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Pinto E Vairo F, Kemppainen JL, Vitek CRR, Whalen DA, Kolbert KJ, Sikkink KJ, Kroc SA, Kruisselbrink T, Shupe GF, Knudson AK, Burke EM, Loftus EC, Bandel LA, Prochnow CA, Mulvihill LA, Thomas B, Gable DM, Graddy CB, Garzon GGM, Ekpoh IU, Porquera EMC, Fervenza FC, Hogan MC, El Ters M, Warrington KJ, Davis JM, Koster MJ, Orandi AB, Basiaga ML, Vella A, Kumar S, Creo AL, Lteif AN, Pittock ST, Tebben PJ, Abate EG, Joshi AY, Ristagno EH, Patnaik MS, Schimmenti LA, Dhamija R, Sabrowsky SM, Wierenga KJ, Keddis MT, Samadder NJJ, Presutti RJ, Robinson SI, Stephens MC, Roberts LR, Faubion WA, Driscoll SW, Wong-Kisiel LC, Selcen D, Flanagan EP, Ramanan VK, Jackson LM, Mauermann ML, Ortega VE, Anderson SA, Aoudia SL, Klee EW, McAllister TM, Lazaridis KN. Correction: Implementation of genomic medicine for rare disease in a tertiary healthcare system: Mayo Clinic Program for Rare and Undiagnosed Diseases (PRaUD). J Transl Med 2024; 22:400. [PMID: 38689323 PMCID: PMC11061992 DOI: 10.1186/s12967-024-05185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Filippo Pinto E Vairo
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Kemppainen
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carolyn R Rohrer Vitek
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Denise A Whalen
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kayla J Kolbert
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kaitlin J Sikkink
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sarah A Kroc
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Teresa Kruisselbrink
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gabrielle F Shupe
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Alyssa K Knudson
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elizabeth M Burke
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elle C Loftus
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lorelei A Bandel
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Lindsay A Mulvihill
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Dale M Gable
- Center for Individualized Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Courtney B Graddy
- Center for Individualized Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Idara U Ekpoh
- Center for Individualized Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Mireille El Ters
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | | | - Amir B Orandi
- Department of Pediatric Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Basiaga
- Department of Pediatric Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ana L Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aida N Lteif
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter J Tebben
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Avni Y Joshi
- Division of Pediatric Allergy and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth H Ristagno
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mrinal S Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Radhika Dhamija
- Department of Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA
| | | | - Klaas J Wierenga
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, USA
| | - Mira T Keddis
- Division of Nephrology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Michael C Stephens
- Department of Pediatric Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - William A Faubion
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sherilyn W Driscoll
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Duygu Selcen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Victor E Ortega
- Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Sarah A Anderson
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Eric W Klee
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Tammy M McAllister
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Konstantinos N Lazaridis
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Arslan M, Bahadir Z, Basiaga ML, Chalmers SJ, Demirel N. A pediatric cystic fibrosis arthropathy case who responded to Elexacaftor/Tezacaftor/Ivacaftor therapy. J Cyst Fibros 2023; 22:1120-1122. [PMID: 37709627 DOI: 10.1016/j.jcf.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 08/04/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
Cystic fibrosis arthropathy (CFA) is a transient, intermittent form of arthritis that cannot be associated with any other disease other than CF thus making CFA a diagnosis of exclusion. NSAIDs, short-term intermittent splinting, glucocorticoids, and disease-modifying anti-rheumatic drugs are treatment options for CFA. Currently, there is no consensus on how to best treat CFA. Diagnosis and treatment of CFA remain a challenge for physicians and people with CF. The newest CFTR modulator therapy, elexacaftor/tezacaftor/ivacaftor (ETI), was approved by the FDA recently for children over the age of 6 with at least one Phe508del allele in the CFTR gene. Multiple clinical benefits of ETI in pulmonary functions and overall disease burden have been reported since its approval, however, the data on the musculoskeletal therapeutic benefits of ETI has been limited. In this report, we present a 7-year-old female with CF whose CFA symptoms resolved after starting ETI therapy.
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Affiliation(s)
| | - Zeynep Bahadir
- Istanbul Medipol University School of Medicine, Istanbul, Turkey
| | - Matthew L Basiaga
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Rheumatology, Rochester, MN, United States of America
| | - Sarah J Chalmers
- Mayo Clinic, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Rochester, MN, United States of America
| | - Nadir Demirel
- Mayo Clinic, Department of Pediatric and Adolescent Medicine, Division of Pediatric Pulmonology, Rochester, MN, United States of America
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Pinto E Vairo F, Kemppainen JL, Vitek CRR, Whalen DA, Kolbert KJ, Sikkink KJ, Kroc SA, Kruisselbrink T, Shupe GF, Knudson AK, Burke EM, Loftus EC, Bandel LA, Prochnow CA, Mulvihill LA, Thomas B, Gable DM, Graddy CB, Garzon GGM, Ekpoh IU, Porquera EMC, Fervenza FC, Hogan MC, El Ters M, Warrington KJ, Davis JM, Koster MJ, Orandi AB, Basiaga ML, Vella A, Kumar S, Creo AL, Lteif AN, Pittock ST, Tebben PJ, Abate EG, Joshi AY, Ristagno EH, Patnaik MS, Schimmenti LA, Dhamija R, Sabrowsky SM, Wierenga KJ, Keddis MT, Samadder NJJ, Presutti RJ, Robinson SI, Stephens MC, Roberts LR, Faubion WA, Driscoll SW, Wong-Kisiel LC, Selcen D, Flanagan EP, Ramanan VK, Jackson LM, Mauermann ML, Ortega VE, Anderson SA, Aoudia SL, Klee EW, McAllister TM, Lazaridis KN. Implementation of genomic medicine for rare disease in a tertiary healthcare system: Mayo Clinic Program for Rare and Undiagnosed Diseases (PRaUD). J Transl Med 2023; 21:410. [PMID: 37353797 PMCID: PMC10288779 DOI: 10.1186/s12967-023-04183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/05/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND In the United States, rare disease (RD) is defined as a condition that affects fewer than 200,000 individuals. Collectively, RD affects an estimated 30 million Americans. A significant portion of RD has an underlying genetic cause; however, this may go undiagnosed. To better serve these patients, the Mayo Clinic Program for Rare and Undiagnosed Diseases (PRaUD) was created under the auspices of the Center for Individualized Medicine (CIM) aiming to integrate genomics into subspecialty practice including targeted genetic testing, research, and education. METHODS Patients were identified by subspecialty healthcare providers from 11 clinical divisions/departments. Targeted multi-gene panels or custom exome/genome-based panels were utilized. To support the goals of PRaUD, a new clinical service model, the Genetic Testing and Counseling (GTAC) unit, was established to improve access and increase efficiency for genetic test facilitation. The GTAC unit includes genetic counselors, genetic counseling assistants, genetic nurses, and a medical geneticist. Patients receive abbreviated point-of-care genetic counseling and testing through a partnership with subspecialty providers. RESULTS Implementation of PRaUD began in 2018 and GTAC unit launched in 2020 to support program expansion. Currently, 29 RD clinical indications are included in 11 specialty divisions/departments with over 142 referring providers. To date, 1152 patients have been evaluated with an overall solved or likely solved rate of 17.5% and as high as 66.7% depending on the phenotype. Noteworthy, 42.7% of the solved or likely solved patients underwent changes in medical management and outcome based on genetic test results. CONCLUSION Implementation of PRaUD and GTAC have enabled subspecialty practices advance expertise in RD where genetic counselors have not historically been embedded in practice. Democratizing access to genetic testing and counseling can broaden the reach of patients with RD and increase the diagnostic yield of such indications leading to better medical management as well as expanding research opportunities.
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Affiliation(s)
- Filippo Pinto E Vairo
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Kemppainen
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carolyn R Rohrer Vitek
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Denise A Whalen
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kayla J Kolbert
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kaitlin J Sikkink
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sarah A Kroc
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Teresa Kruisselbrink
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gabrielle F Shupe
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Alyssa K Knudson
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elizabeth M Burke
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elle C Loftus
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lorelei A Bandel
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Lindsay A Mulvihill
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Dale M Gable
- Center for Individualized Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Courtney B Graddy
- Center for Individualized Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Idara U Ekpoh
- Center for Individualized Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Mireille El Ters
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | | | - Amir B Orandi
- Department of Pediatric Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Basiaga
- Department of Pediatric Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ana L Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aida N Lteif
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter J Tebben
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Avni Y Joshi
- Division of Pediatric Allergy and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth H Ristagno
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mrinal S Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Radhika Dhamija
- Department of Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA
| | | | - Klaas J Wierenga
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, USA
| | - Mira T Keddis
- Division of Nephrology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Michael C Stephens
- Department of Pediatric Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - William A Faubion
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sherilyn W Driscoll
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Duygu Selcen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Victor E Ortega
- Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Sarah A Anderson
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Eric W Klee
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Tammy M McAllister
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Konstantinos N Lazaridis
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Michniacki TF, Walkovich K, DeMeyer L, Saad N, Hannibal M, Basiaga ML, Horst KK, Mohan S, Chen L, Brodeur K, Du Y, Frame D, Ngo S, Simoneau J, Brown N, Lee PY. SOCS1 Haploinsufficiency Presenting as Severe Enthesitis, Bone Marrow Hypocellularity, and Refractory Thrombocytopenia in a Pediatric Patient with Subsequent Response to JAK Inhibition. J Clin Immunol 2022; 42:1766-1777. [PMID: 35976468 PMCID: PMC9381392 DOI: 10.1007/s10875-022-01346-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/09/2022] [Indexed: 11/24/2022]
Abstract
Haploinsufficiency of suppressor of cytokine signaling 1 (SOCS1) is a recently discovered autoinflammatory disorder with significant rheumatologic, immunologic, and hematologic manifestations. Here we report a case of SOCS1 haploinsufficiency in a 5-year-old child with profound arthralgias and immune-mediated thrombocytopenia unmasked by SARS-CoV-2 infection. Her clinical manifestations were accompanied by excessive B cell activity, eosinophilia, and elevated IgE levels. Uniquely, this is the first report of SOCS1 haploinsufficiency in the setting of a chromosomal deletion resulting in complete loss of a single SOCS1 gene with additional clinical findings of bone marrow hypocellularity and radiologic evidence of severe enthesitis. Immunologic profiling showed a prominent interferon signature in the patient's peripheral blood mononuclear cells, which were also hypersensitive to stimulation by type I and type II interferons. The patient showed excellent clinical and functional laboratory response to tofacitinib, a Janus kinase inhibitor that disrupts interferon signaling. Our case highlights the need to utilize a multidisciplinary diagnostic approach and consider a comprehensive genetic evaluation for inborn errors of immunity in patients with an atypical immune-mediated thrombocytopenia phenotype.
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Affiliation(s)
- Thomas F Michniacki
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.
| | - Kelly Walkovich
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Lauren DeMeyer
- Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Nadine Saad
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Mark Hannibal
- Division of Genetics, Metabolism & Genomic Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Matthew L Basiaga
- Division of Pediatric Rheumatology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
| | - Kelly K Horst
- Division of Pediatric Radiology, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Smriti Mohan
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Liang Chen
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kailey Brodeur
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Yan Du
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Frame
- Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor, MI, USA
| | - Sandra Ngo
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Jillian Simoneau
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Noah Brown
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Pui Y Lee
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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5
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Son MBF, Berbert L, Young C, Dallas J, Newhams M, Chen S, Ardoin SP, Basiaga ML, Canny SP, Crandall H, Dhakal S, Dhanrajani A, Sagcal-Gironella ACP, Hobbs CV, Huie L, James K, Jones M, Kim S, Lionetti G, Mannion ML, Muscal E, Prahalad S, Schulert GS, Tejtel KS, Villacis-Nunez DS, Wu EY, Zambrano LD, Campbell AP, Patel MM, Randolph AG. Postdischarge Glucocorticoid Use and Clinical Outcomes of Multisystem Inflammatory Syndrome in Children. JAMA Netw Open 2022; 5:e2241622. [PMID: 36367723 PMCID: PMC9652757 DOI: 10.1001/jamanetworkopen.2022.41622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
IMPORTANCE Minimal data are available regarding the postdischarge treatment of multisystem inflammatory syndrome in children (MIS-C). OBJECTIVES To evaluate clinical characteristics associated with duration of postdischarge glucocorticoid use and assess postdischarge clinical course, laboratory test result trajectories, and adverse events in a multicenter cohort with MIS-C. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study included patients with MIS-C hospitalized with severe illness and followed up for 3 months in an ambulatory setting. Patients younger than 21 years who were admitted between May 15, 2020, and May 31, 2021, at 13 US hospitals were included. Inclusion criteria were inpatient treatment comprising intravenous immunoglobulin, diagnosis of cardiovascular dysfunction (vasopressor requirement or left ventricular ejection fraction ≤55%), and availability of complete outpatient data for 3 months. EXPOSURES Glucocorticoid treatment. MAIN OUTCOMES AND MEASURES Main outcomes were patient characteristics associated with postdischarge glucocorticoid treatment, laboratory test result trajectories, and adverse events. Multivariable regression was used to evaluate factors associated with postdischarge weight gain (≥2 kg in 3 months) and hyperglycemia during illness. RESULTS Among 186 patients, the median age was 10.4 years (IQR, 6.7-14.2 years); most were male (107 [57.5%]), Black non-Hispanic (60 [32.3%]), and Hispanic or Latino (59 [31.7%]). Most children were critically ill (intensive care unit admission, 163 [87.6%]; vasopressor receipt, 134 [72.0%]) and received inpatient glucocorticoid treatment (178 [95.7%]). Most were discharged with continued glucocorticoid treatment (173 [93.0%]); median discharge dose was 42 mg/d (IQR, 30-60 mg/d) or 1.1 mg/kg/d (IQR, 0.7-1.7 mg/kg/d). Inpatient severity of illness was not associated with duration of postdischarge glucocorticoid treatment. Outpatient treatment duration varied (median, 23 days; IQR, 15-32 days). Time to normalization of C-reactive protein and ferritin levels was similar for glucocorticoid duration of less than 3 weeks vs 3 or more weeks. Readmission occurred in 7 patients (3.8%); none was for cardiovascular dysfunction. Hyperglycemia developed in 14 patients (8.1%). Seventy-five patients (43%) gained 2 kg or more after discharge (median 4.1 kg; IQR, 3.0-6.0 kg). Inpatient high-dose intravenous and oral glucocorticoid therapy was associated with postdischarge weight gain (adjusted odds ratio, 6.91; 95% CI, 1.92-24.91). CONCLUSIONS AND RELEVANCE In this multicenter cohort of patients with MIS-C and cardiovascular dysfunction, postdischarge glucocorticoid treatment was often prolonged, but clinical outcomes were similar in patients prescribed shorter courses. Outpatient weight gain was common. Readmission was infrequent, with none for cardiovascular dysfunction. These findings suggest that strategies are needed to optimize postdischarge glucocorticoid courses for patients with MIS-C.
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Affiliation(s)
- Mary Beth F. Son
- Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Laura Berbert
- Institute Centers for Clinical and Translational Research, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Cameron Young
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Johnathan Dallas
- Division of Immunology, Boston Children’s Hospital, Boston, Massachusetts
- Western Atlantic University School of Medicine, Freeport, Grand Bahama, Bahamas
| | - Margaret Newhams
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Sabrina Chen
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Stacy P. Ardoin
- Rheumatology, Nationwide Children’s Hospital, Department of Pediatrics, Ohio State College of Medicine, Columbus
| | - Matthew L. Basiaga
- Division of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Susan P. Canny
- Division of Pediatric Rheumatology, Seattle Children’s Hospital, Department of Pediatrics, University of Washington, Seattle
| | - Hillary Crandall
- Division of Pediatric Critical Care, Department of Pediatrics, University of Utah, Primary Children’s Hospital, Salt Lake City
| | - Sanjeev Dhakal
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Anita Dhanrajani
- Pediatric Rheumatology, Department of Pediatrics, University of Mississippi Medical Center, Jackson
| | - Anna Carmela P. Sagcal-Gironella
- Department of Pediatrics, Hackensack Meridian School of Medicine, Hackensack, New Jersey
- Division of Rheumatology, Joseph M. Sanzari Children’s Hospital, Hackensack, New Jersey
| | - Charlotte V. Hobbs
- Division of Pediatric Infectious Disease, Department of Pediatrics, University of Mississippi Medical Center, Jackson
| | - Livie Huie
- Division of Pediatric Rheumatology, University of Alabama at Birmingham
| | - Karen James
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Utah, Primary Children’s Hospital, Salt Lake City
| | - Madelyn Jones
- Rheumatology, Nationwide Children’s Hospital, Department of Pediatrics, Ohio State College of Medicine, Columbus
| | - Susan Kim
- Pediatric Rheumatology, UCSF Benioff Children’s Hospital, Department of Pediatrics, University of California at San Francisco School of Medicine
| | - Geraldina Lionetti
- Pediatric Rheumatology, UCSF Benioff Children’s Hospital, Department of Pediatrics, University of California at San Francisco School of Medicine
| | | | - Eyal Muscal
- Division of Rheumatology, Texas Children’s Hospital, Department of Pediatrics, Baylor School of Medicine, Houston
| | - Sampath Prahalad
- Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Grant S. Schulert
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kristen Sexson Tejtel
- Division of Cardiology, Texas Children’s Hospital, Department of Pediatrics, Baylor School of Medicine, Houston
| | - D. Sofia Villacis-Nunez
- Children’s Healthcare of Atlanta, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Eveline Y. Wu
- Division of Pediatric Rheumatology, UNC Children’s Hospital, Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill
| | - Laura D. Zambrano
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Angela P. Campbell
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Manish M. Patel
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Public Health Service Commissioned Corps, Rockville, Maryland
| | - Adrienne G. Randolph
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, Massachusetts
- Departments of Pediatrics and Anesthesiology, Harvard Medical School, Boston, Massachusetts
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6
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Randell RL, Stern SM, Van Mater H, Schanberg LE, Lieberman SM, Basiaga ML. Pediatric rheumatologists' perspectives on diagnosis, treatment, and outcomes of Sjögren disease in children and adolescents. Pediatr Rheumatol Online J 2022; 20:79. [PMID: 36064423 PMCID: PMC9446526 DOI: 10.1186/s12969-022-00740-4] [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: 05/19/2022] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sjögren disease in children and adolescents (pedSD) presents differently than adult disease. Diagnosis and classification are controversial, optimal treatment is unknown and outcomes are poorly understood. Here, we describe the current perspectives of pediatric rheumatologists on diagnosis, treatment, and outcomes of pedSD. METHODS A voluntary, 17-question survey was distributed to providers in the Childhood Arthritis and Rheumatology Research Alliance and/or the American College of Rheumatology Childhood Sjögren's Study Group at the 2020 Convergence Virtual Conference. Findings are reported using descriptive statistics and chi-square testing. RESULTS Of 465 eligible providers, 157 (34%) responded with 135 (29%) completing the survey. The majority (85%) saw five or fewer patients with pedSD in the past year. Parotitis, dry eye and/or dry mouth, and constitutional symptoms were among the most specific and common clinical features. Most providers (77%) used clinical judgment guided by adult criteria for diagnosis. The vast majority (86-99%) of survey participants indicated routine use of serologic testing, while salivary gland ultrasound, minor salivary gland biopsy and other diagnostic tests were less often used. The most commonly prescribed systemic immunomodulators were hydroxychloroquine, corticosteroids, methotrexate, rituximab, and mycophenolate. Seven providers reported malignancy in a patient with pedSD, including one death. CONCLUSIONS Pediatric rheumatologists diagnose and treat pedSD; however, most only see a few patients per year and rely on clinical judgment and laboratory testing for diagnosis. Treatment frequently includes systemic immunomodulators and malignancies are reported. More studies are needed to better understand natural history, risk factors, and the impact of interventions on outcomes.
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Affiliation(s)
- Rachel L. Randell
- grid.26009.3d0000 0004 1936 7961Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, MD 2301 Erwin Rd., Box #3212, Durham, NC 27705 USA ,grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Durham, NC USA
| | - Sara M. Stern
- grid.223827.e0000 0001 2193 0096Division of Rheumatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah USA
| | - Heather Van Mater
- grid.26009.3d0000 0004 1936 7961Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, MD 2301 Erwin Rd., Box #3212, Durham, NC 27705 USA
| | - Laura E. Schanberg
- grid.26009.3d0000 0004 1936 7961Division of Pediatric Rheumatology, Department of Pediatrics, Duke University School of Medicine, MD 2301 Erwin Rd., Box #3212, Durham, NC 27705 USA ,grid.26009.3d0000 0004 1936 7961Duke Clinical Research Institute, Durham, NC USA
| | - Scott M. Lieberman
- grid.214572.70000 0004 1936 8294Division of Rheumatology, Allergy, and Immunology, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Matthew L. Basiaga
- grid.66875.3a0000 0004 0459 167XDivision of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
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7
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Baxter S, Van Gelder RN, Cheung JC, Basiaga ML. Simultaneous presentation of idiopathic uveitis in monozygotic 4-year-old twin boys. Am J Ophthalmol Case Rep 2022; 27:101666. [PMID: 35880208 PMCID: PMC9307958 DOI: 10.1016/j.ajoc.2022.101666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 11/26/2022] Open
Abstract
Purpose To report monozygotic twin 4-year-old boys with chronic bilateral anterior uveitis with simultaneous onset. Observations Here we report monozygotic twin 4-year-old boys with chronic bilateral anterior uveitis. The boys had simultaneous onset of uveitis and identical features. Evaluation, including whole exome sequencing (WES), failed to reveal a specific causative etiology. Each patient responded well to immune modulation and achieved uveitis remission on methotrexate monotherapy off topical glucocorticoids. Conclusions and Importance From this case of monozygotic twin boys presenting with chronic uveitis, we conclude that monozygotic twins may warrant evaluation in the setting of idiopathic uveitis, especially in young patients unable to express an adequate history.
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8
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Valenzuela-Almada MO, Hocaoglu M, Dabit JY, Osei-Onomah SA, Basiaga ML, Orandi AB, Giblon RE, Barbour KE, Crowson CS, Duarte-García A. Epidemiology of Childhood-Onset Systemic Lupus Erythematosus: A Population-Based Study. Arthritis Care Res (Hoboken) 2021; 74:728-732. [PMID: 34825516 PMCID: PMC9038612 DOI: 10.1002/acr.24827] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/08/2021] [Accepted: 11/23/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To characterize the incidence and prevalence of childhood onset systemic lupus erythematosus (cSLE), and to estimate the proportion of patients who are diagnosed with SLE during childhood. METHODS A cohort of patients with incident cSLE in 1976 to 2018 from a US 8-county region were identified based on comprehensive medical record review. All cases met the European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) or ACR 97 criteria at or before age 18. Incidence rates were estimated using Poisson methods. We estimated the cSLE point prevalence for 1/1/2015. Results were sex/age-adjusted to the US 2000 population. Among all the SLE patients living in the 8-county region in 1/1/2015, the proportion of patients diagnosed at ≤18 years was estimated. RESULTS A total of 13 children were diagnosed with cSLE during the study period (EULAR/ACR definition, mean age at diagnosis 15.1 years; 85% female, 69% White). cSLE overall adjusted incidence rate was 0.7 (95% CI, 0.2-1.1) per 100,000 children. Incidence rate in girls was 1.2 (95% CI, 0.5-1.9) per 100,000, while in boys it was 0.2 (95% CI, 0.0-0.5) per 100,000. Adjusted prevalence of cSLE was 1.1 (95% CI,0.0-3.1) per 100,000 children. The proportion of patients with SLE diagnosed as children was 9% (95% CI, 6-13%). CONCLUSIONS In this population-based study, both the incidence and prevalence rates of cSLE were ~ 1 per 100,000 children. One in ten adults with SLE were diagnosed in childhood. More studies are needed to further characterize the epidemiology of cSLE in minorities.
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Affiliation(s)
| | - Mehmet Hocaoglu
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.,Department of Medicine, University of Maryland Medical Center, Midtown Campus, Baltimore, MD, USA
| | - Jesse Y Dabit
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | | | - Matthew L Basiaga
- Division of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Amir B Orandi
- Division of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rachel E Giblon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Kamil E Barbour
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.,Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
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9
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Basiaga ML, Stern SM, Mehta JJ, Edens C, Randell RL, Pomorska A, Irga-Jaworska N, Ibarra MF, Bracaglia C, Nicolai R, Susic G, Boneparth A, Srinivasalu H, Dizon B, Kamdar AA, Goldberg B, Knupp-Oliveira S, Antón J, Mosquera JM, Appenzeller S, O'Neil KM, Protopapas SA, Saad-Magalhães C, Akikusa JD, Thatayatikom A, Cha S, Nieto-González JC, Lo MS, Treemarcki EB, Yokogawa N, Lieberman SM. Childhood Sjögren syndrome: features of an international cohort and application of the 2016 ACR/EULAR classification criteria. Rheumatology (Oxford) 2021; 60:3144-3155. [PMID: 33280020 DOI: 10.1093/rheumatology/keaa757] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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: 06/24/2020] [Revised: 10/02/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Sjögren syndrome in children is a poorly understood autoimmune disease. We aimed to describe the clinical and diagnostic features of children diagnosed with Sjögren syndrome and explore how the 2016 ACR/EULAR classification criteria apply to this population. METHODS An international workgroup retrospectively collected cases of Sjögren syndrome diagnosed under 18 years of age from 23 centres across eight nations. We analysed patterns of symptoms, diagnostic workup, and applied the 2016 ACR/EULAR classification criteria. RESULTS We identified 300 children with Sjögren syndrome. The majority of patients n = 232 (77%) did not meet 2016 ACR/EULAR classification criteria, but n = 110 (37%) did not have sufficient testing done to even possibly achieve the score necessary to meet criteria. Even among those children with all criteria items tested, only 36% met criteria. The most common non-sicca symptoms were arthralgia [n = 161 (54%)] and parotitis [n = 140 (47%)] with parotitis inversely correlating with age. CONCLUSION Sjögren syndrome in children can present at any age. Recurrent or persistent parotitis and arthralgias are common symptoms that should prompt clinicians to consider the possibility of Sjögren syndrome. The majority of children diagnosed with Sjögren syndromes did not meet 2016 ACR/EULAR classification criteria. Comprehensive diagnostic testing from the 2016 ACR/EULAR criteria are not universally performed. This may lead to under-recognition and emphasizes a need for further research including creation of paediatric-specific classification criteria.
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Affiliation(s)
- Matthew L Basiaga
- Division of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sara M Stern
- Division of Rheumatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jay J Mehta
- Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Cuoghi Edens
- Department of Internal Medicine and Pediatrics, The University of Chicago Medical Center, Chicago, IL, USA
| | - Rachel L Randell
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Anna Pomorska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Ninela Irga-Jaworska
- Department of Pediatrics, Hematology and Oncology, Medical University of Gdansk, Gdansk, Poland
| | - Maria F Ibarra
- Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Claudia Bracaglia
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Rebecca Nicolai
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Gordana Susic
- Department of Pediatric Rheumatology, Institute of Rheumatology, Belgrade, Serbia
| | - Alexis Boneparth
- Department of Pediatrics, Columbia University Medical Center, New York, NY, USA
| | - Hemalatha Srinivasalu
- Division of Rheumatology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Brian Dizon
- Division of Rheumatology, Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.,National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD, USA
| | - Ankur A Kamdar
- Department of Pediatrics, University of Texas McGovern Medical School at Houston, Houston, TX, USA
| | - Baruch Goldberg
- Division of Pediatric Rheumatology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Sheila Knupp-Oliveira
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Brazil
| | - Jordi Antón
- Pediatric Rheumatology, Hospital Sant Joan de Déu, Esplugues (Barcelona), Spain.,Universitat de Barcelona, Barcelona, Spain
| | - Juan M Mosquera
- Pediatric Rheumatology, Hospital Sant Joan de Déu, Esplugues (Barcelona), Spain
| | - Simone Appenzeller
- Rheumatology Unit, Department of Medicine, School of Medical Science, University of Campinas, São Paulo, Brazil
| | - Kathleen M O'Neil
- Division of Rheumatology, Department of Pediatrics, University of Indiana School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Stella A Protopapas
- Division of Rheumatology, Department of Pediatrics, University of Indiana School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Claudia Saad-Magalhães
- Pediatric Rheumatology Unit, São Paulo State University (UNESP), Botucatu, São Paulo, Brazil
| | - Jonathan D Akikusa
- Rheumatology Service, Royal Children's Hospital, Melbourne and Murdoch Children's Research Institute, Melbourne, Australia
| | - Akaluck Thatayatikom
- Division of Pediatric Allergy, Immunology, & Rheumatology, Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Seunghee Cha
- Division of Oral Medicine, Department of Oral & Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL, USA
| | | | - Mindy S Lo
- Division of Immunology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Erin Brennan Treemarcki
- Division of Rheumatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Naoto Yokogawa
- Department of Rheumatic Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Scott M Lieberman
- Division of Rheumatology, Allergy, and Immunology, Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Al-Shaikhly T, Hayward K, Basiaga ML, Allenspach EJ. Bacterial infections in a pediatric cohort of primary and acquired complement deficiencies. Pediatr Rheumatol Online J 2020; 18:74. [PMID: 32972440 PMCID: PMC7513499 DOI: 10.1186/s12969-020-00467-0] [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: 02/14/2020] [Accepted: 09/03/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Acquired complement deficiency can occur in the setting of autoimmune syndromes, such as systemic lupus erythematosus (SLE), with very low or, occasionally, undetectable C3 levels. Based on inherited complement defects, patients with transiently low complement may be at similar risk for serious bacterial infection, but the degree of risk related to C3 level and temporal association is unknown. METHODS We performed a retrospective study including pediatric patients with undetectable total complement activity or absent individual complement components measured at our institution from 2002 to 2018. We assessed annual rate of serious bacterial infection (SBI) defined as requiring hospitalization and/or parenteral antibiotics by manual chart review. Among included SLE patients, we assessed the 30-day probability of SBI for given C3 measurements using a logistic regression model to determine risk. Primary complement deficiency was analyzed for SBI rate as comparison. Covariates included age, level of immune suppression and history of lupus nephritis. RESULTS Acquired complement deficiency secondary to SLE-related disease [n = 44] was the most common underlying diagnosis associated with depressed complement levels and were compared to a cohort of primary complement deficient patients [n = 18]. SBI per 100 person-years and cohort demographics were described in parallel. Our logistic regression analysis of pediatric patients with SLE showed low C3 level was temporally associated with having an SBI event. Given equivalent immunosuppression, patients with an SBI had lower C3 levels at the beginning of the observation period relative to patients without SBI. CONCLUSION Pediatric patients with the diagnosis of SLE can develop very low C3 levels that associate with risk of serious bacterial infection comparable to that of patients with primary complement deficiency. Patients prone to severe complement consumption may particularly be at risk.
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Affiliation(s)
- Taha Al-Shaikhly
- grid.240473.60000 0004 0543 9901Division of Pulmonary, Allergy & Critical Care Medicine, Department of Medicine, Penn State College of Medicine, Hershey, PA USA
| | - Kristen Hayward
- grid.34477.330000000122986657Division of Rheumatology, Department of Pediatrics, University of Washington, Seattle, WA 98101 USA
| | - Matthew L. Basiaga
- grid.66875.3a0000 0004 0459 167XDivision of Pediatric Rheumatology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN USA
| | - Eric J. Allenspach
- grid.34477.330000000122986657Division of Rheumatology, Department of Pediatrics, University of Washington, Seattle, WA 98101 USA
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Gaal A, Basiaga ML, Zhao Y, Egbert M. Pediatric chronic nonbacterial osteomyelitis of the mandible: Seattle Children's hospital 22-patient experience. Pediatr Rheumatol Online J 2020; 18:4. [PMID: 31941491 PMCID: PMC6964064 DOI: 10.1186/s12969-019-0384-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [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: 09/10/2019] [Accepted: 12/04/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Studies evaluating treatment responses for chronic nonbacterial osteomyelitis (CNO) are lacking. We aimed to measure and compare response rates of medical treatments, time to response of medical treatments among patients with CNO of the mandible, and describe bacterial contamination rates from biopsy. METHODS We conducted a retrospective chart review of all patients diagnosed with CNO of mandible between 2003 and 2017 and extracted demographic, clinical, laboratory, imaging and surgical data. Detailed medication use and response to medications were recorded. The primary outcome was response to medical treatments defined as improvement of presenting symptoms, inflammatory markers, and imaging if available. Medical treatments included nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticoids, disease modifying anti rheumatic drugs (DMARDs), anti-tumor necrosis factor (TNF) therapy, and pamidronate. Descriptive analysis was performed when appropriate. Multivariable logistic regression and Kaplan-Meier curves were applied to compare the responses to medical treatments and time to full response. RESULTS We identified 22 patients with a median age of 11 and 36% were female. Four patients (18%) had multifocal bone lesions. CT findings (n = 21) showed lytic lesions (62%) and sclerosis (90%). MRI (n = 14) revealed hyperintensity within bone marrow (100%), soft tissue (71%) and bony expansion (71%). Non-antibiotic treatments including NSAIDs (n = 18), glucocorticoids (n = 10), DMARDs (n = 9), anti-TNF therapy (n = 5) and pamidronate (n = 6) were applied. Rates of full responses to anti-TNF therapy (60%) and pamidronate (67%) were higher than that to NSAIDs (11%) (p < 0.05). Patients receiving pamidronate responded more rapidly than those receiving anti-TNF therapy (median two vs 17 months, p = 0.01) when there was a full response. All had bone biopsies. Intraoral biopsy was performed in 12 of 13 operated in our center and the most common contaminants were Neisseria spp and Streptococcus viridians. CONCLUSION Both anti-TNF and pamidronate appeared superior to NSAIDs alone in treating mandibular CNO. Patients receiving pamidronate responded faster than those receiving anti-TNF therapy.
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Affiliation(s)
- Austin Gaal
- 0000000122986657grid.34477.33Department of Oral and Maxillofacial Surgery, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105 USA
| | - Matthew L. Basiaga
- 0000 0004 0459 167Xgrid.66875.3aPediatric Rheumatology, Mayo Clinic, Rochester, MN USA
| | - Yongdong Zhao
- 0000000122986657grid.34477.33Pediatric Rheumatology, Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - Mark Egbert
- Pediatric Oral and Maxillofacial Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
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12
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Basiaga ML, Ross ME, Gerber JS, Ogdie A. Incidence of Pneumocystis jirovecii and Adverse Events Associated With Pneumocystis Prophylaxis in Children Receiving Glucocorticoids. J Pediatric Infect Dis Soc 2018; 7:283-289. [PMID: 28992298 PMCID: PMC6276024 DOI: 10.1093/jpids/pix052] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 06/02/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Antimicrobial prophylaxis is indicated to prevent Pneumocystis jirovecii pneumonia (PJP) in profoundly immunosuppressed children. The incidence of PJP infection in children with chronic glucocorticoid exposure is unknown, and PJP prophylaxis has been associated with adverse events. We hypothesized that PJP infection is rare in children without human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), cancer, or a transplant history who are using chronic glucocorticoids and that those exposed to PJP prophylaxis are more likely to experience a cutaneous hypersensitivity reaction or myelosuppression than unexposed patients. METHODS This study involved a retrospective cohort from the Clinformatics Data Mart Database (OptumInsight, Eden Prairie, MN). We identified patients ≤18 years of age who received at least 2 prescriptions for a systemic glucocorticoid within a 60-day period and excluded patients with a history of PJP infection, an oncologic diagnosis, transplant, or HIV/AIDS. PJP prophylaxis exposure was identified by using national drug codes. Cutaneous hypersensitivity reaction or myelosuppression was identified by using International Classification of Diseases, 9th Revision (ICD-9), codes. We used a discrete time-failure model to examine the association between exposure and outcome. RESULTS We identified 119399 children on glucocorticoids, 10% of whom received PJP prophylaxis. The incidences of PJP were 0.61 and 0.53 per 10000 patient-years in children exposed and those unexposed to PJP prophylaxis, respectively. In a multivariable model, trimethoprim-sulfamethoxazole was associated with cutaneous hypersensitivity reaction (odds ratio, 3.20; 95% confidence interval, 2.62-3.92) and myelosuppression (odds ratio, 1.85; 95% confidence interval, 1.56-2.20). CONCLUSIONS PJP infection was rare in children using glucocorticoids chronically, and PJP prophylaxis-associated cutaneous hypersensitivity reactions and myelosuppression are more common. The use of PJP chemoprophylaxis in children without HIV/AIDS, cancer, or a transplant history who are taking glucocorticoids chronically should be considered carefully.
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Affiliation(s)
- Matthew L Basiaga
- Division of Rheumatology, Department of Pediatrics, Seattle Children’s Hospital, University of Washington School of Medicine,Correspondence: M. L. Basiaga, DO, MSCE, Seattle Children’s Hospital, 4800 Sand Point Way NE, M.A.7.110, Seattle, WA 98107 ()
| | - Michelle E Ross
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine
| | - Jeffrey S Gerber
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine,Division of Infectious Diseases, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine
| | - Alexis Ogdie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine,Division of Rheumatology, Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine
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13
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Zhao Y, Wu EY, Oliver MS, Cooper AM, Basiaga ML, Vora SS, Lee TC, Fox E, Amarilyo G, Stern SM, Dvergsten JA, Haines KA, Rouster-Stevens KA, Onel KB, Cherian J, Hausmann JS, Miettunen P, Cellucci T, Nuruzzaman F, Taneja A, Barron KS, Hollander MC, Lapidus SK, Li SC, Ozen S, Girschick H, Laxer RM, Dedeoglu F, Hedrich CM, Ferguson PJ. Consensus Treatment Plans for Chronic Nonbacterial Osteomyelitis Refractory to Nonsteroidal Antiinflammatory Drugs and/or With Active Spinal Lesions. Arthritis Care Res (Hoboken) 2018; 70:1228-1237. [PMID: 29112802 DOI: 10.1002/acr.23462] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/31/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To develop standardized treatment regimens for chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis (CRMO), to enable comparative effectiveness treatment studies. METHODS Virtual and face-to-face discussions and meetings were held within the CNO/CRMO subgroup of the Childhood Arthritis and Rheumatology Research Alliance (CARRA). A literature search was conducted, and CARRA membership was surveyed to evaluate available treatment data and identify current treatment practices. Nominal group technique was used to achieve consensus on treatment plans for CNO refractory to nonsteroidal antiinflammatory drug (NSAID) monotherapy and/or with active spinal lesions. RESULTS Three consensus treatment plans (CTPs) were developed for the first 12 months of therapy for CNO patients refractory to NSAID monotherapy and/or with active spinal lesions. The 3 CTPs are methotrexate or sulfasalazine, tumor necrosis factor inhibitors with optional methotrexate, and bisphosphonates. Short courses of glucocorticoids and continuation of NSAIDs are permitted for all regimens. Consensus was achieved on these CTPs among CARRA members. Consensus was also reached on subject eligibility criteria, initial evaluations that should be conducted prior to the initiation of CTPs, and data items to collect to assess treatment response. CONCLUSION Three consensus treatment plans were developed for pediatric patients with CNO refractory to NSAIDs and/or with active spinal lesions. Use of these CTPs will provide additional information on efficacy and will generate meaningful data for comparative effectiveness research in CNO.
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Affiliation(s)
- Yongdong Zhao
- Seattle Children's Hospital, University of Washington, Seattle
| | | | - Melissa S Oliver
- Stanford Children's Health, Stanford University, Palo Alto, California
| | | | | | | | - Tzielan C Lee
- Stanford Children's Health, Stanford University, Palo Alto, California
| | - Emily Fox
- Children's Mercy, Kansas City, Missouri
| | - Gil Amarilyo
- Schneider Children's Medical Center of Israel, Petach Tikva Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Kathleen A Haines
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
| | | | - Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Julie Cherian
- Stony Brook Children's Hospital, Stony Brook, New York
| | - Jonathan S Hausmann
- Boston Children's Hospital and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Angela Taneja
- Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Karyl S Barron
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | - Suzanne C Li
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
| | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | | | - Ronald M Laxer
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Christian M Hedrich
- Children's Hospital Dresden, University Medical Center Carl Gustav Carus, TU Dresden, Dresden, Germany, and Institute of Translational Medicine, University of Liverpool, and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
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Basiaga ML, Burrows EK, Denburg MR, Meyers KE, Grossman AB, Mamula P, Grundmeier RW, Burnham JM. Variation in Preventive Care in Children Receiving Chronic Glucocorticoid Therapy. J Pediatr 2016; 179:226-232. [PMID: 27622698 PMCID: PMC5123921 DOI: 10.1016/j.jpeds.2016.08.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/26/2016] [Accepted: 08/10/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To assess preventive care measure prescribing in children exposed to glucocorticoids and identify prescribing variation according to subspecialty and patient characteristics. STUDY DESIGN Retrospective cohort study of children initiating chronic glucocorticoids in the gastroenterology, nephrology, and rheumatology divisions at a pediatric tertiary care center. Outcomes included 25-hydroxyvitamin D (25OHD) and lipid testing, pneumococcal polysaccharide (PPV) and influenza vaccination, and stress dose hydrocortisone prescriptions. RESULTS A total of 701 children were followed for a median of 589 days. 25OHD testing was performed in 73%, lipid screening in 29%, and PPV and influenza vaccination in 16% and 78%, respectively. Hydrocortisone was prescribed in 2%. Across specialties, 25OHD, lipid screening, and PPV prescribing varied significantly (all P < .001). Using logistic regression adjusting for specialty, 25OHD testing was associated with older age, female sex, non-Hispanic ethnicity, and lower baseline height and body mass index z-scores (all P < .03). Lipid screening was associated with older age, higher baseline body mass index z-score, and lower baseline height z-score (all P < .01). Vaccinations were associated with lower age (P < .02), and PPV completion was associated with non-White race (P = .04). CONCLUSIONS Among children chronically exposed to glucocorticoids, 25OHD testing and influenza vaccination were common, but lipid screening, pneumococcal vaccination, and stress dose hydrocortisone prescribing were infrequent. Except for influenza vaccination, preventive care measure use varied significantly across specialties. Quality improvement efforts are needed to optimize preventive care in this high-risk population.
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Affiliation(s)
- Matthew L Basiaga
- Division of Rheumatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Evanette K Burrows
- Division of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Michelle R Denburg
- Division of Nephrology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Kevin E Meyers
- Division of Nephrology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Andrew B Grossman
- Division of Gastroenterology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Petar Mamula
- Division of Gastroenterology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Robert W Grundmeier
- Division of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Division of General Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Jon M Burnham
- Division of Rheumatology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
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