1
|
Kostadinova L, Lange A, Damjanovska S, Gad I, Syed S, Siddiqui H, Yousif P, Kowal CM, Shive C, Burant C, Singer N, Bej T, Al-Kindi S, Wilson B, Mattar M, Zidar DA, Anthony DD. Dr. Kostadinova et al reply. J Rheumatol 2023; 50:1356. [PMID: 37399468 DOI: 10.3899/jrheum.2023-0485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Affiliation(s)
- Lenche Kostadinova
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Alyssa Lange
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sofi Damjanovska
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Ibtissam Gad
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sameena Syed
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Husna Siddiqui
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Patrick Yousif
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Corinne M Kowal
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Carey Shive
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
- Department of Pathology, Case Western Reserve University
| | - Christopher Burant
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Nora Singer
- Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| | - Taissa Bej
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sadeer Al-Kindi
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Brigid Wilson
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Maya Mattar
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - David A Zidar
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Donald D Anthony
- Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University;
- Department of Pathology, Case Western Reserve University
- Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
| |
Collapse
|
2
|
Dudley HM, O'Mara M, Auma A, Gong J, Ross Y, Gurevich N, Carbone S, Reihs A, Nguyen Y, McComsey GA, Cao Y, Balazs AB, Gordesky L, Payne M, Singer N, Kostadinova L, Wilson B, Zidar DA, King CL, Canaday DH, Shive CL, Mattar MM, Anthony DD. Rheumatoid arthritis and older age are associated with lower humoral and cellular immune response to primary series COVID-19 mRNA vaccine. Vaccine 2023; 41:6112-6119. [PMID: 37659895 DOI: 10.1016/j.vaccine.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE People with autoimmune disease have worse COVID-19 infection-related outcomes, lower antibody responses to COVID-19 vaccine, and higher rates of breakthrough infection. Immunosuppressive medications used to treat rheumatoid arthritis (RA) are associated with lower COVID-19 vaccine responses, though independent contributions of comorbidities, T-cell immunity, and age are less clear. We sought to test the hypothesis that RA, immunosuppressive medications used to treat RA, and older age, contribute to reduced B and T cell response to COVID-19 vaccine. METHODS We evaluated serum samples, taken the day of 1st vaccine dose, the day of 2nd dose, 2-6 weeks after 2nd dose, 7-12 weeks after 2nd dose, 13-24 weeks after 2nd dose, and 2-6 weeks after the 3rd dose, for anti-spike IgG and neutralizing antibody levels to Wuhan and Omicron BA.1 and peripheral blood mononuclear cells (PBMC) for spike-specific IFN-γ and IL-2 production by ELISPOT assay in 46 RA and 101 non-autoimmune control participants before and after the primary series COVID-19 mRNA vaccination. RESULTS RA participants had lower spike-specific IgG and Wuhan-strain neutralizing antibody levels 2-6 weeks compared to controls after the second dose of primary vaccine series. Neutralizing antibody levels against Omicron BA.1 were low in both groups. IFN-γ production correlated with Wuhan neutralizing antibody levels, while older age negatively correlated with spike-specific IL-2, IFN-γ and IgG. Lower antibody levels were associated with older age, RA status, and medication usage, while lower T cell responses were associated primarily with older age. CONCLUSIONS These data indicate lower COVID-19 mRNA vaccine-induced antibody levels in persons with RA compared to individuals without RA, likely partially attributable to immune suppressive medications. At the same time, older age is associated with lower antibody and cellular immune response to COVID-19 vaccines.
Collapse
Affiliation(s)
- Holly M Dudley
- Department of Molecular Biology, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Megan O'Mara
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Ann Auma
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Jenny Gong
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Yael Ross
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Natalie Gurevich
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Sarah Carbone
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - Alex Reihs
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Ynez Nguyen
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Grace A McComsey
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Yi Cao
- Ragon Institute of MGH, MIT and Harvard, Cambridge, MA, United States
| | | | - Larraine Gordesky
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Michael Payne
- Department of Global Health, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Nora Singer
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| | - Lenche Kostadinova
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Brigid Wilson
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States
| | - David A Zidar
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Global Health, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Christopher L King
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Global Health, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - David H Canaday
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Carey L Shive
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Maya M Mattar
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Donald D Anthony
- Cleveland Veterans Affairs Medical Center, Cleveland, OH, United States; Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH, United States; The MetroHealth System, Cleveland, OH, United States
| |
Collapse
|
3
|
Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
Collapse
|
4
|
Lange A, Kostadinova L, Damjanovska S, Gad I, Syed S, Siddiqui H, Yousif P, Kowal CM, Shive C, Burant C, Singer N, Bej T, Al-Kindi S, Wilson B, Mattar M, Zidar DA, Anthony DD. Red Cell Distribution Width and Absolute Lymphocyte Count Associate With Biomarkers of Inflammation and Subsequent Mortality in Rheumatoid Arthritis. J Rheumatol 2023; 50:166-174. [PMID: 36319020 PMCID: PMC9898085 DOI: 10.3899/jrheum.211411] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Morbidity and mortality in rheumatoid arthritis (RA) is partly mitigated by maintaining immune and hematologic homeostasis. Identification of those at risk is challenging. Red cell distribution width (RDW) and absolute lymphocyte count (ALC) associate with cardiovascular disease (CVD) and mortality in the general population, and with disease activity in RA. How these variables relate to inflammation and mortality in RA was investigated. METHODS In a retrospective single Veterans Affairs (VA) Rheumatology Clinic cohort of 327 patients with RA treated with methotrexate (MTX)+/- a tumor necrosis factor (TNF) inhibitor (TNFi), we evaluated RDW and ALC before and during therapy and in relation to subsequent mortality. Findings were validated in a national VA cohort (n = 13,914). In a subset of patients and controls, we evaluated inflammatory markers. RESULTS In the local cohort, high RDW and low ALC prior to MTX treatment was associated with subsequent mortality over 10 years (both P < 0.001). The highest mortality was observed in those with both high RDW and low ALC. This remained after adjusting for age and comorbidities and was validated in the national RA cohort. In the immunology cohort, soluble and cellular inflammatory markers were higher in patients with RA than in controls. ALC correlated with age, plasma TNF receptor II, natural killer HLA-DR mean fluorescence intensity, and CD4CM/CD8CM HLA-DR/CD38%, whereas RDW associated with age and ALC. MTX initiation was followed by an increase in RDW and a decrease in ALC. TNFi therapy added to MTX resulted in an increase in ALC. CONCLUSION RDW and ALC before disease-modifying antirheumatic drug therapy are associated with biomarkers of monocyte/macrophage inflammation and subsequent mortality. The mechanistic linkage between TNF signaling and lymphopenia found here warrants further investigation.
Collapse
Affiliation(s)
- Alyssa Lange
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Lenche Kostadinova
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sofi Damjanovska
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Ibtissam Gad
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sameena Syed
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Husna Siddiqui
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Patrick Yousif
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Corinne M Kowal
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Carey Shive
- C. Shive, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, Case Western Reserve University
| | - Christopher Burant
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Nora Singer
- N. Singer, MD, Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University
| | - Taissa Bej
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Sadeer Al-Kindi
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Brigid Wilson
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Maya Mattar
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - David A Zidar
- A. Lange, MS, L. Kostadinova, MD, S. Damjanovska, MD, I. Gad, MD, S. Syed, MD, H. Siddiqui, MD, P. Yousif, MD, C.M. Kowal, BS, C. Burant, PhD, T. Bej, MS, S. Al-Kindi, MD, B. Wilson, PhD, M. Mattar, MD, D.A. Zidar, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, Case Western Reserve University
| | - Donald D Anthony
- D.D. Anthony, MD, PhD, Department of Medicine, VA Medical Center and VA GRECC, and Department of Pathology, and Division of Rheumatology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA.
| |
Collapse
|
5
|
Navon EA, Rosen Y, Singer N, Goren O, Maor N, Eyal E, Ständer S, Yosipovitch G. 118 High unmet medical need in brachioradial pruritus: results from a large patient survey. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.128] [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: 11/19/2022]
|
6
|
Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
Collapse
Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
Collapse
Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Mulvihill E, Ardoin S, Thompson SD, Zhou B, Yu GR, King E, Singer N, Levy DM, Brunner H, Wu YL, Nagaraja HN, Schanberg LE, Yu CY. Elevated serum complement levels and higher gene copy number of complement C4B are associated with hypertension and effective response to statin therapy in childhood-onset systemic lupus erythematosus (SLE). Lupus Sci Med 2019; 6:e000333. [PMID: 31448126 PMCID: PMC6687033 DOI: 10.1136/lupus-2019-000333] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 12/17/2022]
Abstract
Objective Systemic lupus erythematosus (SLE) features high frequency of cardiovascular disease (CVD) and fluctuating complement levels. The clinical trial Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) aimed to evaluate whether atorvastatin treatment reduced the progression of atherosclerosis in 221 patients with childhood-onset SLE (cSLE), using carotid intima media thickness (CIMT) as surrogates. We leveraged APPLE biorepository and trial data to investigate the relationship between complement and CVD in cSLE. Methods Gene copy numbers (GCNs) for total C4, C4A and C4B were measured by TaqMan-based real-time PCR and Southern blotting, and analysed with laboratory and clinical parameters through Student's t-test and χ2 analyses. Effects of total C4, C4A and C4B GCNs on the response to placebo or atorvastatin treatment and progression of CIMT were examined by regression analyses. Results At baseline, C4 protein levels strongly correlated with GCNs of total C4 (p=1.8×10-6). Each copy of C4 gene increased mean serum C4 by 3.28 mg/dL. Compared with those without hypertension (N=142), individuals with hypertension demonstrated significantly elevated serum levels for C4 and C3 at baseline and serially (C4: P=5.0×10-25; C3: P=5.84×10-20). Individuals with ≥2 C4B genes had 2.5 times the odds of having hypertension (p=0.016) and higher diastolic blood pressure (p=0.015) compared with those with C4B deficiency. At the study end, subjects with ≥2 C4B and atorvastatin treatment had significantly slower increase in CIMT compared with those treated with placebo (p=0.018). Conclusions cSLE with hypertension had elevated serum levels of C4 and C3 and higher GCN of C4B; cSLE with ≥2 C4B genes would benefit from statins therapy to prevent atherosclerosis.
Collapse
Affiliation(s)
- Evan Mulvihill
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA.,Division of Rheumatology, Nationwide Children's Hospitatl, Columbus, OH, USA
| | - Stacy Ardoin
- Division of Rheumatology, Nationwide Children's Hospitatl, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA
| | - Susan D Thompson
- Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Centre, Cincinnati, Ohio, USA
| | - Bi Zhou
- Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Columbus, Ohio, USA
| | - Gakit Richard Yu
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Emily King
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Nora Singer
- Department of Medicine, University Hospitals/Case Medical Center, Cleveland, Ohio, USA
| | - D M Levy
- Department of Rheumatology, Hospital for Sick Children and Univeristy of Toronto, Toronto, Ontario, Canada
| | - Hermine Brunner
- Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center, PRCSG Coordinating Center, Cincinnati, Ohio, USA
| | - Yee Ling Wu
- Department of Medical Microbiology and Immunology, Loyola University Chicago, Chicago, Illinois, USA
| | - Haikady N Nagaraja
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | | | - Chack-Yung Yu
- Division of Rheumatology, Nationwide Children's Hospitatl, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, Ohio, USA.,Center for Microbial Pathogenesis, Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| |
Collapse
|
9
|
Peterfy C, Kremer J, Rigby W, Singer N, Birchwood C, Gill D, Reiss W, Pei J, Michalska M. Magnetic Resonance Imaging (MRI) Results Following Discontinuation of Methotrexate in Rheumatoid Arthritis Treated with Subcutaneous Tocilizumab: The COMP-ACT MRI Substudy. J Rheumatol 2019; 47:325-332. [PMID: 31154414 DOI: 10.3899/jrheum.180953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess differences in joint damage and inflammation using magnetic resonance imaging (MRI) between patients with rheumatoid arthritis (RA) who achieved low disease activity with tocilizumab (TCZ) + methotrexate (MTX) and subsequently continued or discontinued MTX. METHODS In the COMP-ACT trial, US patients with RA received subcutaneous TCZ 162 mg + MTX. Those who achieved 28-joint count Disease Activity Score calculated with erythrocyte sedimentation rate (DAS28-ESR) ≤ 3.2 at Week 24 were randomized 1:1 (double-blind) to discontinue MTX (TCZ monotherapy; mono) or continue TCZ + MTX until Week 52. In a subset of patients, 1.5-Tesla MRI was used to obtain images of bilateral hands and wrists at weeks 24 and 40. Outcomes included changes in MRI-assessed synovitis, osteitis, erosion, and cartilage loss from Week 24 to Week 40, and in the proportion of patients with progression of each score. RESULTS Of 296 patients who achieved DAS28-ESR ≤ 3.2 at Week 24, 79 were enrolled in the pilot MRI substudy and randomized to TCZ mono (n = 38) or TCZ + MTX (n = 41). Treatment with either TCZ mono or TCZ + MTX suppressed erosion progression, synovitis, osteitis, and cartilage loss. The proportion of patients with no progression in each outcome measure was similar between groups (range, TCZ mono: 84.8-97.0%; TCZ + MTX: 92.3-100%). CONCLUSION In a subset of patients who achieved low disease activity with TCZ + MTX, MRI changes were minimal in intraarticular inflammation and damage measures in patients who discontinued MTX versus those who continued TCZ + MTX.
Collapse
Affiliation(s)
- Charles Peterfy
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA. .,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc.
| | - Joel Kremer
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - William Rigby
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Nora Singer
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Christine Birchwood
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Darcy Gill
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - William Reiss
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Jinglan Pei
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Margaret Michalska
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| |
Collapse
|
10
|
Zhang L, Li Y, Qiu W, Bell BA, Dvorina N, Baldwin WM, Singer N, Kern T, Caspi RR, Fox DA, Lin F. Targeting CD6 for the treatment of experimental autoimmune uveitis. J Autoimmun 2018; 90:84-93. [PMID: 29472120 DOI: 10.1016/j.jaut.2018.02.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/07/2018] [Accepted: 02/09/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE CD6 is emerging as a new target for treating many pathological conditions in which T cells are integrally involved, but even the latest data from studies of CD6 gene engineered mice were still contradictory. To address this issue, we studied experimental autoimmune uveitis (EAU), a model of autoimmune uveitis, in wild-type (WT) and CD6 knockout (KO) mice. METHODS After EAU induction in WT and CD6 KO mice, we evaluated ocular inflammation and compared retinal antigen-specific T-cell responses using scanning laser ophthalmoscopy, spectral-domain optical coherence tomography, histopathology, and T cell recall assays. Uveitogenic T cells from WT and CD6 KO mice were adoptively transferred into WT naïve mice to confirm the impact of CD6 on T cells. In addition, we immunized CD6 KO mice with recombinant CD6 protein to develop mouse anti-mouse CD6 monoclonal antibodies (mAbs) in which functional antibodies exhibiting cross-reactivity with human CD6 were screened and identified for treatment studies. RESULTS In CD6 KO mice with EAU, we found significantly decreased retinal inflammation and reduced autoreactive T-cell responses, and confirmed the impaired uveitogenic capacity of T cells from these mice in an adoptive transfer experiment. Notably, one of these cross-reactive mAbs significantly ameliorated retinal inflammation in EAU induced by the adoptive transfer of uveitogenic T cells. CONCLUSIONS Together, these data strongly suggest that CD6 plays a previously unknown, but pivotal role in autoimmune uveitis, and may be a promising new treatment target for this blinding disease. In addition, the newly developed mouse anti-mouse/human CD6 mAbs could be valuable tools for testing CD6-targeted therapies in other mouse models of human diseases.
Collapse
MESH Headings
- Adoptive Transfer
- Animals
- Antibodies, Monoclonal/metabolism
- Antigens, CD/genetics
- Antigens, CD/immunology
- Antigens, CD/metabolism
- Antigens, Differentiation, T-Lymphocyte/genetics
- Antigens, Differentiation, T-Lymphocyte/immunology
- Antigens, Differentiation, T-Lymphocyte/metabolism
- Autoimmune Diseases/immunology
- Cells, Cultured
- Humans
- Inflammation/immunology
- Mice
- Mice, Inbred C57BL
- Mice, Inbred DBA
- Mice, Knockout
- Models, Animal
- Molecular Targeted Therapy
- Retina/immunology
- T-Lymphocytes/immunology
- T-Lymphocytes/transplantation
- Uveitis/immunology
Collapse
Affiliation(s)
- Lingjun Zhang
- Department of Immunology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Yan Li
- Department of Immunology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Wen Qiu
- Department of Immunology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Brent A Bell
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Nina Dvorina
- Department of Immunology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - William M Baldwin
- Department of Immunology, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Nora Singer
- Department of Medicine and Pediatrics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Timothy Kern
- Department of Medicine and Ophthalmology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Rachel R Caspi
- Laboratory of Immunology, National Eye Institute, National Institutes of Health, Bethesda, MD, USA
| | - David A Fox
- Division of Rheumatology and Clinical Autoimmunity Center of Excellence, University of Michigan, Ann Arbor, MI 48109, USA
| | - Feng Lin
- Department of Immunology, Cleveland Clinic, Cleveland, OH 44195, USA.
| |
Collapse
|
11
|
Li B, Singer N, Rosenthal A, Unal M, Haggins D, Yeni YN, Akkus O. Chemical characterization of Maltese-cross birefringent particles in synovial fluid samples collected from symptomatic joints. Joint Bone Spine 2017; 85:501-503. [PMID: 28965940 DOI: 10.1016/j.jbspin.2017.09.004] [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] [Received: 05/03/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Bolan Li
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 10900, Euclid Avenue, 44106 Cleveland, OH, USA
| | - Nora Singer
- Metro Health Medical Center, Division of Rheumatology, 2500, Metro Health Drive, 44106 Cleveland, OH, USA; Case Western Reserve University, School of Medicine, 10900, Euclid Avenue, 44106 Cleveland, OH, USA
| | - Ann Rosenthal
- Medical College of Wisconsin, Division of Rheumatology, 9200, W Wisconsin Avenue, 53223 Milwaukee, WI, USA
| | - Mustafa Unal
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 10900, Euclid Avenue, 44106 Cleveland, OH, USA
| | - Donard Haggins
- Henry-Ford Hospital, Department of Rheumatology, 2799, W Grand Boulevard, 48202 Detroit, MI, USA
| | - Yener N Yeni
- Henry-Ford Hospital, Department of Orthopaedic Surgery, Bone and Joint Center, 2799, W Grand Boulevard, 48202 Detroit, MI, USA
| | - Ozan Akkus
- Case Western Reserve University, Department of Mechanical and Aerospace Engineering, 10900, Euclid Avenue, 44106 Cleveland, OH, USA; Case Western Reserve University, School of Medicine, Department of Orthopaedics, 10900, Euclid Avenue, 44106 Cleveland, OH, USA; Case Western Reserve University, Department of Biomedical Engineering, 10900, Euclid Avenue, 44106 Cleveland, OH, USA.
| |
Collapse
|
12
|
Li Y, Singer N, Whitbred J, Bowen M, Fox DA, Lin F. CD6 as a potential target for treating multiple sclerosis. The Journal of Immunology 2017. [DOI: 10.4049/jimmunol.198.supp.219.14] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
CD6 was established as a marker of T cells more than three decades ago, and recent studies have identified CD6 as a risk gene for multiple sclerosis (MS), a disease in which autoreactive T cells are integrally involved. Nevertheless, the precise role of CD6 in regulating T cell responses is controversial and its significance in the pathogenesis of various diseases remains elusive, partly due to the lack of animals engineered to alter expression of the CD6 gene. In this report, we found that CD6 KO mice showed decreased pathogenic T cell responses, reduced spinal cord T-cell infiltration and attenuated disease severity in experimental autoimmune encephalomyelitis (EAE), an animal model of MS. CD6-deficient T cells exhibited augmented activation, but also significantly reduced survival and proliferation after activation, leading to overall decreased Th1 and Th17 polarization. Activated CD6-deficient T cells also showed impaired infiltration through brain microvascular endothelial cell monolayers. Furthermore, by developing CD6 humanized mice, we identified a mouse anti-human CD6 monoclonal antibody that is highly effective in treating established EAE without depleting T cells. These results suggest that 1) CD6 is a negative regulator of T cell activation, 2) at the same time, CD6 is a positive regulator of activated T cell survival/proliferation and infiltration; and 3) CD6 is a potential new target for treating MS and potentially other T cell-driven autoimmune conditions.
Collapse
|
13
|
Mina R, Abulaban K, Klein-Gitelman MS, Eberhard BA, Ardoin SP, Singer N, Onel K, Tucker L, O'neil K, Wright T, Brooks E, Rouster-Stevens K, Jung L, Imundo L, Rovin B, Witte D, Ying J, Brunner HI. Validation of the Lupus Nephritis Clinical Indices in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016. [PMID: 26213987 DOI: 10.1002/acr.22651] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To validate clinical indices of lupus nephritis activity and damage when used in children against the criterion standard of kidney biopsy findings. METHODS In 83 children requiring kidney biopsy, the Systemic Lupus Erythematosus Disease Activity Index renal domain (SLEDAI-R), British Isles Lupus Assessment Group index renal domain (BILAG-R), Systemic Lupus International Collaborating Clinics (SLICC) renal activity score (SLICC-RAS), and SLICC Damage Index renal domain (SDI-R) were measured. Fixed effects and logistic models were calculated to predict International Society of Nephrology/Renal Pathology Society (ISN/RPS) class; low-to-moderate versus high lupus nephritis activity (National Institutes of Health [NIH] activity index [AI]) score: ≤10 versus >10; tubulointerstitial activity index (TIAI) score: ≤5 versus >5; or the absence versus presence of lupus nephritis chronicity (NIH chronicity index) score: 0 versus ≥1. RESULTS There were 10, 50, and 23 patients with ISN/RPS class I/II, III/IV, and V, respectively. Scores of the clinical indices did not differentiate among patients by ISN/RPS class. The SLEDAI-R and SLICC-RAS but not the BILAG-R differed with lupus nephritis activity status defined by NIH-AI scores, while only the SLEDAI-R scores differed between lupus nephritis activity status based on TIAI scores. The sensitivity and specificity of the SDI-R to capture lupus nephritis chronicity was 23.5% and 91.7%, respectively. Despite being designed to measure lupus nephritis activity, SLICC-RAS and SLEDAI-R scores significantly differed with lupus nephritis chronicity status. CONCLUSION Current clinical indices of lupus nephritis fail to discriminate ISN/RPS class in children. Despite its shortcomings, the SLEDAI-R appears best for measuring lupus nephritis activity in a clinical setting. The SDI-R is a poor correlate of lupus nephritis chronicity.
Collapse
Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Khalid Abulaban
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Barbara A Eberhard
- Steven and Alexandra Cohen Children's Medical Center of New York, New York
| | - Stacy P Ardoin
- Nationwide Children's Hospital and Ohio State University, Columbus
| | - Nora Singer
- MetroHealth Medical Center and Case Western Reserve University, Cleveland, Ohio
| | - Karen Onel
- University of Chicago Comer Children's Hospital, Chicago, Illinois
| | - Lori Tucker
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Elizabeth Brooks
- University Hospitals Rainbow Babies & Children's Hospital, Cleveland, Ohio
| | | | | | - Lisa Imundo
- Columbia University Medical Center, New York, New York
| | - Brad Rovin
- Ohio State University Wexner Medical Center, Columbus
| | - David Witte
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jun Ying
- University of Cincinnati, Cincinnati, Ohio
| | | |
Collapse
|
14
|
Enyindah-Asonye GM, Li Y, Singer N, Gupta N, Fung J, Lin F. Distribution of CD6 on B cells and its role in regulating B1a cell self-renewal. The Journal of Immunology 2016. [DOI: 10.4049/jimmunol.196.supp.60.15] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
CD6 has been established as a marker and an important regulator for T cells. However, despite a previous report suggesting that CD6 is present on human B1a cells that are the primary source of natural antibodies, the precise distribution and potential role of CD6 on B cells remain unclear. In this report, by studying wild type and CD6 knockout (KO) mice, we found that murine CD6 is not detectable on any B2 cells, but is differentially expressed on B1a cells, and its expression is regulated by the activated state and anatomical location of the B1a cells. CD6 KO mice had significantly reduced numbers of B1a cells in different tissue compartments as a result of impaired ability to undergo self-renewal, and these mice had reduced levels of serum natural antibodies including levels of natural IgM. Consistent with previous reports showing that B1a cells produced natural IgM is critical in the pathogenesis of intestinal ischemia/reperfusion-induced injury, we also found that intestinal inflammation and tissue damage was significantly reduced in CD6 KO mice in this model. These findings clarified the distribution of CD6 on B cells and its expression regulation, and revealed a critical role of CD6 in regulating B1a function
Collapse
|
15
|
Enyindah-Asonye G, Li Y, Singer N, Gupta N, Fung J, Lin F. CD6 is a novel positive regulator of natural antibody producing B-1a cells (INC1P.401). The Journal of Immunology 2015. [DOI: 10.4049/jimmunol.194.supp.54.22] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract
Although CD6 has recently been identified as a risk gene for multiple sclerosis, its biological function remains unclear, partially due to the lack of CD6 gene engineered animals. It is established that CD6 is present on all T cells in both humans and mice; however, it is believed that mouse B cells do not express CD6. B-1a B cells are the primary source of natural antibodies (Nabs), which provide the first line of defense against infection and facilitate the clearance of oxidized lipoproteins that contribute to the pathogenesis of atherosclerosis. By studying CD6 knockout (KO) and WT mice, we found that CD6 is basally expressed selectively on splenic B-1a B cells. CD6 KO mice exhibit smaller B1a B cell population in the spleen concomitant with lower titers of Nabs in the serum than those in WT mice. Interestingly, B-1a-cell-specified progenitors also express CD6 and the frequencies of these progenitors are significantly reduced in the CD6 KO mice. B cell receptor (BCR) signaling is critical for B1a B cell development and T-independent immunoglobulin response. CD6 KO B1a B cells displayed impaired BCR-induced JNK activation and elicited impaired T-independent antibody responses to NP-Ficoll. These findings suggest a positive role for CD6 in regulating B1a B cell homeostasis and immune response.
Collapse
Affiliation(s)
| | - Yan Li
- 1Immunology, Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | | | - Neetu Gupta
- 1Immunology, Cleveland Clinic Lerner Research Institute, Cleveland, OH
| | - John Fung
- 3Digestive Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Feng Lin
- 1Immunology, Cleveland Clinic Lerner Research Institute, Cleveland, OH
| |
Collapse
|
16
|
Singer N, Wagner-Weiner L, Nanda K, Robinson A, Spalding S, Bükülmez H. FRI0553 Immunization with Quadrivalent HPV Vaccine (GARDASIL®) Appears Safe and Induces Antibody Response in Jia: an Interim Analysis. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
17
|
|
18
|
Ghosh A, Holland A, Dogan Y, Yim N, Rao U, Young L, Smith O, Jenq R, Na IK, Tsai J, Singer N, West M, Penack O, Hanash A, Sauer M, Sant'Angelo D, Sadelain M, van den Brink M. Genetically Engineered Donor T Cells for BMT Immunotherapy: Expression of Trail and PLZF Selectively Enhances GVT and Abrogates GVHD. Biol Blood Marrow Transplant 2011. [DOI: 10.1016/j.bbmt.2010.12.521] [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: 11/29/2022]
|
19
|
Brunner HI, Klein-Gitelman MS, Higgins GC, Lapidus SK, Levy DM, Eberhard A, Singer N, Olson JC, Onel K, Punaro M, Schanberg L, von Scheven E, Ying J, Giannini EH. Toward the development of criteria for global flares in juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62:811-20. [PMID: 20535792 PMCID: PMC3049164 DOI: 10.1002/acr.20126] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [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] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To develop a definition of global flare in juvenile systemic lupus erythematosus (SLE) and derive candidate criteria for measuring juvenile SLE flares. METHODS Pediatric rheumatologists answered 2 Delphi questionnaires to achieve consensus on a common definition of juvenile SLE flare and identify variables for use in candidate flare criteria. The diagnostic accuracy of these candidate flare criteria was tested with data from juvenile SLE patients (n = 98; 623 visits total). Physician-rated change in the juvenile SLE course (worsening, yes/no) between visits served as the criterion standard. RESULTS There was 96% consensus that a "a flare is a measurable worsening of juvenile SLE disease activity in at least one organ system, involving new or worse signs of disease that may be accompanied by new or worse SLE symptoms. Depending on the severity of the flare, more intensive therapy may be required." Variables suggested for use in flare criteria were: physician-rated disease activity (V1), patient well-being, protein:creatinine ratio, a validated disease activity index (V2), the Child Health Questionnaire physical summary score (V3), anti-double-stranded DNA antibodies, erythrocyte sedimentation rate, and complement levels. Using multiple logistic regression, several candidate flare criteria were derived with area under the receiver operating characteristic curve (AUC) as high as 0.92 (sensitivity >or=85%, specificity >or=85%); classification and regression tree analysis suggested that V1, V2, and V3 suffice to identify juvenile SLE flares (AUC 0.81; sensitivity = 64%, specificity = 86%). CONCLUSION Consensus about a definition of global disease flare for juvenile SLE has been obtained and promising candidate flare criteria have been developed. These will need further assessment of their ease of use and accuracy in prospective study.
Collapse
Affiliation(s)
- Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Furst DE, Keystone EC, Fleischmann R, Mease P, Breedveld FC, Smolen JS, Kalden JR, Braun J, Bresnihan B, Burmester GR, De Benedetti F, Dörner T, Emery P, Gibofsky A, Kavanaugh A, Kirkham B, Schiff MH, Sieper J, Singer N, Van Riel PLCM, Weinblatt ME, Weisman MH, Winthrop K. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2009. Ann Rheum Dis 2010; 69 Suppl 1:i2-29. [PMID: 19995740 DOI: 10.1136/ard.2009.123885] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- D E Furst
- University of California at Los Angeles, Los Angeles, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Lerner Y, Singer N, Weintraub Y, Rubin N, Ungerleider L, Hendler T. Feeling without Seeing? Segregated Amygdala's Activation with and without Awareness to Fearful Faces. Neuroimage 2009. [DOI: 10.1016/s1053-8119(09)71982-2] [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: 10/20/2022] Open
|
22
|
Furst DE, Keystone EC, Kirkham B, Kavanaugh A, Fleischmann R, Mease P, Breedveld FC, Smolen JS, Kalden JR, Burmester GR, Braun J, Emery P, Winthrop K, Bresnihan B, De Benedetti F, Dörner T, Gibofsky A, Schiff MH, Sieper J, Singer N, Van Riel PLCM, Weinblatt ME, Weisman MH. Updated consensus statement on biological agents for the treatment of rheumatic diseases, 2008. Ann Rheum Dis 2008; 67 Suppl 3:iii2-25. [PMID: 19022808 DOI: 10.1136/ard.2008.100834] [Citation(s) in RCA: 84] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- D E Furst
- David Geffen School of Medicine, UCLA-RM 32-59, Los Angeles, CA 90025, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Singer N, Malkinson M. An avirulent livePasteurella Multocidavaccine for drinking water and aerosol administration against turkey cholera. Avian Pathol 2007; 8:391-9. [DOI: 10.1080/03079457908418366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
25
|
Goldman W, Wasserbauer N, Singer N, Meyerson H, Hostoffer R. Relapsing polychondritis with progressive humoral immunodeficiency. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.632] [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: 11/24/2022]
|
26
|
|
27
|
Singer N. Parish nursing. Jesus people style. J Christ Nurs 2002; 18:4-7. [PMID: 11915113 DOI: 10.1097/00005217-200118030-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
28
|
Affiliation(s)
- N Singer
- Cook County Hospital, Chicago, Illinois, USA
| |
Collapse
|
29
|
Carson R, Burgess C, Glatstein I, Singer N, Cunningham D, McShane P, Wood D. P-223 Preimplantation genetic diagnosis and cryopreservation of embryos. Fertil Steril 1997. [DOI: 10.1016/s0015-0282(97)91037-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
30
|
Abstract
PURPOSE The purpose of this article is to examine the occurrence of battered women seen by ophthalmologists in an eye emergency department, and to make ophthalmologists aware that these women are not a rarity but often go unrecognized. METHODS This retrospective study reviews a large urban eye center's emergency room charts over a 6-month period for documentation of injuries to women as a result of domestic violence. Seventy-nine charts were selected as part of this study. In 18 of these charts, battered women definitely were identified, and in 61 charts abuse was suspected but the abuser was not specifically identified. RESULTS The patients ranged in age from 15 to 90 years. The abuser was most commonly a boyfriend using a fist as the means of inflicting the injury. Injuries ranged from lacerations and contusions to more serious injuries, including three hyphemas and three ruptured globes. Six patients were hospitalized because of their injuries. Substance abuse was documented in 5 of 79 patients. CONCLUSIONS Many of these female victims of intentional violence in their homes go unrecognized or uncharted by physicians. Ophthalmologists see many of these women because of the high frequency of head and neck injuries in these cases, and should therefore maintain a high index of suspicion and be prepared to act appropriately with recognition and documentation of the injury and provision of social service referrals.
Collapse
Affiliation(s)
- S R Beck
- Wills Eye Hospital and Jefferson Medical College, Philadelphia, PA 19129, USA
| | | | | |
Collapse
|
31
|
Ahlgren MA, Singer N. Rwandan relief: when God called me back. J Christ Nurs 1995; 12:34-7, 46. [PMID: 7623270 DOI: 10.1097/00005217-199512020-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
32
|
Singer N. Breaking through to John Doe. J Christ Nurs 1995; 12:34-5. [PMID: 7650601 DOI: 10.1097/00005217-199512010-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
33
|
Cohen S, Amar D, Pantuck EJ, Singer N, Divon M. Decreased incidence of headache after accidental dural puncture in caesarean delivery patients receiving continuous postoperative intrathecal analgesia. Acta Anaesthesiol Scand 1994; 38:716-8. [PMID: 7839783 DOI: 10.1111/j.1399-6576.1994.tb03983.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To examine the effects of prolonged (> 24 h) intrathecal catheterization with the use of postoperative analgesia on the incidence of post-dural puncture headache (PDPH), charts of 45 obstetric patients who had accidental dural puncture following attempts at epidural block were reviewed retrospectively. Three groups were identified: Group I (n = 15) patients had a dural puncture on the first attempt at epidural block, but successful epidural block on a repeated attempt; Group II (n = 17) patients had a dural puncture with immediate conversion to continuous spinal anaesthesia with catheterization lasting only for the duration of caesarean delivery; Group III (n = 13) patients had an immediate conversion to spinal anaesthesia and received post-caesarean section continuous intrathecal patient-controlled analgesia consisting of fentanyl 5 micrograms.ml-1 with bupivacaine 0.25 mg.ml-1 and epinephrine 2 micrograms.ml-1 with catheterization lasting > 24 h. No parturient in group III developed a PDPH. This was substantially lower (P < 0.009) than the 33% incidence for group I and the 47% incidence for group II. The incidence of a PDPH did not differ between group I and II. Similarly, there was no difference between group I and II with regard to requests for a blood patch. Patients receiving continuous intrathecal analgesia had excellent pain relief, could easily ambulate and none complained of pruritus, nausea, vomiting, sensory loss or weakness. In conclusion, indwelling spinal catheterization > 24 h with continuous intrathecal analgesia following accidental dural puncture in parturients may for some patients be a suitable method for providing PDPH prophylaxis and postoperative analgesia.
Collapse
Affiliation(s)
- S Cohen
- Department of Anesthesiology, Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | | |
Collapse
|
34
|
Abstract
It has been repeatedly reported that while risks associated with the injecting behaviour of drug users has been reduced, no parallel changes have been made in sexual risk behaviour. Counselling advice to clients attending drug unit services has not focused sufficiently on the sexual behaviour of this client group. The present study evaluates the impact of a 4-day tailored training course on the counselling practices of two teams of drug workers at a London hospital. The course was designed following the experience and evaluation of a more general training course on sexual issues, and included information, group discussions, experiential learning and skills training. Results indicate that though there were no significant behavioural changes, some attitudinal changes have taken place; training appears to have increased the staff's awareness of the importance of sexual counselling and reduced the perceived difficulty of discussing certain specific sexual issues. The implications of single-agency training courses are discussed and recommendations are made for future training courses on the basis of the findings of this study.
Collapse
Affiliation(s)
- N Singer
- Drug Dependency Unit, St. Mary's Hospital, London, UK
| | | | | | | | | |
Collapse
|
35
|
Singer N. Armed and dangerous: a patient turns violent. J Christ Nurs 1993; 10:18-21. [PMID: 8326477 DOI: 10.1097/00005217-199310030-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
36
|
|
37
|
Cohen S, Amar D, Pantuck CB, Pantuck EJ, Weissman AM, Landa S, Singer N. Epidural patient-controlled analgesia after cesarean section: buprenorphine-0.015% bupivacaine with epinephrine versus fentanyl-0.015% bupivacaine with and without epinephrine. Anesth Analg 1992; 74:226-30. [PMID: 1731541 DOI: 10.1213/00000539-199202000-00009] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We compared the analgesia, side effects, and plasma concentrations of buprenorphine and fentanyl in a double-blind study of 78 parturients receiving one of these drugs by patient-controlled epidural infusion after elective cesarean section with epidural anesthesia. Patients were randomized to three epidural infusion groups: group 1 (n = 26), 3 micrograms/mL buprenorphine with 0.015% bupivacaine and 1 microgram/mL epinephrine; group 2 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine and 1 microgram/mL epinephrine; and group 3 (n = 26), 3 micrograms/mL fentanyl with 0.015% bupivacaine. Plasma for determination of opioid concentrations was obtained in some subjects in each group at intervals up to 48 h during the infusion and in some subjects from each group at intervals after the infusion was stopped. Pain relief was similar and satisfactory in all three groups. The median overall satisfaction scores were high for all three groups. Pruritus was more common in the fentanyl groups (P less than 0.05). However, vomiting was more disturbing to the patients and seen only with buprenorphine. No patient had a respiratory rate less than 12 breaths/min. Epinephrine use was associated with a slower infusion rate (P less than 0.05, group 2 vs 3). All patients were able to ambulate without difficulty. Mean opioid plasma concentrations did not exceed 1.5 ng/mL. Thus, epidural patient-controlled analgesia in all three groups provided excellent analgesia, permitted ambulation, and was without serious side effects. Epidural buprenorphine offered no advantages over epidural fentanyl.
Collapse
Affiliation(s)
- S Cohen
- Department of Anesthesiology, Albert Einstein College of Medicine of Yeshiva University, Bronx
| | | | | | | | | | | | | |
Collapse
|
38
|
Donham CS, Maple BT, Singer N. Health care indicators. Health Care Financ Rev 1991; 11:169-96. [PMID: 10113401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; health care prices; and national economic indicators.
Collapse
|
39
|
Donham CS, Letsch SW, Maple BT, Singer N, Cowan CA. Health care indicators. Health Care Financ Rev 1991; 12:141-70. [PMID: 10112766 PMCID: PMC4193198] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Contained in this regular feature of the journal is a section on each of the following four topics: community hospital statistics; employment, hours, and earnings in the private health sector; prices; and national economic indicators. These statistics are valuable in their own right for understanding the relationship between the health care sector and the overall economy. In addition, they provide indicators of the direction and magnitude of health care costs prior to the availability of more comprehensive data.
Collapse
Affiliation(s)
- C S Donham
- Office of National Health Statistics, Baltimore, MD 21207
| | | | | | | | | |
Collapse
|
40
|
Freeland MS, Chulis GS, Brown AP, Skellan D, Maple BT, Singer N, Lemieux J, Arnett RH. Measuring hospital input price increases: the rebased hospital market basket. Health Care Financ Rev 1991; 12:1-14. [PMID: 10113610 PMCID: PMC4193652] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The input prices indexes used in part to set payment rates for Medicare inpatient hospital services in both prospective payment system (PPS) and PPS-excluded hospitals were rebased from 1982 to 1987 beginning with payments for fiscal year 1991. In this article, the issues and evidence used to determine the composition of the revised hospital input price indexes are discussed. One issue is the need for a separate market basket for PPS-excluded hospitals. Also, the payment implications of using hospital-industry versus economywide measures of wage rates as price proxies for the growth in hospital wage rates are addressed.
Collapse
|
41
|
Singer N. Emergency thoracotomy. Care of the patient in the OR: a case study. AORN J 1987; 46:1086-9. [PMID: 3426204 DOI: 10.1016/s0001-2092(07)69717-8] [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] [Indexed: 01/05/2023]
Abstract
As an OR staff nurse at Cook County Hospital, some of my most challenging and rewarding nursing experiences have come from caring for emergency open-chest trauma patients. From the moment we receive a call that an open-chest patient is on the way, everyone assigned is in a high state of tension. Every decision takes on exaggerated importance. The circulating nurse, by virtue of his or her position during an emergency, is the "hub of the wheel" of activity. He or she is privy to all facets of care that are being administered to the patient. The nursing challenge of the emergency open-chest trauma is great, but it is not an impossible task.
Collapse
|
42
|
Singer N, Gersen S, Warburton D. The value of chromosome analysis in cases of neural tube defects: a case of anencephaly associated with fetal dup(2)(p24----pter). Prenat Diagn 1987; 7:567-71. [PMID: 3317387 DOI: 10.1002/pd.1970070807] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
A family is described in which two anencephalic fetuses were identified in two pregnancies. Autopsy revealed kidney anomalies in both fetuses. Chromosome analysis was performed only on the second fetus, which had a 46,XY,10q+ karyotype. Parental chromosome analysis showed the maternal karyotype to be 46,XX,t(2;10)(p24;q26) thus demonstrating that the fetus was carrying a duplication 2(p24----pter). Recurrence risks for anencephaly based on the cytogenetic abnormality were much higher than those which would be quoted for isolated anencephaly. This points out the necessity for complete diagnostic studies when a fetus with a neural tube defect is identified. The literature in regard to the 2p duplication phenotype is reviewed. It is possible that the duplication of the distal segment of 2p results in a neural tube defect/kidney anomaly phenotype.
Collapse
Affiliation(s)
- N Singer
- Genetics and Birth Defects Center, Morristown Memorial Hospital, New Jersey 07960
| | | | | |
Collapse
|
43
|
Abstract
Pseudomosaicism is of particular concern in prenatal diagnosis when it involves mosaicism for a cytogenetic abnormality associated with a clinical syndrome which is compatible with postnatal life, such as trisomies for chromosomes 13, 18, and 21. The lack of data regarding the outcome of pregnancies involving these specific kinds of pseudomosaicism makes genetic counselling difficult. Three cases of prenatal diagnosis of pseudomosaicism for trisomy 13, each of which had a normal outcome, will be presented (Tables 1 and 2). The three main areas for consideration are: (1) the genetic counselling issues, (2) the additional prenatal diagnostic options available to evaluate the status of the fetus in an attempt to identify some of the clinical features of trisomy 13, and (3) the outcome of the pregnancies.
Collapse
Affiliation(s)
- J Malin
- Department of Obstetrics and Gynecology, Columbia University, New York, New York 10032
| | | | | | | | | |
Collapse
|
44
|
Shapiro LR, Singer N, Mannor SM. Immediate and unexplained fetal death during mid-trimester amniocentesis. Prenat Diagn 1983; 3:151-4. [PMID: 6684772 DOI: 10.1002/pd.1970030213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Immediate and unexplained fetal death during mid-trimester amniocentesis for prenatal diagnosis was found to be an uncommon though real phenomenon. A survey of programmes in the United States detected 5 cases from 7524 at 4 centres. Postmortem examination was not helpful and a neurogenic mechanism is postulated. Awareness of this phenomenon and routine pre- and post-amniocentesis ultrasound monitoring may clarify the actual prevalence and etiology.
Collapse
|
45
|
Singer N, Weisman Y, Aronovici A. Negative Findings concerning Alcaligenes faecalis as an Etiologic Agent in Acute Respiratory Disease of Turkeys. Avian Dis 1981. [DOI: 10.2307/1589918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
46
|
Singer N, Weisman Y, Aronovici A. Negative findings concerning Alcaligenes faecalis as an etiologic agent in acute respiratory disease of turkeys. Avian Dis 1981; 25:245-53. [PMID: 7259671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
An acute respiratory disease of turkeys in Israel was first reported in November 1978. Alcaligenes faecalis was isolated from sick turkeys and from chickens not affected by the disease. Plate agglutination tests with A. faecalis antigen of 1,067 turkey and 494 chicken serum samples gave variable results: healthy turkeys gave positive reactions and sick turkeys sometimes gave negative ones. All isolated strains were highly sensitive in vitro drug sensitivity tests, but chemotherapy failed in the field. Pathogenicity trials with A. faecalis, given alone or in combination with Yucaipa virus to 8-day-old turkey poults, failed to reproduce the disease.
Collapse
|
47
|
|
48
|
Ziv G, Neumann J, Fridman J, Ziv E, Singer N, Meshorer A. Effects of probenecid on blood levels and tissue distribution of ampicillin in fowls and turkeys. Avian Dis 1979; 23:927-39. [PMID: 546414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The effect of probenecid (a benzoic acid derivative which competitively inhibits active secretion of weak organic acids by the renal tubules) on serum ampicillin concentrations and the distribution of ampicillin in body organs was examined in fowls and turkeys. An aqueous solution of probenecid coadministered intramuscularly, at 200 mg/kg, with sodium ampicillin solution, at 25 mg/kg, resulted in peak serum antibiotic concentration of 16.5 microgram/ml. A similar dose of ampicillin administered alone produced a peak level of 4.6 microgram/ml. Subcutaneous injections of sodium ampicillin at 25 mg/kg with aqueous probenecid at 200 mg/kg resulted in a peak serum ampicillin concentration (12.8 microgram/ml) three times as high as the peak produced by the subcutaneous injection of ampicillin alone at 50 mg/kg (4.2 microgram/ml). The elimination half-life (t 1/2) of the drug (30 min) was increased to 1.5 hr by coadministration of probenecid parenterally, and serum antibiotic levels greater than or equal to 5.0 microgram/ml were maintained during 3 hours. Ampicillin seemed to be poorly absorbed from the gastrointestinal tract of fowls. A single oral bolus administration of ampicillin trihydrate aqueous suspension produced a peak of 0.6 microgram/ml, and coadministrations of aqueous probenecid suspension at 20, 50, and 100 mg/kg respectively produced peaks of 0.9, 1.25, and 1.5 microgram/ml. During 4 and 5 days, when ampicillin was added to the drinking water at rates of 200 and 50 mg/liter, serum ampicillin levels were rather low (peaks of 0.20 and 0.12 microgram/ml, respectively), and although these levels were increased by 50% with the coadministration of probenecid they were considered to be of limited clinical value for treating systemic bacterial infections. Probenecid did not change the distribution of ampicillin in the organs.
Collapse
|
49
|
Ziv G, Neumann J, Fridman J, Ziv E, Singer N, Meshorer A. Effects of Probenecid on Blood Levels and Tissue Distribution of Ampicillin in Fowls and Turkeys. Avian Dis 1979. [DOI: 10.2307/1589609] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
50
|
|