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Nguyen K, Barsalou J, Basodan D, Batthish M, Benseler SM, Berard RA, Blanchette N, Boire G, Bolaria R, Bruns A, Cabral DA, Cameron B, Campillo S, Cellucci T, Chan M, Chédeville G, Chetaille AL, Chhabra A, Couture J, Dancey P, De Bruycker JJ, Demirkaya E, Dhalla M, Duffy CM, Feldman BM, Feldman DE, Gerschman T, Haddad E, Heale L, Herrington J, Houghton K, Huber AM, Human A, Johnson N, Jurencak R, Lang B, Larché M, Laxer RM, LeBlanc CM, Lee JJY, Levy DM, Lim L, Lim LSH, Luca N, McGrath T, McMillan T, Miettunen PM, Morishita KA, Ng HY, Oen K, Park J, Petty RE, Proulx-Gauthier JP, Ramsey S, Roth J, Rosenberg AM, Rozenblyum E, Rumsey DG, Schmeling H, Schneider R, Scuccimarri R, Shiff NJ, Silverman E, Soon G, Spiegel L, Stringer E, Tam H, Tse SM, Tucker L, Turvey S, Twilt M, Duffy KW, Yeung RSM, Guzman J. A decade of progress in juvenile idiopathic athritis treatments and outcomes in Canada: results from ReACCh-Out and the CAPRI registry. Rheumatology (Oxford) 2023:kead560. [PMID: 37851400 DOI: 10.1093/rheumatology/kead560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To assess changes in juvenile idiopathic arthritis (JIA) treatments and outcomes in Canada, comparing a 2005-2010 and a 2017-2021 inception cohorts. METHODS Patients enrolled within three months of diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) and the Canadian Alliance of Pediatric Rheumatology Investigators Registry (CAPRI) cohorts were included. Cumulative incidences of drug starts and outcome attainment within 70 weeks of diagnosis were compared with Kaplan Meier survival analysis and multivariable Cox regression. RESULTS The 2005-2010 and 2017-2021 cohorts included 1128 and 721 patients, respectively. JIA category distribution and baseline clinical juvenile idiopathic arthritis disease activity (cJADAS10) scores at enrolment were comparable. By 70 weeks, 6% of patients (95% CI 5, 7) in the 2005-2010 and 26% (23, 30) in the 2017-2021 cohort had started a biologic DMARD (bDMARD), and 43% (40, 47) and 60% (56, 64) had started a conventional DMARD (cDMARD), respectively. Outcome attainment was 64% (61, 67) and 83% (80, 86) for Inactive disease (Wallace criteria), 69% (66, 72) and 84% (81, 87) for minimally active disease (cJADAS10 criteria), 57% (54, 61) and 63% (59, 68) for pain control (<1/10), and 52% (47, 56) and 54% (48, 60) for a good health-related quality of life. CONCLUSION Although baseline disease characteristics were comparable in the 2005-2010 and 2017-2021 cohorts, cDMARD and bDMARD use increased with a concurrent increase in minimally active and inactive disease. Improvements in parent and patient reported outcomes were smaller than improvements in disease activity.
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Affiliation(s)
- Kelly Nguyen
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Roxana Bolaria
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David A Cabral
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Mercedes Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Paul Dancey
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | | | | | | | | | | | - Tommy Gerschman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie Haddad
- Université de Montréal, Montréal, Quebec, Canada
| | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | | | - Kristin Houghton
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam M Huber
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Human
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Bianca Lang
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Lillian Lim
- University of Alberta, Edmonton, Alberta, Canada
| | - Lily S H Lim
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nadia Luca
- University of Ottawa, Ottawa, Ontario, Canada
| | - Tara McGrath
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | - Hon Yan Ng
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Ross E Petty
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Dax G Rumsey
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | - Gordon Soon
- Health Sciences North, Sudbury, Ontario, Canada
- North York General Hospital, North York, Toronto, Ontario, Canada
| | | | | | - Herman Tam
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori Tucker
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Turvey
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Jaime Guzman
- University of British Columbia, Vancouver, British Columbia, Canada
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2
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Lim L, McMillan T, Chédeville G, Lahiry P, Lee JJY, Heale LD, Human AL, McGrath TR, MacQueen SE, Stringer E, Jariwala MP, Neufeld KM, Soon GS, Spiegel LR, Luca NJC. Choosing Wisely: The Canadian Rheumatology Association Pediatric Committee's List of Items Physicians and Patients Should Question. J Rheumatol 2023:jrheum.2023-0043. [PMID: 37527858 DOI: 10.3899/jrheum.2023-0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To develop a list of tests or treatments frequently used in pediatric rheumatology practice that may be unnecessary based on existing evidence. METHODS A Choosing Wisely (CW) working group composed of 16 pediatric rheumatologists, 1 allied health professional, 1 parent, and 1 patient used the Delphi method to generate, rank, and refine a list of tests and treatments that may be unnecessary or harmful. The items with the highest content agreement and perceived impact were presented in a survey to all Canadian Rheumatology Association (CRA) physicians who practice pediatric rheumatology. Respondents were asked to rate their agreement and impact, and to rank the items. Five items with the highest composite scores and 2 additional items selected by the CW working group were put forward for literature review. RESULTS The initial Delphi procedure generated 80 items. After 3 rounds, the list was narrowed to 13 items. The survey was completed by 41/81 (51%) CRA pediatric members across Canada. Respondent characteristics were similar to those of the CRA pediatric membership for self-reported gender, geographical location, and career stage. The highest composite score items were antinuclear antibody testing, drug toxicity monitoring, HLA-B27 testing, rheumatoid factor/anticyclic citrullinated peptide testing, and Lyme serology testing. Two additional items (numerous or repeated intraarticular corticosteroid injections, and autoinflammatory diseases genetic testing) were also selected. Literature review was performed for these 7 highest priority items. CONCLUSION We have identified areas for quality improvement in the evaluation and treatment of rheumatic diseases in Canadian children.
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Affiliation(s)
- Lillian Lim
- L. Lim, MD, MPH, Division of Rheumatology, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta
| | - Tara McMillan
- T. McMillan, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Manitoba, Children's Hospital of Winnipeg, Winnipeg, Manitoba
| | - Gaëlle Chédeville
- G. Chédeville, MD, Division of Rheumatology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Piya Lahiry
- P. Lahiry, MD, PhD, Division of Rheumatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Jennifer J Y Lee
- J.J.Y. Lee, MD, MSc, Division of Rheumatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Liane D Heale
- L.D. Heale, MD, Division of Rheumatology, Department of Pediatrics, McMaster Children's Hospital and McMaster University, Hamilton, Ontario
| | - Andrea L Human
- A.L. Human, MD, MScHQ, Division of Rheumatology, Department of Pediatrics, BC Children's Hospital and University of British Columbia, Vancouver, British Columbia
| | - Tara R McGrath
- T.R. McGrath, MD, Division of Rheumatology, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta
| | - Sue E MacQueen
- S.E. MacQueen, PT, BScPT, ACPAC, Arthritis Society Canada, and Western University, Waterloo, Ontario
| | - Elizabeth Stringer
- E. Stringer, MD, MSc, IWK Health, Dalhousie University, Halifax, Nova Scotia
| | - Mehul P Jariwala
- M.P. Jariwala, MBBS, DNB (Pediatrics), Division of Rheumatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kate M Neufeld
- K.M. Neufeld, MD, Division of Rheumatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Gordon S Soon
- G.S. Soon, MD, Division of Rheumatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Lynn R Spiegel
- L.R. Spiegel, MD, Division of Rheumatology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario
| | - Nadia J C Luca
- N.J.C. Luca, MD, MSc, Section of Rheumatology, Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
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3
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Berard R, Ng HY, Human A, Piskin D, Dhalla M, Gottlieb C, Batthish M, Chédeville G, Forest C, Fortin E, Gardiner J, Gerhold K, Jastrzebski A, Lang B, Miettunen PMH, Morgenstern S, Morin MP, Rosenberg A, Rumsey DG, Solarte CE, Tehrani N, Duffy KW, Pardo JP, Hazlewood GS, Levy DM. Canadian Rheumatology Association Recommendations for the Screening, Monitoring, and Treatment of Juvenile Idiopathic Arthritis-Associated Uveitis. J Rheumatol 2023; 50:390-399. [PMID: 36243417 DOI: 10.3899/jrheum.220261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To develop Canadian recommendations for the screening, monitoring, and treatment of uveitis associated with juvenile idiopathic arthritis (JIA). METHODS Recommendations were developed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-ADOLOPMENT approach. A working group of 14 pediatric rheumatologists, 6 ophthalmologists, 2 methodologists, and 3 caregiver/patient representatives reviewed recent American College of Rheumatology (ACR)/Arthritis Foundation (AF) recommendations and worked in pairs to develop evidence-to-decision (EtD) tables. A survey to assess agreement and recommendations requiring group discussion was completed. EtD tables were presented, discussed, and voted upon at a virtual meeting, to produce the final recommendations. A health equity framework was applied to all aspects of the adolopment process including the EtD tables, survey responses, and virtual meeting discussion. RESULTS The survey identified that 7 of the 19 recommendations required rigorous discussion. Seventy-five percent of working group members attended the virtual meeting to discuss controversial topics as they pertained to the Canadian environment, including timing to first eye exam, frequency of screening, escalation criteria for systemic and biologic therapy, and the role of nonbiologic therapies. Equity issues related to access to care and advanced therapeutics across Canadian provinces and territories were highlighted. Following the virtual meeting, 5 recommendations were adapted, 2 recommendations were removed, and 1 was developed de novo. CONCLUSION Recommendations for JIA-associated uveitis were adapted to the Canadian context by a working group of pediatric rheumatologists, ophthalmologists with expertise in the management of uveitis, and parent/patient input, taking into consideration cost, equity, and access.
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Affiliation(s)
- Roberta Berard
- R. Berard, MD, MSc, Division of Rheumatology, and Department of Pediatrics, Western University, London, Ontario;
| | - Hon Yan Ng
- H.Y. Ng, MD, Division of Pediatric Rheumatology, and Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Andrea Human
- A. Human, MD, MSc, Division of Rheumatology, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia
| | - David Piskin
- D. Piskin, MSc, Lawson Health Research Institute, London, Ontario
| | - Muhammed Dhalla
- M. Dhalla, MD, Division of Pediatric Rheumatology, and Department of Pediatrics, University of Calgary, Calgary, Alberta
| | - Chloe Gottlieb
- C. Gottlieb, MD, University of Ottawa Eye Institute and Department of Ophthalmology, Faculty of Medicine, University of Ottawa, and The Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Michelle Batthish
- M. Batthish, MD, MSc, Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Gaëlle Chédeville
- G. Chédeville, MD, Division of Rheumatology, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | | | - Eric Fortin
- E. Fortin, MD, Department of Ophthalmology, University of Montreal, Montreal, Quebec
| | - Jane Gardiner
- J. Gardiner, MD, Department of Ophthalmology and Vision Science, University of British Columbia, Vancouver, British Columbia
| | - Kerstin Gerhold
- K. Gerhold, MD, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada, and Mississippi Center for Advanced Medicine, Madison, Mississippi, USA
| | - Andre Jastrzebski
- A. Jastrzebski, MD, Department of Ophthalmology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Bianca Lang
- B. Lang, MD, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia
| | - Paivi M H Miettunen
- P.M.H. Miettunen, MD, Division of Rheumatology, University of Calgary and Alberta Children's Hospital, Calgary, Alberta
| | | | - Marie-Paule Morin
- M.P. Morin, MD, PhD, Division of Immunology and Rheumatology, Department of Pediatrics, University of Montreal, Montreal, Quebec
| | - Alan Rosenberg
- A. Rosenberg, MD, Division of Rheumatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Dax G Rumsey
- D.G. Rumsey, MD, MSc, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Carlos E Solarte
- C.E. Solarte, MD, Department of Ophthalmology and Visual Sciences, University of Alberta, Edmonton, Alberta
| | - Nasrin Tehrani
- N. Tehrani, MD, Division of Ophthalmology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Karen Watanabe Duffy
- K.W. Duffy, MD, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Ontario
| | - Jordi Pardo Pardo
- J. Pardo Pardo, MSc, Cochrane Musculoskeletal, Faculty of Medicine, University of Ottawa, Ottawa, Ontario
| | - Glen S Hazlewood
- G.S. Hazlewood, MD, PhD, Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Deborah M Levy
- D.M. Levy, MD, MS, Division of Rheumatology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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4
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Houghton K, McPherson M, Surjanovic N, Loughin T, Berard R, Proulx-Gauthier JP, Chédeville G, Rumsey D, Schmeling H, Luca N, Johnson N, Gerschman T, Miettunen P, Tam H, Lim L, Morishita K, Scuccimarri R, Roth J, Duffy C, Tucker L, Feldman BM, Guzman J. Development and validation of the Kids Disability Screen for children with juvenile idiopathic arthritis: results from the CAPRI Registry. Rheumatology (Oxford) 2022; 61:4835-4844. [PMID: 35438140 DOI: 10.1093/rheumatology/keac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this study was to develop and validate a brief disability screen for children with JIA, the Kids Disability Screen (KDS). METHODS A total of 216 children enrolled in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry in 2017-2018 formed a development cohort, and 220 children enrolled in 2019-2020 formed a validation cohort. At every clinic visit, parents answered two questions derived from the Childhood Health Assessment Questionnaire (CHAQ): 'Is it hard for your child to run and play BECAUSE OF ARTHRITIS?' ('Hard' 0-10), and 'Does your child usually need help from you or another person BECAUSE OF ARTHRITIS?' ('Help', 0-10). We used 36-fold cross-validation and tested nine different mathematical methods to combine the answers and optimize psychometric properties. The results were confirmed in the validation cohort. RESULTS Expressed as the mean of the two answers, KDS best balanced ease of use and psychometric properties, while a LASSO regression model combining the two answers with other patient characteristics [estimated CHAQ [eCHAQ]) had the highest responsiveness. In the validation cohort, 22.7%, 25.9% and 28.6% of patients had a score of 0 at enrolment for the KDS, eCHAQ and CHAQ, respectively. Responsiveness was 0.67, 0.74 and 0.62, respectively. Sensitivity to detect a CHAQ > 0 was 0.90 and specificity 0.56, KDS detecting some disability in 44% of children with a CHAQ = 0. CONCLUSION This simple KDS has psychometric properties comparable with those of a full CHAQ and may be used at every clinic visit to identify those children who need a full disability assessment.
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Affiliation(s)
- Kristin Houghton
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Meghan McPherson
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | | | | | - Roberta Berard
- London Health Sciences Centre and Western University, London
| | | | | | - Dax Rumsey
- The Stollery Children's Hospital and University of Alberta, Edmonton
| | | | - Nadia Luca
- The Alberta Children's Hospital and University of Calgary, Calgary
| | - Nicole Johnson
- The Alberta Children's Hospital and University of Calgary, Calgary
| | - Tommy Gerschman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Paivi Miettunen
- The Alberta Children's Hospital and University of Calgary, Calgary
| | - Herman Tam
- The Stollery Children's Hospital and University of Alberta, Edmonton
| | - Lillian Lim
- The Stollery Children's Hospital and University of Alberta, Edmonton
| | - Kimberly Morishita
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | | | - Johannes Roth
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa
| | - Ciaran Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa
| | - Lori Tucker
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Brian M Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
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Mahmood F, Nguyen A, Muntyanu A, Jfri A, McCuaig C, Chédeville G, Piram M, Netchiporouk E. Prevalence and Incidence of Localized Scleroderma: A Qualitative Systematic Review. J Cutan Med Surg 2022; 26:632-633. [PMID: 36225142 DOI: 10.1177/12034754221129876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Farhan Mahmood
- 12365 Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Alex Nguyen
- 12367 Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Anastasiya Muntyanu
- 54473 Division of Dermatology, McGill University Health Center, Montreal, QC, Canada
| | - Abdulhadi Jfri
- 25461 Division of Dermatology, Department of Medicine, Ministry of the National Guard-Health Affairs, Jeddah, Saudi Arabia.,54473 College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia.,King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Catherine McCuaig
- 25461 Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Montréal, Quebec, Canada
| | - Gaëlle Chédeville
- 54473 Division of Rheumatology, Department of Pediatrics, McGill University Health Center, Montreal, QC, Canada
| | - Maryam Piram
- 25461 Division of Dermatology, Department of Pediatrics, Centre Hospitalier Universitaire Sainte Justine, Montréal, Quebec, Canada
| | - Elena Netchiporouk
- 54473 Division of Dermatology, McGill University Health Center, Montreal, QC, Canada
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6
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Park J, Batthish M, Berard RA, Chédeville G, Proulx-Gauthier JP, Rumsey DG, Tucker LB, Wong S, Guzman J. Comparing Canadian pediatric rheumatology practice to the 2019 ACR Juvenile Idiopathic Arthritis guidelines. Results from the CAPRI Registry. Rheumatology (Oxford) 2022; 62:1616-1620. [PMID: 35977388 DOI: 10.1093/rheumatology/keac468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify differences between baseline Canadian JIA practices and the 2019 American College of Rheumatology guidelines for juvenile idiopathic arthritis (JIA Guidelines). METHODS Canadian pediatric rheumatologists were surveyed for their opinion on reasonable a priori target adherence rates for JIA Guideline recommendations. Then, prospectively collected data for 266 newly diagnosed children from 2017 to 2019 were analyzed to calculate observed adherence rates. Kaplan Meier survival curves were used to estimate the cumulative incidence of starting synthetic or biologic DMARDs for different patient groups. RESULTS Twenty-five of 61 (41%) eligible physicians answered the survey. Most survey respondents (64%) felt that adherence targets should vary depending on the strength of recommendation and quality of evidence, from a mean of 84% for strong recommendations with high quality evidence, to 29% for conditional recommendations with very low-quality evidence. Data showed 13/19 (68%) recommendations would have met proposed targets and 10/19 (53%) had ≥80% observed adherence. Exceptions were the use of subcutaneous over oral methotrexate (MTX) (53%) and infrequent treatment escalation from NSAIDs to biologic DMARDs in patients with sacroiliitis (31%) or enthesitis (0%). By 12 weeks, 95% of patients with polyarthritis received synthetic DMARD, 38% of patients with systemic JIA received biologic DMARD, and 22% of patients with sacroiliitis received biologic DMARD. CONCLUSION Canadian pediatric rheumatology practices were in line with many 2019 JIA Guidelines recommendations before their publication, except for frequent use of oral methotrexate and infrequent direct escalation from NSAIDs to biologic DMARDs in sacroiliitis and enthesitis.
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Affiliation(s)
- Jonathan Park
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Batthish
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Roberta A Berard
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montreal, Québec, Canada
| | | | - Dax G Rumsey
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Wong
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
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7
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Karatzios C, Scuccimarri R, Chédeville G, Basfar W, Bullard J, Stein DR. Multisystem Inflammatory Syndrome Following SARS-CoV-2 Vaccination in Two Children. Pediatrics 2022; 150:188099. [PMID: 35614536 DOI: 10.1542/peds.2021-055956] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/05/2022] [Indexed: 12/14/2022] Open
Abstract
This report presents 2 pediatric cases of multisystem inflammatory syndrome in children and adults (MIS-C/A) post severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination (MIS-V). Both children presented with MIS-V within 6 weeks of receiving their first and only dose of Pfizer-BioNTech's SARS-CoV-2 vaccine. The first patient had symptoms of MIS-C/A with peri-myocarditis and shock, and the second 1 had classic Kawasaki disease features. Both responded well to intravenous immunoglobulins and/or systemic corticosteroids. Both children were positive only for SARS-2-CoV antispike (S) (and not for antinucleocapsid [NC]) antibodies consistent with a postvaccine, and not a postinfection, event. Surveillance for rare adverse events following immunization should continue, especially now that SARS-CoV-2 vaccination is approved in the 5 to 11 year age group that has had the highest risk of developing MIS-C post SARS-CoV-2 infection. Our patients did not receive any further SARS-CoV-2 vaccines. Our report highlights the importance of measuring differentiating antibodies (anti-S and anti-NC) that can be used within a specific timeframe to help determine if a patient has MIS-V post vaccine (only anti-S present), or MIS-C/A post SARS-CoV-2 infection (both anti-S and anti-NC present).
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Affiliation(s)
- Christos Karatzios
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.,Divisions of Infectious Diseases
| | - Rosie Scuccimarri
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.,Rheumatology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Gaëlle Chédeville
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.,Rheumatology, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Wijdan Basfar
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Jared Bullard
- Departments of Pediatrics and Child Health.,Medical Microbiology and Infectious Diseases, Cadham Provincial Laboratory, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Derek Riley Stein
- Medical Microbiology and Infectious Diseases, Cadham Provincial Laboratory, University of Manitoba, Winnipeg, Manitoba, Canada
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8
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Heale LD, Houghton KM, Rezaei E, Baxter-Jones ADG, Tupper SM, Muhajarine N, Benseler SM, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Ellsworth J, Guzman J, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Spiegel L, Stringer E, Tse SML, Tucker LB, Turvey SE, Yeung RSM, Rosenberg AM. Clinical and psychosocial stress factors are associated with decline in physical activity over time in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:97. [PMID: 34187498 PMCID: PMC8243495 DOI: 10.1186/s12969-021-00584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Physical activity (PA) patterns in children with juvenile idiopathic arthritis (JIA) over time are not well described. The aim of this study was to describe associations of physical activity (PA) with disease activity, function, pain, and psychosocial stress in the 2 years following diagnosis in an inception cohort of children with juvenile idiopathic arthritis (JIA). METHODS In 82 children with newly diagnosed JIA, PA levels, prospectively determined at enrollment, 12 and 24 months using the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) raw scores, were evaluated in relation to disease activity as reflected by arthritis activity (Juvenile Arthritis Disease Activity Score (JADAS-71)), function, pain, and psychosocial stresses using a linear mixed model approach. Results in the JIA cohort were compared to normative Pediatric Bone Mineral Accrual Study data derived from healthy children using z-scores. RESULTS At enrollment, PA z-score levels of study participants were lower than those in the normative population (median z-score - 0.356; p = 0.005). At enrollment, PA raw scores were negatively associated with the psychosocial domain of the Juvenile Arthritis Quality of Life Questionnaire (r = - 0.251; p = 0.023). There was a significant decline in PAQ-C/A raw scores from baseline (median and IQR: 2.6, 1.4-3.1) to 24 months (median and IQR: 2.1, 1.4-2.7; p = 0.003). The linear mixed-effect model showed that PAQ-C/A raw scores in children with JIA decreased as age, disease duration, and ESR increased. The PAQ-C/A raw scores of the participants was also negatively influenced by an increase in disease activity as measured by the JADAS-71 (p < 0.001). CONCLUSION Canadian children with newly diagnosed JIA have lower PA levels than healthy children. The decline in PA levels over time was associated with disease activity and higher disease-specific psychosocial stress.
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Affiliation(s)
- Liane D. Heale
- grid.422356.40000 0004 0634 5667McMaster Children’s Hospital and McMaster University, Hamilton, Canada
| | - Kristin M. Houghton
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Elham Rezaei
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | | | - Susan M. Tupper
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Nazeem Muhajarine
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Susanne M. Benseler
- grid.413571.50000 0001 0684 7358Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Gilles Boire
- grid.86715.3d0000 0000 9064 6198Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie– Centre Hospitalier Universitaire de Santé (CIUSSS de l’Estrie-CHUS) and University of Sherbrooke, Sherbrooke, Canada
| | - David A. Cabral
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Sarah Campillo
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Gaëlle Chédeville
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Anne-Laure Chetaille
- grid.411081.d0000 0000 9471 1794le Centre Hospitalier Universitaire de Quebec, Quebec, Canada
| | - Paul Dancey
- grid.477424.60000 0004 0640 6407Janeway Children’s Health and Rehabilitation Centre and Memorial University, St. John’s, Canada
| | - Ciaran Duffy
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Karen Watanabe Duffy
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Janet Ellsworth
- grid.416656.60000 0004 0633 3703Stollery Children’s Hospital and University of Alberta, Edmonton, Canada
| | - Jaime Guzman
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Adam M. Huber
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Roman Jurencak
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Bianca Lang
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Ronald M. Laxer
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kimberly Morishita
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Kiem G. Oen
- grid.413983.4The Children’s Hospital of Winnipeg and University of Manitoba, Winnipeg, Canada
| | - Ross E. Petty
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Suzanne E. Ramsey
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Johannes Roth
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Rayfel Schneider
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Rosie Scuccimarri
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Lynn Spiegel
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Elizabeth Stringer
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Shirley M. L. Tse
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Lori B. Tucker
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Stuart E. Turvey
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Rae S. M. Yeung
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Alan M. Rosenberg
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
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9
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Finch SL, Rosenberg AM, Kusalik AJ, Maleki F, Rezaei E, Baxter-Jones A, Benseler S, Boire G, Cabral D, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Stringer E, Tse SML, Tucker LB, Turvey SE, Szafron M, Whiting S, Yeung RS, Vatanparast H. Higher concentrations of vitamin D in Canadian children with juvenile idiopathic arthritis compared to healthy controls are associated with more frequent use of vitamin D supplements and season of birth. Nutr Res 2021; 92:139-149. [PMID: 34311227 DOI: 10.1016/j.nutres.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/05/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
A number of studies have demonstrated that patients with autoimmune disease have lower levels of vitamin D prompting speculation that vitamin D might suppress inflammation and immune responses in children with juvenile idiopathic arthritis (JIA). The objective of this study was to compare vitamin D levels in children with JIA at disease onset with healthy children. We hypothesized that children and adolescents with JIA have lower vitamin D levels than healthy children and adolescents. Data from a Canadian cohort of children with new-onset JIA (n= 164, data collection 2007-2012) were compared to Canadian Health Measures Survey (CHMS) data (n=4027, data collection 2007-2011). We compared 25-hydroxy vitamin D (25(OH)D) concentrations with measures of inflammation, vitamin D supplement use, milk intake, and season of birth. Mean 25(OH)D level was significantly higher in patients with JIA (79 ± 3.1 nmol/L) than in healthy controls (68 ± 1.8 nmol/L P <.05). Patients with JIA more often used vitamin D containing supplements (50% vs. 7%; P <.05). The prevalence of 25(OH)D deficiency (<30 nmol/L) was 6% for both groups. Children with JIA with 25(OH)D deficiency or insufficiency (<50 nmol/L) had higher C-reactive protein levels. Children with JIA were more often born in the fall and winter compared to healthy children. In contrast to earlier studies, we found vitamin D levels in Canadian children with JIA were higher compared to healthy children and associated with more frequent use of vitamin D supplements. Among children with JIA, low vitamin D levels were associated with indicators of greater inflammation.
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Affiliation(s)
- Sarah L Finch
- University of Saskatchewan, Saskatoon, Canada; University of Prince Edward Island, Charlottetown, Canada
| | | | | | | | | | | | - Susanne Benseler
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - David Cabral
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | | | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre, St. John's, Canada
| | - Ciaran Duffy
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Jaime Guzman
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Kristin Houghton
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | | | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Ron M Laxer
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Kimberly Morishita
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Kiem G Oen
- University of Manitoba, Winnipeg, Canada
| | - Ross E Petty
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | - Johannes Roth
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Rayfel Schneider
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | | | | | - Shirley M L Tse
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Lori B Tucker
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Stuart E Turvey
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | | | - Rae Sm Yeung
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
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10
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Chédeville G, McGuire K, Cabral DA, Shiff NJ, Rumsey DG, Proulx-Gauthier JP, Schmeling H, Berard RA, Batthish M, Soon G, Gerhold K, Gerschman T, Bruns A, Duffy CM, Tucker LB, Guzman J. Parent-Reported Medication Side-Effects and Their Impact on Health-Related Quality of Life in Children with Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2021; 74:1567-1574. [PMID: 33787074 DOI: 10.1002/acr.24610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/16/2021] [Accepted: 03/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe frequency and severity of parent-reported medication side effects (SE) in children with Juvenile Idiopathic Arthritis (JIA), relative to physician-reported actionable adverse events (AAE); and to assess their impact on health-related quality of life (HRQoL). METHODS Newly diagnosed JIA patients recruited between 2017 and 2019 to the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry were included. Parents reported presence and severity (0=no problem, 10=very severe) of medication SE at every clinic visit. Physicians were asked to report any AAE. HRQoL was assessed using the Quality of My Life (QoML) questionnaire (0=the worst, 10=the best) and parent's global assessment (0=very well, 10=very poor). Analyses included proportion of visits with SE or AAE, cumulative incidence by Kaplan-Meier methods, and HRQoL impact measured with longitudinal mixed effects models. RESULTS SE were reported at 371/884 (42%) visits (95% CI 39-45%) in 249 patients with a median of 2 SE per visit (IQR 1,3), and median severity of 3 (IQR 1.5,5). Most SE were gastrointestinal (32.5% of visits) or behavioral/psychiatric (22.4%). SE frequency was lowest with NSAID alone (34.7%) and highest with prednisone and methotrexate combinations (66%). SE cumulative incidence was 67% (95% CI 59-75) within 1y of diagnosis, and 36% (95% CI 28-44) for AAE. Parent global and QoML scores were worse with SE present, the impact persisted after adjusting for pain and number of active joints. CONCLUSION Parents report 2/3 children with JIA experience SE impacting their HRQoL within 1y of diagnosis. SE mitigation strategies are needed in managing JIA.
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Affiliation(s)
- Gaëlle Chédeville
- Division of Pediatric Rheumatology. Department of Pediatrics. McGill
| | | | - David A Cabral
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
| | - Natalie J Shiff
- University of Saskatchewan, Department of Community Health and Epidemiology, Saskatoon, SK, Canada
| | - Dax G Rumsey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | | | - Roberta A Berard
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre and Western University, London, ON, Canada
| | | | - Gordon Soon
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Kerstin Gerhold
- Department of Pediatrics and Child Health, University of Manitoba, Manitoba, MB, Canada
| | - Tommy Gerschman
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
| | - Alessandra Bruns
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Ciaran M Duffy
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Lori B Tucker
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
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11
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Rezaei E, Hogan D, Trost B, Kusalik AJ, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Watanabe Duffy K, Gordon J, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Morishita K, Oen KG, Petty RE, Ramsey SE, Scuccimarri R, Spiegel L, Stringer E, Taylor-Gjevre RM, Tse SML, Tucker LB, Turvey SE, Tupper S, Yeung RSM, Benseler S, Ellsworth J, Guillet C, Karananayake C, Muhajarine N, Roth J, Schneider R, Rosenberg AM. Clinical and associated inflammatory biomarker features predictive of short-term outcomes in non-systemic juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 59:2402-2411. [PMID: 31919503 DOI: 10.1093/rheumatology/kez615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To identify early predictors of disease activity at 18 months in JIA using clinical and biomarker profiling. METHODS Clinical and biomarker data were collected at JIA diagnosis in a prospective longitudinal inception cohort of 82 children with non-systemic JIA, and their ability to predict an active joint count of 0, a physician global assessment of disease activity of ≤1 cm, and inactive disease by Wallace 2004 criteria 18 months later was assessed. Correlation-based feature selection and ReliefF were used to shortlist predictors and random forest models were trained to predict outcomes. RESULTS From the original 112 features, 13 effectively predicted 18-month outcomes. They included age, number of active/effused joints, wrist, ankle and/or knee involvement, ESR, ANA positivity and plasma levels of five inflammatory biomarkers (IL-10, IL-17, IL-12p70, soluble low-density lipoprotein receptor-related protein 1 and vitamin D), at enrolment. The clinical plus biomarker panel predicted active joint count = 0, physician global assessment ≤ 1, and inactive disease after 18 months with 0.79, 0.80 and 0.83 accuracy and 0.84, 0.83, 0.88 area under the curve, respectively. Using clinical features alone resulted in 0.75, 0.72 and 0.80 accuracy, and area under the curve values of 0.81, 0.78 and 0.83, respectively. CONCLUSION A panel of five plasma biomarkers combined with clinical features at the time of diagnosis more accurately predicted short-term disease activity in JIA than clinical characteristics alone. If validated in external cohorts, such a panel may guide more rationally conceived, biologically based, personalized treatment strategies in early JIA.
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Affiliation(s)
- Elham Rezaei
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
| | - Daniel Hogan
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Brett Trost
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Anthony J Kusalik
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Gilles Boire
- Département de Médecine, Université de Sherbrooke, Sherbrooke, QCCanada
| | - David A Cabral
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Sarah Campillo
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Gaëlle Chédeville
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Anne-Laure Chetaille
- Département de Médecine le, Centre Hospitalier Universitaire de Quebec, Quebec, QCCanada
| | - Paul Dancey
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St John's, NLCanada
| | - Ciaran Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Karen Watanabe Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - John Gordon
- Department of Medicine, University of Saskatchewan, Saskatoon, SKCanada
| | - Jaime Guzman
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Kristin Houghton
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Adam M Huber
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Roman Jurencak
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Bianca Lang
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Kimberly Morishita
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Kiem G Oen
- Department of Pediatrics, University of Manitoba, Winnipeg, MBCanada
| | - Ross E Petty
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Suzanne E Ramsey
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Rosie Scuccimarri
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Lynn Spiegel
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Elizabeth Stringer
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | | | - Shirley M L Tse
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Lori B Tucker
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Stuart E Turvey
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Susan Tupper
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
| | - Rae S M Yeung
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Susanne Benseler
- Department of Pediatrics, University of Calgary, Calgary, ABCanada
| | - Janet Ellsworth
- Department of Pediatrics, University of Alberta, Edmonton, ABCanada
| | - Chantal Guillet
- Department of Pediatrics, Hôpital Fleurimont (CHUS), Quebec, QCCanada
| | | | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Johannes Roth
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Rayfel Schneider
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Alan M Rosenberg
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
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12
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Rezaei E, Newkirk MM, Li Z, Gordon JR, Oen KG, Benseler SM, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Houghton K, Huber AM, Jurencak R, Lang B, Morishita KA, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Spiegel L, Stringer E, Tse SML, Tucker LB, Turvey SE, Yeung RSM, Rosenberg AM. Soluble Low-density Lipoprotein Receptor-related Protein 1 in Juvenile Idiopathic Arthritis. J Rheumatol 2020; 48:760-766. [PMID: 33060303 DOI: 10.3899/jrheum.200391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to expand knowledge about soluble low-density lipoprotein receptor-related protein 1 (sLRP1) in juvenile idiopathic arthritis (JIA) by determining associations of sLRP1 levels in nonsystemic JIA patients with clinical and inflammatory biomarker indicators of disease activity. METHODS Plasma sLRP1 and 44 inflammation-related biomarkers were measured at enrollment and 6 months later in a cohort of 96 newly diagnosed Canadian patients with nonsystemic JIA. Relationships between sLRP1 levels and indicators of disease activity and biomarker levels were analyzed at both visits. RESULTS At enrollment, sLRP1 levels correlated negatively with age and active joint counts. Children showed significantly higher levels of sLRP1 than adolescents (mean ranks: 55.4 and 41.9, respectively; P = 0.02). Participants with 4 or fewer active joints, compared to those with 5 or more active joints, had significantly higher sLRP1 levels (mean ranks: 56.2 and 40.7, respectively; P = 0.006). At enrollment, considering the entire cohort, sLRP1 correlated negatively with the number of active joints (r = -0.235, P = 0.017). In the entire cohort, sLRP1 levels at enrollment and 6 months later correlated with 13 and 6 pro- and antiinflammatory biomarkers, respectively. In JIA categories, sLRP1 correlations with inflammatory markers were significant in rheumatoid factor-negative polyarticular JIA, oligoarticular JIA, enthesitis-related arthritis, and psoriatic arthritis at enrollment. Higher sLRP1 levels at enrollment increased the likelihood of absence of active joints 6 months later. CONCLUSION Plasma sLRP1 levels correlate with clinical and biomarker indicators of short-term improvement in JIA disease activity, supporting sLRP1 as an upstream biomarker of potential utility for assessing JIA disease activity and outcome prediction.
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Affiliation(s)
- Elham Rezaei
- E. Rezaei, MD, PhD, A.M. Rosenberg, MD, Departments of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Marianna M Newkirk
- M.M. Newkirk, PhD, Department of Medicine, McGill University Health Center, Montreal, Quebec
| | - Zhenhong Li
- Z. Li, MSc, RC-CHUM, University of Montreal, Montreal, Quebec
| | - John R Gordon
- J.R. Gordon, PhD, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kiem G Oen
- K.G. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Susanne M Benseler
- S.M. Benseler, MD, PhD, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta
| | - Gilles Boire
- G. Boire, MD, Département de Médecine, Université de Sherbrooke, Sherbrooke, Quebec
| | - David A Cabral
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Sarah Campillo
- S. Campillo, MD, G. Chédeville, MD, R. Scuccimarri, MD, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Gaëlle Chédeville
- S. Campillo, MD, G. Chédeville, MD, R. Scuccimarri, MD, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Anne-Laure Chetaille
- A.L. Chetaille, MD, Département de Médecine le Centre Hospitalier Universitaire de Quebec, Quebec City, Quebec
| | - Paul Dancey
- P. Dancey, MD, Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland
| | - Ciaran Duffy
- C. Duffy, MD, R. Jurencak, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Karen Watanabe Duffy
- K. Watanabe Duffy, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Kristin Houghton
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Adam M Huber
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Roman Jurencak
- C. Duffy, MD, R. Jurencak, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Bianca Lang
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Kimberly A Morishita
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Ross E Petty
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Suzanne E Ramsey
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Johannes Roth
- J. Roth, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario
| | - Rayfel Schneider
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rosie Scuccimarri
- S. Campillo, MD, G. Chédeville, MD, R. Scuccimarri, MD, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Lynn Spiegel
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Stringer
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Shirley M L Tse
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lori B Tucker
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Stuart E Turvey
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Rae S M Yeung
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alan M Rosenberg
- E. Rezaei, MD, PhD, A.M. Rosenberg, MD, Departments of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan;
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Rezaei E, Hogan D, Trost B, Kusalik AJ, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Eng SWM, Gordon J, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Scherer SW, Scuccimarri R, Spiegel L, Stringer E, Taylor-Gjevre RM, Tse SML, Tucker LB, Turvey SE, Tupper S, Wintle RF, Yeung RSM, Rosenberg AM. Associations of clinical and inflammatory biomarker clusters with juvenile idiopathic arthritis categories. Rheumatology (Oxford) 2020; 59:1066-1075. [PMID: 32321162 DOI: 10.1093/rheumatology/kez382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/30/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify discrete clusters comprising clinical features and inflammatory biomarkers in children with JIA and to determine cluster alignment with JIA categories. METHODS A Canadian prospective inception cohort comprising 150 children with JIA was evaluated at baseline (visit 1) and after six months (visit 2). Data included clinical manifestations and inflammation-related biomarkers. Probabilistic principal component analysis identified sets of composite variables, or principal components, from 191 original variables. To discern new clinical-biomarker clusters (clusters), Gaussian mixture models were fit to the data. Newly-defined clusters and JIA categories were compared. Agreement between the two was assessed using Kruskal-Wallis analyses and contingency plots. RESULTS Three principal components recovered 35% (three clusters) and 40% (five clusters) of the variance in patient profiles in visits 1 and 2, respectively. None of the clusters aligned precisely with any of the seven JIA categories but rather spanned multiple categories. Results demonstrated that the newly defined clinical-biomarker lustres are more homogeneous than JIA categories. CONCLUSION Applying unsupervised data mining to clinical and inflammatory biomarker data discerns discrete clusters that intersect multiple JIA categories. Results suggest that certain groups of patients within different JIA categories are more aligned pathobiologically than their separate clinical categorizations suggest. Applying data mining analyses to complex datasets can generate insights into JIA pathogenesis and could contribute to biologically based refinements in JIA classification.
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Affiliation(s)
- Elham Rezaei
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Daniel Hogan
- Department of Computer Sciences, University of Saskatchewan
| | - Brett Trost
- Department of Computer Sciences, University of Saskatchewan
| | | | - Gilles Boire
- Département de Médecine, Université de Sherbrooke, Sherbrooke
| | - David A Cabral
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Sarah Campillo
- Department of Pediatrics, McGill University Health Center, Montreal
| | | | | | - Paul Dancey
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's
| | - Ciaran Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa
| | | | - Simon W M Eng
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - John Gordon
- Department of Medicine, University of Saskatchewan
| | - Jaime Guzman
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Kristin Houghton
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Adam M Huber
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | - Roman Jurencak
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa
| | - Bianca Lang
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | - Ronald M Laxer
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Kimberly Morishita
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Kiem G Oen
- Department of Pediatrics, University of Manitoba, Winnipeg
| | - Ross E Petty
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Suzanne E Ramsey
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | | | | | - Lynn Spiegel
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Elizabeth Stringer
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | | | - Shirley M L Tse
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Lori B Tucker
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Stuart E Turvey
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Susan Tupper
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | | | - Rae S M Yeung
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Alan M Rosenberg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
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14
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Chhabra A, Oen K, Huber AM, Shiff NJ, Boire G, Benseler SM, Berard RA, Scuccimarri R, Feldman BM, Lim LSH, Barsalou J, Bruns A, Cabral DA, Chédeville G, Ellsworth J, Houghton K, Lang B, Morishita K, Rumsey DG, Rosenberg AM, Tse SM, Watanabe Duffy K, Duffy CM, Guzman J, Bolaria R, Gross K, Turvey SE, Chan M, Tucker LB, Petty R, Johnson N, Luca N, Miettunen P, Schmeling H, Gerhold K, Larché M, Levy DM, Laxer RM, Feldman D, Spiegel L, Schneider R, Silverman E, Cameron B, Yeung RSM, Roth J, Jurencak R, Gibbon M, Chetaille A, Dorval J, Campillo S, LeBlanc C, Chédeville G, Haddad E, Cyr CS, Ramsey SE, Stringer E, Dancey P. Real‐World Effectiveness of Common Treatment Strategies for Juvenile Idiopathic Arthritis: Results From a Canadian Cohort. Arthritis Care Res (Hoboken) 2020; 72:897-906. [DOI: 10.1002/acr.23922] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/26/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Amieleena Chhabra
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Kiem Oen
- University of Manitoba Winnipeg Manitoba Canada
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University Halifax Nova Scotia Canada
| | - Natalie J. Shiff
- Shands Children's Hospital and University of Florida Gainesville
| | - Gilles Boire
- Centre intégré universitaire de santé et de services sociaux de l'EstrieCentre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke Sherbrooke Quebec Canada
| | - Susanne M. Benseler
- Alberta Children's Hospital and University of Calgary Calgary Alberta Canada
| | - Roberta A. Berard
- London Health Sciences Centre and Western University London Ontario Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University Montreal Quebec Canada
| | - Brian M. Feldman
- Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | | | - Julie Barsalou
- Centre hospitalier universitaire Sainte‐Justine and Université de Montréal Montreal Quebec Canada
| | - Alessandra Bruns
- Centre intégré universitaire de santé et de services sociaux de l'EstrieCentre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke Sherbrooke Quebec Canada
| | - David A. Cabral
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University Montreal Quebec Canada
| | - Janet Ellsworth
- Stollery Children's Hospital and University of Alberta Edmonton Alberta Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University Halifax Nova Scotia Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Dax G. Rumsey
- Stollery Children's Hospital and University of Alberta Edmonton Alberta Canada
| | - Alan M. Rosenberg
- Royal University Hospital and University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Shirley M. Tse
- Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa Ottawa Ontario Canada
| | - Ciaran M. Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa Ottawa Ontario Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
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Rumsey DG, Guzman J, Rosenberg AM, Huber AM, Scuccimarri R, Shiff NJ, Bruns A, Feldman BM, Eurich DT, Benseler S, Berard R, Boire G, Bolaria R, Cabral D, Cameron B, Campillo S, Chan M, Chédeville G, Chetaille A, Dancey P, Dorval J, Duffy C, Ellsworth J, Feldman D, Gross K, Haddad E, Houghton K, Johnson N, Jurencak R, Lang B, Larché M, Laxer R, LeBlanc C, Levy D, Luca N, Miettunen P, Morishita K, Oen K, Petty R, Ramsey S, Roth J, Saint‐Cyr C, Schmeling H, Schneider R, Silverman E, Spiegel L, Stringer E, Tse S, Tucker L, Turvey S, Watanabe Duffy K, Yeung R. Worse Quality of Life, Function, and Pain in Children With Enthesitis, Irrespective of Their Juvenile Arthritis Category. Arthritis Care Res (Hoboken) 2020; 72:441-446. [DOI: 10.1002/acr.23844] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/05/2019] [Indexed: 11/07/2022]
Affiliation(s)
| | - Jaime Guzman
- University of British Columbia Vancouver British Columbia Canada
| | | | | | | | | | | | - Brian M. Feldman
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
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Batthish M, Berard R, Cabral D, Bolaria R, Chédeville G, Duffy C, Gerhold K, Gerschman T, Huber A, Proulx-Gauthier JP, Rosenberg A, Rumsey D, Schmeling H, Shiff N, Soon G, Bruns A, Tucker L, Guzman J. A new Canadian inception cohort for juvenile idiopathic arthritis: The Canadian Alliance of Pediatric Rheumatology Investigators Registry. Rheumatology (Oxford) 2020; 59:2796-2805. [DOI: 10.1093/rheumatology/keaa006] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The aim was to describe the design, methods and initial findings of a new Canadian inception cohort of children with JIA, The Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) JIA Registry.
Methods
The CAPRI JIA Registry was started in 2017 to collect information prospectively on children enrolled within 3 months of JIA diagnosis across Canada. The registry has a non-traditional modular design, with no artificially set times for registry visits to occur, streamlined multi-method data collection that requires 2–4 min per visit, and reports cumulative incidence of treatments, outcomes and adverse events calculated by Kaplan–Meier survival methods.
Results
A total of 166 patients, enrolled a median of 6 weeks after JIA diagnosis at 10 centres, were included. The median age at diagnosis was 9 years [interquartile range (IQR) 3, 13], 61% were female and 51% had oligoarticular JIA. The median three-variable clinical Juvenile Arthritis Disease Activity Score was 6.5 (IQR 4, 10) at enrolment, and the median time to first attainment of clinically inactive disease (CID) was 24 weeks (by 1 year, 81%). Within 1 year of diagnosis, 70% of patients had started a DMARD and 35% a biologic agent. The rates of adverse events and serious adverse events were 60 and 5.8 per 100 patient-years, respectively.
Conclusion
This streamlined and flexible registry minimizes the burden of data collection and interference with clinic operations. Initial findings suggest that treatments for newly diagnosed patients with JIA in Canada have intensified, and now 81% of patients attain CID within 1 year of diagnosis.
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Affiliation(s)
- Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Roberta Berard
- Division of Rheumatology, Department of Pediatrics, Western University, London, Ontario
| | - David Cabral
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Roxana Bolaria
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Gaëlle Chédeville
- Division of Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec
| | - Ciaran Duffy
- Division of Rheumatology, Department of Pediatrics, University of Ottawa, Ottawa, Ontario
| | - Kerstin Gerhold
- Division of Rheumatology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
| | - Tommy Gerschman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Adam Huber
- Division of Rheumatology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | | | - Alan Rosenberg
- Division of Rheumatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Dax Rumsey
- Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Heinrike Schmeling
- Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Natalie Shiff
- Division of Rheumatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Gordon Soon
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Alessandra Bruns
- Division of Rheumatology, Department of Pediatrics, University de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lori Tucker
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Jaime Guzman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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Guzman J, Henrey A, Loughin T, Berard RA, Shiff NJ, Jurencak R, Huber AM, Oen K, Gerhold K, Feldman BM, Scuccimarri R, Houghton K, Chédeville G, Morishita K, Lang B, Dancey P, Rosenberg AM, Barsalou J, Bruns A, Watanabe Duffy K, Benseler S, Duffy CM, Tucker LB. Predicting Which Children with Juvenile Idiopathic Arthritis Will Not Attain Early Remission with Conventional Treatment: Results from the ReACCh-Out Cohort. J Rheumatol 2019; 46:628-635. [PMID: 30647178 DOI: 10.3899/jrheum.180456] [Citation(s) in RCA: 18] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the probability of early remission with conventional treatment for each child with juvenile idiopathic arthritis (JIA). Children with a low chance of remission may be candidates for initial treatment with biologics or triple disease-modifying antirheumatic drugs (DMARD). METHODS We used data from 1074 subjects in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. The predicted outcome was clinically inactive disease for ≥ 6 months starting within 1 year of JIA diagnosis in patients who did not receive early biologic agents or triple DMARD. Models were developed in 200 random splits of 75% of the cohort and tested on the remaining 25% of subjects, calculating expected and observed frequencies of remission and c-index values. RESULTS Our best Cox logistic model combining 18 clinical variables a median of 2 days after diagnosis had a c-index of 0.69 (95% CI 0.67-0.71), better than using JIA category alone (0.59, 95% CI 0.56-0.63). Children in the lowest probability decile had a 20% chance of remission and 21% attained remission; children in the highest decile had a 69% chance of remission and 73% attained remission. Compared to 5% of subjects identified by JIA category alone, the model identified 14% of subjects as low chance of remission (probability < 0.25), of whom 77% failed to attain remission. CONCLUSION Although the model did not meet our a priori performance threshold (c-index > 0.70), it identified 3 times more subjects with low chance of remission than did JIA category alone, and it may serve as a benchmark for assessing value added by future laboratory/imaging biomarkers.
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Affiliation(s)
- Jaime Guzman
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA. .,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada. .,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia.
| | - Andrew Henrey
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Thomas Loughin
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Roberta A Berard
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Natalie J Shiff
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Roman Jurencak
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Adam M Huber
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Kiem Oen
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Kerstin Gerhold
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Brian M Feldman
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Rosie Scuccimarri
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Kristin Houghton
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Gaëlle Chédeville
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Kimberly Morishita
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Bianca Lang
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Paul Dancey
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Alan M Rosenberg
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Julie Barsalou
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Alessandra Bruns
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Karen Watanabe Duffy
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Susanne Benseler
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Ciaran M Duffy
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Lori B Tucker
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
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Peschken CA, Wang Y, Abrahamowicz M, Pope J, Silverman E, Sayani A, Iczkovitz S, Ross J, Zummer M, Tucker L, Pineau C, Levy D, Hudson M, Hitchon CA, Huber AM, Smith CD, Avina-Zubieta A, Arbillaga H, Chédeville G, Wynant W, Fortin PR. Persistent Disease Activity Remains a Burden for Patients with Systemic Lupus Erythematosus. J Rheumatol 2018; 46:166-175. [DOI: 10.3899/jrheum.171454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2018] [Indexed: 12/26/2022]
Abstract
Objective.Persistent systemic lupus erythematosus (SLE) disease activity is associated with increased morbidity and mortality. In a multicenter cohort of patients with prevalent SLE, we described persistence, patterns, and predictors of change in disease activity over time.Methods.Based on SLE Disease Activity Index (SLEDAI)-2K scores at cohort entry, patients were classified into 4 groups: low (score < 4; LOW), moderate (4 to < 6; MOD), moderately high (6 to ≤ 10; MHIGH), and very high (> 10; VHIGH). Multivariable linear and longitudinal mixed linear regression models were used to identify predictors of change over time in SLEDAI-2K.Results.There were 2019 participants, with declining followup data over 5 years (1326, 580, 274, 186, and 148 patients, respectively). At cohort entry, mean (± SD) age was 42 (± 17) years, disease duration 11 (± 10) years, and 90% were female. The 4 groups included 44% LOW (n = 891), 20% MOD (n = 400), 22% MHIGH (n = 442), and 14% VHIGH (n = 286); therefore, 36% had clinically important SLE activity. The proportion of patients in the LOW group at entry who moved to a higher activity level varied from 30% (167/557) at 1 year, to 49% (41/83) at 3 years, and 54% (30/56) at 5 years. Among 181 patients with MOD to VHIGH entry activity and 3 years of followup, 116 (64.1%) remained active. In all analyses, only higher SLEDAI-2K at cohort entry remained a significant predictor of higher SLEDAI-2K in subsequent years.Conclusion.Higher SLEDAI-2K at study entry was the single major independent predictor of higher SLEDAI-2K over time, reflecting frequent persistence of active disease, even in patients with longstanding disease. This highlights gaps in the optimal treatment of SLE.
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Oen K, Guzman J, Dufault B, Tucker LB, Shiff NJ, Duffy KW, Lee JJY, Feldman BM, Berard RA, Dancey P, Huber AM, Scuccimarri R, Cabral DA, Morishita KA, Ramsey SE, Rosenberg AM, Boire G, Benseler SM, Lang B, Houghton K, Miettunen PM, Chédeville G, Levy DM, Bruns A, Schmeling H, Haddad E, Yeung RSM, Duffy CM. Health-Related Quality of Life in an Inception Cohort of Children With Juvenile Idiopathic Arthritis: A Longitudinal Analysis. Arthritis Care Res (Hoboken) 2017; 70:134-144. [PMID: 28320056 DOI: 10.1002/acr.23236] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 03/14/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe changes in health-related quality of life (HRQoL) over time in children with juvenile idiopathic arthritis (JIA), relative to other outcomes, and to identify predictors of unfavorable HRQoL trajectories. METHODS Children with JIA in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort were included. The Juvenile Arthritis Quality of Life Questionnaire (JAQQ, a standardized instrument), health-related Quality of My Life (HRQoML, an instrument based on personal valuations), and JIA core variables were completed serially. Analyses included median values, Kaplan-Meier survival curves, and latent trajectory analysis. RESULTS A total of 1,249 patients enrolled at a median of 0.5 months after diagnosis were followed for a median of 34.2 months. The degree of initial HRQoL impairment and probabilities of reaching the best possible HRQoL scores varied across JIA categories (best for oligoarthritis, worst for rheumatoid factor-positive polyarthritis). Median times to attain best possible HRQoL scores (JAQQ 59.3 months, HRQoML 34.5 months), lagged behind those for disease activity, pain, and disability measures. Most patients followed trajectories with minimal or mild impairment; however, 7.6% and 13.8% of patients, respectively, followed JAQQ and HRQoML trajectories with persistent major impairment in HRQoL. JIA category, aboriginal ethnicity, and baseline disease activity measures distinguished between membership in trajectories with major and minimal impairments. CONCLUSION Improvement in HRQoL is slower than for disease activity, pain, and disability. Improvement of a measure based on respondents' preferences (HRQoML) is more rapid than that of a standardized measure (JAQQ). Higher disease activity at diagnosis heralds an unfavorable HRQoL trajectory.
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Affiliation(s)
- Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jaime Guzman
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori B Tucker
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Natalie J Shiff
- University of Florida, Gainesville, Florida, and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | | | - Brian M Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roberta A Berard
- Children's Hospital, London Health Sciences Centre, and Western University, London, Ontario, Canada
| | - Paul Dancey
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - David A Cabral
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly A Morishita
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Suzanne E Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Susanne M Benseler
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristin Houghton
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Paivi M Miettunen
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | | | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Elie Haddad
- CHU Ste. Justine and Université de Montréal, Montreal, Quebec, Canada
| | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
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20
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Guzman J, Kerr T, Ward LM, Ma J, Oen K, Rosenberg AM, Feldman BM, Boire G, Houghton K, Dancey P, Scuccimarri R, Bruns A, Huber AM, Watanabe Duffy K, Shiff NJ, Berard RA, Levy DM, Stringer E, Morishita K, Johnson N, Cabral DA, Larché M, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey SE, Roth J, Campillo S, Benseler S, Chédeville G, Schneider R, Tse SML, Bolaria R, Gross K, Feldman D, Cameron B, Jurencak R, Dorval J, LeBlanc C, St. Cyr C, Gibbon M, Yeung RSM, Duffy CM, Tucker LB. Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Pediatr Rheumatol Online J 2017; 15:68. [PMID: 28830457 PMCID: PMC5567720 DOI: 10.1186/s12969-017-0196-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND With modern treatments, the effect of juvenile idiopathic arthritis (JIA) on growth may be less than previously reported. Our objective was to describe height, weight and body mass index (BMI) development in a contemporary JIA inception cohort. METHODS Canadian children newly-diagnosed with JIA 2005-2010 had weight and height measurements every 6 months for 2 years, then yearly up to 5 years. These measurements were used to calculate mean age- and sex-standardized Z-scores, and estimate prevalence and cumulative incidence of growth impairments, and the impact of disease activity and corticosteroids on growth. RESULTS One thousand one hundred forty seven children were followed for median 35.5 months. Mean Z-scores, and the point prevalence of short stature (height < 2.5th percentile, 2.5% to 3.4%) and obesity (BMI > 95th percentile, 15.8% to 16.4%) remained unchanged in the whole cohort. Thirty-three children (2.9%) developed new-onset short stature, while 27 (2.4%) developed tall stature (>97.5th percentile). Children with systemic arthritis (n = 77) had an estimated 3-year cumulative incidence of 9.3% (95%CI: 4.3-19.7) for new-onset short stature and 34.4% (23-49.4) for obesity. Most children (81.7%) received no systemic corticosteroids, but 1 mg/Kg/day prednisone-equivalent maintained for 6 months corresponded to a drop of 0.64 height Z-scores (0.56-0.82) and an increase of 0.74 BMI Z-scores (0.56-0.92). An increase of 1 in the 10-cm physician global assessment of disease activity maintained for 6 months corresponded to a drop of 0.01 height Z-scores (0-0.02). CONCLUSIONS Most children in this modern JIA cohort grew and gained weight as children in the general population. About 1 in 10 children who had systemic arthritis, uncontrolled disease and/or prolonged corticosteroid use, had increased risk of growth impairment.
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Affiliation(s)
- Jaime Guzman
- From British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada. .,Division of Pediatric Rheumatology, BC Children's Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC, V6H 3N1, Canada.
| | - Tristan Kerr
- 0000 0001 0684 7788grid.414137.4Division of Pediatric Rheumatology, BC Children’s Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC V6H 3N1 Canada
| | - Leanne M. Ward
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Jinhui Ma
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Kiem Oen
- 0000 0004 1936 9609grid.21613.37Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Alan M. Rosenberg
- 0000 0004 0462 8356grid.412271.3Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Brian M. Feldman
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Gilles Boire
- 0000 0001 0081 2808grid.411172.0Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Kristin Houghton
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Paul Dancey
- grid.477424.6Janeway Children’s Health and Rehabilitation Centre and Memorial University, Saint John, ’s Canada
| | - Rosie Scuccimarri
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Alessandra Bruns
- 0000 0001 0081 2808grid.411172.0Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Karen Watanabe Duffy
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Natalie J. Shiff
- 0000 0004 1936 8091grid.15276.37Shands Children’s Hospital and University of Florida, Gainesville, USA
| | - Roberta A. Berard
- 0000 0000 9132 1600grid.412745.1London Health Sciences Centre and Western University, London, Canada
| | - Deborah M. Levy
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | - Kimberly Morishita
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Nicole Johnson
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - David A. Cabral
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Maggie Larché
- 0000 0004 1936 8227grid.25073.33McMaster University, Hamilton, Canada
| | - Ross E. Petty
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Ronald M. Laxer
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Earl Silverman
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paivi Miettunen
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | | | - Elie Haddad
- 0000 0001 2292 3357grid.14848.31Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada
| | - Lynn Spiegel
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stuart E. Turvey
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Heinrike Schmeling
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Janet Ellsworth
- 0000 0004 0633 3703grid.416656.6Stollery Children’s Hospital and University of Alberta, Edmonton, Canada
| | | | - Johannes Roth
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Sarah Campillo
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Susanne Benseler
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Gaëlle Chédeville
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Rayfel Schneider
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Shirley M. L. Tse
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roxana Bolaria
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics University of British Columbia, Vancouver, Canada
| | - Katherine Gross
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics University of British Columbia, Vancouver, Canada
| | - Debbie Feldman
- 0000 0001 2292 3357grid.14848.31Université de Montréal, Montréal, Canada
| | - Bonnie Cameron
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roman Jurencak
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Jean Dorval
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Canada
| | - Claire LeBlanc
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Claire St. Cyr
- 0000 0001 2292 3357grid.14848.31Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada
| | - Michele Gibbon
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Rae S. M. Yeung
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ciarán M. Duffy
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Lori B. Tucker
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
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Guzman J, Oen K, Huber AM, Watanabe Duffy K, Boire G, Shiff N, Berard RA, Levy DM, Stringer E, Scuccimarri R, Morishita K, Johnson N, Cabral DA, Rosenberg AM, Larché M, Dancey P, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Houghton K, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey SE, Bruns A, Roth J, Campillo S, Benseler S, Chédeville G, Schneider R, Tse SML, Bolaria R, Gross K, Feldman B, Feldman D, Cameron B, Jurencak R, Dorval J, LeBlanc C, St Cyr C, Gibbon M, Yeung RSM, Duffy CM, Tucker LB. The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Ann Rheum Dis 2015; 75:1092-8. [PMID: 25985972 DOI: 10.1136/annrheumdis-2014-207164] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 12/16/2014] [Accepted: 05/01/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe probabilities and characteristics of disease flares in children with juvenile idiopathic arthritis (JIA) and to identify clinical features associated with an increased risk of flare. METHODS We studied children in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) prospective inception cohort. A flare was defined as a recurrence of disease manifestations after attaining inactive disease and was called significant if it required intensification of treatment. Probability of first flare was calculated with Kaplan-Meier methods, and associated features were identified using Cox regression. RESULTS 1146 children were followed up a median of 24 months after attaining inactive disease. We observed 627 first flares (54.7% of patients) with median active joint count of 1, physician global assessment (PGA) of 12 mm and duration of 27 weeks. Within a year after attaining inactive disease, the probability of flare was 42.5% (95% CI 39% to 46%) for any flare and 26.6% (24% to 30%) for a significant flare. Within a year after stopping treatment, it was 31.7% (28% to 36%) and 25.0% (21% to 29%), respectively. A maximum PGA >30 mm, maximum active joint count >4, rheumatoid factor (RF)-positive polyarthritis, antinuclear antibodies (ANA) and receiving disease-modifying antirheumatic drugs (DMARDs) or biological agents before attaining inactive disease were associated with increased risk of flare. Systemic JIA was associated with the lowest risk of flare. CONCLUSIONS In this real-practice JIA cohort, flares were frequent, usually involved a few swollen joints for an average of 6 months and 60% led to treatment intensification. Children with a severe disease course had an increased risk of flare.
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Affiliation(s)
- Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Natalie Shiff
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Roberta A Berard
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Stringer
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Johnson
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - David A Cabral
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Maggie Larché
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland, Canada
| | - Ross E Petty
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald M Laxer
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Earl Silverman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Paivi Miettunen
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Anne-Laure Chetaille
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Elie Haddad
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Stuart E Turvey
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Ellsworth
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne E Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alessandra Bruns
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Johannes Roth
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Campillo
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Susanne Benseler
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Rayfel Schneider
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Shirley M L Tse
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roxana Bolaria
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Gross
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Bonnie Cameron
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roman Jurencak
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Jean Dorval
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Claire LeBlanc
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Claire St Cyr
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Michele Gibbon
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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Levy DM, Peschken CA, Tucker LB, Chédeville G, Huber AM, Pope JE, Silverman ED. Association of health-related quality of life in childhood-onset systemic lupus erythematosus with ethnicity: results from a multiethnic multicenter Canadian cohort. Arthritis Care Res (Hoboken) 2015; 66:1767-74. [PMID: 24821613 DOI: 10.1002/acr.22363] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 04/29/2014] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the influence of ethnicity on self-reported health-related quality of life (HRQOL) in the Canadian childhood-onset systemic lupus erythematosus (cSLE) population. METHODS Patients with cSLE at 4 pediatric centers were consecutively enrolled. Sociodemographics and multiple disease activity measures were collected. The Child Health Questionnaire (CHQ) was administered and analyzed by ethnicity. RESULTS We enrolled 213 cSLE patients, and complete data from 196 patients with the following ethnicities were analyzed: white (33%), Asian (32%), South Asian (16%), African American (11%), Latino/Hispanic (5%), and Aboriginal (4%). Compared to healthy children, cSLE patients rated their HRQOL significantly more poorly in 9 of 10 individual domains, and in 4 of 10 domains when compared to a cohort of juvenile arthritis patients. Within the cSLE cohort, CHQ scores were lower in 5 of 10 domains in white patients versus nonwhite ethnicities (P < 0.05 for each). Physical summary scores were lower for white patients compared to the other ethnicities aggregated together (mean ± SD 46.0 ± 11.9 versus 50.4 ± 10.1; P = 0.009); however, psychosocial summary scores were similar among the groups (mean ± SD 40.5 ± 14.6 versus 42.8 ± 12.7; P = 0.26). Disease activity measures, including the Systemic Lupus Erythematosus Disease Activity Index 2000, the Systemic Lupus Activity Measure, Revised, and physician global visual analog scale, were similar across ethnicities. However, patient-reported Systemic Lupus Erythematosus Activity Questionnaire symptom scores were greater in patients of white ethnicity compared to those of Asian ethnicity (mean ± SD 8.2 ± 5.8 versus 4.5 ± 4.7; P = 0.004). CONCLUSION The self- and parent-reported health status of Canadian cSLE patients differed across ethnicities, with white patients reporting lower HRQOL despite similar and overall low disease activity.
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Affiliation(s)
- Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
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Guzman J, Oen K, Tucker LB, Huber AM, Shiff N, Boire G, Scuccimarri R, Berard R, Tse SML, Morishita K, Stringer E, Johnson N, Levy DM, Duffy KW, Cabral DA, Rosenberg AM, Larché M, Dancey P, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Houghton K, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey S, Bruns A, Campillo S, Benseler S, Chédeville G, Schneider R, Yeung R, Duffy CM. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis 2014; 74:1854-60. [PMID: 24842571 DOI: 10.1136/annrheumdis-2014-205372] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/03/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe clinical outcomes of juvenile idiopathic arthritis (JIA) in a prospective inception cohort of children managed with contemporary treatments. METHODS Children newly diagnosed with JIA at 16 Canadian paediatric rheumatology centres from 2005 to 2010 were included. Kaplan-Meier survival curves for each JIA category were used to estimate probability of ever attaining an active joint count of 0, inactive disease (no active joints, no extraarticular manifestations and a physician global assessment of disease activity <10 mm), disease remission (inactive disease >12 months after discontinuing treatment) and of receiving specific treatments. RESULTS In a cohort of 1104 children, the probabilities of attaining an active joint count of 0 exceeded 78% within 2 years in all JIA categories. The probability of attaining inactive disease exceeded 70% within 2 years in all categories, except for RF-positive polyarthritis (48%). The probability of discontinuing treatment at least once was 67% within 5 years. The probability of attaining remission within 5 years was 46-57% across JIA categories except for polyarthritis (0% RF-positive, 14% RF-negative). Initial treatment included joint injections and non-steroidal anti-inflammatory drugs for oligoarthritis, disease-modifying antirheumatic drugs (DMARDs) for polyarthritis and systemic corticosteroids for systemic JIA. CONCLUSIONS Most children with JIA managed with contemporary treatments attain inactive disease within 2 years of diagnosis and many are able to discontinue treatment. The probability of attaining remission within 5 years of diagnosis is about 50%, except for children with polyarthritis.
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Affiliation(s)
- Jaime Guzman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Kiem Oen
- Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Natalie Shiff
- Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Roberta Berard
- London Health Sciences Centre and Western University, London, Canada
| | - Shirley M L Tse
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | | | - Nicole Johnson
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | - David A Cabral
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Canada
| | - Ross E Petty
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Ronald M Laxer
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Earl Silverman
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paivi Miettunen
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | | | - Elie Haddad
- CHU Ste. Justine and Université de Montréal, Montréal, Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stuart E Turvey
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Heinrike Schmeling
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Janet Ellsworth
- The Stollery Children's Hospital and University of Alberta, Edmonton, Canada
| | - Suzanne Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Alessandra Bruns
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Sarah Campillo
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Susanne Benseler
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Rayfel Schneider
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Rae Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
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Levy DM, Peschken CA, Tucker LB, Chédeville G, Huber AM, Pope JE, Silverman ED. Influence of ethnicity on childhood-onset systemic lupus erythematosus: results from a multiethnic multicenter Canadian cohort. Arthritis Care Res (Hoboken) 2013; 65:152-60. [PMID: 22744999 DOI: 10.1002/acr.21779] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Accepted: 06/16/2012] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the influence of ethnicity and sociodemographic factors on disease characteristics of the Canadian pediatric lupus population. METHODS Childhood-onset systemic lupus erythematosus (SLE) patients at 4 pediatric centers in Halifax, Montreal, Toronto, and Vancouver were consecutively recruited. Sociodemographics and disease data were collected. Patients were categorized by their primary self-selected ethnicity, and exploratory cluster analyses were examined for disease expression by ethnicity. RESULTS We enrolled 213 childhood-onset SLE patients, and ethnicity data were available for 206 patients: white (31%), Asian (30%), South Asian (15%), black (10%), Latino/Hispanic (4%), Aboriginal (4%), and Arab/Middle Eastern (3%). The frequency of clinical classification criteria (malar rash, arthritis, serositis, and renal disease) and autoantibodies significantly differed among ethnicities. Medications were prescribed equally across ethnicities: 76% were taking prednisone, 86% antimalarials, and 56% required additional immunosuppressants. Cluster analysis partitioned into 3 main groups: mild (n = 50), moderate (n = 82), and severe (n = 68) disease clusters. Only 20% of white patients were in the severe cluster compared to 51% of Asian and 41% of black patients (P = 0.03). However, disease activity indices and damage scores were similar across ethnicities. CONCLUSION Canadian childhood-onset SLE patients reflect our multiethnic population, with differences in disease manifestations, autoantibody profiles, and severity of disease expression by ethnicity.
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Affiliation(s)
- Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
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Mina R, von Scheven E, Ardoin SP, Eberhard BA, Punaro M, Ilowite N, Hsu J, Klein-Gitelman M, Moorthy LN, Muscal E, Radhakrishna SM, Wagner-Weiner L, Adams M, Blier P, Buckley L, Chalom E, Chédeville G, Eichenfield A, Fish N, Henrickson M, Hersh AO, Hollister R, Jones O, Jung L, Levy D, Lopez-Benitez J, McCurdy D, Miettunen PM, Quintero-del Rio AI, Rothman D, Rullo O, Ruth N, Schanberg LE, Silverman E, Singer NG, Soep J, Syed R, Vogler LB, Yalcindag A, Yildirim-Toruner C, Wallace CA, Brunner HI. Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2012. [PMID: 22162255 DOI: 10.1002/acr.21558.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To formulate consensus treatment plans (CTPs) for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (SLE). METHODS A structured consensus formation process was employed by the members of the Childhood Arthritis and Rheumatology Research Alliance after considering the existing medical evidence and current treatment approaches. RESULTS After an initial Delphi survey (response rate = 70%), a 2-day consensus conference, and 2 followup Delphi surveys (response rates = 63-79%), consensus was achieved for a limited set of CTPs addressing the induction therapy of proliferative LN. These CTPs were developed for prototypical patients defined by eligibility characteristics, and included immunosuppressive therapy with either mycophenolic acid orally twice per day, or intravenous cyclophosphamide once per month at standardized dosages for 6 months. Additionally, the CTPs describe 3 options for standardized use of glucocorticoids, including a primarily oral, a mixed oral/intravenous, and a primarily intravenous regimen. There was consensus on measures of effectiveness and safety of the CTPs. The CTPs were well accepted by the pediatric rheumatology providers treating children with LN, and up to 300 children per year in North America are expected to be candidates for the treatment with the CTPs. CONCLUSION CTPs for induction therapy of proliferative LN in juvenile SLE based on the available scientific evidence and pediatric rheumatology group experience have been developed. Consistent use of the CTPs may improve the prognosis of proliferative LN, and support the conduct of comparative effectiveness studies aimed at optimizing therapeutic strategies for proliferative LN in juvenile SLE.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Mina R, von Scheven E, Ardoin SP, Eberhard BA, Punaro M, Ilowite N, Hsu J, Klein-Gitelman M, Moorthy LN, Muscal E, Radhakrishna SM, Wagner-Weiner L, Adams M, Blier P, Buckley L, Chalom E, Chédeville G, Eichenfield A, Fish N, Henrickson M, Hersh AO, Hollister R, Jones O, Jung L, Levy D, Lopez-Benitez J, McCurdy D, Miettunen PM, Quintero-del Rio AI, Rothman D, Rullo O, Ruth N, Schanberg LE, Silverman E, Singer NG, Soep J, Syed R, Vogler LB, Yalcindag A, Yildirim-Toruner C, Wallace CA, Brunner HI. Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2012; 64:375-83. [PMID: 22162255 DOI: 10.1002/acr.21558] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To formulate consensus treatment plans (CTPs) for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (SLE). METHODS A structured consensus formation process was employed by the members of the Childhood Arthritis and Rheumatology Research Alliance after considering the existing medical evidence and current treatment approaches. RESULTS After an initial Delphi survey (response rate = 70%), a 2-day consensus conference, and 2 followup Delphi surveys (response rates = 63-79%), consensus was achieved for a limited set of CTPs addressing the induction therapy of proliferative LN. These CTPs were developed for prototypical patients defined by eligibility characteristics, and included immunosuppressive therapy with either mycophenolic acid orally twice per day, or intravenous cyclophosphamide once per month at standardized dosages for 6 months. Additionally, the CTPs describe 3 options for standardized use of glucocorticoids, including a primarily oral, a mixed oral/intravenous, and a primarily intravenous regimen. There was consensus on measures of effectiveness and safety of the CTPs. The CTPs were well accepted by the pediatric rheumatology providers treating children with LN, and up to 300 children per year in North America are expected to be candidates for the treatment with the CTPs. CONCLUSION CTPs for induction therapy of proliferative LN in juvenile SLE based on the available scientific evidence and pediatric rheumatology group experience have been developed. Consistent use of the CTPs may improve the prognosis of proliferative LN, and support the conduct of comparative effectiveness studies aimed at optimizing therapeutic strategies for proliferative LN in juvenile SLE.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Chédeville G, Scuccimarri R. Orbital myositis: a report of 3 pediatric cases. Pediatr Rheumatol Online J 2012. [PMCID: PMC3402952 DOI: 10.1186/1546-0096-10-s1-a92] [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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Oen K, Duffy CM, Tse SML, Ramsey S, Ellsworth J, Chédeville G, Chetaille AL, Saint-Cyr C, Cabral DA, Spiegel LR, Schneider R, Lang B, Huber AM, Dancey P, Silverman E, Rosenberg AM, Cameron B, Johnson N, Dorval J, Scuccimarri R, Campillo S, Petty RE, Duffy KNW, Boire G, Haddad E, Houghton K, Laxer R, Turvey SE, Miettunen P, Gross K, Guzman J, Benseler S, Feldman BM, Espinosa V, Yeung RSM, Tucker L. Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort. Arthritis Care Res (Hoboken) 2010; 62:527-36. [DOI: 10.1002/acr.20044] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [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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Oen K, Tucker L, Huber AM, Miettunen P, Scuccimarri R, Campillo S, Cabral DA, Feldman BM, Tse S, Chédeville G, Spiegel L, Schneider R, Lang B, Ellsworth J, Ramsey S, Dancey P, Silverman E, Chetaille AL, Cameron B, Johnson N, Dorval J, Petty RE, Duffy KW, Boire G, Haddad E, Houghton K, Saint-Cyr C, Turvey SE, Benseler S, Cheang M, Yeung RSM, Duffy CM. Predictors of early inactive disease in a juvenile idiopathic arthritis cohort: Results of a Canadian multicenter, prospective inception cohort study. ACTA ACUST UNITED AC 2009; 61:1077-86. [DOI: 10.1002/art.24539] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- Roberta Berard
- Department of Pediatrics, Division of Rheumatology, Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec
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Sbrocchi AM, Chédeville G, Scuccimarri R, Duffy CM, Krishnamoorthy P. Pediatric hypothyroidism presenting with a polymyositis-like syndrome and increased creatinine: report of three cases. J Pediatr Endocrinol Metab 2008; 21:89-92. [PMID: 18404977 DOI: 10.1515/jpem.2008.21.1.89] [Citation(s) in RCA: 3] [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: 11/15/2022]
Abstract
We report three pediatric cases of primary hypothyroidism presenting with musculoskeletal complaints, elevated muscle enzymes and increased creatinine. Thyroid hormone replacement led to improvement in both the clinical features and laboratory abnormalities.
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Affiliation(s)
- Anne Marie Sbrocchi
- Department of Pediatrics, Divisions of Rheumatology and Endocrinology, Montreal Children's Hospital, McGill University Health Center, McGill University, Montreal, Quebec, Canada
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Chédeville G, Scuccimarri R, Duffy CM. Survey on the use of methotrexate by pediatric rheumatologists in Canada. J Rheumatol 2007; 34:818-22. [PMID: 17309120] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To determine methotrexate (MTX) use and the degree to which Canadian pediatric rheumatologists adhere to the American College of Rheumatology (ACR) guidelines on monitoring for MTX toxicity. METHODS A 20-item questionnaire was e-mailed to 37 pediatric rheumatologists in 17 centers in Canada. A total of 28 (75.7%) responded. RESULTS The oral route (PO) of administration was preferred initially by 78.6% in most cases, but for more severe cases, this fell to 42.8%. Those who chose not to start PO used the subcutaneous route (SQ). When PO was initial treatment, a switch to SQ was undertaken because of dose escalation, lack of efficacy, or GI toxicity. An initial mean dose of 0.35-0.5 mg/kg/wk was prescribed by 51.8%. For 75%, the maximum dose was 1 mg/kg/wk (up to 25 mg). Complete blood count, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were determined by 100% at baseline and in followup; albumin and creatinine by 85.7% at baseline, but by only 71.4% and 67.8%, respectively, in followup. After a change in dose, 96.3% requested blood tests at least monthly; this was extended to every 6 to 8 weeks by 78.6% when the dose was stable. Side effects of recurrent nausea and/or vomiting were reported to occur frequently. No severe toxicity, and in particular no case of cirrhosis, was reported. Prophylactic folate supplementation was prescribed by almost all physicians. CONCLUSION Most Canadian pediatric rheumatologists follow ACR guidelines to monitor for MTX toxicity in children with rheumatic diseases who were prescribed MTX. The variation in monitoring and response to toxicity raises the question whether specific pediatric guidelines should be developed.
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Affiliation(s)
- Gaëlle Chédeville
- Division of Rheumatology, Department of Pediatrics, Montreal Children's Hospital, Quebec, Canada.
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Picard C, Mellouli F, Duprez R, Chédeville G, Neven B, Fraitag S, Delaunay J, Le Deist F, Fischer A, Blanche S, Bodemer C, Gessain A, Casanova JL, Bejaoui M. Kaposi's sarcoma in a child with Wiskott-Aldrich syndrome. Eur J Pediatr 2006; 165:453-7. [PMID: 16602009 DOI: 10.1007/s00431-006-0107-2] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [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] [Received: 11/30/2005] [Revised: 01/30/2006] [Accepted: 02/01/2006] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Kaposi's sarcoma (KS) is rare in childhood. It may be favored by acquired immune deficiencies, but the predisposing factors to KS in other children are unclear. DISCUSSION KS has been reported in only two children and one adult with primary immunodeficiency. We report here a Tunisian child with a Wiskott-Aldrich syndrome who developed KS at the age of 14 months. CONCLUSION This observation expands the spectrum of primary immunodeficiencies associated with KS in childhood.
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Affiliation(s)
- Capucine Picard
- Unité d'Immunologie et d'Hématologie Pédiatriques AP-HP, Hôpital Necker-Enfants Malades, 149 rue de Sèvres, 75015, Paris, EU, France.
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Chédeville G, Quartier P, Miranda M, Brauner R, Prieur AM. Improvements in growth parameters in children with juvenile idiopathic arthritis associated with the effect of methotrexate on disease activity. Joint Bone Spine 2005; 72:392-6. [PMID: 16087383 DOI: 10.1016/j.jbspin.2005.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2002] [Accepted: 03/15/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess changes in growth parameters associated with the response to methotrexate (MTX) therapy in pre-pubertal children with juvenile idiopathic arthritis (JIA) and who had not been treated with steroids. METHODS We enrolled 27 pre-pubertal children with JIA who had been treated with MTX but not with steroids. The children were considered to have responded to treatment if the number of joints with active disease decreased by at least 50% 1 year after treatment initiation. We compared growth parameters (height, growth rate, weight and body mass index (BMI)) in responders and non-responders. RESULTS Twenty-one children (77.8%) responded to MTX therapy. The growth parameters were similar in the responders and non-responders before the onset of treatment. After 1 year, height (P=0.025), growth rate (P=0.03), weight (P=0.007) and BMI (P=0.05) increased significantly in the responder group, but not in the non-responder group. This increase was maintained for growth rate and weight after 2 and 3 years of treatment. After 1 year, height (P=0.023) and growth rate (P=0.0009) were significantly higher in the responders than in the non-responders, and these differences were still significant after 3 years (P=0.01 and P=0.033, respectively). CONCLUSION In pre-pubertal children with JIA, a clinical response to MTX therapy is associated with a significant increase in growth parameters.
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Affiliation(s)
- Gaëlle Chédeville
- Unité d'Immuno-Hématologie-Rhumatologie Pédiatrique, hôpital Necker-Enfants-Malades, 149 rue de Sèvres, 75743 Paris cedex 15, France.
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Abstract
AIMS To define the characteristics of patients dying in a pediatric hospital, including causes and modes of death. PATIENTS AND METHODS This retrospective, descriptive, epidemiologic study was performed between 1 January 1990 and 31 December 1995. All patients who died in the hospital between these dates were included. Patients already dead on arrival (sudden infant death syndrome, children deceased during their transport), and those whose hospital records could not be found, were excluded. RESULTS A total of 375 children were studied, including 195 neonates. The sex ratio was 1.3. Ninety-one percent of deaths took place in three departments: intensive care, neurosurgery-neurology and oncology. Median duration of hospitalization was three days. The most common causes of deaths were accidents, neurologic diseases (particularly among neonates) and tumours. Analysis of modes of death revealed that 41.1% occurred following unsuccessful resuscitation, 38.8% were the result of withdrawal of life-support or a 'do not resuscitate' order and 21.6% resulted from brain death. Evolution of modes of death over the six years showed a reduction of cases with unsuccessful resuscitation, an increase in decisions of 'do not resuscitate' orders and withdrawal of life-support and no change in rates of brain death. Organs were made available for transplantation from 12 of the 81 children with brain death (14.8%). CONCLUSION Accidents were the most common cause of death. The distribution of deaths showed a clear increase in withdrawal or withholding of life-support care, relying on ethical decisions, which are more frequent than some years ago.
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Affiliation(s)
- S Cantagrel
- Unité pédiatrique de soins intensifs, centre de pédiatrie Gatien-de-Clocheville, Tours, France
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Cantagrel S, Chédeville G, Charasson M, Lamour P, Tessier V, Laugier J. Vecu Infirmier de la Mort D'un Enfant en Reanimation Pediatrique. Arch Pediatr 1999. [DOI: 10.1016/s0929-693x(99)81521-8] [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: 10/25/2022]
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Ducrocq S, Chédeville G, Cantagrel S, Marchand S. Mortalite pediatrique hospitaliere. resultats preliminaires d'une etude retrospective sur 6 ans. Arch Pediatr 1997. [DOI: 10.1016/s0929-693x(97)86536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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