DMARD, all received a tumor necrosis factor (TNF) inhibitor. TNF inhibitor use was associated with a higher frequency of cataracts (52 % vs 21 %; P = 0.001) and antinuclear antibody positivity (49 % vs 29 %; P = 0.04), although overall complication rates were not higher in these patients. CONCLUSION Among idiopathic uveitis patients enrolled in the CARRAnet registry, MTX was the most commonly used DMARD, with subcutaneous and oral forms equally favored. Patients who received a TNF inhibitor were more likely to be ANA positive and have cataracts.
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Affiliation(s)
- Lauren A. Henderson
- Division of Immunology, Boston Children’s Hospital, Boston, MA and Department of Pediatrics, Harvard Medical School, 1 Blackfan Circle, Karp Building, 10th Floor, Boston, MA 02115 USA
| | - David Zurakowski
- Departments of Anesthesia and Surgery, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
| | - Sheila T. Angeles-Han
- Department of Pediatrics and Ophthalmology, Emory University School of Medicine, Atlanta, GA USA
| | - Andrew Lasky
- Department of Pediatric Rheumatology, Randall Children's Hospital at Legacy Emanuel, Portland, OR, USA.
| | - C. Egla Rabinovich
- Division of Rheumatology, Department of Pediatrics, Duke Children’s, Durham, NC USA
| | - Mindy S. Lo
- Division of Immunology, Boston Children’s Hospital, Boston, MA and Department of Pediatrics, Harvard Medical School, 1 Blackfan Circle, Karp Building, 10th Floor, Boston, MA 02115 USA
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23
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Elahi S, Homstad A, Vaidya H, Stout J, Hall G, Wu G, Conlon P, Routh JC, Wiener JS, Ross SS, Nagaraj S, Wigfall D, Foreman J, Adeyemo A, Gupta IR, Brophy PD, Rabinovich CE, Gbadegesin RA. Rare variants in tenascin genes in a cohort of children with primary vesicoureteric reflux. Pediatr Nephrol 2016; 31:247-53. [PMID: 26408188 PMCID: PMC4747108 DOI: 10.1007/s00467-015-3203-6] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/10/2015] [Accepted: 08/26/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Primary vesicoureteral reflux (PVUR) is the most common malformation of the kidney and urinary tract, and reflux nephropathy is a major cause of chronic kidney disease in children. Recently, we reported mutations in the tenascin XB gene (TNXB) as a cause of PVUR with joint hypermobility. METHODS To define the role of rare variants in tenascin genes in the etiology of PVUR, we screened a cohort of patients with familial PVUR (FPVUR) and non-familial PVUR (NFPVUR) for rare missense variants inTNXB and the tenascin C gene (TNC) after excluding mutations in ROBO2 and SOX17. RESULTS The screening procedure identified 134 individuals from 112 families with PVUR; two families with mutations in ROBO2 were excluded from further analysis. Rare missense variants in TNXB were found in the remaining 110 families, of which 5/55 (9%) families had FPVUR and 2/55 (4%) had NFPVUR. There were no differences in high-grade reflux or renal parenchymal scarring between patients with and without TNXB variants. All patients with TNXB rare variants who were tested exhibited joint hypermobility. Overall we were able to identify causes of FPVUR in 7/57 (12%) families (9% in TNXB and 3% in ROBO2). CONCLUSIONS In conclusion, the identification of a rare missense variant in TNXB in combination with a positive family history of VUR and joint hypermobility may represent a non-invasive method to diagnose PVUR and warrants further evaluation in other cohorts.
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Affiliation(s)
- Shan Elahi
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Alison Homstad
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Duke Molecular Physiology Institute, Durham, NC
| | - Himani Vaidya
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Duke Molecular Physiology Institute, Durham, NC
| | - Jennifer Stout
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Gentzon Hall
- Duke Molecular Physiology Institute, Durham, NC
,Department of Medicine, Duke University Medical Center, Durham, NC
| | - Guanghong Wu
- Duke Molecular Physiology Institute, Durham, NC
,Department of Medicine, Duke University Medical Center, Durham, NC
| | - Peter Conlon
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Jonathan C. Routh
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
| | - John S. Wiener
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
| | - Sherry S. Ross
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham NC
,Department of Urology, Pediatric Urology, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC
| | - Shashi Nagaraj
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Delbert Wigfall
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - John Foreman
- Department of Pediatrics, Duke University Medical Center, Durham, NC
| | - Adebowale Adeyemo
- Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20892-5635, USA
| | - Indra R. Gupta
- Department of Pediatrics and Human Genetics, McGill University, Montreal, Quebec, Canada
| | | | | | - Rasheed A. Gbadegesin
- Department of Pediatrics, Duke University Medical Center, Durham, NC
,Duke Molecular Physiology Institute, Durham, NC
,To whom correspondence should be addressed:
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24
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Abstract
To produce evidence capable of informing healthcare decision making at all critical levels, pragmatic clinical trials are diverse both in terms of the type of intervention (medical, behavioral, and/or technological) and the target of intervention (patients, clinicians, and/or healthcare system processes). Patients and clinicians may be called on to participate as designers, investigators, intermediaries, or subjects of pragmatic clinical trials. Other members of the healthcare team, as well as the healthcare system itself, also may be affected directly or indirectly before, during, or after study implementation. This diversity in the types and targets of pragmatic clinical trial interventions has brought into focus the need to consider whether existing ethics and regulatory principles, policies, and procedures are appropriate for pragmatic clinical trials. Specifically, further examination is needed to identify how the types and targets of pragmatic clinical trial interventions may influence the assessment of net potential risk, understood as the balance of potential harms and benefits. In this article, we build on scholarship seeking to align ethics and regulatory requirements with potential research risks and propose an approach to the assessment of net risks that is sensitive to the diverse nature of pragmatic clinical trial interventions. We clarify the potential harms, burdens, benefits, and advantages of common types of pragmatic clinical trial interventions and discuss implications for patients, clinicians, and healthcare systems.
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Affiliation(s)
- Joseph Ali
- Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA
| | | | - Carol P Somkin
- Kaiser Permanente Division of Research, Oakland, CA, USA
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25
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Abstract
Anterior uveitis (AU), inflammation of the iris, choroid or ciliary body, can cause significant eye morbidity, including visual loss. In the pediatric age group, the most common underlying diagnosis for AU is juvenile idiopathic associated uveitis and idiopathic AU, which are the focus of this paper. AU is often resistant to medications such as topical corticosteroids and methotrexate. In the past 15 years, biologic agents (biologics) have transformed treatment. In this review, we discuss those in widespread use and those with more theoretical applications for anterior uveitis. Tumor necrosis factor alpha inhibitors (anti-TNFα) have been available the longest and are used widely to treat pediatric uveitis. The effects of anti-TNFα in children are described mostly in small retrospective case series. Together, the literature suggests that the majority of children treated with anti-TNFα achieve decreased uveitis activity and reduced corticosteroid burden. However, many will have disease flares even on treatment. Only a few small studies directly compare outcomes between alternate anti-TNFα (infliximab and adalimumab). The use of different uveitis grading systems, inclusion criteria, and outcome measures makes cross-study comparisons difficult. Whether the achievement and maintenance of inactive disease occurs more frequently with certain anti-TNFα remains controversial. Newer biologics that modulate the immune system differently (e.g., interfere with Th17 activation through IL-17a and IL-6 blockade, limit T lymphocyte costimulation, and deplete B lymphocytes), have shown promise for uveitis. Studies of these agents are small and include mostly adults. Additional biologics are also being explored to treat uveitis. With their advent, we are hopeful that outcomes will ultimately be improved for children with AU. With many biologics available, much work remains to identify the optimal inflammatory pathway to target in AU.
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Affiliation(s)
- Melissa A Lerman
- Division of Rheumatology, The Children's Hospital of Philadelphia (CHOP), Abramson Research Center Suite 1102, 3615 Civic Center Boulevard, Philadelphia, PA, 19104, USA,
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26
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Ringold S, Hendrickson A, Abramson L, Beukelman T, Blier PR, Bohnsack J, Chalom EC, Gewanter HL, Gottlieb B, Hollister R, Hsu J, Hudgins A, Ilowite NT, Klein-Gitelman M, Lindsley C, Lopez Benitez JM, Lovell DJ, Mason T, Milojevic D, Moorthy LN, Nanda K, Onel K, Prahalad S, Rabinovich CE, Ray L, Rouster-Stevens K, Ruth N, Shishov M, Spalding S, Syed R, Stoll M, Vehe RK, Weiss JE, White AJ, Wallace CA, Sobel RE. Novel Method to Collect Medication Adverse Events in Juvenile Arthritis: Results From the Childhood Arthritis and Rheumatology Research Alliance Enhanced Drug Safety Surveillance Project. Arthritis Care Res (Hoboken) 2015; 67:529-37. [DOI: 10.1002/acr.22487] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 09/23/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Sarah Ringold
- Seattle Children's Hospital and Research Institute; Seattle Washington
| | | | | | | | - Peter R. Blier
- Baystate Children's Hospital, Springfield, and Tufts University School of Medicine; Boston Massachusetts
| | | | | | | | - Beth Gottlieb
- Cohen Children's Medical Center of New York; New Hyde Park
| | | | - Joyce Hsu
- Stanford University Medical Center; Stanford California
| | | | | | | | | | | | | | | | - Diana Milojevic
- Floating Hospital for Children, Tufts Medical Center; Boston Massachusetts
| | - Lakshmi N. Moorthy
- Robert Wood Johnson Medical School, Rutgers University; New Brunswick New Jersey
| | - Kabita Nanda
- Comer Children's Hospital, University of Chicago; Chicago Illinois
| | - Karen Onel
- Emory University School of Medicine and Children's Healthcare of Atlanta; Atlanta Georgia
| | - Sampath Prahalad
- Emory University School of Medicine and Children's Healthcare of Atlanta; Atlanta Georgia
| | | | | | - Kelly Rouster-Stevens
- Emory University School of Medicine and Children's Healthcare of Atlanta; Atlanta Georgia
| | - Natasha Ruth
- The Medical University of South Carolina; Charleston
| | | | | | - Reema Syed
- Saint Louis University; St. Louis Missouri
| | | | | | | | | | - Carol A. Wallace
- Seattle Children's Hospital and Research Institute; Seattle Washington
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27
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Wu EY, Li SC, Torok KS, Virkud Y, Fuhlbrigge R, Rabinovich CE. A28: Description of the Juvenile Localized Scleroderma Subgroup of the CARRA Registry. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38444] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Eveline Y. Wu
- University of North Carolina at Chapel Hill; Chapel Hill NC
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28
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Henderson LA, Zurakowski D, Angeles-Han S, Lasky A, Rabinovich CE, Lo MS. A70: Medication Use in the Treatment of Juvenile Idiopathic Uveitis Patients Enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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29
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Hashkes PJ, Becker ML, Cabral DA, Laxer RM, Paller AS, Rabinovich CE, Turner D, Zulian F. Methotrexate: new uses for an old drug. J Pediatr 2014; 164:231-6. [PMID: 24286573 DOI: 10.1016/j.jpeds.2013.10.029] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Revised: 09/09/2013] [Accepted: 10/11/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Philip J Hashkes
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel.
| | - Mara L Becker
- Division of Pediatric Rheumatology, Children's Mercy Hospitals and Clinics, Kansas City, MO
| | - David A Cabral
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children, Departments of Pediatrics and Medicine, University of Toronto, Toronto, ON, Canada
| | - Amy S Paller
- Departments of Dermatology and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Dan Turner
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
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30
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Gbadegesin RA, Brophy PD, Adeyemo A, Hall G, Gupta IR, Hains D, Bartkowiak B, Rabinovich CE, Chandrasekharappa S, Homstad A, Westreich K, Wu G, Liu Y, Holanda D, Clarke J, Lavin P, Selim A, Miller S, Wiener JS, Ross SS, Foreman J, Rotimi C, Winn MP. TNXB mutations can cause vesicoureteral reflux. J Am Soc Nephrol 2013; 24:1313-22. [PMID: 23620400 DOI: 10.1681/asn.2012121148] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Primary vesicoureteral reflux (VUR) is the most common congenital anomaly of the kidney and the urinary tract, and it is a major risk factor for pyelonephritic scarring and CKD in children. Although twin studies support the heritability of VUR, specific genetic causes remain elusive. We performed a sequential genome-wide linkage study and whole-exome sequencing in a family with hereditary VUR. We obtained a significant multipoint parametric logarithm of odds score of 3.3 on chromosome 6p, and whole-exome sequencing identified a deleterious heterozygous mutation (T3257I) in the gene encoding tenascin XB (TNXB in 6p21.3). This mutation segregated with disease in the affected family as well as with a pathogenic G1331R change in another family. Fibroblast cell lines carrying the T3257I mutation exhibited a reduction in both cell motility and phosphorylated focal adhesion kinase expression, suggesting a defect in the focal adhesions that link the cell cytoplasm to the extracellular matrix. Immunohistochemical studies revealed that the human uroepithelial lining of the ureterovesical junction expresses TNXB, suggesting that TNXB may be important for generating tensile forces that close the ureterovesical junction during voiding. Taken together, these results suggest that mutations in TNXB can cause hereditary VUR.
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31
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Li SC, Torok KS, Pope E, Dedeoglu F, Hong S, Jacobe HT, Rabinovich CE, Laxer RM, Higgins GC, Ferguson PJ, Lasky A, Baszis K, Becker M, Campillo S, Cartwright V, Cidon M, Inman CJ, Jerath R, O'Neil KM, Vora S, Zeft A, Wallace CA, Ilowite NT, Fuhlbrigge RC. Development of consensus treatment plans for juvenile localized scleroderma: a roadmap toward comparative effectiveness studies in juvenile localized scleroderma. Arthritis Care Res (Hoboken) 2012; 64:1175-85. [PMID: 22505322 DOI: 10.1002/acr.21687] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Juvenile localized scleroderma (LS) is a chronic inflammatory skin disorder associated with substantial morbidity and disability. Although a wide range of therapeutic strategies has been reported in the literature, a lack of agreement on treatment specifics and accepted methods for clinical assessment has made it difficult to compare approaches and identify optimal therapy. Our objective was to develop standardized treatment plans, clinical assessments, and response criteria for active, moderate to high severity juvenile LS. METHODS A core group of pediatric rheumatologists, dermatologists, and a lay advisor was engaged by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) to develop standardized treatment plans and assessment parameters for juvenile LS using consensus methods/nominal group techniques. Recommendations were validated in 2 face-to-face conferences with a larger group of practitioners with expertise in juvenile LS and with the full membership of CARRA, which encompasses the majority of pediatric rheumatologists in the US and Canada. RESULTS Consensus was achieved on standardized treatment plans that reflect the prevailing treatment practices of CARRA members. Standardized clinical assessment methods and provisional treatment response criteria were also developed. Greater than 90% of pediatric rheumatologists responding to a survey (66% of CARRA membership) affirmed the final recommendations and agreed to utilize these consensus plans to treat patients with juvenile LS. CONCLUSION Using consensus methodology, we have developed standardized treatment plans and assessment methods for juvenile LS. The high level of support among pediatric rheumatologists will support future comparative effectiveness studies and enable the development of evidence-based guidelines for the treatment of juvenile LS.
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Affiliation(s)
- Suzanne C Li
- Hackensack University Medical Center, New Jersey, USA
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32
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Li SC, Fuhlbrigge RC, Dedeoglu F, Ferguson PJ, Higgins GC, Hong SD, Jacobe H, Lasky A, Laxer RM, Morris MC, Pope E, Rabinovich CE, Torok KS. Developing juvenile localized scleroderma (jLS) consensus treatment regimens for comparative effectiveness studies. Pediatr Rheumatol Online J 2012. [PMCID: PMC3403067 DOI: 10.1186/1546-0096-10-s1-a68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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33
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Abstract
The array of paediatric pulmonary complications of the various rheumatologic disorders illustrates both the complexities and challenges of the underlying disorders and the continuing lack of detailed knowledge of the pathophysiology and optimal treatment paradigms in children. While the vertical transfer of information has made much progress from adult studies, such as with the diagnosis and management of pulmonary arterial hypertension, in many instances underlying disorders may differ between children and adults in important and fundamental respects. Recognition of pulmonary complications of rheumatic disorders in children is often more difficult and requires anticipation and a high index of suspicion. Further progress in understanding and treating the various paediatric disorders is hampered by the lack of paediatric-specific information. Crucial to further progress are the expansion of orphan childhood disease databases and research networks. In this way a comprehensive approach to determining basic natural history, risks and outcomes, and defining the next generation of therapies in a disease-specific and age-specific manner can be achieved.
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Robinson AB, Thierry-Palmer M, Gibson KL, Rabinovich CE. Disease activity, proteinuria, and vitamin D status in children with systemic lupus erythematosus and juvenile dermatomyositis. J Pediatr 2012; 160:297-302. [PMID: 21924736 PMCID: PMC3258326 DOI: 10.1016/j.jpeds.2011.08.011] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [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: 03/02/2011] [Revised: 06/23/2011] [Accepted: 08/03/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate relationships among vitamin D, proteinuria, and disease activity in pediatric systemic lupus erythematosus (SLE) and juvenile dermatomyositis (JDM). STUDY DESIGN Multiple linear regression was used to associate subject-reported race, sunscreen use, and vitamin D intake with physician-assessed disease activity and serum 25-hydroxyvitamin D (25[OH]D) in 58 subjects with pediatric SLE (n=37) or JDM (n=21). Serum 25(OH)D was correlated with urinary vitamin D binding protein/creatinine ratio (DBP/C) and other indicators of proteinuria. RESULTS Serum 25(OH)D levels in subjects with SLE were inversely associated with the natural log of urinary DBP/C (r=-0.63, P<.001) and urine protein to creatinine ratio (r=-0.60, P<.001), with an adjusted mean 10.9-ng/mL (95% CI, 5.1-16.8) decrease in 25(OH)D for those with proteinuria. Excluding subjects with proteinuria, serum 25(OH)D levels were inversely associated with disease activity in JDM, but not in SLE. Overall, 66% of all subjects were taking concurrent corticosteroids, but this was not associated with 25(OH)D levels. CONCLUSIONS Low serum 25(OH)D in patients with SLE is associated with proteinuria and urinary DBP. Vitamin D deficiency is associated with disease activity in patients with JDM and SLE; this relationship in SLE may be confounded by proteinuria.
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Affiliation(s)
- Angela Byun Robinson
- Division of Pediatric Rheumatology, Rainbow Babies and Children’s Hospital, Cleveland, Ohio
| | - Myrtle Thierry-Palmer
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine
| | - Keisha L. Gibson
- Division of Nephrology and Hypertension, University of North Carolina at Chapel Hill
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Beukelman T, Cron RQ, Patkar NM, Saag KG, DeWitt EM, Lovell DJ, Ilowite NT, Kimura Y, Laxer RM, Martini A, Ruperto N, Rabinovich CE. Reply. Arthritis Care Res (Hoboken) 2011. [DOI: 10.1002/acr.20520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Beukelman T, Patkar NM, Saag KG, Tolleson-Rinehart S, Cron RQ, DeWitt EM, Ilowite NT, Kimura Y, Laxer RM, Lovell DJ, Martini A, Rabinovich CE, Ruperto N. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features. Arthritis Care Res (Hoboken) 2011; 63:465-82. [PMID: 21452260 PMCID: PMC3222233 DOI: 10.1002/acr.20460] [Citation(s) in RCA: 523] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Guidelines and recommendations developed and/or endorsed by the American College of Rheumatology (ACR) are intended to provide guidance for particular patterns of practice and not to dictate the care of a particular patient. The ACR considers adherence to these guidelines and recommendations to be voluntary, with the ultimate determination regarding their application to be made by the physician in light of each patient’s individual circumstances. Guidelines and recommendations are intended to promote beneficial or desirable outcomes but cannot guarantee any specific outcome. Guidelines and recommendations developed or endorsed by the ACR are subject to periodic revision as warranted by the evolution of medical knowledge, technology, and practice.
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Affiliation(s)
- Timothy Beukelman
- University of Alabama at Birmingham, Birmingham, AL 35233-1711, USA.
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Nigrovic PA, Mannion M, Prince FHM, Zeft A, Rabinovich CE, van Rossum MAJ, Cortis E, Pardeo M, Miettunen PM, Janow G, Birmingham J, Eggebeen A, Janssen E, Shulman AI, Son MB, Hong S, Jones K, Ilowite NT, Cron RQ, Higgins GC. Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series. ACTA ACUST UNITED AC 2011; 63:545-55. [PMID: 21280009 DOI: 10.1002/art.30128] [Citation(s) in RCA: 318] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the safety and efficacy of the interleukin-1 (IL-1) receptor antagonist anakinra as first-line therapy for systemic juvenile idiopathic arthritis (JIA). METHODS Patients with systemic JIA receiving anakinra as part of initial disease-modifying antirheumatic drug (DMARD) therapy were identified from 11 centers in 4 countries. Medical records were abstracted using a standardized instrument, and resulting data were analyzed to characterize concomitant therapies, clinical course, adverse events, and predictors of outcome. RESULTS Among 46 patients meeting inclusion criteria, anakinra monotherapy was used in 10 patients (22%), while 67% received corticosteroids and 33% received additional DMARDs. Outcomes were evaluated at a median followup interval of 14.5 months. Fever and rash resolved within 1 month in >95% of patients, while C-reactive protein and ferritin normalized within this interval in >80% of patients. Active arthritis persisted at 1 month in 39% of patients, at 3 months in 27%, and at >6 months of followup in 11%. Approximately 60% of patients, including 8 of 10 receiving anakinra monotherapy, attained a complete response without escalation of therapy. Disease characteristics and treatment were similar in partial and complete responders, except that partial responders were markedly younger at onset (median age 5.2 years versus 10.2 years; P = 0.004). Associated adverse events included documented bacterial infection in 2 patients and hepatitis in 1 patient. Tachyphylaxis was not observed. CONCLUSION Anakinra as first-line therapy for systemic JIA was associated with rapid resolution of systemic symptoms and prevention of refractory arthritis in almost 90% of patients during the interval examined. These results justify further study of IL-1 inhibition as first-line, rather than rescue, therapy in systemic JIA.
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Affiliation(s)
- Peter A Nigrovic
- Children's Hospital Boston and Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Robinson AB, Gallentine WB, Rabinovich CE. Pediatric neuro-Behçet's disease responsive to adalimumab. Pediatr Neurol 2010; 43:291-3. [PMID: 20837311 DOI: 10.1016/j.pediatrneurol.2010.04.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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] [Received: 02/10/2010] [Revised: 04/06/2010] [Accepted: 04/30/2010] [Indexed: 11/24/2022]
Abstract
Neurologic manifestations of Behçet's disease (neuro-Behçet's disease) are uncommon, but may cause patients significant morbidity and mortality. Neuro-Behçet's disease is chronic and may be refractory to treatment. We report on a 12-year-old girl with neuro-Behçet's disease that responded to standard doses of subcutaneous adalimumab.
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Affiliation(s)
- Angela Byun Robinson
- Division of Pediatric Rheumatology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Giannini EH, Ilowite NT, Lovell DJ, Wallace CA, Rabinovich CE, Reiff A, Higgins G, Gottlieb B, Chon Y, Zhang N, Baumgartner SW. Effects of long-term etanercept treatment on growth in children with selected categories of juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2010; 62:3259-64. [DOI: 10.1002/art.27682] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Giannini EH, Ilowite NT, Lovell DJ, Wallace CA, Rabinovich CE, Reiff A, Higgins G, Gottlieb B, Singer NG, Chon Y, Lin SL, Baumgartner SW. Long-term safety and effectiveness of etanercept in children with selected categories of juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2009; 60:2794-804. [PMID: 19714630 DOI: 10.1002/art.24777] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate the long-term safety and effectiveness of etanercept alone or in combination with methotrexate (MTX) in children with selected categories of juvenile idiopathic arthritis (JIA). METHODS Patients ages 2-18 years with rheumatoid factor (RF)-positive or RF-negative polyarthritis, systemic JIA, or extended oligoarthritis were eligible for the study. Patients received MTX alone (> or =10 mg/m(2)/week [ approximately 0.3 mg/kg/week], maximum dosage 1 mg/kg/week), etanercept alone (0.8 mg/kg/week, maximum dose 50 mg), or etanercept plus MTX for 3 years in an open-label, nonrandomized study. Safety was assessed by measuring rates of adverse events, and effectiveness was assessed using the physician's global assessment of disease activity and the pediatric total joint assessment. RESULTS A total of 197, 103, and 294 patients were enrolled in the MTX, etanercept, and etanercept plus MTX groups, respectively. Exposure-adjusted rates of adverse events were similar among the 3 treatment groups (18.3, 18.7, and 21.6 per 100 patient-years in the MTX, etanercept, and etanercept plus MTX groups, respectively). Respective rates per 100 patient-years of serious adverse events (4.6, 7.1, and 6.0) and medically important infections (1.3, 1.8, and 2.1) were also similar among the 3 treatment groups. Scores for physician's global assessment and total active joints improved from baseline, and improvement was maintained for the duration of the study. CONCLUSION These data confirm the findings of other long-term studies and suggest that etanercept or etanercept plus MTX has an acceptable safety and effectiveness profile in children with selected categories of JIA. Improvement was maintained for 3 years in those continuing to receive medication.
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Affiliation(s)
- E H Giannini
- Pediatrics and Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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DeWitt EM, Ardoin SP, Rabinovich CE, Schanberg LE. Clinical trials in pediatric rheumatology: comment on the editorial by Lehman. Arthritis Rheum 2008; 58:1202-1203. [PMID: 18383362 DOI: 10.1002/art.23411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Abstract
PURPOSE OF REVIEW Use of tumor necrosis factor-alpha blocking agents to treat chronic pediatric uveitis is becoming recognized as an important therapeutic modality. This review summarizes the rationale for this use, highlighting new studies of these agents in pediatric uveitis. RECENT FINDINGS The majority of patients with pediatric uveitis either have idiopathic uveitis or uveitis associated with juvenile idiopathic arthritis. Ophthalmologic morbidity among these children is common. Most studies evaluating tumor necrosis factor-alpha blockade in pediatric uveitis are retrospective case series, with attendant limitations that are inherent to any retrospective study. Study of uveitis has been hampered by lack of standardization of disease and outcome measures, which has been addressed by uveitis experts with publication of consensus measures. Data to date suggest that tumor necrosis factor-alpha blockade is efficacious in refractory uveitis. Agents with direct tumor necrosis factor-alpha membrane receptor binding activity may be the most efficacious. There remain many unanswered questions in the treatment of pediatric uveitis, including optimal dosing regimen and long-term efficacy. SUMMARY Tumor necrosis factor-alpha blocking agents play an important role in the treatment of chronic pediatric uveitis. Prospective comparative studies are needed so that we may better understand this role.
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Affiliation(s)
- C Egla Rabinovich
- Division of Pediatric Rheumatology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Jones OY, Spencer CH, Bowyer SL, Dent PB, Gottlieb BS, Rabinovich CE. A multicenter case-control study on predictive factors distinguishing childhood leukemia from juvenile rheumatoid arthritis. Pediatrics 2006; 117:e840-4. [PMID: 16651289 DOI: 10.1542/peds.2005-1515] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Acute lymphocytic leukemia (ALL) often presents with musculoskeletal concerns such as pain or swelling, even before appearance of blasts in the peripheral blood. Such presentation may lead to misdiagnosis of a child with juvenile rheumatoid arthritis (JRA). This study was designed to identify the predictive factors for leukemia using basic clinical and laboratory information. METHODS A retrospective chart review was performed using a simple questionnaire to compare the clinical and laboratory findings present during the initial visit to a pediatric rheumatology clinic for 277 children who were ultimately diagnosed with either JRA (n = 206) or ALL (n = 71). Sensitivity and specificity analysis of a variety of parameters, both singly and in combination, was performed to identify predictive value for ALL. RESULTS The majority (75%) of children with ALL did not have blasts in the peripheral blood at the time of evaluation by pediatric rheumatologists. In children presenting with unexplained musculoskeletal complaints, the 3 most important factors that predicted a diagnosis of ALL were low white blood cell count (< 4 x 10(9)/L), low-normal platelet count (150-250 x 10(9)/L), and history of nighttime pain. In the presence of all 3, the sensitivity and specificity for a diagnosis of ALL were 100% and 85%, respectively. Other findings, including antinuclear antibody, rash, and objective signs of arthritis, were not helpful in differentiating between these diagnoses because they occurred at similar rates in both groups. CONCLUSIONS When a child develops new-onset bone-joint complaints, the presence of subtle complete blood count changes combined with nighttime pain should lead to consideration of leukemia as the underlying cause.
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Affiliation(s)
- Olcay Y Jones
- Department of Pediatric Rheumatology, Children's National Medical Center, George Washington University, Washington, DC 20010, USA.
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Abstract
There is an increasing appreciation among physicians about the importance of bone health in children as a potential modifiable risk factor for development of osteoporosis later in life. Many unanswered questions about normal pediatric bone health make the treatment and clinical investigation of bone disease in children with chronic rheumatic diseases challenging. Understanding normal bone biology along with the epidemiology and diagnosis of osteoporosis is the key to the understanding of the potential for abnormal bone metabolism in the juvenile rheumatic diseases.
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Affiliation(s)
- C Egla Rabinovich
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University Medical Center, Box 3212, Durham, NC 27710, USA.
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Rabinovich CE. Bone mineral status in juvenile rheumatoid arthritis. J Rheumatol Suppl 2000; 58:34-7. [PMID: 10782854] [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] [Indexed: 02/16/2023]
Abstract
Osteoporosis can be thought of as a disease of childhood with manifestations in the adult years. One strategy in prevention of osteoporosis is to maximize peak bone mass with interventions focused during the childhood and adolescent years, taking advantage of this unique window of opportunity to maximize bone mass accrual, maximize peak bone mass, and theoretically decrease fracture risk for life. Factors important in the development of peak bone mass in children are reviewed. Studies examining bone metabolism and bone density in children with juvenile rheumatoid arthritis (JRA) are summarized. There is much work to be done before the best treatments for the osteoporosis of JRA are defined. Optimizing calcium intake and physical activity, along with corticosteroid avoidance and control of disease activity, is sound management for children with JRA.
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Affiliation(s)
- C E Rabinovich
- University of Chicago Pritzker School of Medicine, Illinois, USA
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Abstract
To the arthritic child and his or her family, the pediatrician is a valuable resource. When school problems first occur in elementary school, the pediatrician can try to solve them with an informal contact with the school teacher, nurse, counselor, or principal. If that effort is unsuccessful, the pediatrician can then suggest that the family go to the school and request the Individual Education Plan (IEP). Although this mechanism is hardly a panacea and local school district variability exists, this process provides an opportunity for the parent and school personnel to sit down and discuss how the child's problems and illness impact school performance. Furthermore, the IEP attempts to adapt the school environment specifically for that child. The current mechanism of modification of a child's education is the result of a long, evolutionary societal and educational process. Educators now recognize that children with disabilities and chronic illnesses are entitled to an appropriate public education with a special focus on how illness can interfere with that education. Whatever congressional changes are likely in the 1990s, many of these civil rights advances for the disabled or chronically ill child should survive. The transition of the adolescent with a chronic illness, such as arthritis, into adulthood has received little attention. This is an area where a compassionate and supportive pediatrician may help prevent adolescent problems rather than simply reacting to them. A gradual, incremental transition program in the pediatric office and clinic may increase the chances that more of these special adolescents will become productive, contributing adults.
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Affiliation(s)
- C H Spencer
- Department of Pediatrics, University of Chicago, Pritzker School of Medicine, Illinois, USA
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Mason T, Rabinovich CE, Fredrickson DD, Amoroso K, Reed AM, Stein LD, Kredich DW. Breast feeding and the development of juvenile rheumatoid arthritis. J Rheumatol 1995; 22:1166-70. [PMID: 7674248] [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] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine if children with juvenile rheumatoid arthritis (JRA) are less likely to have been breast fed than controls. METHODS Case-control study of data obtained from a survey of mothers 54 children with JRA and 79 playmates regarding breast feeding. Duration of breast feeding was tabulated and odds ratios (OR) with 95% confidence intervals (CI) were determined. RESULTS OR for breast feeding in children with JRA was 0.40 (0.20-0.81, 95% CI) compared to playmates. For pauciarticular JRA (N = 28) OR was 0.31 (0.10-0.93); in polyarticular JRA (N = 24) OR was 0.60 (0.21-1.70). Lower OR for increased durations of breast feeding were noted in children with JRA. CONCLUSION Children who have had JRA, especially pauciarticular JRA, are less likely to have been breast fed than controls, suggesting that breast feeding may have a protective effect on the development of JRA.
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Affiliation(s)
- T Mason
- Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
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Rabinovich CE, Colbert RA, Kredich DW. Lupus nephritis study--questions. Pediatrics 1992; 90:652-3. [PMID: 1408532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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