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Kaya Akca U, Batu ED, Jelusic M, Calatroni M, Bakry R, Frkovic M, Vinšová N, Campos RT, Horne A, Caglayan S, Vaglio A, Moroni G, Emmi G, Ghiggeri GM, Koker O, Sinico RA, Kim S, Gagro A, Matucci-Cerinic C, Çomak E, Ekici Tekin Z, Arslanoglu Aydin E, Heshin-Bekenstein M, Acar BC, Gattorno M, Akman S, Sozeri B, Palmblad K, Al-Mayouf SM, Silva CA, Doležalová P, Merkel PA, Ozen S. Comparison of EULAR/PRINTO/PReS Ankara 2008 and 2022 ACR/EULAR Classification Criteria for Granulomatosis with Polyangiitis in Children. Rheumatology (Oxford) 2023:kead693. [PMID: 38135503 DOI: 10.1093/rheumatology/kead693] [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: 07/15/2023] [Revised: 10/13/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVE Granulomatosis with polyangiitis (GPA) is an antineutrophil cytoplasmic antibody-associated vasculitis. The 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR)-endorsed classification criteria for GPA was derived using data only from adult patients. We aimed to assess the performance of the ACR/EULAR classification criteria for GPA in pediatric patients and compare it with the EULAR/Pediatric Rheumatology International Trials Organization (PRINTO)/Pediatric Rheumatology European Society (PReS)-endorsed Ankara 2008 criteria for GPA. METHODS Retrospective data of pediatric patients with GPA in 20 centers from 9 countries were evaluated. The diagnosis of GPA was made according to the expert opinion. The sensitivity, specificity, positive predictive value, and negative predictive value of the criteria sets were evaluated. RESULTS The study included 77 patients with GPA and 108 controls (immunoglobulin A vasculitis (n = 44), Takayasu's arteritis (n = 20), microscopic polyangiitis (n = 16), polyarteritis nodosa (n = 14), Behçet's disease (n = 12), eosinophilic granulomatosis with polyangiitis (n = 1), and Cogan's syndrome (n = 1)) with a median age of 17.8 and 15.2 years, respectively. Of patients with GPA, constitutional symptoms (85.7%) and ear-nose-throat involvement (79.2%) were the most common presentations. In the GPA group, 73 patients fulfilled the Ankara 2008 criteria and 69 the ACR/EULAR classification criteria. Sensitivities of the Ankara 2008 criteria and the ACR/EULAR classification criteria were 94.8% and 89.6%, while specificities were 95.3% and 96.3%, respectively. No significant difference was found between sensitivities and specificities of both classification criteria (p= 0.229 and p= 0.733, respectively). CONCLUSION In children, both the ACR/EULAR and EULAR/PRINTO/PReS Ankara 2008 classification criteria for GPA perform well and similarly.
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Affiliation(s)
| | | | - Marija Jelusic
- UHC Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | | | | | - Marijan Frkovic
- UHC Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Nikol Vinšová
- General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Reinan T Campos
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | | | | | | | | | | | | | - Oya Koker
- Marmara University Medical School, Istanbul, Turkey
| | | | - Susan Kim
- University of California, San Francisco, USA
| | | | - Caterina Matucci-Cerinic
- DINOGMI, Università degli Studi di Genova, Genoa, Italy
- UOC Rheumatology and autoinflammatory diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - Elif Arslanoglu Aydin
- Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Merav Heshin-Bekenstein
- Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv University, Tel Aviv, Israel
| | | | - Marco Gattorno
- UOC Rheumatology and autoinflammatory diseases, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Betul Sozeri
- Umraniye Training and Research Hospital, Istanbul, Turkey
| | | | - Sulaiman M Al-Mayouf
- King Faisal Specialist Hospital and Research Center, Alfaisal University, Riyadh, Saudi Arabia
| | - Clovis Artur Silva
- Hospital das Clínicas da Faculdade de Medicina, Universidade de São Paulo (HCFMUSP), São Paulo, Brazil
| | - Pavla Doležalová
- General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | - Seza Ozen
- Hacettepe University Faculty of Medicine, Ankara, Turkey
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Fingerhutová Š, Srp R, Hurňáková J, Hrdinová H, Němcová D, Vinšová N, Sladká Švestková N, Doležalová P. Can ultrasound help to overcome uncertainty in clinical joint assessment in juvenile idiopathic arthritis? Clin Exp Rheumatol 2023; 41:177-185. [PMID: 35930492 DOI: 10.55563/clinexprheumatol/5lk4x2] [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] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 06/24/2022] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Assessment of active synovitis is crucial for the management of juvenile idiopathic arthritis (JIA). We aimed to investigate the correlation of musculoskeletal ultrasound (MSUS) and clinical examination results and relate them to arthritis relapse rate. METHODS JIA patients with questionable presence of active arthritis (Q-joints) and controls (JIA and healthy children) were recruited. MSUS of Q-joints, active joints and their inactive counterparts was performed at study entry. Standard disease activity parameters were prospectively recorded. RESULTS Of 481 joints of 138 JIA patients, 99 joints (20.6%) of 58 patients had one or more Q-joints with 54/99 (54.5%) having MSUS features of active disease. Clinically inactive joints had lower proportion of MSUS synovitis (78/253, 30.8%) while MSUS activity was present in 114/129 (88.4%) of clinically active joints and in 2/105 (1.9%) joints of 36 healthy controls. Within the 15-month follow-up 23/99 (22%) Q-joints and 31/253 (12%) clinically inactive joints relapsed. Joints with subclinical synovitis relapsed more frequently than MSUS inactive ones (p<0.001). The relapse rate was higher in MSUS-active Q-joints (19/23, 82%) than in clinically inactive ones (16/31, 52%) with MSUS synovial hypertrophy as the main relapse predictor in multivariate analysis. Ankle and knee joints relapsed most frequently. CONCLUSIONS Acknowledgement of joints with questionable synovitis may contribute to the assessment of disease activity in JIA. Presence of MSUS synovitis carries a clinically meaningful risk of disease recurrence in these joints. In clinical practice, our findings encourage timely MSUS assessment of the joints in question, especially in patients without any other features of active disease.
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Affiliation(s)
- Šárka Fingerhutová
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Radoslav Srp
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, and Department of Paediatrics, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jana Hurňáková
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic
| | - Hana Hrdinová
- Department of Paediatric and Adult Rheumatology, Motol University Hospital, Prague, Czech Republic
| | - Dana Němcová
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nikol Vinšová
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Natálie Sladká Švestková
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavla Doležalová
- Centre for Paediatric Rheumatology and Autoinflammatory Diseases, Department of Paediatrics and Inherited Metabolic Disorders, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic.
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Kearsley-Fleet L, Lawson-Tovey S, Costello RE, Belot A, Aeschlimann F, Melki I, Koné-Paut I, Clemente D, Pinedo Gago MC, Svestkova N, Vinšová N, Hamad Saied M, Berkun Y, Wulffraat N, Eulert S, Scirè CA, Strangfeld A, Mateus E, Machado P, Uziel Y, Hyrich K. POS1183 OUTCOMES OF COVID-19 INFECTION AMONG CHILDREN AND YOUNG PEOPLE WITH PRE-EXISTING RHEUMATIC AND MUSCULOSKELETAL DISEASES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:It remains unknown whether children and young people with rheumatic and musculoskeletal diseases (RMD) who acquire COVID-19 infection have a more severe COVID-19 course, due to either underlying disease or immunosuppressive treatments.Objectives:To describe outcomes among children and young people with underlying RMD who acquire COVID-19 infection.Methods:All children and young people <18 years of age with COVID-19 (presumptive or confirmed) reported to the EULAR COVID-19 Database, which collects details regarding RMD diagnosis and treatment, COVID infection and outcomes, between 27 March 2020 and 29 January 2021 (cutoff date for this analysis) were included. Patient characteristics and COVID-19 outcomes are presented.Results:A total of 151 children and young people (age range 2-17 years; Table 1) have been reported to the database from 12 countries; mostly Spain (N=30), France (N=29), Israel (N=29), and Czechia (N=25). Most patients had a diagnosis of juvenile idiopathic arthritis (JIA; N=92; 61%). Other diagnoses were autoinflammatory syndrome (including TRAPS, CAPS, FMF; 12%), and systemic lupus erythematosus (4%). There were 14 (9%) hospitalisations and 1 (0.7%) death reported due to COVID-19. The most commonly reported symptoms were fever (46%), cough (34%), anosmia (19%), and headache (19%). Only 19 (13%) patients reported glucocorticoid use. DMARD therapy was used by 104 (69%) patients; 67 (44%) were on csDMARDs (methotrexate [N=54], antimalarials [N=7]), 45 (30%) on anti-TNF, 9 (6%) on IL-6 inhibitors, and 7 (5%) on IL-1 inhibitors. Among the 145 patients with hospitalisation data, patients on any DMARD therapy (cs/b/tsDMARDs) had similar odds for hospitalisation compared with those not on therapy, adjusted for age (odds ratio 0.7; 95% CI 0.2, 2.4).All PatientsN151GenderFemale94 (62%)Male56 (37%)Unknown1 (<1%)Age, yearsMedian (IQR)12 (8, 15)Range2 to 17Top Rheumatology DiagnosesJuvenile Idiopathic Arthritis (JIA)92 (61%)Polyarthritis50 (33%)Oligoarthritis31 (21%)Systemic11 (7%)Autoinflammatory syndrome (e.g.18 (12%)TRAPS, CAPS, FMF)6 (4%)Systemic Lupus ErythematosusComorbiditiesNone stated112 (74%)Obesity9 (6%)Ocular inflammationAsthma9 (6%)3 (2%)Required HospitalisationYes14 (9%)No131 (87%)Missing6 (4%)Top 5 Symptoms ReportedFever69 (46%)Cough51 (34%)Anosmia28 (19%)Headache28 (19%)Fatigue23 (15%)Deaths due to COVID-19Yes1 (<1%)Treatment at onset of COVID-19 infectionGlucocorticoids19 (13%)csDMARDs67 (44%)Methotrexate54 (36%)Antimalarials7 (5%)Mycophenolate5 (3%)bDMARDs64 (42%)Anti-TNF45 (30%)IL-69 (6%)IL-18 (5%)Any DMARD104 (69%)Conclusion:These initial data on outcomes of COVID-19 in paediatric RMDs are very reassuring, with less than 1 in 10 patients reporting hospitalisation. Due to the database design and inherent reporting bias, this is likely an overestimate, suggesting that overall outcomes among this population appear to be generally good, with mild infection. Increasing case reports to the database will allow further exploration of drug- and disease-specific outcomes.Disclosure of Interests:None declared.
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