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Nguyen K, Barsalou J, Basodan D, Batthish M, Benseler SM, Berard RA, Blanchette N, Boire G, Bolaria R, Bruns A, Cabral DA, Cameron B, Campillo S, Cellucci T, Chan M, Chédeville G, Chetaille AL, Chhabra A, Couture J, Dancey P, De Bruycker JJ, Demirkaya E, Dhalla M, Duffy CM, Feldman BM, Feldman DE, Gerschman T, Haddad E, Heale L, Herrington J, Houghton K, Huber AM, Human A, Johnson N, Jurencak R, Lang B, Larché M, Laxer RM, LeBlanc CM, Lee JJY, Levy DM, Lim L, Lim LSH, Luca N, McGrath T, McMillan T, Miettunen PM, Morishita KA, Ng HY, Oen K, Park J, Petty RE, Proulx-Gauthier JP, Ramsey S, Roth J, Rosenberg AM, Rozenblyum E, Rumsey DG, Schmeling H, Schneider R, Scuccimarri R, Shiff NJ, Silverman E, Soon G, Spiegel L, Stringer E, Tam H, Tse SM, Tucker L, Turvey S, Twilt M, Duffy KW, Yeung RSM, Guzman J. A decade of progress in juvenile idiopathic athritis treatments and outcomes in Canada: results from ReACCh-Out and the CAPRI registry. Rheumatology (Oxford) 2023:kead560. [PMID: 37851400 DOI: 10.1093/rheumatology/kead560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To assess changes in juvenile idiopathic arthritis (JIA) treatments and outcomes in Canada, comparing a 2005-2010 and a 2017-2021 inception cohorts. METHODS Patients enrolled within three months of diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) and the Canadian Alliance of Pediatric Rheumatology Investigators Registry (CAPRI) cohorts were included. Cumulative incidences of drug starts and outcome attainment within 70 weeks of diagnosis were compared with Kaplan Meier survival analysis and multivariable Cox regression. RESULTS The 2005-2010 and 2017-2021 cohorts included 1128 and 721 patients, respectively. JIA category distribution and baseline clinical juvenile idiopathic arthritis disease activity (cJADAS10) scores at enrolment were comparable. By 70 weeks, 6% of patients (95% CI 5, 7) in the 2005-2010 and 26% (23, 30) in the 2017-2021 cohort had started a biologic DMARD (bDMARD), and 43% (40, 47) and 60% (56, 64) had started a conventional DMARD (cDMARD), respectively. Outcome attainment was 64% (61, 67) and 83% (80, 86) for Inactive disease (Wallace criteria), 69% (66, 72) and 84% (81, 87) for minimally active disease (cJADAS10 criteria), 57% (54, 61) and 63% (59, 68) for pain control (<1/10), and 52% (47, 56) and 54% (48, 60) for a good health-related quality of life. CONCLUSION Although baseline disease characteristics were comparable in the 2005-2010 and 2017-2021 cohorts, cDMARD and bDMARD use increased with a concurrent increase in minimally active and inactive disease. Improvements in parent and patient reported outcomes were smaller than improvements in disease activity.
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Affiliation(s)
- Kelly Nguyen
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Roxana Bolaria
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David A Cabral
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Mercedes Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Paul Dancey
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | | | | | | | | | | | - Tommy Gerschman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie Haddad
- Université de Montréal, Montréal, Quebec, Canada
| | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | | | - Kristin Houghton
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam M Huber
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Human
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Bianca Lang
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Lillian Lim
- University of Alberta, Edmonton, Alberta, Canada
| | - Lily S H Lim
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nadia Luca
- University of Ottawa, Ottawa, Ontario, Canada
| | - Tara McGrath
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | - Hon Yan Ng
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Ross E Petty
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Dax G Rumsey
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | - Gordon Soon
- Health Sciences North, Sudbury, Ontario, Canada
- North York General Hospital, North York, Toronto, Ontario, Canada
| | | | | | - Herman Tam
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori Tucker
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Turvey
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Jaime Guzman
- University of British Columbia, Vancouver, British Columbia, Canada
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Ward LM, Ma J, Robinson ME, Scharke M, Ho J, Houghton K, Huber A, Scuccimarri R, Barsalou J, Roth J, Shenouda N, Matzinger MA, Lentle B, Jaremko JL, Koujok K, Watanabe Duffy K, Stein R, Sbrocchi AM, Rodd C, Miettunen PM, LeBlanc CMA, Larche M, Jurencak R, Cummings EA, Couch R, Cabral DA, Atkinson S, Alos N, Sykes E, Konji VN, Rauch F, Siminoski K, Lang B. Osteoporotic Fractures and Vertebral Body Reshaping in Children With Glucocorticoid-treated Rheumatic Disorders. J Clin Endocrinol Metab 2021; 106:e5195-e5207. [PMID: 34232311 DOI: 10.1210/clinem/dgab494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Osteoporotic fractures are an important cause of morbidity in children with glucocorticoid-treated rheumatic disorders. OBJECTIVE This work aims to evaluate the incidence and predictors of osteoporotic fractures and potential for recovery over six years following glucocorticoid (GC) initiation in children with rheumatic disorders. METHODS Children with GC-treated rheumatic disorders were evaluated through a prospective inception cohort study led by the Canadian STeroid-induced Osteoporosis in the Pediatric Population (STOPP) Consortium. Clinical outcomes included lumbar spine bone mineral density (LS BMD), vertebral fractures (VF), non-VF, and vertebral body reshaping. RESULTS A total of 136 children with GC-treated rheumatic disorders were enrolled (mean age 9.9 years, SD 4.4). The 6-year cumulative fracture incidence was 16.3% for VF, and 10.1% for non-VF. GC exposure was highest in the first 6 months, and 24 of 38 VF (63%) occurred in the first 2 years. Following VF, 16 of 19 children (84%) had complete vertebral body reshaping. Increases in disease activity and body mass index z scores in the first year and declines in LS BMD z scores in the first 6 months predicted incident VF over the 6 years, while higher average daily GC doses predicted both incident VF and non-VF. LS BMD z scores were lowest at 6 months (mean -0.9, SD 1.2) and remained low by 6 years even when adjusted for height z scores (-0.6, SD 0.9). CONCLUSION VF occurred early and were more common than non-VF in children with GC-treated rheumatic disorders. Eighty-four percent of children with VF underwent complete vertebral body reshaping, whereas vertebral deformity persisted in the remainder of children. On average, LS BMD z scores remained low at 6 years, consistent with incomplete recovery.
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Affiliation(s)
- Leanne M Ward
- University of Ottawa, Ottawa, Ontario K1H 8L1, Canada
| | - Jinhui Ma
- McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | | | - Maya Scharke
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Josephine Ho
- University of Calgary, Calgary T3B 6A8, Alberta, Canada
| | - Kristin Houghton
- University of British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
| | - Adam Huber
- Dalhousie University, Halifax B3K 6R8, Nova Scotia, Canada
| | | | - Julie Barsalou
- Université de Montréal, Montréal H3T 1C5, Quebec, Canada
| | - Johannes Roth
- University of Ottawa, Ottawa, Ontario K1H 8L1, Canada
| | | | | | - Brian Lentle
- University of British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
| | | | | | | | - Robert Stein
- University of Western Ontario, London N6A 5A5, Ontario, Canada
| | | | - Celia Rodd
- University of Manitoba, Winnipeg R3E 0Z3, Manitoba, Canada
| | | | | | - Maggie Larche
- McMaster University, Hamilton, Ontario L8S 4L8, Canada
| | | | | | - Robert Couch
- University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - David A Cabral
- University of British Columbia, Vancouver V6T 1Z4, British Columbia, Canada
| | | | - Nathalie Alos
- Université de Montréal, Montréal H3T 1C5, Quebec, Canada
| | - Elizabeth Sykes
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Victor N Konji
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario K1H 8L1, Canada
| | - Frank Rauch
- McGill University, Montréal H4A 3J1, Quebec, Canada
| | | | - Bianca Lang
- Dalhousie University, Halifax B3K 6R8, Nova Scotia, Canada
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Grazziotin LR, Currie G, Twilt M, Ijzerman MJ, Kip MMA, Koffijberg H, Benseler SM, Swart JF, Vastert SJ, Wulffraat NM, Yeung RSM, Johnson N, Luca NJ, Miettunen PM, Schmeling H, Marshall DA. Evaluation of Real-World Healthcare Resource Utilization and Associated Costs in Children with Juvenile Idiopathic Arthritis: A Canadian Retrospective Cohort Study. Rheumatol Ther 2021; 8:1303-1322. [PMID: 34275124 PMCID: PMC8380593 DOI: 10.1007/s40744-021-00331-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/03/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease, whose multifaceted care path can lead to significant expenditure for the healthcare system. We aim to assess the real-world healthcare resource use (HCRU) and associated cost for children with JIA in a single center in Canada. METHODS A single-center consecutive cohort of newly diagnosed patients with JIA attending the pediatric rheumatology clinic from 2011 to 2019 was identified using an administrative data algorithm and electronic medical charts. HCRU was estimated from six administrative health databases that included hospital admissions, emergency, outpatient care, practitioners' visits, medication, and laboratory and imaging tests. Costs were assigned using appropriate sources. We reported the yearly overall and JIA-associated HCRU and costs 5 years prior to and 6 years after the first visit to the pediatric rheumatologist. The Zhao and Tian estimator was used to calculate cumulative mean costs over a 6-year timeframe. Results were stratified by disease subtype. RESULTS A total of 389 patients were identified. The yearly total overall mean costs per patient ranged between $804 and $4460 during the 5 years prior to the first visit to the pediatric rheumatologist and $8529 and $10,651 for the 6 years after. Medication cost, driven by use of biologic therapies, and outpatient visits were the greatest contributor to the total cost. The overall cumulative mean cost for 6 years of care was $48,649 per patient, while the JIA-associated cumulative mean cost was $26,820 per patient. During the first year of rheumatology care, systemic onset JIA had the highest cumulative mean overall cost, while oligoarticular JIA had the lowest cumulative mean cost. CONCLUSION The care pathway for children with JIA can be expensive, and complex-and varies by JIA subtype. Although the yearly total mean cost per patient was constant, the distribution of costs changes over time with the introduction of biologic therapies later in the care pathway. This study provides a better understanding of the JIA costs profile and can help inform future economic studies.
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Affiliation(s)
- Luiza R Grazziotin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Gillian Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marinka Twilt
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maarten J Ijzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sebastiaan J Vastert
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Rae S M Yeung
- Departments of Paediatrics, Immunology and Medical Science, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nicole Johnson
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nadia J Luca
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paivi M Miettunen
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Heinrike Schmeling
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
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4
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Ma J, Siminoski K, Wang P, Jaremko JL, Koujok K, Matzinger MA, Shenouda N, Lentle B, Alos N, Cummings EA, Ho J, Houghton K, Miettunen PM, Scuccimarri R, Rauch F, Ward LM. The Accuracy of Incident Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches. J Bone Miner Res 2021; 36:1255-1268. [PMID: 33784410 DOI: 10.1002/jbmr.4294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 02/26/2021] [Accepted: 03/16/2021] [Indexed: 12/23/2022]
Abstract
Vertebral fractures are clinically important sequelae of a wide array of pediatric diseases. In this study, we examined the accuracy of case-finding strategies for detecting incident vertebral fractures (IVF) over 2 years in glucocorticoid-treated children (n = 343) with leukemia, rheumatic disorders, or nephrotic syndrome. Two clinical situations were addressed: the prevalent vertebral fracture (PVF) scenario (when baseline PVF status was known), which assessed the utility of PVF and low lumbar spine bone mineral density (LS BMD; Z-score <-1.4), and the non-PVF scenario (when PVF status was unknown), which evaluated low LS BMD and back pain. LS BMD was measured by dual-energy X-ray absorptiometry, vertebral fractures were quantified on spine radiographs using the modified Genant semiquantitative method, and back pain was assessed by patient report. Forty-four patients (12.8%) had IVF. In the PVF scenario, both low LS BMD and PVF were significant predictors of IVF. Using PVF to determine which patients should have radiographs, 11% would undergo radiography (95% confidence interval [CI] 8-15) with 46% of IVF (95% CI 30-61) detected. Sensitivity would be higher with a strategy of PVF or low LS BMD at baseline (73%; 95% CI 57-85) but would require radiographs in 37% of children (95% CI 32-42). In the non-PVF scenario, the strategy of low LS BMD and back pain produced the highest specificity of any non-PVF model at 87% (95% CI 83-91), the greatest overall accuracy at 82% (95% CI 78-86), and the lowest radiography rate at 17% (95% CI 14-22). Low LS BMD or back pain in the non-PVF scenario produced the highest sensitivity at 82% (95% CI 67-92), but required radiographs in 65% (95% CI 60-70). These results provide guidance for targeting spine radiography in children at risk for IVF. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Kerry Siminoski
- Department of Radiology and Diagnostic Imaging and Department of Internal Medicine, University of Alberta, Edmonton, Canada
| | - Peiyao Wang
- Faculty of Science, McMaster University, Hamilton, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Khaldoun Koujok
- Department of Medical Imaging, University of Ottawa, Ottawa, Canada
| | | | - Nazih Shenouda
- Department of Medical Imaging, University of Ottawa, Ottawa, Canada
| | - Brian Lentle
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Nathalie Alos
- Department of Pediatrics, Université de Montréal, Montréal, Canada
| | | | - Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Kristin Houghton
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | | | - Frank Rauch
- Department of Pediatrics, McGill University, Montreal, Canada
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Ottawa, Canada
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- Canadian Pediatric Bone Health Working Group, Ottawa, Canada
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5
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Ma J, Siminoski K, Wang P, Alos N, Cummings EA, Feber J, Halton J, Ho J, Houghton K, Lang B, Miettunen PM, Scuccimarri R, Jaremko JL, Koujok K, Lentle B, Matzinger MA, Shenouda N, Rauch F, Ward LM. The Accuracy of Prevalent Vertebral Fracture Detection in Children Using Targeted Case-Finding Approaches. J Bone Miner Res 2020; 35:460-468. [PMID: 31742768 DOI: 10.1002/jbmr.3922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 11/07/2019] [Accepted: 11/11/2019] [Indexed: 01/06/2023]
Abstract
Due to concerns about cumulative radiation exposure in the pediatric population, it is not standard practice to perform spine radiographs in most conditions that predispose to vertebral fracture (VF). In this study we examined the accuracy of two clinical predictors, back pain and lumbar spine bone mineral density (LS BMD), to derive four case-finding paradigms for detection of prevalent VF (PVF). Subjects were 400 children at risk for PVF (leukemia 186, rheumatic disorders 135, nephrotic syndrome 79). Back pain was assessed by patient report, LS BMD was measured by dual-energy X-ray absorptiometry, and PVF were quantified on spine radiographs using the modified Genant semiquantitative method. Forty-four patients (11.0%) had PVF. Logistic regression analysis between LS BMD and PVF produced an odds ratio (OR) of 1.9 (95% confidence interval [CI], 1.5 to 2.5) per reduction in Z-score unit, an area under the receiver operating characteristic curve of 0.70 (95% CI, 0.60 to 0.79), and an optimal BMD Z-score cutoff of -1.6. Case identification using either low BMD alone (Z-score < -1.6) or back pain alone gave similar results for sensitivity (55%, 52%, respectively), specificity (78%, 81%, respectively), positive predictive value (PPV; 24%, 25%, respectively), and negative predictive value (NPV; 93%, 93%, respectively). The paradigm using low BMD plus back pain produced lower sensitivity (32%), higher specificity (96%), higher PPV (47%), and similar NPV (92%). The approach using low BMD or back pain had the highest sensitivity (75%), lowest specificity (64%), lowest PPV (20%), and highest NPV (95%). All paradigms had increased sensitivities for higher fracture grades. Our results show that BMD and back pain history can be used to identify children with the highest risk of PVF so that radiography can be used judiciously. The specific paradigm to be applied will depend on the expected PVF rate and the clinical approach to the use of radiography. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Jinhui Ma
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Kerry Siminoski
- Department of Radiology and Diagnostic Imaging and Department of Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Peiyao Wang
- Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Nathalie Alos
- Department of Pediatrics, Universite de Montreal, Montreal, QC, Canada
| | | | - Janusz Feber
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Josephine Ho
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | - Kristin Houghton
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Bianca Lang
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Paivi M Miettunen
- Department of Pediatrics, University of Calgary, Calgary, AB, Canada
| | | | - Jacob L Jaremko
- Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Khaldoun Koujok
- Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Brian Lentle
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | | | - Nazih Shenouda
- Department of Medical Imaging, University of Ottawa, Ottawa, ON, Canada
| | - Frank Rauch
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Leanne M Ward
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
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- Canadian Pediatric Bone Health Working Group, Ottawa, ON, Canada
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6
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Oen K, Guzman J, Dufault B, Tucker LB, Shiff NJ, Duffy KW, Lee JJY, Feldman BM, Berard RA, Dancey P, Huber AM, Scuccimarri R, Cabral DA, Morishita KA, Ramsey SE, Rosenberg AM, Boire G, Benseler SM, Lang B, Houghton K, Miettunen PM, Chédeville G, Levy DM, Bruns A, Schmeling H, Haddad E, Yeung RSM, Duffy CM. Health-Related Quality of Life in an Inception Cohort of Children With Juvenile Idiopathic Arthritis: A Longitudinal Analysis. Arthritis Care Res (Hoboken) 2017; 70:134-144. [PMID: 28320056 DOI: 10.1002/acr.23236] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 03/14/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe changes in health-related quality of life (HRQoL) over time in children with juvenile idiopathic arthritis (JIA), relative to other outcomes, and to identify predictors of unfavorable HRQoL trajectories. METHODS Children with JIA in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort were included. The Juvenile Arthritis Quality of Life Questionnaire (JAQQ, a standardized instrument), health-related Quality of My Life (HRQoML, an instrument based on personal valuations), and JIA core variables were completed serially. Analyses included median values, Kaplan-Meier survival curves, and latent trajectory analysis. RESULTS A total of 1,249 patients enrolled at a median of 0.5 months after diagnosis were followed for a median of 34.2 months. The degree of initial HRQoL impairment and probabilities of reaching the best possible HRQoL scores varied across JIA categories (best for oligoarthritis, worst for rheumatoid factor-positive polyarthritis). Median times to attain best possible HRQoL scores (JAQQ 59.3 months, HRQoML 34.5 months), lagged behind those for disease activity, pain, and disability measures. Most patients followed trajectories with minimal or mild impairment; however, 7.6% and 13.8% of patients, respectively, followed JAQQ and HRQoML trajectories with persistent major impairment in HRQoL. JIA category, aboriginal ethnicity, and baseline disease activity measures distinguished between membership in trajectories with major and minimal impairments. CONCLUSION Improvement in HRQoL is slower than for disease activity, pain, and disability. Improvement of a measure based on respondents' preferences (HRQoML) is more rapid than that of a standardized measure (JAQQ). Higher disease activity at diagnosis heralds an unfavorable HRQoL trajectory.
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Affiliation(s)
- Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jaime Guzman
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori B Tucker
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Natalie J Shiff
- University of Florida, Gainesville, Florida, and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | | | - Brian M Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roberta A Berard
- Children's Hospital, London Health Sciences Centre, and Western University, London, Ontario, Canada
| | - Paul Dancey
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - David A Cabral
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly A Morishita
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Suzanne E Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Susanne M Benseler
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristin Houghton
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Paivi M Miettunen
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | | | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Elie Haddad
- CHU Ste. Justine and Université de Montréal, Montreal, Quebec, Canada
| | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
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De Benedetti F, Anton J, Gattorno M, Lachmann H, Kone-Paut I, Ozen S, Frenkel J, Simon A, Zeft A, Ben-Chetrit E, Hoffman HM, Joubert Y, Lheritier K, Speziale A, Guido J, Caorsi R, Penco F, Grossi A, Insalaco A, Alessio M, Conti G, Marchetti F, Tommasini A, Martino S, Gallizzi R, Salis A, Schena F, Caroli F, Martini A, Damonte G, Ceccherini I, Gattorno M, Frémond ML, Uggenti C, Van Eyck L, Melki I, Duffy D, Bondet V, Rose Y, Neven B, Crow Y, Rodero MP, Kusche Y, Roth J, Barczyk-Kahlert K, Ferrara G, Chiocchetti A, Polizzi S, Vuch J, Vozzi D, Mondino A, Valencic E, Pastore S, Taddio A, Faletra F, Dianzani U, Ramenghi U, Tommasini A, Zhou Q, Yu X, Demirkaya E, Deuitch N, Stone D, Tsai W, Ombrello A, Romeo T, Remmers EF, Chae J, Gadina M, Welch S, Ozen S, Topaloglu R, Abinun M, Kastner DL, Aksentijevich I, Vairo D, Ferraro RM, Zani G, Galli J, De Simone M, Cattalini M, Fazzi E, Giliani S, Omoyinmi E, Standing A, Rowczenio D, Keylock A, Gomes SM, Price-Kuehne F, Nanthapisal S, Murphy C, Cullup T, Jenkins L, Gilmour K, Eleftheriou D, Lachmann H, Hawkins P, Klein N, Brogan P, Nikolayenko VB, Şahin K, Karaaslan Y, Civino A, Alighieri G, Davì S, Rondelli R, Martino S, Filocamo G, Magnolato A, Dhanrajani A, Ricci F, Gallizzi R, Olivieri A, Gerloni V, Lattanzi B, Soscia F, De Fanti A, Manzoni SM, Citiso S, Quartulli L, Chan M, La Torre F, Rigante D, Maggio MC, Marsili M, Pelagatti MA, Conter V, Fagioli F, Lepore L, Pession A, Ravelli A, Pau S, Consolaro A, Ruperto N, Garrone M, Rinaldi M, De Inocencio J, Demirkaya E, Garay S, Foell D, Lovell DJ, Lazar C, Ellsworth J, Nielsen S, Flato B, Martini A, Ravelli A, Marasco E, Aquilani A, Cascioli S, Caiello I, Moneta GM, Pires-Marafón D, Guzman J, Magni-Manzoni S, Carsetti R, De Benedetti F, Robinson E, Albani S, Beresford MW, de Jager W, de Roock S, Duong T, Ellis J, Aeschlimann FA, Hyrich K, Jervis L, Lovell D, Marshall L, Mellins ED, Minden K, Munro J, Nigrovic PA, Palman J, Roth J, Twilt M, Ruperto N, Sampath S, Schanberg LE, Thompson SD, Thomson W, Vesely R, Wallace C, Williams C, Wu Q, Wulffraat N, Eng SW, Yeung RSM, Prakken B, Wedderburn LR, Horneff G, Seyger MB, Arikan D, Kalabic J, Anderson JK, Lazar A, Williams DA, Sheikh S, Wang C, Tarzynski-Potempa R, Hymans JS, Simonini G, Scoccimarro E, Pontikaki I, Ferrara G, Giani T, Ventura A, Meroni PL, Laxer RM, Cimaz R, Minnone G, Soligo M, Caiello I, Prencipe G, Marafon DP, Magni-Manzoni S, Manni L, De Benedetti F, Laudiero LB, Hebert D, Groot N, Grein I, Wulffraat NM, Schepp R, Berbers G, de Souza CCBS, Ferriani VPL, Pileggi G, de Roock S, Grein IHR, Noone D, Scala S, Patrone E, Schoemaker C, Costello W, Wulffraat N, Parsons S, McDonagh J, Thomson W, Cohen JD, Bentayou D, Pagnoux C, Brunel MAB, Trope S, Klotsche J, Listing M, Niewerth M, Horneff G, Thon A, Huppertz HI, Mönkemöller K, Foeldvari I, Benseler SM, Föll D, Minden K, Marino A, Stagi S, Carli N, Bertini F, Giani T, Simonini G, Cimaz R, Díaz-Maldonado AS, Yeung RS, Pino S, Guarnizo P, Torres-Jimenez AR, Sanchez-Jara B, Solis-Vallejo E, Cespedes-Cruz AI, Zeferino-Cruz M, Ramirez-Miramontes JV, Kumar A, Gupta A, Kessel C, Suri D, Rawat A, Kakkar N, Singh S, Makay B, Gücenmez ÖA, Ünsal E, Magnusson B, Mördrup K, Vermé A, Lippitz K, Peterson C, Freychet C, Stephan JL, Hofer M, Belot A, Harkness CE, Rooney M, Foster L, Henry E, Taggart P, Weinhage T, Simsek D, Ozkececi CF, Kurt E, Basbozkurt G, Gok F, Demirkaya E, Gorczyca D, Postępski J, Czajkowska A, Szponar B, Hinze C, Paściak M, Gruenpeter A, Lachór-Motyka I, Augustyniak D, Olesińska E, Asuka ES, Golovko T, Aliejim SU, Clemente EI, Jimenez EI, Wittkowski H, Hernandez JC, Fernandez SB, Roca CG, Romo DM, Nieva NR, Angarita JMM, Lopez JA, Nuñez-Cuadros E, Diaz-Cordovés G, Galindo-Zavala R, Holzinger D, Urda-Cardona A, Fernández-Nebro A, Quesada-Masachs E, de la Sierra DÁ, Prat MG, Gallo MM, Borrell RP, Barril SM, Sánchez AMM, Caballero CM, Grün N, Merlin E, Breton S, Fraitag S, Stephan JL, Wouters C, Bodemer C, Bader-Meunier B, Baldo F, Annoni F, Di Landro G, Föll D, Torreggiani S, Torcoletti M, Petaccia A, Corona F, Filocamo G, Tiller G, Buckle J, Munro J, Cox A, Gowdie P, Van Dijkhuizen P, Allen RC, Akikusa JD, Hernández-Huirache HG, Rodea-Montero ER, Cohen JD, Belot A, Fahy W, Quartier P, Sordet C, Trope S, Del Chierico F, Berggren KB, Kembe JT, Bos J, Armbrust W, Wulffraat N, van Brussel M, Cappon J, Dijkstra P, Geertzen J, Legger E, Malattia C, van Rossum M, Sauer P, Lelieveld O, Ozturk K, Buluc L, Akansel G, Muezzinoglu B, Ekinci Z, Rychkova L, Knyazeva T, Russo A, Pogodina A, Belova T, Mandzyak T, Kulesh E, Cafarotti A, Marsili M, Giannini C, Salvatore R, Lapergola G, Di Battista C, Marafon DP, Marcovecchio ML, Basilico R, Pelliccia P, Chiarelli F, Breda L, Almeida B, Tansley S, Simou S, Gunawardena H, McHugh N, ter Haar NM, Wedderburn L, Aouizerate J, Bader-Meunier B, De Antonio M, Bodemer C, Barnerias C, Bassez G, Desguerre I, Quartier P, Gherardi R, Magni-Manzoni S, Charuel JL, Authier FJ, Gitiaux C, Spencer CH, Aziz RA, Yu CY, Adler B, Bout-Tabaku S, Lintner K, Moore-Clingenpeel M, Vastert SJ, Boros C, McCann L, Ambrose N, Cortina-Borja M, Simou S, Pilkington C, Wedderburn L, Hinze C, Oommen PT, Speth F, Dallapiccola B, Haas JP, Hinze C, Oommen PT, Speth F, Haas JP, Speth F, Haas JP, Hinze C, Lavarello C, Giancane G, Prakken B, Pistorio A, Rider L, Aggarwal R, Oliveira SK, Cuttica R, Fischbach M, Sterba G, Brochard K, Dressler F, Barone P, Martini A, Burgos-Vargas R, Chalom EC, Desjonqueres M, Espada G, Fasth A, Garay SM, Herbigneaux RM, Hoyoux C, Deslandre CJ, Miller FW, De Benedetti F, Vencovsky J, Ravelli A, Martini A, Ruperto N, Sag E, Ozen S, Kale G, Topaloglu H, Talim B, Giancane G, Putignani L, Lavarello C, Pistorio A, Zulian F, Magnusson B, Avcin T, Corona F, Gerloni V, Pastore S, Marini R, Martino S, Fidanci BE, Pagnier A, Rodiere M, Soler C, Stanevicha V, Ten Cate R, Uziel Y, Vojinovic J, Ravelli A, Martini A, Ruperto N, Barut K, Villarreal AV, Acevedo N, Diaz T, Ramirez Y, Faugier E, Maldonado R, Arabshahi B, Lee JH, Leibowitz I, Okong’o LO, Arıcı S, Wilmshurst J, Esser M, Scott C, Batu ED, Emiroglu N, Sonmez HE, Tugcu GD, Arici ZS, Yalcin E, Dogru D, Simsek D, Ozcelik U, Bilginer Y, Haliloglu M, Kiper N, Ozen S, Yashiro M, Yamada M, Yabuuchi T, Kikkawa T, Nosaka N, Cakan M, Fujii Y, Saito Y, Tsukahara H, Al-Mayouf SM, AlMutiari N, Muzaffer M, shehata R, Al-Wahadneh A, Abdwani R, Al-Abrawi S, Batu ED, Abu-shukair M, El-Habahbeh Z, Alsonbul A, Szabat A, Chęć M, Opoka-Winiarska V, Kumar A, Gupta A, Rawat A, Saikia B, Şahin S, Minz RW, Suri D, Singh S, Arango C, Malagon C, Gomez MDP, Mosquera AC, Yepez R, Gonzalez T, Vargas C, Kısaarslan A, Zulian F, Balzarin M, Castaldi B, Reffo E, Sperotto F, Martini G, Meneghel A, Milanesi O, Foeldvari I, Klotsche J, Yilmaz E, Kasapçopur O, Adrovic A, Stanevicha V, Terreri MT, Alexeeva E, Katsicas M, Cimaz R, Kostik M, Lehman T, Sifuentes-Giraldo WA, Basaran Ö, Smith V, Sztajnbok F, Avcin T, Santos MJ, Nemcova D, Battagliotti C, Eleftheriou D, Harel L, Janarthanan M, Kallinich T, Demir F, Lopez JA, Minden K, Nielsen S, Torok K, Uziel Y, Helmus N, Foeldvari I, Baildem E, Blakley M, Boros C, Ozturk K, Fligelstone K, Kienast A, Nemcova D, Pain C, Saracino A, Simoni G, Torok K, Weibel L, Helmus N, Foeldvari I, Gunduz Z, Klotsche J, Kasapçopur O, Adrovic A, Stanevicha V, Terreri MT, Alexeeva E, Katsicas M, Cimaz R, Kostik M, Lehman T, Sozeri B, Sifuentes-Giraldo WA, Smith V, Sztajnbok F, Avcin T, Santos MJ, Nemcova D, Battagliotti C, Eleftheriou D, Harel L, Janarthanan M, Makay B, Kallinich T, Lopez JA, Minden K, Nielsen S, Torok K, Uziel Y, Helmus N, Osminina MK, Geppe NA, Niconorova OV, Ayaz N, Karashtina OV, Abbyasova OV, Shpitonkova OV, Adrovic A, Sahin S, Barut K, Durmus S, Uzun H, Kasapcopur O, Foeldvari I, Yavascan O, Klotsche J, Kasapçopur O, Adrovic A, Stanevicha V, Terreri MT, Alexeeva E, Katsicas M, Cimaz R, Kostik M, Lehman T, Aydog O, Sifuentes-Giraldo WA, Smith V, Sztajnbok F, Avcin T, Santos MJ, Nemcova D, Battagliotti C, Eleftheriou D, Harel L, Janarthanan M, Bilginer Y, Kallinich T, Lopez JA, Minden K, Nielsen S, Torok K, Uziel Y, Helmus N, Mauro A, Fanti E, Voller F, Ekinci Z, Rusconi F, Cimaz R, Garcia-Rodriguez F, Villarreal-Treviño AV, Flores-Pineda AJ, Lara-Herrea PB, Salinas-Encinas DR, Diaz-Prieto T, Maldonado-Velazquez MR, Moreno-Espinosa S, Yıldız D, Faugier-Fuentes E, Gallizzi R, Finetti M, Crapanzano M, Cantarini L, Cattalini M, Filocamo G, Insalaco A, Mauro A, Rigante D, Gök F, Zulian F, Alessio M, Parissenti I, Ruperto N, Gattorno M, Cimaz R, Parihar MS, Singh S, Vignesh P, Gupta A, Erguven M, Rohit M, Gopalan K, Singh S, Vignesh P, Gupta A, Rohit M, Attri SV, Hong Y, Eleftheriou D, Nanthapisal S, Unsal E, Salama A, Jayne D, Little M, Brogan P, Kostina Y, Lyskina G, Shpitonkova O, Torbyak A, Lyskina G, Shirinsky O, Kasapcopur O, Mauro A, Gicchino MF, Smaldone MC, Diplomatico M, Olivieri AN, Spencer CH, Aziz RA, McClead R, Bout-Tabaku S, Patel H, Ozen S, Yu CY, Ozkececi CF, Basbozkurt G, Simsek D, Kurt E, Gok F, Demirkaya E, Cebecauerová D, Dallos T, Kabíčková E, Demirkaya E, Kynčl M, Chroustová D, Hoza J, Němcová D, Tesař V, Doležalová P, Batu ED, Sonmez HE, Hazirolan T, Ozaltin F, Sönmez HE, Bilginer Y, Ozen S, Almeida F, de Paula IHF, Sampaio MM, Arita FN, Alves AG, Santos MC, Okuda EM, Sacchetti SB, Batu ED, Falcini F, Francesca M, Stagi S, Rigante D, Lepri G, Matucci-Cerinic M, Brandi ML, Di Landro G, Torreggiani S, Petaccia A, Sözeri B, Torcoletti M, Corona F, Filocamo G, Kisaoglu H, Misir S, Demir S, Aliyazicioglu Y, Kalyoncu M, de Paula IHF, Ramalho CE, Butbul Y, Almeida FD, Alves AG, Santos MC, Sacchetti SB, Okuda EM, Calzada-Hernández J, Bou R, Iglesias E, Sánchez-Manubens J, Martínez FHP, Bilginer Y, Roca CG, Fernández SB, Angarita JMM, Anton J, Bohm M, Mahmood K, Leone V, Wood M, Yamaguchi KI, Fujikawa S, Özen S, Kim KY, Kim DY, Kim DS, Ioseliani M, Chkhaidze I, Lekishvili M, Tskhakaia N, Tvalabeishvili S, Kajrishvili A, Takakura M, Bracaglia C, Shimizu M, Inoue N, Mizuta M, Yachie A, Alizzi C, Corsello G, Maggio MC, Piram M, Maldini C, Biscardi S, Prencipe G, Desuremain N, Orzechowski C, Georget E, Regnard D, Kone-Paut I, Mahr A, Sparchez M, Damian L, Sparchez Z, Silva NA, Pardeo M, Treviño AVV, Loyola YR, Prieto TD, Fuentes EF, Velazquez MDRM, Perez P, Mosquera AC, Malagon C, Bhattad S, Rawat A, Lapeyre G, Saikia B, Minz R, Shandilya J, Singh S, Parihar MS, Singh S, Vignesh P, Gupta A, Rohit M, Maldonado R, Marasco E, Faugier E, Villarreal A, Acevedo N, Ramírez Y, Diaz T, Kostina Y, Lyskina G, Shpitonkova O, Ozturk K, Ekinci Z, Insalaco A, Özçakar ZB, Fitoz S, Yalcinkaya F, Horne A, Minoia F, Bovis F, Davi S, Pal P, Anton J, Stein K, Ferlin W, Enciso S, Kasapcopur O, Jeng M, Maritsi D, Cron RC, Ravelli A, Thorwarth A, von Stuckrad SL, Rösen-Wolff A, Luksch H, Nelson R, Hundsdoerfer P, Minden K, Krawitz P, Kallinich T, Sozeri B, Ayaz NA, Batu ED, Makay B, Şahin S, Simsek D, de Min C, Kılıc ŞS, Ozturk K, Sonmez E, Kisaarslan AP, Gucenmez OA, Cakan M, Arıcı ZS, Adrovic A, Kelesoglu F, Bilginer Y, De Benedetti F, Demirkaya E, Ekinci ZE, Dusunsel R, Unsal E, Kasapcopur O, Ozen S, Lerkvaleekul B, Vilaiyuk S, Miranda-Garcia M, Pretzer C, Ruperto N, Huppertz HI, Horneff G, Haas JP, Ganser G, Kuemmerle-Deschner J, Wittkowski H, Frosch M, Roth J, Foell D, Holzinger D, Brunner HI, Gohar F, McArdle A, Callan N, Hernandez B, Lavric M, Kessel C, Holzinger D, FitzGerald O, Pennington SR, Foell D, Quartier P, Horneff G, Peitz J, Kekow J, Klein A, Horneff G, Schulz AC, Minden K, Weller-Heinemann F, Hospach A, Haas JP, Constantin T, Put K, Vandenhaute J, Avau A, van Nieuwenhuijze A, Brisse E, Dierckx T, Rutgeerts O, Garcia-Perez JE, Toelen J, Waer M, Alexeeva E, Leclercq G, Goris A, Van Weyenbergh J, Liston A, De Somer L, Matthys P, Wouters CH, Mizuta M, Shimizu M, Inoue N, Kone-Paut I, Nakagishi Y, Yachie A, Shimizu M, Inoue N, Mizuta M, Yachie A, Ombrello MJ, Arthur V, Remmers EF, Hinks A, Marzan K, Kastner DL, Woo P, Thomson W, Stanimirovic B, Djurdjevic-Banjac B, Ljuboja O, Hugle B, Speth F, Haas JP, Maritsi D, Wulffraat N, Onoufriou MA, Vougiouka O, Eleftheriou D, Horneff G, Peitz J, Kekow J, Foell D, Bouayed K, El Hani S, Hafid I, Schneider R, Mikou N, Ioseliani M, Lekishvili M, Shelia N, Tvalabeishvili S, Kajrishvili A, Laan M, Ilisson J, Pruunsild C, Padeh S, Chasnyk V, Wouters C, Kuemmerle-Deschner JB, Kallinich T, Lauwerys B, Haddad E, Nasonov E, Trachana M, Vougiouka O, Leon K, Vritzali E, Lheritier K, Martini A, Lovell D, Schena F, Volpi S, Caorsi R, Penco F, Pastorino C, Kalli F, Omenetti A, Chiesa S, Bertoni A, Picco P, Filaci G, Aksentijevich I, Grossi A, Ceccherini I, Martini A, Traggiai E, Gattorno M, Melki I, Rose Y, Uggenti C, Fremond ML, Van Eyck L, Kitabayashi N, Gattorno M, Volpi S, Sacco O, Meyts I, Morren MA, Wouters C, Legius E, Callebaut I, Bodemer C, Rieux-Laucat F, Rodero M, Crow Y, Frémond ML, Rodero MP, Jeremiah N, Belot A, Jeziorski E, Duffy D, Bessis D, Cros G, Rice GI, Charbit B, Hulin A, Khoudour N, Caballero CM, Bodemer C, Fabre M, Berteloot L, Le Bourgeois M, Reix P, Walzer T, Moshous D, Blanche S, Fischer A, Bader-Meunier B, Rieux-Laucat F, Crow Y, Neven B, Annink K, ter Haar N, Al-Mayouf S, Amaryan G, Anton J, Barron K, Benseler S, Brogan P, Cantarini L, Cattalini M, Cochino A, De Benedetti F, Dedeoglu F, De Jesus A, Dellacasa O, Demirkaya E, Dolezalova P, Durrant K, Fabio G, Gallizzi R, Goldbach-Mansky R, Hachulla E, Hentgen V, Herlin T, Hofer M, Hoffman H, Insalaco A, Jansson A, Kallinich T, Koné-Paut I, Kozlova A, Kuemmerle-Deschner J, Lachmann H, Laxer R, Martini A, Nielsen S, Nikishina I, Ombrello A, Ozen S, Papadopoulou-Alataki E, Quartier P, Ravelli A, Rigante D, Russo R, Simon A, Trachana M, Uziel Y, Gattorno M, Frenkel J, ter Haar N, Jeyaratnam J, Lachmann H, Simon A, Brogan P, Doglio M, Cattalini M, Anton J, Modesto C, Quartier P, Hoppenreijs E, Martino S, Insalaco A, Cantarini L, Lepore L, Alessio M, Penades IC, Boros C, Consolini R, Rigante D, Russo R, Schmid JP, Lane T, Martini A, Ruperto N, Frenkel J, Gattorno M, Passarelli C, Pisaneschi E, Messia V, Pardeo M, Novelli A, Debenedetti F, Insalaco A, Brogan PA, Hofer M, Kuemmerle-Deschner JB, Lauwerys B, Speziale A, Wei X, Laxer R, Insalaco A, Marafon DP, Finetti M, Pardeo M, Martino S, Cattalini M, Alessio M, Orlando F, Taddio A, Pastore S, Cortis E, Miniaci A, Ruperto N, Martini A, De Benedetti F, Gattorno M, Eijkelboom C, ter Haar N, Cantarini L, Finetti M, Brogan P, Dolezalova P, Koné-Paut I, Insalaco A, Jelusic-Drazic M, Bezrodnik L, Pinedo MC, Stanevicha V, van Gijn M, Federici S, Ruperto N, Frenkel J, Gattorno M, Girschick H, Finetti M, Orlando F, Insalaco A, Ganser G, Nielsen S, Herlin T, Koné-Paut I, Martino S, Cattalini M, Anton J, Al-Mayouf SM, Hofer M, Quartier P, Boros C, Kuemmerle-Deschner J, Schalm S, Alessio M, Ruperto N, Martini A, Jansson A, Gattorno M, Finetti M, Marchi M, Marini C, Doglio M, Malattia C, Ravelli A, Martini A, Garaventa A, Gattorno M, Bertoni A, Carta S, Balza E, Castellani P, Pellecchia C, Penco F, Schena F, Borghini S, Trotta ML, Pastorino C, Ceccherini I, Martini A, Gattorno M, Rubartelli A, Chiesa S, Guzman J, Henrey A, Loughin T, Berard R, Shiff N, Jurencak R, Benseler S, Tucker L, Papadopoulou C, Hong Y, Krol P, Ioannou Y, Pilkington C, Chaplin H, Simou S, Charakida M, Wedderburn L, Brogan P, Eleftheriou D, Spiegel LR, Kohut SA, Stinson J, Forgeron P, Kaufman M, Luca N, Amaria K, Bell M, Swart J, Boris F, Castagnola E, Groll A, Giancane G, Horneff G, Huppertz HI, Lovell D, Wolfs T, Hofer M, Alekseeva E, Panaviene V, Nielsen S, Anton J, Uettwiller F, Stanevicha V, Trachana M, De Benedetti F, Ailioaie LM, Tsitami E, Kamphuis S, Herlin T, Dolezalova P, Susic G, Sztajnbok F, Flato B, Pistorio A, Martini A, Wulffraat N, Ruperto N, Shoop SJW, Verstappen SMM, McDonagh JE, Thomson W, Hyrich KL, Tarkiainen M, Tynjala P, Lahdenne P, Martikainen J, Wilkinson M, Piper C, Otto G, Deakin CT, Dowle S, Simou S, Kelberman D, Ioannou Y, Mauri C, Jury E, Isenberg D, Wedderburn LR, Nistala K, Foeldvari I, Ruperto N, Lovell DJ, Horneff G, Huppertz HI, Quartier P, Simonini G, Bereswill M, Kalabic J, Martini A, Brunner HI, Oen K, Guzman J, Feldman BM, Dufault B, Lee J, Shiff N, Duffy KW, Tucker L, Duffy C, Ruperto N, Lovell DJ, Tzaribachev N, Vega-Cornejo G, Louw I, Berman A, Calvo I, Cuttica R, Horneff G, Avila-Zapata F, Anton J, Cimaz R, Solau-Gervais E, Joos R, Espada G, Li X, Nys M, Wong R, Banerjee S, Martini A, Brunner HI, Nicolai R, Marafon DP, Verardo M, D’Amico A, Bracci-Laudiero L, De Benedetti F, Moneta GM, Belot A, Rice G, Mathieu AL, Omarjee SO, Bader-Meunier B, Walzer T, Briggs TA, O’Sullivan J, Williams S, Cimaz R, Smith E, Beresford MW, Crow YJ, Rooney M, Bishop N, davidson J, pilkington C, Beresford M, Clinch J, Satyapal R, Foster H, Medwin JG, McDonagh J, Wyatt S, Modignani VL, Baldo F, Lanni S, Consolaro A, Ravelli A, Filocamo G, Omenetti A, Frenkel J, Lachmann HJ, Ozen S, Ruperto N, Gattorno M, Insalaco A, Moneta G, Pardeo M, Passarelli C, Celani C, Messia V, De Benedetti F, Cherqaoui B, Rossi-Semerano L, Dusser P, Hentgen V, Koné-Paut I, Grimwood C, Dusser P, Rossi L, Paut IK, Hentgen V, Lasigliè D, Ferrera D, Amico G, Di Duca M, Caorsi R, Lepore L, Insalaco A, Cattalini M, Obici L, Consolini R, Ravazzolo R, Martini A, Ceccherini I, Nishikomori R, Arostegui J, Gattorno M, Borghini S, Penco F, Petretto A, Lavarello C, Inglese E, Omenetti A, Finetti M, Pastorino C, Bertoni A, Gattorno M, Vanoni F, Federici S, Ozen S, Frenkel J, Lachmann H, Martini A, Ruperto N, Gattorno M, Hofer M, Kuemmerle-Deschner JB, Hoffman HM, Hawkins PN, van der Poll T, Walker UA, Speziale A, Joubert Y, Tilson HH, Kuemmerle-Deschner J, Ozen S, Tyrrell PN, Koné-Paut I, Goldbach-Mansky R, Lachmann H, Blank N, Hoffman HM, Weissbarth-Riedel E, Huegle B, Kallinich T, Gattorno M, Gul A, ter Haar NM, Oswald M, Dedeoglu F, Benseler 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Lehmann H, Ganser G, Berendes R, Haller M, Krumrey-Langkammerer M, Nimtz-Talaska A, Schoof P, Trauzeddel RF, Nirschl C, Quesada-Masachs E, Blancafort CA, Barril SM, Caballero CM, Aguiar F, Fonseca R, Alves D, Vieira A, Vieira A, Dias JA, Brito I, Susic G, Milic V, Radunovic G, Boricic I, Marteau P, Adamsbaum C, Rossi-Semerano L, De Bandt M, Lemelle I, Deslandre C, Tran TA, Lohse A, Solau-Gervais E, Pillet P, Bader-Meunier B, Wipff J, Gaujoux-Viala C, Breton S, Devauchelle-Pensec V, Gran S, Fehler O, Zenker S, Schäfers M, Roth J, Vogl T, Czitrom SG, Foell D, Holzinger D, Lanni S, Van Dijkhuizen EHP, Manzoni SM, Marafon DP, Magnaguagno F, de Horatio LT, Ter Haar NM, Littooij AS, Vastert SJ, De Benedetti F, Ravelli A, Martini A, Malattia C, Teixeira VA, Campanilho-Marques R, Mourão AF, Ramos FO, Costa M, Madan WA, Killeen OG, Vidal AR, Delgado DS, Fernandez MIG, Montesinos BL, Penades IC, Kozhevnikov A, Pozdeeva N, Konev M, Melchenko E, Kenis V, Novik G, Sozeri B, Kısaarslan AP, Gunduz Z, Poyrazoglu H, Dusunsel R, Lerkvaleekul B, Jaovisidha S, Sungkarat W, Chitrapazt N, Fuangfa P, Ruangchaijatuporn T, Vilaiyuk S, Pradsgaard DØ, Hørlyck A, Spannow AH, Heuck CW, Herlin T, Diaz T, Garcia F, De La Cruz L, Rubio N, Świdrowska-Jaros J, Smolewska E, Lamot M, Lamot L, Vidovic M, Bosak EP, Rados I, Harjacek M, Tzaribachev N, Louka P, Hagoug R, Trentin C, Kubassova O, Hinton M, Boesen M, Oshlianska OA, Chaikovsky IA, Mjasnikov G, Kazmirchyk A, Garagiola U, Borzani I, Cressoni P, Corona F, Dzsida E, Farronato G, Garagiola U, Cressoni P, Corona F, Petaccia A, Dzsida E, Farronato G, Gagro A, Pasini AM, Roic G, Vrdoljak O, Lujic L, Zutelija-Fattorini M, Esser MM, Abraham DR, Kinnear C, Durrheim G, Urban M, Hoal E, Crow Y, Oshlianska OA. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part one. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461530 DOI: 10.1186/s12969-017-0141-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Cummings EA, Ma J, Fernandez CV, Halton J, Alos N, Miettunen PM, Jaremko JL, Ho J, Shenouda N, Matzinger MA, Lentle B, Stephure D, Stein R, Sbrocchi AM, Rodd C, Lang B, Israels S, Grant RM, Couch R, Barr R, Hay J, Rauch F, Siminoski K, Ward LM. Incident Vertebral Fractures in Children With Leukemia During the Four Years Following Diagnosis. J Clin Endocrinol Metab 2015; 100:3408-17. [PMID: 26171800 PMCID: PMC4909472 DOI: 10.1210/jc.2015-2176] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purpose of this article was to determine the incidence and predictors of vertebral fractures (VF) during the 4 years after diagnosis in pediatric acute lymphoblastic leukemia (ALL). PATIENTS AND METHODS Children were enrolled within 30 days of chemotherapy initiation, with incident VF assessed annually on lateral spine radiographs according to the Genant method. Extended Cox models were used to assess the association between incident VF and clinical predictors. RESULTS A total of 186 children with ALL completed the baseline evaluation (median age, 5.3 years; interquartile range, 3.4-9.7 years; 58% boys). The VF incidence rate was 8.7 per 100 person-years, with a 4-year cumulative incidence of 26.4%. The highest annual incidence occurred at 12 months (16.1%; 95% confidence interval [CI], 11.2-22.7), falling to 2.9% at 4 years (95% CI, 1.1-7.3). Half of the children with incident VF had a moderate or severe VF, and 39% of those with incident VF were asymptomatic. Every 10 mg/m(2) increase in average daily glucocorticoid dose (prednisone equivalents) was associated with a 5.9-fold increased VF risk (95% CI, 3.0-11.8; P < .01). Other predictors of increased VF risk included VF at diagnosis, younger age, and lower spine bone mineral density Z-scores at baseline and each annual assessment. CONCLUSIONS One quarter of children with ALL developed incident VF in the 4 years after diagnosis; most of the VF burden was in the first year. Over one third of children with incident VF were asymptomatic. Discrete clinical predictors of a VF were evident early in the patient's clinical course, including a VF at diagnosis.
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Affiliation(s)
- Elizabeth A Cummings
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Jinhui Ma
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Conrad V Fernandez
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Jacqueline Halton
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Nathalie Alos
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Paivi M Miettunen
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Jacob L Jaremko
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Josephine Ho
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Nazih Shenouda
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Mary Ann Matzinger
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Brian Lentle
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - David Stephure
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Robert Stein
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Ann Marie Sbrocchi
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Celia Rodd
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Bianca Lang
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Sara Israels
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Ronald M Grant
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Robert Couch
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Ronald Barr
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - John Hay
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Frank Rauch
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Kerry Siminoski
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
| | - Leanne M Ward
- Dalhousie University (E.A.C., C.V.F., B.La.), Halifax, Nova Scotia B3H 4R2, Canada; University of Ottawa (H.M., J.Ha., N.S., M.A.M., L.M.W.), Ottawa, Ontario K1N 6N5, Canada; Université de Montréal (N.A.), Montreal, Quebec H3T 1J4, Canada; University of Calgary (P.M.M., J.Ho., D.S.), Calgary, Alberta T2N 1N4, Canada; University of Alberta (J.L.J., R.C., K.S.), Edmonton, Alberta T6G 2R3, Canada; University of British Columbia (B.Le.), Vancouver, British Columbia V6T 1Z4, Canada; University of Western Ontario (R.S.), London, Ontario N6A 3K7, Canada; McGill University (A.M.S., F.R.), Montréal, Quebec H3A 0G4, Canada; University of Manitoba (C.R., S.I.), Winnipeg, Manitoba R3T 2N2, Canada; University of Toronto (R.M.G.), Toronto, Ontario M5S 2J7, Canada; McMaster University (R.B.), Hamilton, Ontario L8S 4L8, Canada; and Brock University (J.H.), St. Catharines, Ontario L2S 3A1, Canada
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LeBlanc CMA, Ma J, Scuccimarri R, Cabral DA, Dent PB, Ellsworth JE, Houghton K, Huber AM, Jurencak R, Lang BA, Larche M, Lentle B, Matzinger MA, Miettunen PM, Oen K, Roth J, Saint-Cyr C, Shenouda N, Taljaard M, Ward LM. A154: Glucocorticoid Therapy and the Risk of Incident Vertebral Fracture in Children with Rheumatic Disorders. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kiem Oen
- University of Manitoba; Winnipeg MB
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Siminoski K, Lee KC, Abish S, Alos N, Bell L, Blydt-Hansen T, Couch R, Cummings EA, Ellsworth J, Feber J, Fernandez CV, Halton J, Huber AM, Israels S, Jurencak R, Lang B, Laverdière C, LeBlanc C, Lewis V, Midgley J, Miettunen PM, Oen K, Phan V, Pinsk M, Rauch F, Rodd C, Roth J, Saint-Cyr C, Scuccimarri R, Stephure D, Taback S, Wilson B, Ward LM. The development of bone mineral lateralization in the arms. Osteoporos Int 2013; 24:999-1006. [PMID: 22744715 PMCID: PMC4105250 DOI: 10.1007/s00198-012-2054-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Accepted: 05/08/2012] [Indexed: 01/04/2023]
Abstract
UNLABELLED Bone mineral content (BMC) is known to be greater in the dominant arm after the age of 8 years. We studied a group of children and found that BMC sidedness gradually increased up to the age of 6 years and then remained stable into late adolescence. INTRODUCTION Bone mineral content (BMC) exhibits sidedness in the arms after the age of 8 years, but it is not known whether BMC is greater in the dominant arm from birth or whether lateralization develops in early childhood. To address this, we examined bone mineral status in relation to handedness and age. METHODS Subjects (N = 158) were children recently initiating glucocorticoids for underlying disease (leukemia 43 %, rheumatic conditions 39 %, nephrotic syndrome 18 %). Handedness was determined by questionnaire and BMC by dual-energy X-ray absorptiometry. RESULTS Median age was 7.2 years (range, 1.5 to 17.0 years), 49 % was male, and the spine BMD Z-score was -0.9 (SD, 1.3). By linear regression, BMC sidedness in the arms was significantly related to age (r = 0.294, p = 0.0005). Breakpoint analysis revealed two lines with a knot at 6.0 years (95 % CI, 4.5-7.5 years). The formula for the first line was: dominant:nondominant arm BMC ratio = 0.029 × age [in years] + 0.850 (r = 0.323, p = 0.017). The slope of the second line was not different from 0 (p = 0.332), while the slopes for the two lines were significantly different (p = 0.027). CONCLUSIONS These results show that arm BMC sidedness in this patient group develops up to age 6 years and then remains stable into late adolescence. This temporal profile is consistent with mechanical stimulation of the skeleton in response to asymmetrical muscle use as handedness becomes manifest.
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Affiliation(s)
- K Siminoski
- University of Alberta, 6628-123 Street, Edmonton, Alberta, Canada T6H 3T6.
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Miettunen PM, Pistorio A, Palmisani E, Ravelli A, Silverman E, Oliveira S, Alessio M, Cuttica R, Mihaylova D, Espada G, Pasic S, Insalaco A, Ozen S, Porras O, Sztajnbok F, Lazarevic D, Martini A, Ruperto N. Therapeutic approaches for the treatment of renal disease in juvenile systemic lupus erythematosus: an international multicentre PRINTO study. Ann Rheum Dis 2012; 72:1503-9. [PMID: 23100607 DOI: 10.1136/annrheumdis-2012-201937] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To evaluate therapeutic approaches and response to therapy in juvenile systemic lupus erythematosus (SLE) with renal involvement in a large prospective international cohort from four geographic areas. METHODS New onset and flared patients with active renal disease (proteinuria ≥0.5 g/24 h) were enrolled in 2001-2004. Therapeutic approaches and disease activity parameters were analysed at baseline, 6, 12 and 24 months. Response was assessed by the PRINTO/ACR criteria. RESULTS 218/557 (79.8% female subjects, 117 new onset and 101 flared) patients with active renal disease were identified; 66 patients were lost to follow-up and 11 died. Mean age at disease onset for new onset group was higher than for flared group (13.1 vs 10.2 years, p<0.0001). At baseline, both groups had similar renal activity with similar median doses of corticosteroids (1.0-0.76 mg/kg/day). Cyclophosphamide (43.1%) and azathioprine (22%) were the most common immunosuppressive drugs. At baseline, South American patients received higher doses of corticosteroids than in other areas in new onset (median 1.16 vs 0.8-1 mg/kg/day) while cyclophosphamide use was similar in all four regions in the new onset group. There were no differences regarding the use of azathioprine or mycophenolate mofetil worldwide. PRINTO 70 response was reached in a greater percentage of new onset versus flared patients (74.8% vs 53.3%; p=0.005) at 6 months while at 24 months ACR 90 was reached by 69.9% and 56.1%, respectively. CONCLUSIONS New onset and flared juvenile SLE improved similarly over 24 months with minimal differences in therapeutic approaches worldwide.
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Affiliation(s)
- Paivi M Miettunen
- Division of Pediatric Rheumatology, University of Calgary, Alberta Children's Hospital, Calgary, Canada
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Mina R, von Scheven E, Ardoin SP, Eberhard BA, Punaro M, Ilowite N, Hsu J, Klein-Gitelman M, Moorthy LN, Muscal E, Radhakrishna SM, Wagner-Weiner L, Adams M, Blier P, Buckley L, Chalom E, Chédeville G, Eichenfield A, Fish N, Henrickson M, Hersh AO, Hollister R, Jones O, Jung L, Levy D, Lopez-Benitez J, McCurdy D, Miettunen PM, Quintero-del Rio AI, Rothman D, Rullo O, Ruth N, Schanberg LE, Silverman E, Singer NG, Soep J, Syed R, Vogler LB, Yalcindag A, Yildirim-Toruner C, Wallace CA, Brunner HI. Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2012. [PMID: 22162255 DOI: 10.1002/acr.21558.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To formulate consensus treatment plans (CTPs) for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (SLE). METHODS A structured consensus formation process was employed by the members of the Childhood Arthritis and Rheumatology Research Alliance after considering the existing medical evidence and current treatment approaches. RESULTS After an initial Delphi survey (response rate = 70%), a 2-day consensus conference, and 2 followup Delphi surveys (response rates = 63-79%), consensus was achieved for a limited set of CTPs addressing the induction therapy of proliferative LN. These CTPs were developed for prototypical patients defined by eligibility characteristics, and included immunosuppressive therapy with either mycophenolic acid orally twice per day, or intravenous cyclophosphamide once per month at standardized dosages for 6 months. Additionally, the CTPs describe 3 options for standardized use of glucocorticoids, including a primarily oral, a mixed oral/intravenous, and a primarily intravenous regimen. There was consensus on measures of effectiveness and safety of the CTPs. The CTPs were well accepted by the pediatric rheumatology providers treating children with LN, and up to 300 children per year in North America are expected to be candidates for the treatment with the CTPs. CONCLUSION CTPs for induction therapy of proliferative LN in juvenile SLE based on the available scientific evidence and pediatric rheumatology group experience have been developed. Consistent use of the CTPs may improve the prognosis of proliferative LN, and support the conduct of comparative effectiveness studies aimed at optimizing therapeutic strategies for proliferative LN in juvenile SLE.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Mina R, von Scheven E, Ardoin SP, Eberhard BA, Punaro M, Ilowite N, Hsu J, Klein-Gitelman M, Moorthy LN, Muscal E, Radhakrishna SM, Wagner-Weiner L, Adams M, Blier P, Buckley L, Chalom E, Chédeville G, Eichenfield A, Fish N, Henrickson M, Hersh AO, Hollister R, Jones O, Jung L, Levy D, Lopez-Benitez J, McCurdy D, Miettunen PM, Quintero-del Rio AI, Rothman D, Rullo O, Ruth N, Schanberg LE, Silverman E, Singer NG, Soep J, Syed R, Vogler LB, Yalcindag A, Yildirim-Toruner C, Wallace CA, Brunner HI. Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2012; 64:375-83. [PMID: 22162255 DOI: 10.1002/acr.21558] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To formulate consensus treatment plans (CTPs) for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (SLE). METHODS A structured consensus formation process was employed by the members of the Childhood Arthritis and Rheumatology Research Alliance after considering the existing medical evidence and current treatment approaches. RESULTS After an initial Delphi survey (response rate = 70%), a 2-day consensus conference, and 2 followup Delphi surveys (response rates = 63-79%), consensus was achieved for a limited set of CTPs addressing the induction therapy of proliferative LN. These CTPs were developed for prototypical patients defined by eligibility characteristics, and included immunosuppressive therapy with either mycophenolic acid orally twice per day, or intravenous cyclophosphamide once per month at standardized dosages for 6 months. Additionally, the CTPs describe 3 options for standardized use of glucocorticoids, including a primarily oral, a mixed oral/intravenous, and a primarily intravenous regimen. There was consensus on measures of effectiveness and safety of the CTPs. The CTPs were well accepted by the pediatric rheumatology providers treating children with LN, and up to 300 children per year in North America are expected to be candidates for the treatment with the CTPs. CONCLUSION CTPs for induction therapy of proliferative LN in juvenile SLE based on the available scientific evidence and pediatric rheumatology group experience have been developed. Consistent use of the CTPs may improve the prognosis of proliferative LN, and support the conduct of comparative effectiveness studies aimed at optimizing therapeutic strategies for proliferative LN in juvenile SLE.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Lang BA, Rodd C, Ramsay T, Cabral DA, Dent PB, Ellsworth JE, Houghton KM, Huber A, Jurencak R, Larché M, LeBlanc CMA, Lentle B, Matzinger M, Miettunen PM, Oen K, Roth J, Saint-Cyr C, Scuccimarri R, Shenouda N, Ward LM. Incident vertebral fractures 12 months following glucocorticoid initiation in children with rheumatic disorders. Pediatr Rheumatol Online J 2012. [PMCID: PMC3403113 DOI: 10.1186/1546-0096-10-s1-a75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Alos N, Grant RM, Ramsay T, Halton J, Cummings EA, Miettunen PM, Abish S, Atkinson S, Barr R, Cabral DA, Cairney E, Couch R, Dix DB, Fernandez CV, Hay J, Israels S, Laverdière C, Lentle B, Lewis V, Matzinger M, Rodd C, Shenouda N, Stein R, Stephure D, Taback S, Wilson B, Williams K, Rauch F, Siminoski K, Ward LM. High incidence of vertebral fractures in children with acute lymphoblastic leukemia 12 months after the initiation of therapy. J Clin Oncol 2012; 30:2760-7. [PMID: 22734031 DOI: 10.1200/jco.2011.40.4830] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Vertebral fractures due to osteoporosis are a potential complication of childhood acute lymphoblastic leukemia (ALL). To date, the incidence of vertebral fractures during ALL treatment has not been reported. PATIENT AND METHODS We prospectively evaluated 155 children with ALL during the first 12 months of leukemia therapy. Lateral thoracolumbar spine radiographs were obtained at baseline and 12 months. Vertebral bodies were assessed for incident vertebral fractures using the Genant semiquantitative method, and relevant clinical indices such as spine bone mineral density (BMD), back pain, and the presence of vertebral fractures at baseline were analyzed for association with incident vertebral fractures. RESULTS Of the 155 children, 25 (16%; 95% CI, 11% to 23%) had a total of 61 incident vertebral fractures, of which 32 (52%) were moderate or severe. Thirteen (52%) of the 25 children with incident vertebral fractures also had fractures at baseline. Vertebral fractures at baseline increased the odds of an incident fracture at 12 months by an odds ratio of 7.3 (95% CI, 2.3 to 23.1; P = .001). In addition, for every one standard deviation reduction in spine BMD Z-score at baseline, there was 1.8-fold increased odds of incident vertebral fracture at 12 months (95% CI, 1.2 to 2.7; P = .006). CONCLUSION Children with ALL have a high incidence of vertebral fractures after 12 months of chemotherapy, and the presence of vertebral fractures and reductions in spine BMD Z-scores at baseline are highly associated clinical features.
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Rodd C, Lang B, Ramsay T, Alos N, Huber AM, Cabral DA, Scuccimarri R, Miettunen PM, Roth J, Atkinson SA, Couch R, Cummings EA, Dent PB, Ellsworth J, Hay J, Houghton K, Jurencak R, Larché M, LeBlanc C, Oen K, Saint-Cyr C, Stein R, Stephure D, Taback S, Lentle B, Matzinger M, Shenouda N, Moher D, Rauch F, Siminoski K, Ward LM. Incident vertebral fractures among children with rheumatic disorders 12 months after glucocorticoid initiation: a national observational study. Arthritis Care Res (Hoboken) 2012; 64:122-31. [PMID: 22213727 DOI: 10.1002/acr.20589] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the frequency of incident vertebral fractures (IVF) 12 months after glucocorticoid (GC) initiation in children with rheumatic diseases and to identify children at higher risk. METHODS Children with rheumatic diseases initiating GC were enrolled in a prospective observational study. Annual spine radiographs were evaluated using the Genant semiquantitative method. Spine areal bone mineral density (aBMD) was measured every 6 months. Clinical features, including cumulative GC dose, back pain, disease and physical activity, calcium and vitamin D intake, and spine aBMD Z scores, were analyzed for association with IVF. RESULTS Seven (6%) of 118 children (95% confidence interval 2.9-11.7%) had IVF. Their diagnoses were: juvenile dermatomyositis (n = 2), systemic lupus erythematosus (n = 3), systemic vasculitis (n = 1), and mixed connective tissue disease (n = 1). One child was omitted from the analyses after 4 months because of osteoporosis treatment for symptomatic IVF. Children with IVF received on average 50% more GC than those without (P = 0.030), had a greater increase in body mass index (BMI) at 6 months (P = 0.010), and had greater decrements in spine aBMD Z scores in the first 6 months (P = 0.048). Four (67%) of 6 children with IVF and data to 12 months had spine aBMD Z scores less than -2.0 at 12 months compared to 16% of children without IVF (P = 0.011). CONCLUSION The incidence of VF 12 months following GC initiation was 6%; most children were asymptomatic. Children with IVF received more GC, had greater increases in BMI, and had greater declines in spine aBMD Z scores in the first 6 months.
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Affiliation(s)
- Celia Rodd
- McGill University, Montreal, Quebec, Canada
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Nigrovic PA, Mannion M, Prince FHM, Zeft A, Rabinovich CE, van Rossum MAJ, Cortis E, Pardeo M, Miettunen PM, Janow G, Birmingham J, Eggebeen A, Janssen E, Shulman AI, Son MB, Hong S, Jones K, Ilowite NT, Cron RQ, Higgins GC. Anakinra as first-line disease-modifying therapy in systemic juvenile idiopathic arthritis: report of forty-six patients from an international multicenter series. ACTA ACUST UNITED AC 2011; 63:545-55. [PMID: 21280009 DOI: 10.1002/art.30128] [Citation(s) in RCA: 318] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the safety and efficacy of the interleukin-1 (IL-1) receptor antagonist anakinra as first-line therapy for systemic juvenile idiopathic arthritis (JIA). METHODS Patients with systemic JIA receiving anakinra as part of initial disease-modifying antirheumatic drug (DMARD) therapy were identified from 11 centers in 4 countries. Medical records were abstracted using a standardized instrument, and resulting data were analyzed to characterize concomitant therapies, clinical course, adverse events, and predictors of outcome. RESULTS Among 46 patients meeting inclusion criteria, anakinra monotherapy was used in 10 patients (22%), while 67% received corticosteroids and 33% received additional DMARDs. Outcomes were evaluated at a median followup interval of 14.5 months. Fever and rash resolved within 1 month in >95% of patients, while C-reactive protein and ferritin normalized within this interval in >80% of patients. Active arthritis persisted at 1 month in 39% of patients, at 3 months in 27%, and at >6 months of followup in 11%. Approximately 60% of patients, including 8 of 10 receiving anakinra monotherapy, attained a complete response without escalation of therapy. Disease characteristics and treatment were similar in partial and complete responders, except that partial responders were markedly younger at onset (median age 5.2 years versus 10.2 years; P = 0.004). Associated adverse events included documented bacterial infection in 2 patients and hepatitis in 1 patient. Tachyphylaxis was not observed. CONCLUSION Anakinra as first-line therapy for systemic JIA was associated with rapid resolution of systemic symptoms and prevention of refractory arthritis in almost 90% of patients during the interval examined. These results justify further study of IL-1 inhibition as first-line, rather than rescue, therapy in systemic JIA.
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Affiliation(s)
- Peter A Nigrovic
- Children's Hospital Boston and Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
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Miettunen PM, Narendran A, Jayanthan A, Behrens EM, Cron RQ. Successful treatment of severe paediatric rheumatic disease-associated macrophage activation syndrome with interleukin-1 inhibition following conventional immunosuppressive therapy: case series with 12 patients. Rheumatology (Oxford) 2010; 50:417-9. [PMID: 20693540 DOI: 10.1093/rheumatology/keq218] [Citation(s) in RCA: 213] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Abstract
OBJECTIVE To determine the incidence and longitudinal trends of Wegener's granulomatosis (WG) in the pediatric population of Southern Alberta over the last 15 years. RESULTS Fifteen cases of childhood WG were confirmed. The average annual incidence was 2.75 cases/million/year, with a steep increase over the last 5 years to 6.39 cases/million/year. CONCLUSION In Southern Alberta the incidence of childhood WG during the past 15 years was comparable to the incidence reported in adults and it seems to be increasing. Further studies are required to determine if this is a regional or global phenomenon.
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Affiliation(s)
- Silviu Grisaru
- Division of Pediatric Nephrology, Department of Pediatrics, University of Calgary, Alberta, Canada.
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Miettunen PM, Hamiwka LA, Wade AW, Midgley JP, Grisaru S. Effective use of rituximab in combination with low dose cyclophosphamide in childhood onset systemic lupus erythematosus (SLE) with relapsing class IV nephritis. Pediatr Rheumatol Online J 2008. [PMCID: PMC3334042 DOI: 10.1186/1546-0096-6-s1-p237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Miettunen PM, Ortiz-Alvarez O, Petty RE, Cimaz R, Malleson PN, Cabral DA, Ensworth S, Tucker LB. Gender and ethnic origin have no effect on longterm outcome of childhood-onset systemic lupus erythematosus. J Rheumatol 2004; 31:1650-4. [PMID: 15290748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To investigate the associations of gender and ethnic origin with longterm outcome in childhood-onset systemic lupus erythematosus (SLE). METHODS The study cohort consisted of 51 patients (13 males and 38 females) with childhood-onset SLE followed for > or = 5 years at the British Columbia Children's Hospital in Vancouver. Fifteen patients were Caucasian, 14 Chinese, 9 East Indian, and 13 patients were of other ethnic backgrounds: none was African-American or Hispanic. Outcome measures assessed retrospectively included Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score (SDI), SLE-related death, need for dialysis or renal transplantation, and use of intensive immunosuppressive therapy. A SDI > or = 2 was assigned as poor outcome. RESULTS The median age at diagnosis was 10.8 years and the median duration of followup was 7.2 years. Five-year survival was 100%; 10-year survival was 85.7% (12/14 patients). The median SDI score at last followup was 2.0 (range 0-9); 2.0 for male, 1.5 for female; 2.0 for Caucasian and 2.03 for non-Caucasian patients. Twenty-six out of 51 patients (51%) had poor outcome (SDI score > 2). Three female patients required dialysis: 2 had subsequent renal transplants. Thirty patients received intensive immunosuppressive therapy. The SDI scores, mortality, and need for intensive immunosuppressive therapy were not influenced by either gender or ethnic origin. CONCLUSION The median SDI score was high for this cohort with childhood-onset SLE. In contrast to other published data, no association of male gender and/or non-Caucasian ethnicity with poor outcome was found in our study cohort.
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Affiliation(s)
- Paivi M Miettunen
- Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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Miettunen PM, Ortiz-Alvarez O, Petty RE, Cimaz R, Malleson PN, Cabral DA, Ensworth S, Tucker LB. Is it Worse to be a Boy with Systemic Lupus Erythematosus (Sle)? Effect of Sex and Ethnicity on Outcome of Childhood Onset Sle. Paediatr Child Health 2002. [DOI: 10.1093/pch/7.suppl_a.31a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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