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Charras A, Haldenby S, Smith EMD, Egbivwie N, Olohan L, Kenny JG, Schwarz K, Roberts C, Al-Abadi E, Armon K, Bailey K, Ciurtin C, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, McErlane F, Modgil G, Pilkington C, Ramanan AV, Rangaraj S, Riley P, Sridhar A, Beresford MW, Hedrich CM. Panel sequencing links rare, likely damaging gene variants with distinct clinical phenotypes and outcomes in juvenile-onset SLE. Rheumatology (Oxford) 2023; 62:SI210-SI225. [PMID: 35532072 PMCID: PMC9949710 DOI: 10.1093/rheumatology/keac275] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Juvenile-onset systemic lupus erythematosus (jSLE) affects 15-20% of lupus patients. Clinical heterogeneity between racial groups, age groups and individual patients suggests variable pathophysiology. This study aimed to identify highly penetrant damaging mutations in genes associated with SLE/SLE-like disease in a large national cohort (UK JSLE Cohort Study) and compare demographic, clinical and laboratory features in patient sub-cohorts with 'genetic' SLE vs remaining SLE patients. METHODS Based on a sequencing panel designed in 2018, target enrichment and next-generation sequencing were performed in 348 patients to identify damaging gene variants. Findings were integrated with demographic, clinical and treatment related datasets. RESULTS Damaging gene variants were identified in ∼3.5% of jSLE patients. When compared with the remaining cohort, 'genetic' SLE affected younger children and more Black African/Caribbean patients. 'Genetic' SLE patients exhibited less organ involvement and damage, and neuropsychiatric involvement developed over time. Less aggressive first line treatment was chosen in 'genetic' SLE patients, but more second and third line agents were used. 'Genetic' SLE associated with anti-dsDNA antibody positivity at diagnosis and reduced ANA, anti-LA and anti-Sm antibody positivity at last visit. CONCLUSION Approximately 3.5% of jSLE patients present damaging gene variants associated with younger age at onset, and distinct clinical features. As less commonly observed after treatment induction, in 'genetic' SLE, autoantibody positivity may be the result of tissue damage and explain reduced immune complex-mediated renal and haematological involvement. Routine sequencing could allow for patient stratification, risk assessment and target-directed treatment, thereby increasing efficacy and reducing toxicity.
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Affiliation(s)
- Amandine Charras
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
| | - Sam Haldenby
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
| | - Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Naomi Egbivwie
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Lisa Olohan
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
| | - John G Kenny
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
| | - Klaus Schwarz
- Institut for Transfusion Medicine, University Ulm, Ulm
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg—Hessen, Ulm, Germany
| | - Carla Roberts
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s Hospital, Birmingham
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds
| | - Flora McErlane
- Paediatric Rheumatology, Great North Children’s Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Gita Modgil
- Department of Paediatrics, Musgrove Park Hospital, Taunton
| | | | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham
| | - Phil Riley
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester
| | - Arani Sridhar
- Department of Paediatrics, Leicester Royal Infirmary, Leicester, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
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Smith EMD, Egbivwie N, Jorgensen AL, Ciurtin C, Al-Abadi E, Armon K, Bailey K, Brennan M, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, Malik G, McLaren Z, Pilkington C, Ramanan AV, Rangaraj S, Ratcliffe A, Riley P, Sen E, Sridhar A, Wilkinson N, Wood F, Beresford MW, Hedrich CM. Real world treatment of juvenile-onset systemic lupus erythematosus: Data from the UK JSLE cohort study. Clin Immunol 2022; 239:109028. [PMID: 35513304 DOI: 10.1016/j.clim.2022.109028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the absence of clinical trials evidence, Juvenile-onset Systemic Lupus Erythematosus (JSLE) treatment plans vary. AIM To explore 'real world' treatment utilising longitudinal UK JSLE Cohort Study data. METHODS Data collected between 07/2009-05/2020 was used to explore the choice/sequence of immunomodulating drugs from diagnosis. Multivariate logistic regression determined how organ-domain involvement (pBILAG-2004) impacted treatment choice. RESULT 349 patients met inclusion criteria, median follow-up 4-years (IQR:2,6). Mycophenolate mofetil (MMF) was most commonly used for the majority of organ-domains, and significantly associated with renal involvement (OR:1.99, 95% CI:1.65-2.41, pc < 0.01). Analyses assessing the sequence of immunomodulators focused on 197/349 patients (meeting relevant inclusion/exclusion criteria). 10/197 (5%) solely recieved hydroxychloroquine/prednisolone, 62/197 (31%) received a single-immunomodulator, 69/197 (36%) received two, and 36/197 patients (28%) received ≥three immunomodulators. The most common first and second line immunomodulator was MMF. Rituximab was the most common third-line immunomodulator. CONCLUSIONS Most UK JSLE patients required ≥two immunomodulators, with MMF used most commonly.
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Affiliation(s)
- Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK.
| | - Naomi Egbivwie
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
| | | | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London, UK
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mary Brennan
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds, UK
| | - Gulshan Malik
- Paediatric Rheumatology, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Zoe McLaren
- Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham, UK
| | - Annie Ratcliffe
- Department of Paediatrics, Taunton & Somerset NHS Foundation Trust - Musgrove Park Hospital, Taunton, UK
| | - Phil Riley
- Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ethan Sen
- Paediatric Rheumatology, Great North Children's Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Arani Sridhar
- Leicester Children's Hospital, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Nick Wilkinson
- Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Fiona Wood
- Department of Paediatrics, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
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Garner AJ, Saatchi R, Ward O, Hawley DP. Juvenile Idiopathic Arthritis: A Review of Novel Diagnostic and Monitoring Technologies. Healthcare (Basel) 2021; 9:1683. [PMID: 34946409 PMCID: PMC8700900 DOI: 10.3390/healthcare9121683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/01/2021] [Accepted: 12/02/2021] [Indexed: 12/29/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease of childhood and is characterized by an often insidious onset and a chronic relapsing-remitting course, once diagnosed. With successive flares of joint inflammation, joint damage accrues, often associated with pain and functional disability. The progressive nature and potential for chronic damage and disability caused by JIA emphasizes the critical need for a prompt and accurate diagnosis. This article provides a review of recent studies related to diagnosis, monitoring and management of JIA and outlines recent novel tools and techniques (infrared thermal imaging, three-dimensional imaging, accelerometry, artificial neural networks and fuzzy logic) which have demonstrated potential value in assessment and monitoring of JIA. The emergence of novel techniques to assist clinicians' assessments for diagnosis and monitoring of JIA has demonstrated promise; however, further research is required to confirm their clinical utility.
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Affiliation(s)
- Amelia J. Garner
- The Medical School, University of Sheffield, Sheffield S10 2TN, UK
| | - Reza Saatchi
- Industry and Innovation Research Institute, Sheffield Hallam University, Sheffield S1 1WB, UK;
| | - Oliver Ward
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield S10 2TH, UK; (O.W.); (D.P.H.)
| | - Daniel P. Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield S10 2TH, UK; (O.W.); (D.P.H.)
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Smith EMD, Gorst SL, Al-Abadi E, Hawley DP, Leone V, Pilkington C, Ramanan AV, Rangaraj S, Sridhar A, Beresford MW, Young B. 'It is good to have a target in mind': qualitative views of patients and parents informing a treat to target clinical trial in juvenile-onset systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:5630-5641. [PMID: 33629109 PMCID: PMC8645274 DOI: 10.1093/rheumatology/keab173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/05/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE We sought to explore patient and parental views on treatment targets, outcome measures and study designs being considered for a future JSLE treat-to-target (T2T) study. METHODS We conducted topic-guided, semistructured interviews with JSLE patients and parents and analysed the audio recorded interviews using thematic approaches. RESULTS Patients and parents differed regarding symptoms they felt would be tolerable, representing 'low disease activity'. Patients often classed symptoms that they had previously experienced, were 'invisible' or had minimal disruption on their life as signs of low disease activity. Parents were more accepting of visible signs but were concerned about potential organ involvement and symptom severity. Overall, patients and parents preferred that children were entirely asymptomatic, with no ongoing treatment side effects. They regarded fatigue as particularly challenging, requiring proper monitoring using a fatigue patient-reported outcome measure. Most families felt that reducing corticosteroids would also be a good treatment target. Overall, families liked the concept of T2T, commenting that it could help to improve disease control, help structure treatment and improve communication with clinicians and treatment compliance. They were concerned that T2T might increase the frequency of hospital visits, thus impacting upon schooling, parental employment and finances. Families made suggestions on how to modify the future trial design to mitigate such effects. CONCLUSION This study provides guidance from patients and parents on T2T targets and study designs. Complementary quantitative studies assessing the achievability and impact of different targets (e.g. lupus low disease activity state or remission) are now warranted to inform an international consensus process to develop treatment targets.
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Affiliation(s)
- Eve M D Smith
- Institute of Life Course and Medical Science, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust
| | - Sarah L Gorst
- Department of Health Data Science, University of Liverpool, Liverpool
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s Hospital, Birmingham
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s NHS Foundation Trust, Sheffield
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds General Infirmary, Leeds
| | | | - Athimalaipet V Ramanan
- Bristol Royal Hospital for Children & Translational Health Sciences, University of Bristol, Bristol
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham
| | - Arani Sridhar
- Leicester Children’s Hospital, University Hospitals of Leicester NHS Trust, Leicester
| | - Michael W Beresford
- Institute of Life Course and Medical Science, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, UK
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5
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Massias JS, Smith EMD, Al-Abadi E, Armon K, Bailey K, Ciurtin C, Davidson J, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, McErlane F, Mewar D, Modgil G, Moots R, Pilkington C, Ramanan AV, Rangaraj S, Riley P, Sridhar A, Wilkinson N, Beresford MW, Hedrich CM. Clinical and laboratory characteristics in juvenile-onset systemic lupus erythematosus across age groups. Lupus 2020; 29:474-481. [PMID: 32233733 PMCID: PMC7528537 DOI: 10.1177/0961203320909156] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Systemic lupus erythematous (SLE) is a systemic autoimmune/inflammatory condition. Approximately 15–20% of patients develop symptoms before their 18th birthday and are diagnosed with juvenile-onset SLE (JSLE). Gender distribution, clinical presentation, disease courses and outcomes vary significantly between JSLE patients and individuals with adult-onset SLE. This study aimed to identify age-specific clinical and/or serological patterns in JSLE patients enrolled to the UK JSLE Cohort Study. Methods Patient records were accessed and grouped based on age at disease-onset: pre-pubertal (≤7 years), peri-pubertal (8–13 years) and adolescent (14–18 years). The presence of American College of Rheumatology (ACR) classification criteria, laboratory results, disease activity [British Isles Lupus Assessment Group (BILAG) and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) scores] and damage [Systemic Lupus International Collaborating Clinics (SLICC) damage index] were evaluated at diagnosis and last follow up. Results A total of 418 JSLE patients were included in this study: 43 (10.3%) with pre-pubertal disease onset; 240 (57.4%) with peri-pubertal onset and 135 (32.3%) were diagnosed during adolescence. At diagnosis, adolescent JSLE patients presented with a higher number of ACR criteria when compared with pre-pubertal and peri-pubertal patients [pBILAG2004 scores: 9(4–20] vs. 7(3–13] vs. 7(3–14], respectively, p = 0.015] with increased activity in the following BILAG domains: mucocutaneous (p = 0.025), musculoskeletal (p = 0.029), renal (p = 0.027) and cardiorespiratory (p = 0.001). Furthermore, adolescent JSLE patients were more frequently ANA-positive (p = 0.034) and exhibited higher anti-dsDNA titres (p = 0.001). Pre-pubertal individuals less frequently presented with leukopenia (p = 0.002), thrombocytopenia (p = 0.004) or low complement (p = 0.002) when compared with other age groups. No differences were identified in disease activity (pBILAG2004 score), damage (SLICC damage index) and the number of ACR criteria fulfilled at last follow up. Conclusions Disease presentations and laboratory findings vary significantly between age groups within a national cohort of JSLE patients. Patients diagnosed during adolescence exhibit greater disease activity and “classic” autoantibody, immune cell and complement patterns when compared with younger patients. This supports the hypothesis that pathomechanisms may vary between patient age groups.
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Affiliation(s)
- J S Massias
- School of Medicine, University of Liverpool, UK
| | - E M D Smith
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - E Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - K Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - K Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Davidson
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - K Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - D P Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - A Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - V Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds, UK
| | - F McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - D Mewar
- Department of Rheumatology, Royal Liverpool University Hospital, Liverpool, UK
| | - G Modgil
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
| | - R Moots
- Department of Rheumatology, University Hospital Aintree, Liverpool, UK
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - A V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - S Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals Nottingham, UK
| | - P Riley
- Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - A Sridhar
- Department of Paediatrics, Leicester Royal Infirmary, Leicester, UK
| | - N Wilkinson
- Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
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Choi J, Hawley DP, Ashworth J, Edelsten C, Bossuyt ASAM. An update on the modern management of paediatric uveitis. Br J Ophthalmol 2019; 103:1685-1689. [PMID: 31272956 DOI: 10.1136/bjophthalmol-2019-314212] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/10/2019] [Accepted: 06/17/2019] [Indexed: 11/04/2022]
Abstract
Uveitis in children and young people (CYP) is often painless, chronic and persistent. It is an often silent blinding condition. Uveitis can be isolated or develop as a manifestation of a systemic disease. Due to the symptomless nature, it can present late with advanced ocular comorbidities such as band keratopathy, hypotony, cataracts. Inadequate control of the eye inflammation can result in permanent and severe ocular complications, structural damage and visual loss. One of the most common systemic associations is juvenile idiopathic arthritis where uveitis has a cumulative incidence of approximately 10%-14% (though wide variation in incidence is reported) after 5 years. Appropriately targeted uveitis screening is recommended to continue for at least 7 years in some subgroups. Paediatric uveitis poses multiple diagnostic and therapeutic challenges. Clinical manifestation and disease course may differ significantly from adult-onset uveitis. However, some CYP are still managed by adult specialists alone, without the opportunity for the prompt use of National Health Service England approved therapy. Optimal management of paediatric uveitis requires a multidisciplinary approach involving coordinated working of different specialities and healthcare professionals. This article highlights the evidence-based practice for the contemporary management of paediatric uveitis to readers in different specialities who may come across this condition. It raises awareness of early systemic treatment aiming to achieve early and complete disease inactivity thereby improving the chances of a long-term positive outcome.
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Affiliation(s)
- Jessy Choi
- Department of Ophthalmology, Sheffield Children's Hospital, Sheffield, UK
| | - Daniel P Hawley
- Department of Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | | | - Clive Edelsten
- Department of Ophthalmology, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
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Porter-Young FM, Offiah AC, Broadley P, Lang I, McMahon AM, Howsley P, Hawley DP. Correction to: Inter- and intra-observer reliability of contrast-enhanced magnetic resonance imaging parameters in children with suspected juvenile idiopathic arthritis of the hip. Pediatr Radiol 2018; 48:1901. [PMID: 30328480 DOI: 10.1007/s00247-018-4285-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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] [Indexed: 11/28/2022]
Abstract
The article "Inter- and intra-observer reliability of contrast-enhanced magnetic resonance imaging parameters in children with suspected juvenile idiopathic arthritis of the hip".
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Affiliation(s)
| | - Amaka C Offiah
- Academic Unit of Child Health, Sheffield Children's NHS Foundation Trust, University of Sheffield, Sheffield, UK
| | - Penny Broadley
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Isla Lang
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Anne-Marie McMahon
- Department of Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Philippa Howsley
- Department of Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
| | - Daniel P Hawley
- Department of Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UK
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8
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Hawley DP, Howsley P, McDonagh JE, McErlane F, Rapley T, Tattersall RS, Webb N. P24 United Kingdom survey of access to psychology services for adolescents and young adults with rheumatic and musculoskeletal disease. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key273.026] [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: 11/13/2022] Open
Affiliation(s)
- Daniel P Hawley
- Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UNITED KINGDOM
| | - Philippa Howsley
- Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UNITED KINGDOM
| | - Janet E McDonagh
- School of Biological Sciences, The University of Manchester, Manchester, UNITED KINGDOM
- Division of Musculoskeletal and Dermatological Sciences, Arthritis Research UK Centre for Epidemiology, Manchester, UNITED KINGDOM
- Centre for MSK Research, The University of Manchester, Manchester, UNITED KINGDOM
| | - Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UNITED KINGDOM
| | - Tim Rapley
- Social Work, Education & Community Wellbeing, Northumbria University, Newcastle upon Tyne, UNITED KINGDOM
| | | | - Nicola Webb
- Psychology, Sheffield Children's Hospital, Sheffield, UNITED KINGDOM
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Chang RSO, McMillan R, Edgerton J, McMahon AM, Hawley DP, Verstegen RHJ. P39 Screening for evolving lupus in children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key273.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rachelle S O Chang
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Rhona McMillan
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Jenny Edgerton
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Anne-Marie McMahon
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Daniel P Hawley
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Ruud H J Verstegen
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
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Howsley P, Dunkley L, Calvert R, Hawley SJ, Edgerton J, Forsythe M, McMahon AM, Tattersall RS, Verstegen RHJ, Hawley DP. P01 Psychosocial factors associated with transition readiness in adolescents and young adults with juvenile idiopathic arthritis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key273.003] [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: 11/13/2022] Open
Affiliation(s)
- Philippa Howsley
- Research and Innovation, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Lisa Dunkley
- Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Rachel Calvert
- Paediatric Psychology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Samuel J Hawley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UNITED KINGDOM
| | - Jenny Edgerton
- Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Maria Forsythe
- Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Anne-Marie McMahon
- Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Rachel S Tattersall
- Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Ruud H J Verstegen
- Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Daniel P Hawley
- Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
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Chang RSO, McMillan R, Edgerton J, McMahon AM, Hawley DP, Verstegen RHJ. P38 Evolving coeliac disease and thyroid disease in children with juvenile idiopathic arthritis: reason for annual screening? Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key273.040] [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: 11/14/2022] Open
Affiliation(s)
- Rachelle S O Chang
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Rhona McMillan
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Jenny Edgerton
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Anne-Marie McMahon
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Daniel P Hawley
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Ruud H J Verstegen
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
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McMillan R, Chang RSO, Edgerton J, McMahon AM, Hawley DP, Verstegen RHJ. P43 Serial testing of anti-nuclear antibodies in children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key273.045] [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: 11/14/2022] Open
Affiliation(s)
- Rhona McMillan
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Rachelle S O Chang
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Jenny Edgerton
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Anne-Marie McMahon
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Daniel P Hawley
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Ruud H J Verstegen
- Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
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Howsley P, Dunkley L, Calvert R, Choi J, Quhill F, Hawley SJ, Tattersall RS, McMahon AM, Verstegen RHJ, Cooper G, Clarke S, Hawley DP. R04 Psychosocial factors associated with transition readiness in adolescents and young adults with uveitis. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key273.054] [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: 11/14/2022] Open
Affiliation(s)
- Philippa Howsley
- Research and Innovation, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Lisa Dunkley
- Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Rachel Calvert
- Paediatric Psychology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Jessy Choi
- Ophthalmology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Fahd Quhill
- Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Samuel J Hawley
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UNITED KINGDOM
| | - Rachel S Tattersall
- Rheumatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Anne-Marie McMahon
- Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Ruud H J Verstegen
- Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Gisella Cooper
- Ophthalmology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Sian Clarke
- Ophthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UNITED KINGDOM
| | - Daniel P Hawley
- Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, UNITED KINGDOM
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Hawley DP, Foster HE, Beresford MW, Ramanan A, Rapley T, McErlane F. 12. Prescribing Patterns in Juvenile Idiopathic Arthritis: A Survey of Current Practice in the United Kingdom. Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/kex390.012] [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: 11/13/2022] Open
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Dunbar C, McMahon AM, Leach S, Hawley DP. 35. Splinting in children with inflammatory joint disease and hypermobility: A survey of current practice in the United Kingdom. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex390.035] [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: 11/14/2022] Open
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16
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Ward OJ, Leach S, McMahon AM, Hawley DP. 39. United Kingdom survey of Physiotherapy group exercise classes in paediatric Rheumatology. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex390.039] [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: 11/13/2022] Open
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Ross B, Mukhtar M, Tattersall RS, Chisem H, McMahon AM, Hawley DP. 019. Prospective evaluation of patient engagement with clinical research. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.003] [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: 11/12/2022] Open
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18
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Hawley DP, Pratt E, Hartley B, Offiah AC, Burke D. 055. Development of three-dimensional computer modeling of paediatric Gait, Arms, Legs, Spine (pGALS) manoeuvres and description of reference data for children and young people without joint pathology. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.039] [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: 11/13/2022] Open
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Hubble J, Sharrard M, Shackley F, McMahon AM, Lee H, Hawley DP. 025. Unusual case report highlighting association between metabolic and autoimmune disorders. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.009] [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: 11/14/2022] Open
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Howsley P, Dunkley L, Calvert R, Hawley S, Hawley DP. 016. Describing relationships between psychosocial outcomes and readiness for transition in adolescent and young adult patients with Juvenile Idiopathic Arthritis – a pilot study. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356] [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: 11/12/2022] Open
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21
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McMahon AM, Armstrong S, Edgerton J, Nash C, Welch F, Bull S, Ward O, Leach S, Dunbar C, Rew T, Hawley DP, Lee H, Spray T. 051. Annual Paediatric and Adolescent Raynaud’s Clinic Initiative. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.035] [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: 11/12/2022] Open
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Dunbar C, Holland N, Leach S, Massey SJE, McMahon AM, Hawley DP. 011. A paired school and family survey: How effectively is information regarding Juvenile Idiopathic Arthritis communicated with schools and how useful is it perceived to be? Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.057] [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: 11/15/2022] Open
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23
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Scholl A, Dunbar C, Howsley P, Leach S, McMachon AM, Massey SJE, Hawley DP. 058. How school attendance relates to perceived and objective measures of disease severity in paediatric rheumatological conditions – a service evaluation project. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.042] [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: 11/14/2022] Open
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Hawley DP, Foster HE, Beresford MW, Ramanan A, Rapley T, McErlane F. 298. PRESCRIBING PATTERNS IN JUVENILE IDIOPATHIC ARTHRITIS: A SURVEY OF CURRENT PRACTICE IN THE UNITED KINGDOM. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.300] [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: 11/14/2022] Open
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Cooper G, Choi JL, McMahon AM, Nash C, Dunkley L, Tattersall RS, Sapountzi E, Bale P, Lee H, Edgerton J, Welch F, Bull S, Hawley DP. 039. INTERFERON-ALFA USED TO TREAT A CHALLENGING CASE OF REFRACTORY PAEDIATRIC BEHÇETS DISEASE WITH SIGHT-THREATENING UVEITIS. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex062.039] [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: 11/12/2022] Open
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26
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Gormley S, Choi J, Hawley DP. PP19. Evaluation of the use of combined treatment regimens involving methotrexate and mycophenolate mofetil in the Sheffield paediatric uveitis service. Rheumatology (Oxford) 2015. [DOI: 10.1093/rheumatology/keu512] [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: 11/14/2022] Open
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Loveley M, Al-Obaidi M, McMahon A, Hawley DP. PP24. Evaluation of the effectiveness of specialist occupational therapy input in schools attended by children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2015. [DOI: 10.1093/rheumatology/keu517] [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: 11/12/2022] Open
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Hawley DP, Pain CE, Baildam EM, Murphy R, Taylor AEM, Foster HE. United Kingdom survey of current management of juvenile localized scleroderma. Rheumatology (Oxford) 2014; 53:1849-54. [PMID: 24850875 DOI: 10.1093/rheumatology/keu212] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Juvenile localized scleroderma (JLS) is a rare condition that is often difficult to assess and for which a variety of monitoring tools have been described. We aimed to describe how monitoring tools are used and perceived by clinicians in the UK, to ascertain treatments used for JLS and to provide a description of transition arrangements to adult care. METHODS An e-survey of UK paediatric rheumatologists and dermatologists managing children and young people (CYP) with JLS was distributed using the national organisations representing these clinician groups. We asked respondents for their views and experience using 15 JLS monitoring tools, about transition services and about treatments used. RESULTS Thirty-five dermatologists and 13 paediatric rheumatologists responded. Paediatric rheumatologists managed more CYP with JLS than dermatologists (median 16-20 and 3, respectively). Transition arrangements were reported by 43% of dermatologists and 91% of paediatric rheumatologists. Medical photography was the most frequently regularly used monitoring tool (73% respondents). The modified Rodnan skin score was the skin score used most commonly: 33% of paediatric rheumatologists and 3% of dermatologists reported using this tool frequently. Topical treatments and ultraviolet light were used by 49-80% of dermatologists and 0-8% paediatric rheumatologists. Biologic drugs and CYC were used by 0-3% of dermatologists and 31-46% of paediatric rheumatologists. CONCLUSION How monitoring tools are accessed, used and perceived by paediatric rheumatologists and dermatologists in the UK varies between and within clinician groups, as do treatment prescribing patterns and transition arrangements. These differences will impact on the feasibility of conducting multicentre clinical trials and on standardising clinical care.
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Affiliation(s)
- Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, Department of Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, and Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Clare E Pain
- Department of Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, Department of Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, and Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Eileen M Baildam
- Department of Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, Department of Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, and Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Ruth Murphy
- Department of Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, Department of Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, and Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aileen E M Taylor
- Department of Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, Department of Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, and Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Helen E Foster
- Department of Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, Department of Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, and Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. Department of Paediatric Rheumatology, Sheffield Children's NHS Foundation Trust, Sheffield, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Department of Dermatology, Nottingham University Hospitals NHS Trust, Nottingham, Department of Dermatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, and Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Hawley DP, Pain CE, Baildam EM, Murphy R, Taylor AEM, Foster HE. 283. UK Survey of Current Management of Juvenile Localized Scleroderma. Rheumatology (Oxford) 2014. [DOI: 10.1093/rheumatology/keu125.005] [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: 11/13/2022] Open
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30
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Hawley DP, Pain CE, Baildam EM, Foster HE. PReS-FINAL-2119: United Kingdom survey of current management of juvenile localised scleroderma. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044558 DOI: 10.1186/1546-0096-11-s2-p131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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31
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Hawley DP, Camina N, Rangaraj S. British isles survey of methotrexate monitoring practice during treatment of juvenile idiopathic arthritis. Semin Arthritis Rheum 2010; 40:358-64.e1-2. [PMID: 20822799 DOI: 10.1016/j.semarthrit.2010.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 04/29/2010] [Accepted: 05/04/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We surveyed current pediatric rheumatology monitoring practice in methotrexate treatment of juvenile idiopathic arthritis in the British Isles, and experiences of significant side effects during methotrexate monitoring. METHODS Single-center responses were sought from the current British Society for Pediatric and Adolescent Rheumatology membership, using a web-based survey tool. RESULTS Thirty-three centers across the British Isles responded. Twenty-eight centers reported following British Society for Pediatric and Adolescent Rheumatology or local guidelines. Thirty-one centers were willing to modify their monitoring practice to individual circumstances. All centers used a full blood count and liver enzymes as monitoring tests. There was variation in frequency at which monitoring tests were performed, both at initiation of methotrexate therapy and once methotrexate therapy was established; 27 centers were willing to change the frequency of monitoring blood tests after a period of stability. Centers reported acting on alanine aminotransferase values ranging from 50 to 500 IU/L. Particular variation existed between smaller and larger centers. Few centers reported any experience of serious side effects, and only 1 cited a case of liver cirrhosis. CONCLUSIONS Despite specific pediatric guidance for monitoring low-dose methotrexate use in juvenile idiopathic arthritis, variation in practice exists in the British Isles. It may be that blood test monitoring could safely be performed less frequently than currently recommended. To inform future changes to guidance, we suggest establishing a prospective registry for serious side effects.
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Affiliation(s)
- Daniel P Hawley
- Department of Paediatric Rheumatology, Nottingham Children's Hospital, University Hospital Queen's Medical Centre, Nottingham, United Kingdom.
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Hawley DP, Walker DA. A symptomatic journey to the centre of the brain. Arch Dis Child Educ Pract Ed 2010; 95:59-64. [PMID: 20351153 DOI: 10.1136/adc.2009.174045] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Daniel P Hawley
- Division of Child Health, University Hospital Queen's Medical Centre, Nottingham NG7 2UH, UK.
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Gnanalingham MG, Robinson SG, Hawley DP, Gnanalingham KK. A 30 year perspective of the quality of evidence published in 25 clinical journals: signs of change? Postgrad Med J 2006; 82:397-9. [PMID: 16754709 PMCID: PMC2563750 DOI: 10.1136/pgmj.2005.041251] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
METHODS The quality of clinical studies published in five different specialties, over three decades was evaluated. Computerised search of the Medline database was undertaken to evaluate the articles published in 25 clinical journals in 1983, 1993, and 2003 from five different specialties (medicine, surgery, paediatrics, anaesthesia, and psychiatry). The number of randomised controlled trials (RCTs), meta-analyses, and other clinical trials (non-RCT) were noted. RESULTS From the 27,030 articles evaluated, there were 2283 (8.4%) RCTs, 166 (0.6%) meta-analyses, and 4153 (15.4%) other clinical trials. For the proportion of RCTs, the rank order of the specialties was; anaesthesia (503; 18%), psychiatry (294; 9.6%), medicine (899; 8.1%), paediatrics (326; 6.4%), and surgery (261; 5.3%) (p<0.001). For the proportion of meta-analysis, the rank order of the specialties was; psychiatry (36; 1.2%), medicine (105; 0.9%), paediatrics (15; 0.3%), anaesthesia (6; 0.2%), and surgery (4; 0.1%) (p<0.001). Overall, from 1983 to 2003, there were increases in the proportion of RCTs (449, 5.9% to 1027, 9.6%), meta-analysis (0, 0% to 127, 1.2%), and other clinical trials (897, 12% to 1983, 19%) (p<0.001). This trend was apparent in each clinical specialty (p<0.001). CONCLUSIONS Over the three decades evaluated, clinical trials, notably RCTs and meta-analysis form only a small proportion of articles published in prominent journals from five clinical specialties. This is notwithstanding the modest increases in the proportions of RCTs and meta-analysis over the same period.
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Affiliation(s)
- M G Gnanalingham
- Department of Paediatrics, Queens Medical Centre, Nottingham, UK.
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