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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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Bowers SM, Sundqvist M, Dancey P, Cabral DA, Brown KL. Pathogenic variant c.1052T>A (p.Leu351Gln) in adenosine deaminase 2 impairs secretion and elevates type I IFN responsive gene expression. Front Immunol 2022; 13:995191. [PMID: 36248868 PMCID: PMC9562767 DOI: 10.3389/fimmu.2022.995191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAdenosine deaminase 2 (ADA2) is a homodimeric, extracellular enzyme and putative growth factor that is produced by cells of the myeloid lineage and, catalytically, deaminates extracellular adenosine to inosine. Loss-of-(catalytic)-function variants in the ADA2 gene are associated with Deficiency of ADA2 (DADA2), an autosomal recessive disease associated with an unusually broad range of inflammatory manifestations including vasculitis, hematological defects and cytopenia. Previous work by our group led to the identification of ADA2 variants of novel association with DADA2, among which was a unique c.1052T>A (p.Leu351Gln; herein referred to as L351Q) variant located in the catalytic domain of the protein.MethodsMammalian (Flp-IN CHO) cells were engineered to stably express wild-type ADA2 and ADA2 protein variants, including the pathogenic L351Q variant identified in DADA2 patients. An enzyme assay and immunoblotting were used to assess ADA2 catalytic activity and secretion, respectively, and the outcome of experimentally induced inhibition of protein processing (Golgi transport and N-linked glycosylation) was assessed. Reverse transcription quantitative real-time PCR (RT-qPCR) was applied to determine the relative expression of Type I Interferon stimulated genes (ISGs), IFIT3 and IRF7.ResultsIn addition to abrogating catalytic activity, the L351Q variant impaired secretion of L351Q ADA2 resulting in an intracellular accumulation of L351Q ADA2 protein that was not observed in cells expressing wild-type ADA2 or other ADA2 protein variants. Retention of L351Q ADA2 was not attributable to impaired glycosylation on neighboring asparagine residues and did not impact cell growth or integrity. Constitutive expression of Type I ISGs IFIT3 and IRF7 was observed in cells expressing L351Q ADA2.ConclusionsThe impaired secretion of L351Q ADA2 may be an important factor leading to the severe phenotype observed in patients with this variant further emphasizing the importance of assessing impacts beyond catalytic activity when evaluating genotype-phenotype relationships in DADA2.
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Affiliation(s)
- Sarah M. Bowers
- Department of Microbiology and Immunology, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Martina Sundqvist
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
| | - Paul Dancey
- Janeway Children’s Health and Rehabilitation Centre, Saint John’s, NL, Canada
| | - David A. Cabral
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Kelly L. Brown
- British Columbia Children’s Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- *Correspondence: Kelly L. Brown,
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3
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Heale LD, Houghton KM, Rezaei E, Baxter-Jones ADG, Tupper SM, Muhajarine N, Benseler SM, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Ellsworth J, Guzman J, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Spiegel L, Stringer E, Tse SML, Tucker LB, Turvey SE, Yeung RSM, Rosenberg AM. Clinical and psychosocial stress factors are associated with decline in physical activity over time in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:97. [PMID: 34187498 PMCID: PMC8243495 DOI: 10.1186/s12969-021-00584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Physical activity (PA) patterns in children with juvenile idiopathic arthritis (JIA) over time are not well described. The aim of this study was to describe associations of physical activity (PA) with disease activity, function, pain, and psychosocial stress in the 2 years following diagnosis in an inception cohort of children with juvenile idiopathic arthritis (JIA). METHODS In 82 children with newly diagnosed JIA, PA levels, prospectively determined at enrollment, 12 and 24 months using the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) raw scores, were evaluated in relation to disease activity as reflected by arthritis activity (Juvenile Arthritis Disease Activity Score (JADAS-71)), function, pain, and psychosocial stresses using a linear mixed model approach. Results in the JIA cohort were compared to normative Pediatric Bone Mineral Accrual Study data derived from healthy children using z-scores. RESULTS At enrollment, PA z-score levels of study participants were lower than those in the normative population (median z-score - 0.356; p = 0.005). At enrollment, PA raw scores were negatively associated with the psychosocial domain of the Juvenile Arthritis Quality of Life Questionnaire (r = - 0.251; p = 0.023). There was a significant decline in PAQ-C/A raw scores from baseline (median and IQR: 2.6, 1.4-3.1) to 24 months (median and IQR: 2.1, 1.4-2.7; p = 0.003). The linear mixed-effect model showed that PAQ-C/A raw scores in children with JIA decreased as age, disease duration, and ESR increased. The PAQ-C/A raw scores of the participants was also negatively influenced by an increase in disease activity as measured by the JADAS-71 (p < 0.001). CONCLUSION Canadian children with newly diagnosed JIA have lower PA levels than healthy children. The decline in PA levels over time was associated with disease activity and higher disease-specific psychosocial stress.
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Affiliation(s)
- Liane D. Heale
- grid.422356.40000 0004 0634 5667McMaster Children’s Hospital and McMaster University, Hamilton, Canada
| | - Kristin M. Houghton
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Elham Rezaei
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | | | - Susan M. Tupper
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Nazeem Muhajarine
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Susanne M. Benseler
- grid.413571.50000 0001 0684 7358Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Gilles Boire
- grid.86715.3d0000 0000 9064 6198Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie– Centre Hospitalier Universitaire de Santé (CIUSSS de l’Estrie-CHUS) and University of Sherbrooke, Sherbrooke, Canada
| | - David A. Cabral
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Sarah Campillo
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Gaëlle Chédeville
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Anne-Laure Chetaille
- grid.411081.d0000 0000 9471 1794le Centre Hospitalier Universitaire de Quebec, Quebec, Canada
| | - Paul Dancey
- grid.477424.60000 0004 0640 6407Janeway Children’s Health and Rehabilitation Centre and Memorial University, St. John’s, Canada
| | - Ciaran Duffy
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Karen Watanabe Duffy
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Janet Ellsworth
- grid.416656.60000 0004 0633 3703Stollery Children’s Hospital and University of Alberta, Edmonton, Canada
| | - Jaime Guzman
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Adam M. Huber
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Roman Jurencak
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Bianca Lang
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Ronald M. Laxer
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kimberly Morishita
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Kiem G. Oen
- grid.413983.4The Children’s Hospital of Winnipeg and University of Manitoba, Winnipeg, Canada
| | - Ross E. Petty
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Suzanne E. Ramsey
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Johannes Roth
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Rayfel Schneider
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Rosie Scuccimarri
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Lynn Spiegel
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Elizabeth Stringer
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Shirley M. L. Tse
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Lori B. Tucker
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Stuart E. Turvey
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Rae S. M. Yeung
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Alan M. Rosenberg
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
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4
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Finch SL, Rosenberg AM, Kusalik AJ, Maleki F, Rezaei E, Baxter-Jones A, Benseler S, Boire G, Cabral D, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Stringer E, Tse SML, Tucker LB, Turvey SE, Szafron M, Whiting S, Yeung RS, Vatanparast H. Higher concentrations of vitamin D in Canadian children with juvenile idiopathic arthritis compared to healthy controls are associated with more frequent use of vitamin D supplements and season of birth. Nutr Res 2021; 92:139-149. [PMID: 34311227 DOI: 10.1016/j.nutres.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/05/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
A number of studies have demonstrated that patients with autoimmune disease have lower levels of vitamin D prompting speculation that vitamin D might suppress inflammation and immune responses in children with juvenile idiopathic arthritis (JIA). The objective of this study was to compare vitamin D levels in children with JIA at disease onset with healthy children. We hypothesized that children and adolescents with JIA have lower vitamin D levels than healthy children and adolescents. Data from a Canadian cohort of children with new-onset JIA (n= 164, data collection 2007-2012) were compared to Canadian Health Measures Survey (CHMS) data (n=4027, data collection 2007-2011). We compared 25-hydroxy vitamin D (25(OH)D) concentrations with measures of inflammation, vitamin D supplement use, milk intake, and season of birth. Mean 25(OH)D level was significantly higher in patients with JIA (79 ± 3.1 nmol/L) than in healthy controls (68 ± 1.8 nmol/L P <.05). Patients with JIA more often used vitamin D containing supplements (50% vs. 7%; P <.05). The prevalence of 25(OH)D deficiency (<30 nmol/L) was 6% for both groups. Children with JIA with 25(OH)D deficiency or insufficiency (<50 nmol/L) had higher C-reactive protein levels. Children with JIA were more often born in the fall and winter compared to healthy children. In contrast to earlier studies, we found vitamin D levels in Canadian children with JIA were higher compared to healthy children and associated with more frequent use of vitamin D supplements. Among children with JIA, low vitamin D levels were associated with indicators of greater inflammation.
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Affiliation(s)
- Sarah L Finch
- University of Saskatchewan, Saskatoon, Canada; University of Prince Edward Island, Charlottetown, Canada
| | | | | | | | | | | | - Susanne Benseler
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - David Cabral
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | | | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre, St. John's, Canada
| | - Ciaran Duffy
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Jaime Guzman
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Kristin Houghton
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | | | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Ron M Laxer
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Kimberly Morishita
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Kiem G Oen
- University of Manitoba, Winnipeg, Canada
| | - Ross E Petty
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | - Johannes Roth
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Rayfel Schneider
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | | | | | - Shirley M L Tse
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Lori B Tucker
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Stuart E Turvey
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | | | - Rae Sm Yeung
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
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5
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Rezaei E, Hogan D, Trost B, Kusalik AJ, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Watanabe Duffy K, Gordon J, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Morishita K, Oen KG, Petty RE, Ramsey SE, Scuccimarri R, Spiegel L, Stringer E, Taylor-Gjevre RM, Tse SML, Tucker LB, Turvey SE, Tupper S, Yeung RSM, Benseler S, Ellsworth J, Guillet C, Karananayake C, Muhajarine N, Roth J, Schneider R, Rosenberg AM. Clinical and associated inflammatory biomarker features predictive of short-term outcomes in non-systemic juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 59:2402-2411. [PMID: 31919503 DOI: 10.1093/rheumatology/kez615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To identify early predictors of disease activity at 18 months in JIA using clinical and biomarker profiling. METHODS Clinical and biomarker data were collected at JIA diagnosis in a prospective longitudinal inception cohort of 82 children with non-systemic JIA, and their ability to predict an active joint count of 0, a physician global assessment of disease activity of ≤1 cm, and inactive disease by Wallace 2004 criteria 18 months later was assessed. Correlation-based feature selection and ReliefF were used to shortlist predictors and random forest models were trained to predict outcomes. RESULTS From the original 112 features, 13 effectively predicted 18-month outcomes. They included age, number of active/effused joints, wrist, ankle and/or knee involvement, ESR, ANA positivity and plasma levels of five inflammatory biomarkers (IL-10, IL-17, IL-12p70, soluble low-density lipoprotein receptor-related protein 1 and vitamin D), at enrolment. The clinical plus biomarker panel predicted active joint count = 0, physician global assessment ≤ 1, and inactive disease after 18 months with 0.79, 0.80 and 0.83 accuracy and 0.84, 0.83, 0.88 area under the curve, respectively. Using clinical features alone resulted in 0.75, 0.72 and 0.80 accuracy, and area under the curve values of 0.81, 0.78 and 0.83, respectively. CONCLUSION A panel of five plasma biomarkers combined with clinical features at the time of diagnosis more accurately predicted short-term disease activity in JIA than clinical characteristics alone. If validated in external cohorts, such a panel may guide more rationally conceived, biologically based, personalized treatment strategies in early JIA.
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Affiliation(s)
- Elham Rezaei
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
| | - Daniel Hogan
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Brett Trost
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Anthony J Kusalik
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Gilles Boire
- Département de Médecine, Université de Sherbrooke, Sherbrooke, QCCanada
| | - David A Cabral
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Sarah Campillo
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Gaëlle Chédeville
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Anne-Laure Chetaille
- Département de Médecine le, Centre Hospitalier Universitaire de Quebec, Quebec, QCCanada
| | - Paul Dancey
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St John's, NLCanada
| | - Ciaran Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Karen Watanabe Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - John Gordon
- Department of Medicine, University of Saskatchewan, Saskatoon, SKCanada
| | - Jaime Guzman
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Kristin Houghton
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Adam M Huber
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Roman Jurencak
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Bianca Lang
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Kimberly Morishita
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Kiem G Oen
- Department of Pediatrics, University of Manitoba, Winnipeg, MBCanada
| | - Ross E Petty
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Suzanne E Ramsey
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Rosie Scuccimarri
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Lynn Spiegel
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Elizabeth Stringer
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | | | - Shirley M L Tse
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Lori B Tucker
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Stuart E Turvey
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Susan Tupper
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
| | - Rae S M Yeung
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Susanne Benseler
- Department of Pediatrics, University of Calgary, Calgary, ABCanada
| | - Janet Ellsworth
- Department of Pediatrics, University of Alberta, Edmonton, ABCanada
| | - Chantal Guillet
- Department of Pediatrics, Hôpital Fleurimont (CHUS), Quebec, QCCanada
| | | | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Johannes Roth
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Rayfel Schneider
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Alan M Rosenberg
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
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6
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de Jesus AA, Hou Y, Brooks S, Malle L, Biancotto A, Huang Y, Calvo KR, Marrero B, Moir S, Oler AJ, Deng Z, Montealegre Sanchez GA, Ahmed A, Allenspach E, Arabshahi B, Behrens E, Benseler S, Bezrodnik L, Bout-Tabaku S, Brescia AC, Brown D, Burnham JM, Caldirola MS, Carrasco R, Chan AY, Cimaz R, Dancey P, Dare J, DeGuzman M, Dimitriades V, Ferguson I, Ferguson P, Finn L, Gattorno M, Grom AA, Hanson EP, Hashkes PJ, Hedrich CM, Herzog R, Horneff G, Jerath R, Kessler E, Kim H, Kingsbury DJ, Laxer RM, Lee PY, Lee-Kirsch MA, Lewandowski L, Li S, Lilleby V, Mammadova V, Moorthy LN, Nasrullayeva G, O'Neil KM, Onel K, Ozen S, Pan N, Pillet P, Piotto DG, Punaro MG, Reiff A, Reinhardt A, Rider LG, Rivas-Chacon R, Ronis T, Rösen-Wolff A, Roth J, Ruth NM, Rygg M, Schmeling H, Schulert G, Scott C, Seminario G, Shulman A, Sivaraman V, Son MB, Stepanovskiy Y, Stringer E, Taber S, Terreri MT, Tifft C, Torgerson T, Tosi L, Van Royen-Kerkhof A, Wampler Muskardin T, Canna SW, Goldbach-Mansky R. Distinct interferon signatures and cytokine patterns define additional systemic autoinflammatory diseases. J Clin Invest 2020; 130:1669-1682. [PMID: 31874111 DOI: 10.1172/jci129301] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUNDUndifferentiated systemic autoinflammatory diseases (USAIDs) present diagnostic and therapeutic challenges. Chronic interferon (IFN) signaling and cytokine dysregulation may identify diseases with available targeted treatments.METHODSSixty-six consecutively referred USAID patients underwent underwent screening for the presence of an interferon signature using a standardized type-I IFN-response-gene score (IRG-S), cytokine profiling, and genetic evaluation by next-generation sequencing.RESULTSThirty-six USAID patients (55%) had elevated IRG-S. Neutrophilic panniculitis (40% vs. 0%), basal ganglia calcifications (46% vs. 0%), interstitial lung disease (47% vs. 5%), and myositis (60% vs. 10%) were more prevalent in patients with elevated IRG-S. Moderate IRG-S elevation and highly elevated serum IL-18 distinguished 8 patients with pulmonary alveolar proteinosis (PAP) and recurrent macrophage activation syndrome (MAS). Among patients with panniculitis and progressive cytopenias, 2 patients were compound heterozygous for potentially novel LRBA mutations, 4 patients harbored potentially novel splice variants in IKBKG (which encodes NF-κB essential modulator [NEMO]), and 6 patients had de novo frameshift mutations in SAMD9L. Of additional 12 patients with elevated IRG-S and CANDLE-, SAVI- or Aicardi-Goutières syndrome-like (AGS-like) phenotypes, 5 patients carried mutations in either SAMHD1, TREX1, PSMB8, or PSMG2. Two patients had anti-MDA5 autoantibody-positive juvenile dermatomyositis, and 7 could not be classified. Patients with LRBA, IKBKG, and SAMD9L mutations showed a pattern of IRG elevation that suggests prominent NF-κB activation different from the canonical interferonopathies CANDLE, SAVI, and AGS.CONCLUSIONSIn patients with elevated IRG-S, we identified characteristic clinical features and 3 additional autoinflammatory diseases: IL-18-mediated PAP and recurrent MAS (IL-18PAP-MAS), NEMO deleted exon 5-autoinflammatory syndrome (NEMO-NDAS), and SAMD9L-associated autoinflammatory disease (SAMD9L-SAAD). The IRG-S expands the diagnostic armamentarium in evaluating USAIDs and points to different pathways regulating IRG expression.TRIAL REGISTRATIONClinicalTrials.gov NCT02974595.FUNDINGThe Intramural Research Program of the NIH, NIAID, NIAMS, and the Clinical Center.
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Affiliation(s)
- Adriana A de Jesus
- Translational Autoinflammatory Diseases Section (TADS), NIAID/NIH, Bethesda, Maryland, USA
| | - Yangfeng Hou
- Department of Rheumatology, Shandong Provincial Qianfoshan Hospital, Shandong University, Shandong, China
| | - Stephen Brooks
- Biomining and Discovery Section, NIAMS/NIH, Bethesda, Maryland, USA
| | - Louise Malle
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Angelique Biancotto
- Immunology & Inflammation Research Therapeutic Area, Sanofi, Boston, Massachusetts, USA
| | - Yan Huang
- Translational Autoinflammatory Diseases Section (TADS), NIAID/NIH, Bethesda, Maryland, USA
| | - Katherine R Calvo
- Department of Laboratory Medicine (DLM), Clinical Center/NIH, Bethesda, Maryland, USA
| | | | | | - Andrew J Oler
- Bioinformatics and Computational Biosciences Branch (BCBB), Office of Cyber Infrastructure and Computational Biology (OCICB), NIAID/NIH, Bethesda, Maryland, USA
| | - Zuoming Deng
- Biomining and Discovery Section, NIAMS/NIH, Bethesda, Maryland, USA
| | | | - Amina Ahmed
- The Autoinflammatory Diseases Consortium.,Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Eric Allenspach
- The Autoinflammatory Diseases Consortium.,Divisions of Immunology & Rheumatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Bita Arabshahi
- The Autoinflammatory Diseases Consortium.,Virginia Commonwealth University & Pediatric Specialists of Virginia, Fairfax, Virginia, USA
| | - Edward Behrens
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susanne Benseler
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, Pediatric Rheumatology Section, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Liliana Bezrodnik
- The Autoinflammatory Diseases Consortium.,Immunology Unit, Pediatric Hospital R. Gutierrez, Buenos Aires, Argentina
| | - Sharon Bout-Tabaku
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Medicine, Sidra Medicine, Qatar Foundation, Doha, Qatar
| | - AnneMarie C Brescia
- The Autoinflammatory Diseases Consortium.,Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Diane Brown
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital Los Angeles & USC, Los Angeles, California, USA
| | - Jon M Burnham
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria Soledad Caldirola
- The Autoinflammatory Diseases Consortium.,Immunology Unit, Pediatric Hospital R. Gutierrez, Buenos Aires, Argentina
| | - Ruy Carrasco
- The Autoinflammatory Diseases Consortium.,Pediatric Rheumatology, Dell Children's Medical Center of Central Texas, Austin, Texas, USA
| | - Alice Y Chan
- The Autoinflammatory Diseases Consortium.,Divisions of Pediatric AIBMT & Rheumatology, UCSF, San Francisco, California, USA
| | - Rolando Cimaz
- The Autoinflammatory Diseases Consortium.,Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Paul Dancey
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Janeway Children's Hospital & Rehabilitation Centre, Saint John's, Newfoundland and Labrador, Canada
| | - Jason Dare
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Marietta DeGuzman
- The Autoinflammatory Diseases Consortium.,Department of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, Texas, USA
| | - Victoria Dimitriades
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Allergy, Immunology & Rheumatology, UC Davis Health, Sacramento, California, USA
| | - Ian Ferguson
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics/Pediatric Rheumatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Polly Ferguson
- The Autoinflammatory Diseases Consortium.,Pediatrics Department, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Laura Finn
- The Autoinflammatory Diseases Consortium.,Pathology Department, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Marco Gattorno
- The Autoinflammatory Diseases Consortium.,Center for Autoinflammatory Diseases and Immunedeficiencies, IRCCS Giannina Gaslini, Genoa, Italy
| | - Alexei A Grom
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Eric P Hanson
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Philip J Hashkes
- The Autoinflammatory Diseases Consortium.,Pediatric Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Christian M Hedrich
- The Autoinflammatory Diseases Consortium.,Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool & Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom
| | - Ronit Herzog
- The Autoinflammatory Diseases Consortium.,Department of Otolaryngology, Division of Allergy and Immunology, New York University, New York, New York, USA
| | - Gerd Horneff
- The Autoinflammatory Diseases Consortium.,Asklepios Klinik Sankt, Augustin GmbH, St. Augustin, Germany and Department of Pediatric and Adolescents Medicine, University of Cologne, Cologne, Germany
| | - Rita Jerath
- The Autoinflammatory Diseases Consortium.,Augusta University Medical Center, Augusta, Georgia, USA
| | - Elizabeth Kessler
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Mercy, Kansas City and University of Missouri, Kansas City, Missouri, USA
| | - Hanna Kim
- The Autoinflammatory Diseases Consortium.,Pediatric Translational Research Branch, NIAMS/NIH, Bethesda, Maryland, USA
| | - Daniel J Kingsbury
- The Autoinflammatory Diseases Consortium.,Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA
| | - Ronald M Laxer
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pui Y Lee
- The Autoinflammatory Diseases Consortium.,Division of Allergy, Immunology and Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Min Ae Lee-Kirsch
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Laura Lewandowski
- The Autoinflammatory Diseases Consortium.,Systemic Autoimmunity Branch, NIAMS/NIH, Bethesda, Maryland, USA
| | - Suzanne Li
- The Autoinflammatory Diseases Consortium.,Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Vibke Lilleby
- The Autoinflammatory Diseases Consortium.,Department of Rheumatology, Pediatric Section, Oslo University Hospital, Oslo, Norway
| | - Vafa Mammadova
- The Autoinflammatory Diseases Consortium.,Azerbaijan Medical University, Baku, Azerbaijan
| | - Lakshmi N Moorthy
- The Autoinflammatory Diseases Consortium.,Rutgers - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gulnara Nasrullayeva
- The Autoinflammatory Diseases Consortium.,Azerbaijan Medical University, Baku, Azerbaijan
| | - Kathleen M O'Neil
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Karen Onel
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, Weill Cornell Medicine & Hospital for Special Surgery, New York, New York, USA
| | - Seza Ozen
- The Autoinflammatory Diseases Consortium.,Hacettepe University, Department of Pediatrics, Ankara, Turkey
| | - Nancy Pan
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, Weill Cornell Medicine & Hospital for Special Surgery, New York, New York, USA
| | - Pascal Pillet
- The Autoinflammatory Diseases Consortium.,Children Hospital Pellegrin-Enfants, Bordeaux, France
| | - Daniela Gp Piotto
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marilynn G Punaro
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andreas Reiff
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital Los Angeles, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Adam Reinhardt
- The Autoinflammatory Diseases Consortium.,University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Lisa G Rider
- The Autoinflammatory Diseases Consortium.,Environmental Autoimmunity Group, NIEHS/NIH, Bethesda, Maryland, USA
| | - Rafael Rivas-Chacon
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Rheumatology, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Tova Ronis
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, Children's National Health System, Washington, DC, USA
| | - Angela Rösen-Wolff
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Johannes Roth
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Natasha Mckerran Ruth
- The Autoinflammatory Diseases Consortium.,Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marite Rygg
- The Autoinflammatory Diseases Consortium.,Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, and Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - Heinrike Schmeling
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, Pediatric Rheumatology Section, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Grant Schulert
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christiaan Scott
- The Autoinflammatory Diseases Consortium.,University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Gisella Seminario
- The Autoinflammatory Diseases Consortium.,Immunology Unit, Pediatric Hospital R. Gutierrez, Buenos Aires, Argentina
| | - Andrew Shulman
- The Autoinflammatory Diseases Consortium.,Pediatric Rheumatology, Children's Hospital of Orange County, UC Irvine, Irvine, California, USA
| | - Vidya Sivaraman
- The Autoinflammatory Diseases Consortium.,Section of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mary Beth Son
- The Autoinflammatory Diseases Consortium.,Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yuriy Stepanovskiy
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Infectious Diseases and Immunology, Shupyk National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - Elizabeth Stringer
- The Autoinflammatory Diseases Consortium.,IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Taber
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, Department of Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Maria Teresa Terreri
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Cynthia Tifft
- The Autoinflammatory Diseases Consortium.,Undiagnosed Diseases Program, NHGRI/NIH, Bethesda, Maryland, USA
| | - Troy Torgerson
- The Autoinflammatory Diseases Consortium.,Divisions of Immunology & Rheumatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Laura Tosi
- The Autoinflammatory Diseases Consortium.,Bone Health Program, Children's National Health System, Washington, DC, USA
| | - Annet Van Royen-Kerkhof
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital Utrecht, Utrecht, Netherlands
| | - Theresa Wampler Muskardin
- The Autoinflammatory Diseases Consortium.,New York University School of Medicine, New York, New York, USA
| | - Scott W Canna
- Children's Hospital Pittsburgh, Pittsburgh, Pennsylvania, USA
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7
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Rezaei E, Newkirk MM, Li Z, Gordon JR, Oen KG, Benseler SM, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Houghton K, Huber AM, Jurencak R, Lang B, Morishita KA, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Spiegel L, Stringer E, Tse SML, Tucker LB, Turvey SE, Yeung RSM, Rosenberg AM. Soluble Low-density Lipoprotein Receptor-related Protein 1 in Juvenile Idiopathic Arthritis. J Rheumatol 2020; 48:760-766. [PMID: 33060303 DOI: 10.3899/jrheum.200391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to expand knowledge about soluble low-density lipoprotein receptor-related protein 1 (sLRP1) in juvenile idiopathic arthritis (JIA) by determining associations of sLRP1 levels in nonsystemic JIA patients with clinical and inflammatory biomarker indicators of disease activity. METHODS Plasma sLRP1 and 44 inflammation-related biomarkers were measured at enrollment and 6 months later in a cohort of 96 newly diagnosed Canadian patients with nonsystemic JIA. Relationships between sLRP1 levels and indicators of disease activity and biomarker levels were analyzed at both visits. RESULTS At enrollment, sLRP1 levels correlated negatively with age and active joint counts. Children showed significantly higher levels of sLRP1 than adolescents (mean ranks: 55.4 and 41.9, respectively; P = 0.02). Participants with 4 or fewer active joints, compared to those with 5 or more active joints, had significantly higher sLRP1 levels (mean ranks: 56.2 and 40.7, respectively; P = 0.006). At enrollment, considering the entire cohort, sLRP1 correlated negatively with the number of active joints (r = -0.235, P = 0.017). In the entire cohort, sLRP1 levels at enrollment and 6 months later correlated with 13 and 6 pro- and antiinflammatory biomarkers, respectively. In JIA categories, sLRP1 correlations with inflammatory markers were significant in rheumatoid factor-negative polyarticular JIA, oligoarticular JIA, enthesitis-related arthritis, and psoriatic arthritis at enrollment. Higher sLRP1 levels at enrollment increased the likelihood of absence of active joints 6 months later. CONCLUSION Plasma sLRP1 levels correlate with clinical and biomarker indicators of short-term improvement in JIA disease activity, supporting sLRP1 as an upstream biomarker of potential utility for assessing JIA disease activity and outcome prediction.
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Affiliation(s)
- Elham Rezaei
- E. Rezaei, MD, PhD, A.M. Rosenberg, MD, Departments of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Marianna M Newkirk
- M.M. Newkirk, PhD, Department of Medicine, McGill University Health Center, Montreal, Quebec
| | - Zhenhong Li
- Z. Li, MSc, RC-CHUM, University of Montreal, Montreal, Quebec
| | - John R Gordon
- J.R. Gordon, PhD, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kiem G Oen
- K.G. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Susanne M Benseler
- S.M. Benseler, MD, PhD, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta
| | - Gilles Boire
- G. Boire, MD, Département de Médecine, Université de Sherbrooke, Sherbrooke, Quebec
| | - David A Cabral
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Sarah Campillo
- S. Campillo, MD, G. Chédeville, MD, R. Scuccimarri, MD, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Gaëlle Chédeville
- S. Campillo, MD, G. Chédeville, MD, R. Scuccimarri, MD, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Anne-Laure Chetaille
- A.L. Chetaille, MD, Département de Médecine le Centre Hospitalier Universitaire de Quebec, Quebec City, Quebec
| | - Paul Dancey
- P. Dancey, MD, Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland
| | - Ciaran Duffy
- C. Duffy, MD, R. Jurencak, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Karen Watanabe Duffy
- K. Watanabe Duffy, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Kristin Houghton
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Adam M Huber
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Roman Jurencak
- C. Duffy, MD, R. Jurencak, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Bianca Lang
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Kimberly A Morishita
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Ross E Petty
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Suzanne E Ramsey
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Johannes Roth
- J. Roth, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario
| | - Rayfel Schneider
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rosie Scuccimarri
- S. Campillo, MD, G. Chédeville, MD, R. Scuccimarri, MD, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Lynn Spiegel
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Stringer
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Shirley M L Tse
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lori B Tucker
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Stuart E Turvey
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Rae S M Yeung
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alan M Rosenberg
- E. Rezaei, MD, PhD, A.M. Rosenberg, MD, Departments of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan;
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8
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Rezaei E, Hogan D, Trost B, Kusalik AJ, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Eng SWM, Gordon J, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Scherer SW, Scuccimarri R, Spiegel L, Stringer E, Taylor-Gjevre RM, Tse SML, Tucker LB, Turvey SE, Tupper S, Wintle RF, Yeung RSM, Rosenberg AM. Associations of clinical and inflammatory biomarker clusters with juvenile idiopathic arthritis categories. Rheumatology (Oxford) 2020; 59:1066-1075. [PMID: 32321162 DOI: 10.1093/rheumatology/kez382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/30/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify discrete clusters comprising clinical features and inflammatory biomarkers in children with JIA and to determine cluster alignment with JIA categories. METHODS A Canadian prospective inception cohort comprising 150 children with JIA was evaluated at baseline (visit 1) and after six months (visit 2). Data included clinical manifestations and inflammation-related biomarkers. Probabilistic principal component analysis identified sets of composite variables, or principal components, from 191 original variables. To discern new clinical-biomarker clusters (clusters), Gaussian mixture models were fit to the data. Newly-defined clusters and JIA categories were compared. Agreement between the two was assessed using Kruskal-Wallis analyses and contingency plots. RESULTS Three principal components recovered 35% (three clusters) and 40% (five clusters) of the variance in patient profiles in visits 1 and 2, respectively. None of the clusters aligned precisely with any of the seven JIA categories but rather spanned multiple categories. Results demonstrated that the newly defined clinical-biomarker lustres are more homogeneous than JIA categories. CONCLUSION Applying unsupervised data mining to clinical and inflammatory biomarker data discerns discrete clusters that intersect multiple JIA categories. Results suggest that certain groups of patients within different JIA categories are more aligned pathobiologically than their separate clinical categorizations suggest. Applying data mining analyses to complex datasets can generate insights into JIA pathogenesis and could contribute to biologically based refinements in JIA classification.
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Affiliation(s)
- Elham Rezaei
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Daniel Hogan
- Department of Computer Sciences, University of Saskatchewan
| | - Brett Trost
- Department of Computer Sciences, University of Saskatchewan
| | | | - Gilles Boire
- Département de Médecine, Université de Sherbrooke, Sherbrooke
| | - David A Cabral
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Sarah Campillo
- Department of Pediatrics, McGill University Health Center, Montreal
| | | | | | - Paul Dancey
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's
| | - Ciaran Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa
| | | | - Simon W M Eng
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - John Gordon
- Department of Medicine, University of Saskatchewan
| | - Jaime Guzman
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Kristin Houghton
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Adam M Huber
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | - Roman Jurencak
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa
| | - Bianca Lang
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | - Ronald M Laxer
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Kimberly Morishita
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Kiem G Oen
- Department of Pediatrics, University of Manitoba, Winnipeg
| | - Ross E Petty
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Suzanne E Ramsey
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | | | | | - Lynn Spiegel
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Elizabeth Stringer
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | | | - Shirley M L Tse
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Lori B Tucker
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Stuart E Turvey
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Susan Tupper
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | | | - Rae S M Yeung
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Alan M Rosenberg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
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Stinson JN, Lalloo C, Hundert AS, Campillo S, Cellucci T, Dancey P, Duffy C, Ellsworth J, Feldman BM, Huber AM, Johnson N, Jong G, Oen K, Rosenberg AM, Shiff NJ, Spiegel L, Tse SML, Tucker L, Victor JC. Teens Taking Charge: A Randomized Controlled Trial of a Web-Based Self-Management Program With Telephone Support for Adolescents With Juvenile Idiopathic Arthritis. J Med Internet Res 2020; 22:e16234. [PMID: 32723728 PMCID: PMC7424488 DOI: 10.2196/16234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/03/2020] [Accepted: 02/03/2020] [Indexed: 11/22/2022] Open
Abstract
Background Juvenile idiopathic arthritis (JIA) is a serious and potentially debilitating pediatric illness. Improved disease self-management may help to improve health outcomes. Objective This study aimed to evaluate the effectiveness of the Teens Taking Charge Web-based self-management intervention in reducing symptoms and improving health-related quality of life (HRQL) in adolescents with JIA compared with a Web-based education control condition. Methods Adolescents with JIA aged 12 to 18 years were recruited from 11 Canadian pediatric rheumatology centers. Caregivers were invited to participate along with their child. In addition to standard medical care, participants were randomized to receive either (1) the Teens Taking Charge self-management intervention or (2) a Web-based education control condition for a period of 12 weeks. Adolescents in the intervention group completed website modules addressing cognitive behavioral coping skills, stress management, and other self-management topics, while also receiving monthly telephone calls from a trained health coach. Adolescents in the education control group were instructed to view a series of preselected public JIA educational websites and received monthly calls from a coach who asked about their own best efforts at managing JIA. Caregivers in the intervention group completed website modules related to promoting independence and disease self-management in their child. Caregivers in the education control group were instructed to view a series of preselected public JIA educational websites. Outcome assessment occurred at baseline, 12 weeks (posttreatment), and at 6 and 12 months postrandomization. The primary outcomes were pain intensity, pain interference, and HRQL. Secondary outcomes were emotional symptoms, adherence, coping, knowledge, and self-efficacy. Results In total, 333 adolescents and 306 caregivers were enrolled. Significant overall reductions in pain intensity (P=.02) and pain interference (P=.007) were observed for intervention group participants compared with those in the education control group, after adjusting for baseline levels. There was a significant overall improvement in HRQL related to problems with pain (P=.02) and problems with daily activities (P=.01). There was also a significant difference in the intervention group over time (P=.008) for HRQL related to treatment problems, with the intervention group participants demonstrating improved HRQL by 12 months compared with education control group participants. Both groups showed nonsignificant improvements compared with baseline in other primary outcomes. There were no significant differences between the groups in any secondary outcomes or caregiver-reported outcomes. Conclusions The results of this randomized trial suggest that the Teens Taking Charge Web-based intervention is effective at reducing both pain intensity and pain interference, as well as improving HRQL in adolescents with JIA, compared with education control. These effects are sustained for up to 12 months following program completion. The Teens Taking Charge program is now publicly available at no cost. Trial Registration ClinicalTrials.gov NCT01572896; https://clinicaltrials.gov/ct2/show/NCT01572896
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Affiliation(s)
| | - Chitra Lalloo
- The Hospital for Sick Children, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - Tania Cellucci
- Department of Pediatrics, Division of Rheumatology, McMaster University, Hamilton, ON, Canada
| | - Paul Dancey
- Department of Pediatrics, Division of Rheumatology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Ciaran Duffy
- Department of Pediatrics, Division of Rheumatology, McGill Research Institute, Montreal, QC, Canada
| | - Janet Ellsworth
- Department of Pediatrics, Division of Rheumatology, University of Alberta, Edmonton, AB, Canada
| | | | | | | | - Geert't Jong
- Children's Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
| | - Kiem Oen
- Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - Natalie J Shiff
- Biobehavioral Nursing Science, University of Florida, Gainesville, FL, United States
| | | | | | - Lori Tucker
- Department of Pediatrics, Division of Rheumatology, University of British Columbia, Vancouver, ON, Canada
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10
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Chhabra A, Oen K, Huber AM, Shiff NJ, Boire G, Benseler SM, Berard RA, Scuccimarri R, Feldman BM, Lim LSH, Barsalou J, Bruns A, Cabral DA, Chédeville G, Ellsworth J, Houghton K, Lang B, Morishita K, Rumsey DG, Rosenberg AM, Tse SM, Watanabe Duffy K, Duffy CM, Guzman J, Bolaria R, Gross K, Turvey SE, Chan M, Tucker LB, Petty R, Johnson N, Luca N, Miettunen P, Schmeling H, Gerhold K, Larché M, Levy DM, Laxer RM, Feldman D, Spiegel L, Schneider R, Silverman E, Cameron B, Yeung RSM, Roth J, Jurencak R, Gibbon M, Chetaille A, Dorval J, Campillo S, LeBlanc C, Chédeville G, Haddad E, Cyr CS, Ramsey SE, Stringer E, Dancey P. Real‐World Effectiveness of Common Treatment Strategies for Juvenile Idiopathic Arthritis: Results From a Canadian Cohort. Arthritis Care Res (Hoboken) 2020; 72:897-906. [DOI: 10.1002/acr.23922] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/26/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Amieleena Chhabra
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Kiem Oen
- University of Manitoba Winnipeg Manitoba Canada
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University Halifax Nova Scotia Canada
| | - Natalie J. Shiff
- Shands Children's Hospital and University of Florida Gainesville
| | - Gilles Boire
- Centre intégré universitaire de santé et de services sociaux de l'EstrieCentre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke Sherbrooke Quebec Canada
| | - Susanne M. Benseler
- Alberta Children's Hospital and University of Calgary Calgary Alberta Canada
| | - Roberta A. Berard
- London Health Sciences Centre and Western University London Ontario Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University Montreal Quebec Canada
| | - Brian M. Feldman
- Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | | | - Julie Barsalou
- Centre hospitalier universitaire Sainte‐Justine and Université de Montréal Montreal Quebec Canada
| | - Alessandra Bruns
- Centre intégré universitaire de santé et de services sociaux de l'EstrieCentre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke Sherbrooke Quebec Canada
| | - David A. Cabral
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University Montreal Quebec Canada
| | - Janet Ellsworth
- Stollery Children's Hospital and University of Alberta Edmonton Alberta Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University Halifax Nova Scotia Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Dax G. Rumsey
- Stollery Children's Hospital and University of Alberta Edmonton Alberta Canada
| | - Alan M. Rosenberg
- Royal University Hospital and University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Shirley M. Tse
- Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa Ottawa Ontario Canada
| | - Ciaran M. Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa Ottawa Ontario Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
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11
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Rumsey DG, Guzman J, Rosenberg AM, Huber AM, Scuccimarri R, Shiff NJ, Bruns A, Feldman BM, Eurich DT, Benseler S, Berard R, Boire G, Bolaria R, Cabral D, Cameron B, Campillo S, Chan M, Chédeville G, Chetaille A, Dancey P, Dorval J, Duffy C, Ellsworth J, Feldman D, Gross K, Haddad E, Houghton K, Johnson N, Jurencak R, Lang B, Larché M, Laxer R, LeBlanc C, Levy D, Luca N, Miettunen P, Morishita K, Oen K, Petty R, Ramsey S, Roth J, Saint‐Cyr C, Schmeling H, Schneider R, Silverman E, Spiegel L, Stringer E, Tse S, Tucker L, Turvey S, Watanabe Duffy K, Yeung R. Worse Quality of Life, Function, and Pain in Children With Enthesitis, Irrespective of Their Juvenile Arthritis Category. Arthritis Care Res (Hoboken) 2020; 72:441-446. [DOI: 10.1002/acr.23844] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/05/2019] [Indexed: 11/07/2022]
Affiliation(s)
| | - Jaime Guzman
- University of British Columbia Vancouver British Columbia Canada
| | | | | | | | | | | | - Brian M. Feldman
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
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12
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Gibson KM, Morishita KA, Dancey P, Moorehead P, Drögemöller B, Han X, Graham J, Hancock REW, Foell D, Benseler S, Luqmani R, Yeung RSM, Shenoi S, Bohm M, Rosenberg AM, Ross CJ, Cabral DA, Brown KL. Identification of Novel Adenosine Deaminase 2 Gene Variants and Varied Clinical Phenotype in Pediatric Vasculitis. Arthritis Rheumatol 2019; 71:1747-1755. [PMID: 31008556 DOI: 10.1002/art.40913] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 04/16/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with deficiency of adenosine deaminase 2 (DADA2), a recently recognized autosomal recessive disease, present with various systemic vascular and inflammatory manifestations, often with young age at disease onset or with early onset of recurrent strokes. Their clinical features and histologic findings overlap with those of childhood-onset polyarteritis nodosa (PAN), a primary "idiopathic" systemic vasculitis. Despite similar clinical presentation, individuals with DADA2 may respond better to biologic therapy than to traditional immunosuppression. The aim of this study was to screen an international registry of children with systemic primary vasculitis for variants in ADA2. METHODS The coding exons of ADA2 were sequenced in 60 children and adolescents with a diagnosis of PAN, cutaneous PAN, or unclassifiable vasculitis (UCV), any chronic vasculitis with onset at age 5 years or younger, or history of stroke. The functional consequences of the identified variants were assessed by ADA2 enzyme assay and immunoblotting. RESULTS Nine children with DADA2 (5 with PAN, 3 with UCV, and 1 with antineutrophil cytoplasmic antibody-associated vasculitis) were identified. Among them, 1 patient had no rare variants in the coding region of ADA2 and 8 had biallelic, rare variants (minor allele frequency <0.01) with a known association with DADA2 (p.Gly47Arg and p.Gly47Ala) or a novel association (p.Arg9Trp, p.Leu351Gln, and p.Ala357Thr). The clinical phenotype varied widely. CONCLUSION These findings support previous observations indicating that DADA2 has extensive genotypic and phenotypic variability. Thus, screening ADA2 among children with vasculitic rash, UCV, PAN, or unexplained, early-onset central nervous system disease with systemic inflammation may enable an earlier diagnosis of DADA2.
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Affiliation(s)
- Kristen M Gibson
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kimberly A Morishita
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Paul Dancey
- Janeway Children's Hospital and Rehabilitation Centre, Saint John's, Newfoundland and Labrador, Canada
| | - Paul Moorehead
- Janeway Children's Hospital and Rehabilitation Centre, Saint John's, Newfoundland and Labrador, Canada
| | - Britt Drögemöller
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Xiaohua Han
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jinko Graham
- Simon Fraser University, Burnaby, British Columbia, Canada
| | | | - Dirk Foell
- University Hospital Muenster, Muenster, Germany
| | | | | | - Rae S M Yeung
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan Shenoi
- Seattle Children's Hospital, Seattle, Washington
| | - Marek Bohm
- Leeds General Infirmary, Leeds Teaching Hospitals Trust, Leeds, UK
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Colin J Ross
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - David A Cabral
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kelly L Brown
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia, Canada
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13
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Guzman J, Henrey A, Loughin T, Berard RA, Shiff NJ, Jurencak R, Huber AM, Oen K, Gerhold K, Feldman BM, Scuccimarri R, Houghton K, Chédeville G, Morishita K, Lang B, Dancey P, Rosenberg AM, Barsalou J, Bruns A, Watanabe Duffy K, Benseler S, Duffy CM, Tucker LB. Predicting Which Children with Juvenile Idiopathic Arthritis Will Not Attain Early Remission with Conventional Treatment: Results from the ReACCh-Out Cohort. J Rheumatol 2019; 46:628-635. [PMID: 30647178 DOI: 10.3899/jrheum.180456] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the probability of early remission with conventional treatment for each child with juvenile idiopathic arthritis (JIA). Children with a low chance of remission may be candidates for initial treatment with biologics or triple disease-modifying antirheumatic drugs (DMARD). METHODS We used data from 1074 subjects in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort. The predicted outcome was clinically inactive disease for ≥ 6 months starting within 1 year of JIA diagnosis in patients who did not receive early biologic agents or triple DMARD. Models were developed in 200 random splits of 75% of the cohort and tested on the remaining 25% of subjects, calculating expected and observed frequencies of remission and c-index values. RESULTS Our best Cox logistic model combining 18 clinical variables a median of 2 days after diagnosis had a c-index of 0.69 (95% CI 0.67-0.71), better than using JIA category alone (0.59, 95% CI 0.56-0.63). Children in the lowest probability decile had a 20% chance of remission and 21% attained remission; children in the highest decile had a 69% chance of remission and 73% attained remission. Compared to 5% of subjects identified by JIA category alone, the model identified 14% of subjects as low chance of remission (probability < 0.25), of whom 77% failed to attain remission. CONCLUSION Although the model did not meet our a priori performance threshold (c-index > 0.70), it identified 3 times more subjects with low chance of remission than did JIA category alone, and it may serve as a benchmark for assessing value added by future laboratory/imaging biomarkers.
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Affiliation(s)
- Jaime Guzman
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA. .,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada. .,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia.
| | - Andrew Henrey
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Thomas Loughin
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Roberta A Berard
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Natalie J Shiff
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Roman Jurencak
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Adam M Huber
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Kiem Oen
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Kerstin Gerhold
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Brian M Feldman
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Rosie Scuccimarri
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Kristin Houghton
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Gaëlle Chédeville
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Kimberly Morishita
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Bianca Lang
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Paul Dancey
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Alan M Rosenberg
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Julie Barsalou
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Alessandra Bruns
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Karen Watanabe Duffy
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Susanne Benseler
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Ciaran M Duffy
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
| | - Lori B Tucker
- From the British Columbia Children's Hospital and the University of British Columbia, Vancouver; Simon Fraser University, Burnaby, British Columbia; London Health Sciences Centre and Western University, London; Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario; IWK Health Centre and Dalhousie University, Halifax, Nova Scotia; Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Manitoba; Hospital for Sick Children and University of Toronto, Toronto, Ontario; McGill University Health Centre and McGill University, Montreal, Quebec; Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland and Labrador; Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan; Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal, Montreal; Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec; Alberta Children's Hospital and University of Calgary, Alberta, Canada; Shands Children's Hospital and University of Florida, Gainesville, Florida, USA.,The Research in Arthritis in Canadian Children Emphasizing Outcomes cohort was funded by a New Emerging Team research grant from the Canadian Institutes of Health Research (funding reference QNT 69301). Dr. Guzman was funded by a Clinical Investigator Award from the BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada.,J. Guzman, MD, MSc, Department of Pediatrics, University of British Columbia; A. Henrey, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; T. Loughin, PhD, Department of Statistics and Actuarial Sciences, Simon Fraser University; R.A. Berard, MD, MSc, Department of Pediatrics, Western University; N.J. Shiff, MD, MHSc, Department of Pediatrics, University of Florida; R. Jurencak, MD, Department of Pediatrics, University of Ottawa; A.M. Huber, MD, MSc, Department of Pediatrics, Dalhousie University; K. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba; K. Gerhold, MD, Department of Pediatrics and Child Health, University of Manitoba; B.M. Feldman, MD, MSc, Department of Pediatrics and Dalla Lana School of Public Health, University of Toronto; R. Scuccimarri, MD, Research Institute of the McGill University Health Centre; K. Houghton, MD, MSc, Department of Pediatrics, University of British Columbia; G. Chédeville, MD, Research Institute of the McGill University Health Centre; K. Morishita, MD, MHSc, Department of Pediatrics, University of British Columbia; B. Lang, MD, Department of Pediatrics, Dalhousie University; P. Dancey, MD, Department of Pediatrics, Memorial University; A.M. Rosenberg, MD, Department of Pediatrics, University of Saskatchewan; J. Barsalou, MD, MSc, Centre Hospitalier Universitaire Sainte-Justine and Université de Montréal; A. Bruns, MD, MSc, Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke; K. Watanabe Duffy, MD, Department of Pediatrics, University of Ottawa; S. Benseler, MD, PhD, Department of Pediatrics, University of Calgary; C.M. Duffy, MB, MSc, Department of Pediatrics, University of Ottawa; L.B. Tucker, MD, Department of Pediatrics, University of British Columbia
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14
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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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15
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Guzman J, Kerr T, Ward LM, Ma J, Oen K, Rosenberg AM, Feldman BM, Boire G, Houghton K, Dancey P, Scuccimarri R, Bruns A, Huber AM, Watanabe Duffy K, Shiff NJ, Berard RA, Levy DM, Stringer E, Morishita K, Johnson N, Cabral DA, Larché M, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey SE, Roth J, Campillo S, Benseler S, Chédeville G, Schneider R, Tse SML, Bolaria R, Gross K, Feldman D, Cameron B, Jurencak R, Dorval J, LeBlanc C, St. Cyr C, Gibbon M, Yeung RSM, Duffy CM, Tucker LB. Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Pediatr Rheumatol Online J 2017; 15:68. [PMID: 28830457 PMCID: PMC5567720 DOI: 10.1186/s12969-017-0196-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND With modern treatments, the effect of juvenile idiopathic arthritis (JIA) on growth may be less than previously reported. Our objective was to describe height, weight and body mass index (BMI) development in a contemporary JIA inception cohort. METHODS Canadian children newly-diagnosed with JIA 2005-2010 had weight and height measurements every 6 months for 2 years, then yearly up to 5 years. These measurements were used to calculate mean age- and sex-standardized Z-scores, and estimate prevalence and cumulative incidence of growth impairments, and the impact of disease activity and corticosteroids on growth. RESULTS One thousand one hundred forty seven children were followed for median 35.5 months. Mean Z-scores, and the point prevalence of short stature (height < 2.5th percentile, 2.5% to 3.4%) and obesity (BMI > 95th percentile, 15.8% to 16.4%) remained unchanged in the whole cohort. Thirty-three children (2.9%) developed new-onset short stature, while 27 (2.4%) developed tall stature (>97.5th percentile). Children with systemic arthritis (n = 77) had an estimated 3-year cumulative incidence of 9.3% (95%CI: 4.3-19.7) for new-onset short stature and 34.4% (23-49.4) for obesity. Most children (81.7%) received no systemic corticosteroids, but 1 mg/Kg/day prednisone-equivalent maintained for 6 months corresponded to a drop of 0.64 height Z-scores (0.56-0.82) and an increase of 0.74 BMI Z-scores (0.56-0.92). An increase of 1 in the 10-cm physician global assessment of disease activity maintained for 6 months corresponded to a drop of 0.01 height Z-scores (0-0.02). CONCLUSIONS Most children in this modern JIA cohort grew and gained weight as children in the general population. About 1 in 10 children who had systemic arthritis, uncontrolled disease and/or prolonged corticosteroid use, had increased risk of growth impairment.
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Affiliation(s)
- Jaime Guzman
- From British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada. .,Division of Pediatric Rheumatology, BC Children's Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC, V6H 3N1, Canada.
| | - Tristan Kerr
- 0000 0001 0684 7788grid.414137.4Division of Pediatric Rheumatology, BC Children’s Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC V6H 3N1 Canada
| | - Leanne M. Ward
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Jinhui Ma
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Kiem Oen
- 0000 0004 1936 9609grid.21613.37Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Alan M. Rosenberg
- 0000 0004 0462 8356grid.412271.3Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Brian M. Feldman
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Gilles Boire
- 0000 0001 0081 2808grid.411172.0Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Kristin Houghton
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Paul Dancey
- grid.477424.6Janeway Children’s Health and Rehabilitation Centre and Memorial University, Saint John, ’s Canada
| | - Rosie Scuccimarri
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Alessandra Bruns
- 0000 0001 0081 2808grid.411172.0Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Karen Watanabe Duffy
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Natalie J. Shiff
- 0000 0004 1936 8091grid.15276.37Shands Children’s Hospital and University of Florida, Gainesville, USA
| | - Roberta A. Berard
- 0000 0000 9132 1600grid.412745.1London Health Sciences Centre and Western University, London, Canada
| | - Deborah M. Levy
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | - Kimberly Morishita
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Nicole Johnson
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - David A. Cabral
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Maggie Larché
- 0000 0004 1936 8227grid.25073.33McMaster University, Hamilton, Canada
| | - Ross E. Petty
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Ronald M. Laxer
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Earl Silverman
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paivi Miettunen
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | | | - Elie Haddad
- 0000 0001 2292 3357grid.14848.31Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada
| | - Lynn Spiegel
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stuart E. Turvey
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Heinrike Schmeling
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Janet Ellsworth
- 0000 0004 0633 3703grid.416656.6Stollery Children’s Hospital and University of Alberta, Edmonton, Canada
| | | | - Johannes Roth
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Sarah Campillo
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Susanne Benseler
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Gaëlle Chédeville
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Rayfel Schneider
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Shirley M. L. Tse
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roxana Bolaria
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics University of British Columbia, Vancouver, Canada
| | - Katherine Gross
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics University of British Columbia, Vancouver, Canada
| | - Debbie Feldman
- 0000 0001 2292 3357grid.14848.31Université de Montréal, Montréal, Canada
| | - Bonnie Cameron
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roman Jurencak
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Jean Dorval
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Canada
| | - Claire LeBlanc
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Claire St. Cyr
- 0000 0001 2292 3357grid.14848.31Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada
| | - Michele Gibbon
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Rae S. M. Yeung
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ciarán M. Duffy
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Lori B. Tucker
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
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Garg M, de Jesus AA, Chapelle D, Dancey P, Herzog R, Rivas-Chacon R, Muskardin TLW, Reed A, Reynolds JC, Goldbach-Mansky R, Sanchez GAM. Rilonacept maintains long-term inflammatory remission in patients with deficiency of the IL-1 receptor antagonist. JCI Insight 2017; 2:94838. [PMID: 28814674 DOI: 10.1172/jci.insight.94838] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 07/11/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Deficiency of IL-1 receptor antagonist (DIRA) is a rare autoinflammatory disease that presents with life-threatening systemic inflammation, aseptic multifocal osteomyelitis, and pustulosis responsive to IL-1-blocking treatment. This study was performed (a) to investigate rilonacept, a long-acting IL-1 inhibitor, in maintaining anakinra-induced inflammatory remission in DIRA patients, (b) to determine doses needed to maintain remission, and (c) to evaluate the safety and pharmacokinetics of rilonacept in young children (<12 years). METHODS Six mutation-positive DIRA patients (children, ages 3-6 years), treated with daily anakinra, were enrolled into an open-label pilot study of subcutaneous rilonacept for 24 months. Clinical symptoms and inflammatory blood parameters were measured at all visits. A loading dose (4.4 mg/kg) was administered, followed by once weekly injections (2.2 mg/kg) for 12 months. Dose escalation (4.4 mg/kg) was allowed if inflammatory remission was not maintained. Subjects in remission at 12 months continued rilonacept for an additional 12 months. RESULTS Five of six patients required dose escalation for findings of micropustules. Following dose escalation, all patients were in remission on weekly rilonacept administration, with stable laboratory parameters for the entire study period of 24 months. All children are growing at normal rates and have normal heights and weights. Quality of life improved while on rilonacept. No serious adverse events were reported. CONCLUSION Rilonacept was found to maintain inflammatory remission in DIRA patients. The once weekly injection was well tolerated and correlated with increased quality of life, most likely related to the lack of daily injections. TRIAL REGISTRATION ClinicalTrials.gov NCT01801449. FUNDING NIH, NIAMS, and NIAID.
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Affiliation(s)
- Megha Garg
- Translational Autoinflammatory Disease Studies, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Adriana A de Jesus
- Translational Autoinflammatory Disease Studies, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Dawn Chapelle
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, Bethesda, Maryland, USA
| | - Paul Dancey
- Memorial University of Newfoundland, St. John's, Newfoundland, Canada
| | | | | | | | - Ann Reed
- Duke University School of Medicine, Durham, North Carolina, USA
| | - James C Reynolds
- Radiology and Imaging Sciences, Clinical Center, NIH, Bethesda, Maryland, USA
| | - Raphaela Goldbach-Mansky
- Translational Autoinflammatory Disease Studies, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
| | - Gina A Montealegre Sanchez
- Translational Autoinflammatory Disease Studies, National Institute of Allergy and Infectious Diseases (NIAID), NIH, Bethesda, Maryland, USA
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17
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Morishita KA, Moorthy LN, Lubieniecka JM, Twilt M, Yeung RSM, Toth MB, Shenoi S, Ristic G, Nielsen SM, Luqmani RA, Li SC, Lee T, Lawson EF, Kostik MM, Klein-Gitelman M, Huber AM, Hersh AO, Foell D, Elder ME, Eberhard BA, Dancey P, Charuvanij S, Benseler SM, Cabral DA. Early Outcomes in Children With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Arthritis Rheumatol 2017; 69:1470-1479. [DOI: 10.1002/art.40112] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/23/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Kimberly A. Morishita
- Kimberly A. Morishita, MD, MHSc, David A. Cabral, MBBS: British Columbia Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
| | | | | | - Marinka Twilt
- Marinka Twilt, MD, PhD, Susanne M. Benseler, MD, PhD: Alberta Children's Hospital; University of Calgary; Calgary Alberta Canada
| | - Rae S. M. Yeung
- Rae S. M. Yeung, MD, PhD: The Hospital for Sick Children; University of Toronto; Toronto Ontario Canada
| | | | | | - Goran Ristic
- Mother and Child Health Care Institute of Serbia; Belgrade Serbia
| | | | | | - Suzanne C. Li
- Joseph M. Sanzari Children's Hospital; Hackensack New Jersey
| | - Tzielan Lee
- Tzielan Lee, MD: Stanford Children's Health; Stanford University School of Medicine; Stanford California
| | | | - Mikhail M. Kostik
- Saint-Petersburg State Pediatric Medical University; Saint Petersburg Russia
| | | | - Adam M. Huber
- IWK Health Centre and Dalhousie University; Halifax Nova Scotia Canada
| | | | - Dirk Foell
- University Children's Hospital; Muenster Germany
| | | | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre; St. John's Newfoundland Canada
| | - Sirirat Charuvanij
- Sirirat Charuvanij, MD: Siriraj Hospital; Mahidol University; Bangkok Thailand
| | - Susanne M. Benseler
- Marinka Twilt, MD, PhD, Susanne M. Benseler, MD, PhD: Alberta Children's Hospital; University of Calgary; Calgary Alberta Canada
| | - David A. Cabral
- Kimberly A. Morishita, MD, MHSc, David A. Cabral, MBBS: British Columbia Children's Hospital; University of British Columbia; Vancouver British Columbia Canada
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18
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Papa R, Consolaro A, Minoia F, Caorsi R, Magnano G, Gattorno M, Ravelli A, Picco P, Pillon R, Marafon DP, Meli L, Bracaglia C, Taddio A, De Benedetti F, Turan E, Kilic SS, Itoh Y, Shigemori T, Yamanishi S, Nagasaki H, Tarakci E, Arman N, Tarakci D, Akgul YS, Kasapcopur O, Wilson E, Lythgoe H, Smith E, Preston J, Beresford MW, Spiegel LR, Stinson J, Connelly M, Huber A, Luca N, Tsimicalis A, Luca S, Tajuddin N, Berard R, Barsalou J, Campillo S, Feldman B, Tse S, Dancey P, Duffy C, Johnson N, McGrath P, Shiff N, Tucker L, Victor C, Spiegel LR, Lalloo C, Harris L, Cafazzo J, Tucker L, Houghton K, Feldman B, Luca N, Laxer R, Stinson J, Arman N, Tarakci E, Kasapcopur O, Rooney M, Campbell R, Wright C, Armbrust W, Lelieveld O, Tuinstra J, Wulffraat N, Bos J, Cappon J, van Rossum M, Hagedoorn M, Vermé A, Lampela Y, Ozdogan AH, Ugurlu S, Barut K, Androvic A, Kasapçopu O, Wilson E, Etheridge J, Smith E, Dobson K, Kemp S, Beresford MW, Horne A, Palmblad K, Höglund M, Stepanenko N, Salugina S, Fedorov E, Nikishina I, Kaleda M, Arman N, Tarakci E, Barut K, Adrovic A, Sahin S, Kasapcopur O, Arman N, Tarakci E, Kasapcopur O, Toumoulin L, Frossard J, Archimbaut S, Paitier A, Guastalli R, Czitrom SG, Charuvanij S, Chaiyadech C, Miyamae T, Yamanaka H, Picard C, Thouvenin G, Kannengiesser C, Dubus JC, Jeremiah N, Rieux-Laucat F, Crestani B, Secq V, Ménard C, Reynaud-Gaubert M, Thivolet-Bejui F, Reix P, Belot A, Batu ED, Sonmez HE, Erden A, Taskiran EZ, Karadag O, Kalyoncu U, Oncel İ, Kaplan B, Arici ZS, Temucin CM, Topaloglu H, Bilginer Y, Alikasifoglu M, Ozen S, Van Eyck L, De Langhe E, Jéru I, Van Nieuwenhove E, Lagou V, Baker PJ, Garcia-Perez J, Dooley J, De Somer L, Sciot R, Jeandel PY, Ruuth-Praz J, Copin B, Medley-Hashim M, Megarbane A, Savic S, Goris A, Amselem S, Liston A, Masters S, Wouters C, Okamoto N, Sugita Y, Shabana K, Murata T, Tamai H, Ferenczová J, Banóova E, Mrážik P, Vargova V, Bajramovic D, Novacki KS, Potocki K, Frkovic M, Jelusic M, Nikishina I, Kostareva O, Arsenyeva S, Kaleda M, Shapovalenko A, Jans L, Herregods N, Jaremko J, Joos R, Dehoorne J, Herregods N, Jaremko J, Baraliakos X, Dehoorne J, Joos R, Jans L, Ramiro S, Casasola-Vargas JC, van der Heijde D, Landewé R, Burgos-Vargas R, Burgos-Vargas R, Tse SM, Horneff G, Unnebrink K, Anderson JK, Kisaarslan AP, Sözeri B, Gündüz Z, Zararsız G, Poyrazoğlu H, Düşünsel R, Ouchi K, Akioka S, Kubo H, Nakagawa N, Hosoi H, Lamot L, Borovecki F, Kapitanovic S, Gotovac K, Vidovic M, Lamot M, Bosak EP, Harjacek M, Russo RA, Katsicas MM, Vargas RB, Ortiz-Peyegahud AL, Pingping Z, Yikun M, Jun Q, Yutong J, Jieruo G, Kostik MM, Ekaterina S, Avrusin I, Korin Y, Kopchak O, Isupova E, Chikova I, Tatyana P, Dubko M, Masalova V, Snegireva L, Kornishina T, Kalashnikova O, Chasnyk V, Kostik MM, Chikova I, Isupova E, Dubko M, Masalova V, Snegireva L, Kornishina T, Likhacheva T, Kalashnikova O, Chasnyk V, Ruperto N, Brunner HI, Quartier P, Constantin T, Alexeeva E, Schneider R, Kone-Paut I, Schikler K, Marzan K, Wulffraat N, Padeh S, Chasnyk V, Wouters C, Kuemmerle-Deschner JB, Kallinich T, Lauwerys B, Haddad E, Nasonov E, Trachana M, Vougiouka O, Leon K, Speziale A, Lheritier K, Vritzali E, Martini A, Lovell D, Ter Haar N, Scholman R, de Jager W, Tak T, Leliefeld P, Vastert B, de Roock S, Ter Haar N, Scholman R, de Jager W, de Ganck A, Ryter N, Lavric M, Foell D, de Roock S, Vastert B, Modica RF, Lomax KG, Batzel P, Cassanas A, Elder ME, Denisova R, Alexeeva E, Valieva S, Bzarova T, Isayeva K, Sleptsova T, Lomakina O, Chomahidze A, Soloshenko M, Shingarova M, Kachshenko E, De Jager W, Vastert SJ, Mijnheer G, Prakken BJ, Wulffraat NM, Sönmez HE, Karhan AN, Batu ED, Bilginer Y, Arıcı ZS, Gümüş E, Demir H, Yüce A, Özen S, Ahluwalia J, Bharti B, Rajpal S, Uppal V, Walia A, Samlok SS, Kumar N, Valões CC, Molinari BC, Pitta ACG, Gormezano NW, Farhat SC, Kozu K, Sallum AM, Appenzeller S, Sakamoto AP, Terreri MT, Pereira RM, Magalhães CS, Barbosa CM, Gomes FH, Bonfá E, Silva CA, Ozturk K, Ekinci Z, Helal M, Cabrera N, Belot A, Lega JC, Drai J, Ecochard R, Shpitonkova OV, Podchernyaeva NS, Kostina YO, Dashkova NG, Osminina MK, Yucel G, Sahin S, Adrovic A, Barut K, Tarakci E, Arvas A, Moorthy N, Kasapcopur O, Dimou P, Midgley A, Peak M, Satchell SC, Wright RD, Beresford MW, Corkhill R, Smith EM, Beresford MW, Bhattad S, Rawat A, Singh S, Gupta A, Suri D, de Boer M, Kuijpers T, Bhattad S, Rawat A, Gupta A, Suri D, Pandiarajan V, Singh S, Sandal S, Rawat A, Gupta A, Singh S, Giraldo S, Sanguino R, Diaz AS, Uzuner S, Sahin S, Durcan G, Adrovic A, Barut K, Kilicoglu AG, Bilgic A, Bahali K, Kasapcopur O, Sahin S, Adrovic A, Barut K, Durmus S, Uzun H, Kasapcopur O, Sahin S, Adrovic A, Barut K, Canpolat N, Caliskan S, Sever L, Kasapcopur O, Sato T, Kimura F, Suwairi W, Abdwani R, Al Rowais A, Al qanatish J, Al Asiri A, Ozturk K, Ekinci Z, Gaidar E, Kostik M, Dubko M, Masalova V, Serogodskaya E, Snegireva L, Nikitina T, Chasnyk V, Kalashnikova O, Isupova E, Sardar E, Dusser P, Rousseau A, Labetoulle M, Barreau E, Bodaghi B, Kone-Paut I, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Foeldvari I, Anton J, Bou R, Angeles-Han S, Bangsgaard R, Brumm G, Constantin T, Edelsten C, Klotsche J, Minden K, Miserocchi E, Nielsen S, Simonini G, Heiligenhaus A, Angarita JMM, Bou R, de Vicuña CG, Hernandez MV, Adan A, Llorens V, Alcobendas R, Noval S, Robledillo JCL, Valls I, Pinedo MC, Fonollosa A, de Inocencio J, Tejada P, Bravo B, Torribio M, de Yebenes MJG, Antón J, Argolini LM, Pontikaki I, Borghi MO, Cesana L, Miserocchi E, Castiglioni B, Gattinara M, Meroni P, Quartier P, Despert V, Poignant S, Baptiste A, Elie C, Kone-Paut I, Belot A, Kodjikian L, Monnet D, Weber M, Bodaghi B, Moal L, Rousseau A, Pham L, Barreau E, Titah C, Dureau P, Labetoulle M, Bodaghi B, Czitrom SG, Cecchin V, Zannin ME, Ferrari D, Comacchio F, Pontikaki I, Bracaglia C, Cimaz R, Falcini F, Petaccia A, Viola S, Breda L, La Torre F, Vittadello F, Martini G, Zulian F, Galeotti C, Sarrabay G, Fogel O, Touitou I, Bodaghi B, Miceli-Richard C, Koné-Paut I, Etayari H, Soad H, El Kadry I, Eatamadi H, AlAlgawi K, Al Maini M, Khawaja K, Van den Berghe S, de Schryver I, Raes A, Joos R, Dehoorne J, Teixeira LLC, Duarte A, Sousa S, Vinagre F, Santos MJ, Shevchenko NS, Bogmat LF, Demyanenko MV, Ramchurn NR, Friswell M, James RA, Wedderburn LR, Edelsten C, Pattani R, Pilkington CA, Compeyrot-Lacassagne S, James RA, Compeyrot-Lacassagne S, Edelsten C, Pattani R, Pilkington CA, Wedderburn LR, Villarreal AV, Acevedo N, Faugier E, Maldonado R, Yılmaz D, Uysal HB, Fedorov E, Salugina S, Kamenets E, Zaharova E, Radenska-Lopovok S, Nascimento J, Sofia H, Zilhão C, Almeida R, Guedes M, Ozturk K, Deveci M, Ekinci Z, Rodionovskaya S, Vinnikova V, Salugina S, Fedorov E, Tsymbal I, Olesińska E, Postępski J, Mroczkowska-Juchkiewicz A, Pawłowska-Kamieniak A, Chrapko B, Ključevšek D, Emeršič N, Toplak N, Avčin T, Rokhlina F, Glazyrina G, Kolyadina N, Kim K, Eom S, Kim D, Rhim J, Ricci F, Montesano P, Bonafini B, Medeghini V, Parissenti I, Meini A, Cattalini M, Airò P, Panko N, Shevchenko N, Lebec I, Zajceva Y, Rostlund S, André M, Hara T, Kishi T, Tani Y, Hanaya A, Miyamae T, Nagata S, Yamanaka H, Selmanovic V, Omercahic-Dizdarevic A, Cengic A, Cosickic A, Dizdarević AO, Lepri G, Picco P, Malattia C, Bellucci E, Matucci-Cerinic M, Falcini F, Dubko M, Solovyev A, Fedotova E, Maldonado R, Faugier E, Villarreal AV, Acevedo N, Diaz T, Ramirez Y, Giani T, Marino A, Simonini G, Cimaz R, Hunt D, Al Obaidi M, Veli V, Papadopoulou C, Kammermeier J, Olesińska E, Poluha A, Postępski J, Bharmappanavara GC, Kelly A, Shaw L, Giani T, Ferrara G, Luzzati M, Marino A, Giovannini M, Simonini G, Cimaz R, Jurado L, Giraldo S, Chamorro J, Sarmiento L, Diaz AS, Medeghini V, Ricci F, Montesano P, Bonafini B, Parissenti I, Meini A, Conversano E, Cattalini M, Gicchino MF, Macchini G, Granato C, Tirelli A, Olivieri AN, Perica M, Bukovac LT, Bogmat LF, Shevchenko NS, Demyanenko MV, Sinaei R, Parvaneh VJ, Shiari R, Rahmani K, Mehregan FF, Yeganeh MH, Penadés IC, Montesinos BL, Fernández MIG, Vidal AR, Rao AP, Romana A, Raghuram J, Kumar A, Suri D, Gupta V, Rawat A, Singh S, Comak E, Aksoy GK, Yılmaz A, Atalay A, Koyun M, Artan R, Akman S, Gicchino MF, Macchini G, Granato C, Olivieri AN, Kaleda MI, Nikishina IP, Soloviev SK, Malievsky VA, Nikolaeva EV, Giani T, Marino A, Simonini G, Cimaz R, Gazda A, Kołodziejczyk B, Rutkowska-Sak L, Mauro A, Giani T, Simonini G, Cimaz R, Gicchino MF, Marzuillo P, Guarino S, Olivieri AN, La Manna A. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part three. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461520 DOI: 10.1186/s12969-017-0143-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 03/05/2023] Open
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Cabral DA, Canter DL, Muscal E, Nanda K, Wahezi DM, Spalding SJ, Twilt M, Benseler SM, Campillo S, Charuvanij S, Dancey P, Eberhard BA, Elder ME, Hersh A, Higgins GC, Huber AM, Khubchandani R, Kim S, Klein-Gitelman M, Kostik MM, Lawson EF, Lee T, Lubieniecka JM, McCurdy D, Moorthy LN, Morishita KA, Nielsen SM, O'Neil KM, Reiff A, Ristic G, Robinson AB, Sarmiento A, Shenoi S, Toth MB, Van Mater HA, Wagner-Weiner L, Weiss JE, White AJ, Yeung RSM. Comparing Presenting Clinical Features in 48 Children With Microscopic Polyangiitis to 183 Children Who Have Granulomatosis With Polyangiitis (Wegener's): An ARChiVe Cohort Study. Arthritis Rheumatol 2016; 68:2514-26. [DOI: 10.1002/art.39729] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 04/19/2016] [Indexed: 11/05/2022]
Affiliation(s)
- David A. Cabral
- British Columbia Children's Hospital, Vancouver; British Columbia Canada
| | | | | | | | | | | | - Marinka Twilt
- Alberta Children's Hospital and University of Calgary; Calgary Alberta Canada
| | - Susanne M. Benseler
- Alberta Children's Hospital and University of Calgary; Calgary Alberta Canada
| | - Sarah Campillo
- Montreal Children's Hospital and McGill University Health Centre; Montreal Quebec Canada
| | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre; St. John's Newfoundland Canada
| | | | | | | | | | - Adam M. Huber
- IWK Health Centre and Dalhousie University; Halifax Nova Scotia
| | | | - Susan Kim
- Children's Hospital of Boston; Boston Massachusetts
| | | | - Mikhail M. Kostik
- St. Petersburg State Pediatric Medical University; St. Petersburg Russia
| | | | - Tzielan Lee
- Stanford Children's Health and Stanford University School of Medicine; Stanford California
| | | | | | | | | | | | | | - Andreas Reiff
- Children's Hospital Los Angeles; Los Angeles California
| | - Goran Ristic
- Mother and Child Health Care Institute of Serbia; Belgrade Serbia
| | - Angela B. Robinson
- University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital; Cleveland Ohio
| | - Angelyne Sarmiento
- British Columbia Children's Hospital, Vancouver; British Columbia Canada
| | | | | | - Heather A. Van Mater
- Duke Children's Hospital and Health Center and Duke University Medical Center; Durham North Carolina
| | | | - Jennifer E. Weiss
- Joseph M. Sanzari Children's Hospital and Hackensack University Medical Center; Hackensack New Jersey
| | - Andrew J. White
- St. Louis Children's Hospital and Washington University School of Medicine; St. Louis Missouri
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Fotis L, Shaikh N, Baszis K, French A, Tarr P, Grevich S, Lee P, Ringold S, Leroux B, Leahey H, Yuasa M, Foster J, Sokolove J, Lahey L, Robinson W, Newsom J, Stevens A, Karasawa R, Tamaki M, Tanaka M, Sato T, Yudoh K, Jarvis JN, Moncrieffe H, Bennett MF, Tsoras M, Luyrink L, Xu H, Prahalad S, Morris P, Dare J, Nigrovic PA, Rosenkranz M, Becker M, O’Neil KM, Griffin T, Lovell DJ, Grom AA, Medvedovic M, Thompson SD, Zhu L, Jiang K, Wong L, Buck MJ, Chen Y, Moncrieffe H, Brungs L, Liu T, Wang T, Jarvis JN, Alsaeid K, Alfailakawi J, Alenezi H, Alsaeed H, Beukelman T, Natter M, Ilowite N, Mieszkalski K, Burrell G, Best B, Bristow H, Carr S, Dennos A, Kaufmann R, Kimura Y, Schanberg L, Blier PR, Boneparth A, Wenderfer SE, Moorthy LN, Radhakrishna SM, Sagcal-Gironella ACP, von Scheven E, Gedik KC, Siddique S, Aguiar CL, Erkan D, Cohen E, Lee Y, Dossett M, Mehta D, Davis R, Gilbert M, Goilav B, Meidan E, Hsu J, Boneparth A, Chua A, Ardoin S, Wenderfer SE, Von Scheven E, Ruth NM, Hui-Yuen J, Gedik KC, Bermudez L, Cook A, Imundo L, Starr A, Eichenfield A, Askanase A, Janow G, Schanberg LE, Setoguchi S, Hasselblad V, Mellins ED, Schneider R, Kimura Y, Kimura Y, Grevich S, Beukelman T, Morgan E, Graham TB, Ibarra M, Ruas YS, Klein-Gitelman M, Onel K, Prahalad S, Punaro M, Ringold S, Toib D, Van Mater H, Weiss JE, Weiss PF, Mieszkalski K, Schanberg LE, Kwok TSH, Bisaillon J, Smith C, Brosseau L, Stinson J, Huber AM, Duffy CM, April KT, Lewandowski LB, Scott C, Li SC, Torok KS, Rabinovich CE, Hong SD, Becker ML, Dedeoglu F, Ibarra MF, Ferguson PJ, Fuhbrigge RC, Stewart KG, Pope E, Laxer RM, Mason TG, Higgins GC, Li X, Punaro MG, Tomlinson G, Pullenayegum E, Matelski J, Schanberg L, Feldman BM, Manthiram K, Correa H, Edwards K, Oberle EJ, Bayer M, Co DO, Baris HE, Chiu Y, Huber A, Kim S, Oberle EJ, Beukelman T, Orandi AB, Baszis KW, Dharnidharka V, Hoeltzel MF, Reed A, Huber A, Tomlinson G, Pullenayegum E, Matelski J, Goh YI, Schanberg L, Feldman BM, Schnabel A, Range U, Hahn G, Siepmann T, Berner R, Hedrich CM, Stevens B, Torok KS, Li S, Hershey N, Curran M, Higgins G, Moore K, Rabinovich E, Stevens AM, Stinson J, Connelly M, Huber A, Luca N, Spiegel L, Tsimicalis A, Luca S, Tajuddin N, Berard R, Barsalou J, Campillo S, Dancey P, Duffy C, Feldman B, Johnson N, McGrath P, Shiff N, Tse S, Tucker L, Victor C, Stinson J, Lalloo C, Harris L, Cafazzo J, Spiegel L, Feldman B, Luca N, Laxer R, Bullock DR, Vehe RK, Zhang L, Correll CK, Ganguli S, Shenberger M, Korumilli R, Gottlieb B, Rodriguez M, de Ranieri D, Onel K, Wagner-Weiner L, Tesher M, Wojcicki ER, Maletta KL, Co DO, Malloy M, Thomson S, Olson JC, Wenderfer SE, Gilbert M, Hsu J, Sule S, Rubinstein TB, Goilav B, Okamura DM, Chua A, Greenbaum LA, Lane JC, von Scheven E, Ardoin SP, Ruth NM, Woo JMP, Malloy MM, Jegers JA, Hahn DJ, Hintermeyer MK, Martinetti SM, Heckel GR, Roth-Wojcicki EL, Co DO. Proceedings of the 2016 Childhood Arthritis and Rheumatology Research Alliance (CARRA) Scientific Meeting : Toronto, Canada. 14-17 April 2016. Pediatr Rheumatol Online J 2016; 14 Suppl 1:41. [PMID: 27409414 PMCID: PMC4943514 DOI: 10.1186/s12969-016-0098-0] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
P1 Serologic evidence of gut-driven systemic inflammation in juvenile idiopathic arthritis Lampros Fotis, Nur Shaikh, Kevin Baszis, Anthony French, Phillip Tarr P2 Oral health and anti-citrullinated peptide antibodies (ACPA) in juvenile idiopathic arthritis Sriharsha Grevich, Peggy Lee, Sarah Ringold, Brian Leroux, Hannah Leahey, Megan Yuasa, Jessica Foster, Jeremy Sokolove, Lauren Lahey, William Robinson, Joshua Newsom, Anne Stevens P3 Novel autoantigens for endothelial cell antibodies in pediatric rheumatic diseases identified by proteomics Rie Karasawa, Mayumi Tamaki, Megumi Tanaka, Toshiko Sato, Kazuo Yudoh, James N. Jarvis P4 Transcriptional profiling reveals monocyte signature associated with JIA patient poor response to methotrexate Halima Moncrieffe, Mark F. Bennett, Monica Tsoras, Lorie Luyrink, Huan Xu, Sampath Prahalad, Paula Morris, Jason Dare, Peter A. Nigrovic, Margalit Rosenkranz, Mara Becker, Kathleen M. O’Neil, Thomas Griffin, Daniel J. Lovell, Alexei A. Grom, Mario Medvedovic, Susan D. Thompson P5 A multi-dimensional genomic map for polyarticular juvenile idiopathic arthritis Lisha Zhu, Kaiyu Jiang, Laiping Wong, Michael J Buck, Yanmin Chen, Halima Moncrieffe, Laura Brungs, Tao Liu, Ting Wang, James N Jarvis P6 Tocilizumab for treatment of children with refractory JIA Khaled Alsaeid, Jasim Alfailakawi, Hamid Alenezi, Hazim Alsaeed P7 Clinical characteristics of the initial patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry Tim Beukelman, Marc Natter, Norm Ilowite, Kelly Mieszkalski, Grendel Burrell, Brian Best, Helen Bristow, Shannon Carr, Anne Dennos, Rachel Kaufmann, Yukiko Kimura, Laura Schanberg P8 Comparative performance of small and large clinical centers in a comprehensive pediatric rheumatology disease registry Peter R Blier P9 Clinical characteristics of children with membranous lupus nephritis: The Childhood Arthritis and Rheumatology Research Alliance Legacy Registry Alexis Boneparth, Scott E. Wenderfer, L. Nandini Moorthy, Suhas M. Radhakrishna, Anna Carmela P. Sagcal-Gironella, Emily von Scheven P10 Rituximab use in pediatric lupus anticoagulant hypoprothrombinemia syndrome - a two center experience Kader Cetin Gedik, Salma Siddique, Cassyanne L. Aguiar, Doruk Erkan P11 Predictors of complementary and alternative medicine use and response in children with musculoskeletal conditions Ezra Cohen, Yvonne Lee, Michelle Dossett, Darshan Mehta, Roger Davis P12 Comparison of pediatric rheumatology and nephrology survey results for the treatment of refractory proliferative lupus nephritis and renal flare in juvenile SLE Mileka Gilbert, Beatrice Goilav, Esra Meidan, Joyce Hsu, Alexis Boneparth, Anabelle Chua, Stacy Ardoin, Scott E. Wenderfer, Emily Von Scheven, Natasha M. Ruth P13 Transitioning lupus patients from pediatric to adult rheumatology Joyce Hui-Yuen, Kader Cetin Gedik, Liza Bermudez, Ashlea Cook, Lisa Imundo, Amy Starr, Andrew Eichenfield, Anca Askanase P14 The systemic juvenile idiopathic arthritis cohort of the Childhood Arthritis & Rheumatology Research Alliance Registry Ginger Janow, Laura E. Schanberg, Soko Setoguchi, Victor Hasselblad, Elizabeth D. Mellins, Rayfel Schneider, Yukiko Kimura, The CARRA Legacy Registry Investigators P15 Results of the pilot study of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans for new-onset systemic juvenile idiopathic arthritis Yukiko Kimura, Sriharsha Grevich, Timothy Beukelman, Esi Morgan, T Brent Graham, Maria Ibarra, Yonit Sterba Ruas, Marisa Klein-Gitelman, Karen Onel, Sampath Prahalad, Marilynn Punaro, Sarah Ringold, Dana Toib, Heather Van Mater, Jennifer E. Weiss, Pamela F. Weiss, Kelly Mieszkalski, Laura E. Schanberg P16 A systemic review of pain relief modalities in juvenile idiopathic arthritis: First step in developing a novel decision support intervention Timothy S. H. Kwok, Jacinthe Bisaillon, Christine Smith, Lucie Brosseau, Jennifer Stinson, Adam M. Huber, Ciaran M. Duffy, Karine Toupin April P17 Barriers and facilitators to care retention for pediatric systemic lupus erythematous patients in South Africa: A qualitative study Laura B Lewandowski, Christiaan Scott P18 Evaluating the feasibility of conducting comparative effectiveness studies in juvenile Localized Scleroderma (jLS) Suzanne C. Li, Kathryn S. Torok, C. Egla Rabinovich, Sandy D. Hong, Mara L Becker, Fatma Dedeoglu, Maria F. Ibarra, Polly J Ferguson, Rob C. Fuhbrigge, Katie G. Stewart, Elena Pope, Ronald M. Laxer, Thomas G. Mason, Gloria C. Higgins, Xiaohu Li, Marilynn G. Punaro, George Tomlinson, Eleanor Pullenayegum, John Matelski, Laura Schanberg, Brian M. Feldman P19 Tonsillar histology in patients with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome Kalpana Manthiram, Hernan Correa, Kathryn Edwards P20 Clinical course of juvenile dermatomyositis presenting as skin predominant disease Edward J. Oberle, Michelle Bayer, Dominic O. Co, Hatice Ezgi Baris, Yvonne Chiu, Adam Huber, Susan Kim P21 A Survey of musculoskeletal ultrasound practices of pediatric rheumatologists in North America Edward J Oberle, Timothy Beukelman P22 Assessment, classification and treatment of calcinosis as a complication of juvenile dermatomyositis: A survey of pediatric rheumatologists by the Childhood Arthritis and Rheumatology Research Alliance Amir B. Orandi, Kevin W. Baszis, Vikas Dharnidharka, Mark F. Hoeltzel, for the CARRA JDM Committee P23 CARRA dermatomyositis CTP pilot study Ann Reed, Adam Huber, George Tomlinson, Eleanor Pullenayegum, John Matelski, Y. Ingrid Goh, Laura Schanberg, Brian M. Feldman P24 Unexpectedly high incidences and prolonged disease activity in children with chronic non-bacterial osteomyelitis (CNO) as compared to bacterial osteomyelitis Anja Schnabel, Ursula Range, Gabriele Hahn, Timo Siepmann, Reinhard Berner, Christian Michael Hedrich P25 Juvenile systemic sclerosis cohort within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry: Follow up characteristics Brandi Stevens, Kathryn S. Torok, Suzanne Li, Nicole Hershey, Megan Curran, Gloria Higgins, Katharine Moore, Egla Rabinovich, Anne M. Stevens, for the CARRA Registry Investigators P26 Development and usability testing of an iPad and desktop psycho-educational game for children with Juvenile Idiopathic Arthritis and their parents Jennifer Stinson, Mark Connelly, Adam Huber, Nadia Luca, Lynn Spiegel, Argerie Tsimicalis, Stephanie Luca, Naweed Tajuddin, Roberta Berard, Julia Barsalou, Sarah Campillo, Paul Dancey, Ciaran Duffy, Brian Feldman, Nicole Johnson, Patrick McGrath, Natalie Shiff, Shirley Tse, Lori Tucker, Charles Victor P27 iCanCopeTM: User-centred design and development of a smartphone app to support self-management for youth with arthritis pain Jennifer Stinson, Chitra Lalloo, Lauren Harris, Joseph Cafazzo, Lynn Spiegel, Brian Feldman, Nadia Luca, Ronald Laxer P28 Accessing pediatric rheumatology care: Despite barriers, few parents prefer telemedicine Danielle R. Bullock, Richard K. Vehe, Lei Zhang, Colleen K. Correll1 P29 Exploration of factors contributing to time to achieve clinically inactive disease (CID) in juvenile idiopathic arthritis (JIA): A preliminary report Suhas Ganguli, Max Shenberger, Ritesh Korumilli, Beth Gottlieb P30 Pediatric rheumatology referral patterns: Presenting complaints of new patients at a large, urban academic center Martha Rodriguez, Deirdre de Ranieri, Karen Onel, Linda Wagner-Weiner, Melissa Tesher P31 Quality improvement (QI) initiatives in childhood systemic lupus erythematosus (cSLE) Elizabeth Roth Wojcicki, Kristyn L. Maletta, Dominic O. Co, Marsha Malloy, Sarah Thomson, Judyann C. Olson P32 Proliferative lupus nephritis in juvenile SLE: Support from the pediatric nephrology community for the definitions of responsiveness and flare in the 2012 consensus treatment plans Scott E. Wenderfer, Mileka Gilbert, Joyce Hsu, Sangeeta Sule, Tamar B. Rubinstein, Beatrice Goilav, Daryl M. Okamura, Annabelle Chua, Laurence A. Greenbaum, Jerome C. Lane, Emily von Scheven, Stacy P. Ardoin, Natasha M. Ruth P33 The steroid taper app: Making of a mobile app Jennifer M. P. Woo, Marsha M. Malloy, James A. Jegers, Dustin J. Hahn, Mary K. Hintermeyer, Stacey M. Martinetti, Gretchen R. Heckel, Elizabeth L. Roth-Wojcicki, Dominic O. Co
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Affiliation(s)
- Lampros Fotis
- Washington University School of Medicine, St Louis, Missouri USA
| | - Nur Shaikh
- Washington University School of Medicine, St Louis, Missouri USA
| | - Kevin Baszis
- Washington University School of Medicine, St Louis, Missouri USA
| | - Anthony French
- Washington University School of Medicine, St Louis, Missouri USA
| | - Phillip Tarr
- Washington University School of Medicine, St Louis, Missouri USA
| | - Sriharsha Grevich
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA USA
| | - Peggy Lee
- Department of Oral Medicine, University of Washington, Seattle, WA USA
| | - Sarah Ringold
- Department of Rheumatology, Seattle Children’s Hospital, Seattle, WA USA
| | - Brian Leroux
- Department of Oral Health Sciences, University of Washington, Seattle, WA USA
| | | | | | | | - Jeremy Sokolove
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University, Stanford, CA USA
| | - Lauren Lahey
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University, Stanford, CA USA
| | - William Robinson
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University, Stanford, CA USA
| | | | - Anne Stevens
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA USA ,Seattle Children’s Research Institute, Seattle, WA USA
| | - Rie Karasawa
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mayumi Tamaki
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Megumi Tanaka
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshiko Sato
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuo Yudoh
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - James N. Jarvis
- University at Buffalo, State University of New York, Buffalo, NY USA
| | - Halima Moncrieffe
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,University of Cincinnati, Cincinnati, OH USA
| | | | - Monica Tsoras
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Lorie Luyrink
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Huan Xu
- University of Cincinnati, Cincinnati, OH USA
| | | | - Paula Morris
- Arkansas Children’s Hospital Research Institute, Little Rock, AR USA
| | - Jason Dare
- Arkansas Children’s Hospital Research Institute, Little Rock, AR USA
| | | | | | - Mara Becker
- Children’s Mercy Hospital, Kansas City, MO USA
| | | | | | - Daniel J. Lovell
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Alexei A. Grom
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | | | - Susan D. Thompson
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,University of Cincinnati, Cincinnati, OH USA
| | - Lisha Zhu
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Kaiyu Jiang
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Laiping Wong
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Michael J Buck
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Yanmin Chen
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | | | | | - Tao Liu
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Ting Wang
- Washington University, St. Louis, MO USA
| | - James N Jarvis
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Khaled Alsaeid
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait ,Mubarak Hospital, Jabriya, Kuwait
| | | | | | | | - Tim Beukelman
- University of Alabama at Birmingham, Birmingham, AL USA
| | - Marc Natter
- Tufts University, Medford, MA USA ,Harvard University, Boston, MA USA
| | - Norm Ilowite
- The Children’s Hospital at Montefiore, Bronx, NY USA
| | | | | | | | | | | | | | | | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ USA
| | | | - Peter R. Blier
- Baystate Children’s Hospital, Springfield, MA USA ,Tufts University School of Medicine, Boston, MA USA
| | - Alexis Boneparth
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | | | | | | | | | | | | | - Salma Siddique
- Hospital for Special Surgery-Weill Cornell Medical Center, New York, NY USA
| | | | - Doruk Erkan
- Hospital for Special Surgery-Weill Cornell Medical Center, New York, NY USA
| | - Ezra Cohen
- Boston Children’s Hospital, Boston, MA USA
| | - Yvonne Lee
- Brigham and Women’s Hospital, Boston, MA USA
| | | | | | | | - Mileka Gilbert
- Medical University of South Carolina, Charleston, SC USA
| | | | | | - Joyce Hsu
- Stanford University, Stanford, CA USA
| | | | | | - Stacy Ardoin
- Nationwide Children’s Hospital, Columbus, OH USA
| | | | | | | | - Joyce Hui-Yuen
- Division of Pediatric Rheumatology, Cohen Children’s Medical Center, New Hyde Park, NY USA
| | - Kader Cetin Gedik
- Division of Pediatric Rheumatology, Cohen Children’s Medical Center, New Hyde Park, NY USA
| | - Liza Bermudez
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Ashlea Cook
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Lisa Imundo
- Division of Adult Rheumatology, Columbia University Medical Center, New York, NY USA
| | - Amy Starr
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Andrew Eichenfield
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Anca Askanase
- Division of Adult Rheumatology, Columbia University Medical Center, New York, NY USA
| | - Ginger Janow
- Pediatrics, Joseph M Sanzari Children’s Hospital, Hackensack, NJ USA
| | - Laura E. Schanberg
- Pediatrics, Duke University, Durham, NC USA ,Duke Clinical Research Institute, Durham, NC USA
| | | | | | | | - Rayfel Schneider
- Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Yukiko Kimura
- Pediatrics, Joseph M Sanzari Children’s Hospital, Hackensack, NJ USA
| | | | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ USA
| | | | | | - Esi Morgan
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | | | | | | | | | - Karen Onel
- Comer Children’s Hospital of Chicago, Chicago, IL USA
| | | | | | | | - Dana Toib
- St. Christopher’s Hospital for Children, Philadelphia, PA USA
| | | | | | | | | | | | - Timothy S. H. Kwok
- Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Jacinthe Bisaillon
- School of Nursing Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Christine Smith
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Lawrence S. Bloomberg Faculty of Nursing University of Toronto, Toronto, Ontario Canada
| | - Adam M. Huber
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia Canada
| | - Ciaran M. Duffy
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario Canada
| | - Karine Toupin April
- Department of Pediatrics, Children’s Hospital of Eastern Ontario Research Institute, Faculty of Medicine, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Laura B. Lewandowski
- Pediatric Rheumatology, Duke University Medical Center, Durham, NC USA ,Duke Global Health Institute, Duke University, Durham, NC USA ,Paediatric Rheumatology, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa ,National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, Bethesda, MD USA
| | - Christiaan Scott
- Paediatric Rheumatology, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
| | - Suzanne C. Li
- Hackensack University Medical Center, Hackensack, NJ USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xiaohu Li
- Stevens Institute of Technology, Hoboken, NJ USA
| | | | | | | | | | | | | | - Kalpana Manthiram
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Hernan Correa
- Department of Pathology, Immunology, and Microbiology, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Kathryn Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Edward J. Oberle
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH USA
| | - Michelle Bayer
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | - Dominic O. Co
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | | | - Yvonne Chiu
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | - Adam Huber
- IWK Health Centre, Dalhousie University, Halifax, NS Canada
| | - Susan Kim
- Boston Children’s Hospital, Boston, MA USA ,Harvard Medical School, Boston, MA USA
| | - Edward J. Oberle
- Nationwide Children’s Hospital, Columbus, OH USA ,The Ohio State University, Columbus, OH USA
| | | | - Amir B. Orandi
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Kevin W. Baszis
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Vikas Dharnidharka
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Mark F. Hoeltzel
- Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor, MI USA
| | | | | | - Adam Huber
- Dalhousie University, Halifax, NS Canada
| | | | | | | | | | | | | | - Anja Schnabel
- Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Hahn
- Department of Radiology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Reinhard Berner
- Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Michael Hedrich
- Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Brandi Stevens
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA USA
| | | | - Suzanne Li
- Hackensack University Medical Center, Hackensack, NJ USA
| | - Nicole Hershey
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA USA
| | - Megan Curran
- Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | | | | | | | - Anne M. Stevens
- Seattle Children’s Research Institute, University of Washington, Seattle, WA USA
| | | | - Jennifer Stinson
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mark Connelly
- University of Kansas Medical Center, Kansas City, MO USA
| | - Adam Huber
- IWK Health Centre, Halifax, Nova Scotia Canada
| | - Nadia Luca
- Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Lynn Spiegel
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Stephanie Luca
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Naweed Tajuddin
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | | | | | - Paul Dancey
- Memorial University of Newfoundland, Newfoundland, Canada
| | - Ciaran Duffy
- Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Brian Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | | | | | - Shirley Tse
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lori Tucker
- British Columbia Children’s Hospital, Vancouver, British Columbia Canada
| | | | | | | | - Lauren Harris
- The Hospital for Sick Children, Toronto, Canada ,University of Toronto, Toronto, Canada ,Centre for Global eHealth Innovation, Toronto, Canada
| | | | | | | | - Nadia Luca
- Alberta Children’s Hospital, Calgary, Alberta Canada
| | | | - Danielle R. Bullock
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Richard K. Vehe
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Lei Zhang
- Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN USA
| | - Colleen K. Correll
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Suhas Ganguli
- Pediatric Rheumatology, Cohen Children’s Medical Center, New York, NY 11040 USA
| | - Max Shenberger
- Pediatric Rheumatology, Cohen Children’s Medical Center, New York, NY 11040 USA
| | - Ritesh Korumilli
- Pediatrics, Flushing Hospital Medical Center, New York, NY 11355 USA
| | - Beth Gottlieb
- Pediatric Rheumatology, Cohen Children’s Medical Center, New York, NY 11040 USA
| | - Martha Rodriguez
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | - Deirdre de Ranieri
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | - Karen Onel
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | | | - Melissa Tesher
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | | | | | | | | | | | | | | | - Mileka Gilbert
- Medical University of South Carolina, Charleston, SC USA
| | - Joyce Hsu
- Stanford University, Stanford, CA USA
| | - Sangeeta Sule
- Johns Hopkins Children’s Hospital, Baltimore, MD USA
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21
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Dancey P, Benseler S, Miettunen P, Turner L, Gattorno M, Laxer RM, Junker A. Surveillance of Periodic Fever Syndromes in Canada. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.supp5.e59a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND: Periodic fever syndromes (PFS) represent a group of rare, inflammatory disorders, which have their onset in childhood, and are associated with significant lifelong morbidity, and at times, increased mortality. The majority of affected children have recurrent, self-limited inflammatory episodes with unprovoked fever. The severe inflammatory state during an attack causes signs and symptoms in one or more organ systems. The Canadian Pediatric Surveillance Program (CPSP) studies relevant conditions of public health importance that are of such low incidence or prevalence that national ascertainment of cases are needed. Conditions that are studied share a high disability, morbidity and economic costs to society, despite the low frequency. More than 2400 pediatricians including relevant subspecialists, have been enrolled as CPSP participants. This program provides an ideal mechanism for surveillance of PFS in Canada.
OBJECTIVES: To estimate the incidence of periodic fever syndromes in the Canadian paediatric population, to describe the patterns of presentation, and to raise awareness in the medical community.
DESIGN/METHODS: This study was initiated through the Canadian Paediatric Surveillance Program (CPSP), and was carried out over a three year period ending in September 2014. The case definition included patients less than 18 years of age presenting with a newly diagnosed periodic fever syndrome (PFS). Conditions under surveillance included Familial Mediterranean fever (FMF), Tumor necrosis factor receptor-associated periodic syndrome (TRAPS), Hyperimmunoglobulin D syndrome (HIDS), cryopyrin-associated periodic syndromes (CAPS), Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA), and Undefined periodic fever syndromes. The study protocol outlined established clinical and/or genetic criteria for diagnosis. Participating pediatricians and pediat-ric subspecialists across the country were sent monthly reporting forms. Detailed questionnaires were completed by physicians who report a recent diagnosis. Submissions were screened for accuracy and confirmed cases then entered into a database.
RESULTS: Between September 2011 and August 2014 a total of 221 cases of PFS were reported. Detailed questionnaires were completed on 194 (88%), from which 13 were excluded. Of the 181 confirmed cases, 85 (47%) were PFAPA, 72 (40%) were undefined PFS, 17 (10%) were FMF, and the remaining 6 cases were CAPS, TRAPS, and HIDS. The mean age at diagnosis was 5.5 years (range 12 months – 16 years). On average symptom onset occurred 2.5 years before diagnosis (range 1-4 years). The majority of reporting physicians were rheumatologists (58%), and paediatricians (36%). Cases were identified in all provinces across Canada with the majority (103, 57%) from Ontario. For the 72 undefined PFS cases the reporting physicians described 36% as PFAPA-like, 10% FMF-like, 5% HIDS-like, 3% CAPS-like, and 1% TRAPS-like. Such cases had features of the specified PFS but either did not meet the full criteria, or confirmatory tests were not available at the time of reporting. Among all cases reported in the study, 58% had genetic testing completed as part of their diagnosis. The majority of cases without any genetic testing had been diagnosed as PFAPA.
CONCLUSION: Periodic fever syndromes represent rare forms of autoin-flammatory disease, which affect many Canadian children. This CPSP study identified that the most common PFS diagnosed was PFAPA followed by undefined PFS and FMF. CAPS, HIDS, and TRAPS were rarely diagnosed. Children with PFS were seen by multiple physicians over an average of two to three years before a diagnosis was made. It is hoped that increased awareness of these rare conditions will facilitate earlier diagnosis and the initiation of effective treatments for these children.
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22
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Guzman J, Kerr T, Ward L, Ma J, Oen K, Boire G, Feldman B, Scuccimarri R, Houghton K, Bruns A, Dancey P, Rosenberg A, Tucker L. SAT0507 Growth and Weight Gain in Children with Juvenile Idiopathic Arthritis: Results from the Reacch-Out Cohort. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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23
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Guzman J, Oen K, Huber AM, Watanabe Duffy K, Boire G, Shiff N, Berard RA, Levy DM, Stringer E, Scuccimarri R, Morishita K, Johnson N, Cabral DA, Rosenberg AM, Larché M, Dancey P, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Houghton K, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey SE, Bruns A, Roth J, Campillo S, Benseler S, Chédeville G, Schneider R, Tse SML, Bolaria R, Gross K, Feldman B, Feldman D, Cameron B, Jurencak R, Dorval J, LeBlanc C, St Cyr C, Gibbon M, Yeung RSM, Duffy CM, Tucker LB. The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Ann Rheum Dis 2015; 75:1092-8. [PMID: 25985972 DOI: 10.1136/annrheumdis-2014-207164] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/01/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe probabilities and characteristics of disease flares in children with juvenile idiopathic arthritis (JIA) and to identify clinical features associated with an increased risk of flare. METHODS We studied children in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) prospective inception cohort. A flare was defined as a recurrence of disease manifestations after attaining inactive disease and was called significant if it required intensification of treatment. Probability of first flare was calculated with Kaplan-Meier methods, and associated features were identified using Cox regression. RESULTS 1146 children were followed up a median of 24 months after attaining inactive disease. We observed 627 first flares (54.7% of patients) with median active joint count of 1, physician global assessment (PGA) of 12 mm and duration of 27 weeks. Within a year after attaining inactive disease, the probability of flare was 42.5% (95% CI 39% to 46%) for any flare and 26.6% (24% to 30%) for a significant flare. Within a year after stopping treatment, it was 31.7% (28% to 36%) and 25.0% (21% to 29%), respectively. A maximum PGA >30 mm, maximum active joint count >4, rheumatoid factor (RF)-positive polyarthritis, antinuclear antibodies (ANA) and receiving disease-modifying antirheumatic drugs (DMARDs) or biological agents before attaining inactive disease were associated with increased risk of flare. Systemic JIA was associated with the lowest risk of flare. CONCLUSIONS In this real-practice JIA cohort, flares were frequent, usually involved a few swollen joints for an average of 6 months and 60% led to treatment intensification. Children with a severe disease course had an increased risk of flare.
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Affiliation(s)
- Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Natalie Shiff
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Roberta A Berard
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Stringer
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Johnson
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - David A Cabral
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Maggie Larché
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland, Canada
| | - Ross E Petty
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald M Laxer
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Earl Silverman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Paivi Miettunen
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Anne-Laure Chetaille
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Elie Haddad
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Stuart E Turvey
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Ellsworth
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne E Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alessandra Bruns
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Johannes Roth
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Campillo
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Susanne Benseler
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Rayfel Schneider
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Shirley M L Tse
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roxana Bolaria
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Gross
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Bonnie Cameron
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roman Jurencak
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Jean Dorval
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Claire LeBlanc
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Claire St Cyr
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Michele Gibbon
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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Guzman J, Oen K, Tucker LB, Huber AM, Shiff N, Boire G, Scuccimarri R, Berard R, Tse SML, Morishita K, Stringer E, Johnson N, Levy DM, Duffy KW, Cabral DA, Rosenberg AM, Larché M, Dancey P, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Houghton K, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey S, Bruns A, Campillo S, Benseler S, Chédeville G, Schneider R, Yeung R, Duffy CM. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis 2014; 74:1854-60. [PMID: 24842571 DOI: 10.1136/annrheumdis-2014-205372] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/03/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe clinical outcomes of juvenile idiopathic arthritis (JIA) in a prospective inception cohort of children managed with contemporary treatments. METHODS Children newly diagnosed with JIA at 16 Canadian paediatric rheumatology centres from 2005 to 2010 were included. Kaplan-Meier survival curves for each JIA category were used to estimate probability of ever attaining an active joint count of 0, inactive disease (no active joints, no extraarticular manifestations and a physician global assessment of disease activity <10 mm), disease remission (inactive disease >12 months after discontinuing treatment) and of receiving specific treatments. RESULTS In a cohort of 1104 children, the probabilities of attaining an active joint count of 0 exceeded 78% within 2 years in all JIA categories. The probability of attaining inactive disease exceeded 70% within 2 years in all categories, except for RF-positive polyarthritis (48%). The probability of discontinuing treatment at least once was 67% within 5 years. The probability of attaining remission within 5 years was 46-57% across JIA categories except for polyarthritis (0% RF-positive, 14% RF-negative). Initial treatment included joint injections and non-steroidal anti-inflammatory drugs for oligoarthritis, disease-modifying antirheumatic drugs (DMARDs) for polyarthritis and systemic corticosteroids for systemic JIA. CONCLUSIONS Most children with JIA managed with contemporary treatments attain inactive disease within 2 years of diagnosis and many are able to discontinue treatment. The probability of attaining remission within 5 years of diagnosis is about 50%, except for children with polyarthritis.
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Affiliation(s)
- Jaime Guzman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Kiem Oen
- Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Natalie Shiff
- Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Roberta Berard
- London Health Sciences Centre and Western University, London, Canada
| | - Shirley M L Tse
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | | | - Nicole Johnson
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | - David A Cabral
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Canada
| | - Ross E Petty
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Ronald M Laxer
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Earl Silverman
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paivi Miettunen
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | | | - Elie Haddad
- CHU Ste. Justine and Université de Montréal, Montréal, Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stuart E Turvey
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Heinrike Schmeling
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Janet Ellsworth
- The Stollery Children's Hospital and University of Alberta, Edmonton, Canada
| | - Suzanne Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Alessandra Bruns
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Sarah Campillo
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Susanne Benseler
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Rayfel Schneider
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Rae Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
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25
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Dancey P, Benseler S, Gattorno M, Junker AK, Laxer RM, Miettunen P, Turner LA. A40: Periodic Fever Syndromes in Canada: Results from a National Surveillance Program. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Ronald M. Laxer
- The Hospital for Sick Children, University of Toronto; Toronto ON
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Abstract
Scleredema adultorum is a rare condition characterised by progressive collagen and mucin deposition in the skin. While the aetiology has not been clearly delineated, the condition is often associated with common infections. The current report describes a previously healthy 16-year-old boy who presented with 3 weeks of progressive neck swelling and skin induration. He had evidence of both active streptococcal and Ebstein-Barr virus (EBV) infections. Skin biopsy confirmed the diagnosis of scleredema. The patient was treated for his streptococcal infection, but otherwise managed conservatively. Clear improvement in the signs and symptoms was seen at a 3-month follow-up appointment. Scleredema can be a complication of streptococcal infection but to our knowledge has not been reported in association with EBV. It should be considered in the differential diagnosis of any patient presenting with cutaneous/subcutaneous induration and swelling of the face and/or neck.
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Affiliation(s)
- Erin Peebles
- Department of Pediatrics, Memorial University, St. John's, Canada.
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27
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Grenier D, Amed S, Dancey P, Dean H, Hadjiyannakis S, Hamilton J, Huber A, Pelletier L, Sellers E, Tucker L, Vaudry W, Wong T. Can surveillance provide epidemiological data on Aboriginal health? Paediatr Child Health 2012; 17:441-2. [DOI: 10.1093/pch/17.8.441] [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] [Accepted: 04/18/2012] [Indexed: 11/14/2022] Open
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28
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Dancey P, Benseler S, Junker AK, Laxer RM, Miettunen PMH, Turner LA, Gattorno M. The challenge of periodic fevers in children. Paediatr Child Health 2012; 17:123. [DOI: 10.1093/pch/17.3.123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2012] [Indexed: 11/13/2022] Open
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29
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Oen K, Duffy CM, Tse SML, Ramsey S, Ellsworth J, Chédeville G, Chetaille AL, Saint-Cyr C, Cabral DA, Spiegel LR, Schneider R, Lang B, Huber AM, Dancey P, Silverman E, Rosenberg AM, Cameron B, Johnson N, Dorval J, Scuccimarri R, Campillo S, Petty RE, Duffy KNW, Boire G, Haddad E, Houghton K, Laxer R, Turvey SE, Miettunen P, Gross K, Guzman J, Benseler S, Feldman BM, Espinosa V, Yeung RSM, Tucker L. Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort. Arthritis Care Res (Hoboken) 2010; 62:527-36. [DOI: 10.1002/acr.20044] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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30
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Oen K, Tucker L, Huber AM, Miettunen P, Scuccimarri R, Campillo S, Cabral DA, Feldman BM, Tse S, Chédeville G, Spiegel L, Schneider R, Lang B, Ellsworth J, Ramsey S, Dancey P, Silverman E, Chetaille AL, Cameron B, Johnson N, Dorval J, Petty RE, Duffy KW, Boire G, Haddad E, Houghton K, Saint-Cyr C, Turvey SE, Benseler S, Cheang M, Yeung RSM, Duffy CM. Predictors of early inactive disease in a juvenile idiopathic arthritis cohort: Results of a Canadian multicenter, prospective inception cohort study. ACTA ACUST UNITED AC 2009; 61:1077-86. [DOI: 10.1002/art.24539] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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31
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Aksentijevich I, Masters SL, Ferguson PJ, Dancey P, Frenkel J, van Royen-Kerkhoff A, Laxer R, Tedgård U, Cowen EW, Pham TH, Booty M, Estes JD, Sandler NG, Plass N, Stone DL, Turner ML, Hill S, Butman JA, Schneider R, Babyn P, El-Shanti HI, Pope E, Barron K, Bing X, Laurence A, Lee CCR, Chapelle D, Clarke GI, Ohson K, Nicholson M, Gadina M, Yang B, Korman BD, Gregersen PK, van Hagen PM, Hak AE, Huizing M, Rahman P, Douek DC, Remmers EF, Kastner DL, Goldbach-Mansky R. An autoinflammatory disease with deficiency of the interleukin-1-receptor antagonist. N Engl J Med 2009; 360:2426-37. [PMID: 19494218 PMCID: PMC2876877 DOI: 10.1056/nejmoa0807865] [Citation(s) in RCA: 655] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Autoinflammatory diseases manifest inflammation without evidence of infection, high-titer autoantibodies, or autoreactive T cells. We report a disorder caused by mutations of IL1RN, which encodes the interleukin-1-receptor antagonist, with prominent involvement of skin and bone. METHODS We studied nine children from six families who had neonatal onset of sterile multifocal osteomyelitis, periostitis, and pustulosis. Response to empirical treatment with the recombinant interleukin-1-receptor antagonist anakinra in the first patient prompted us to test for the presence of mutations and changes in proteins and their function in interleukin-1-pathway genes including IL1RN. RESULTS We identified homozygous mutations of IL1RN in nine affected children, from one family from Newfoundland, Canada, three families from The Netherlands, and one consanguineous family from Lebanon. A nonconsanguineous patient from Puerto Rico was homozygous for a genomic deletion that includes IL1RN and five other interleukin-1-family members. At least three of the mutations are founder mutations; heterozygous carriers were asymptomatic, with no cytokine abnormalities in vitro. The IL1RN mutations resulted in a truncated protein that is not secreted, thereby rendering cells hyperresponsive to interleukin-1beta stimulation. Patients treated with anakinra responded rapidly. CONCLUSIONS We propose the term deficiency of the interleukin-1-receptor antagonist, or DIRA, to denote this autosomal recessive autoinflammatory disease caused by mutations affecting IL1RN. The absence of interleukin-1-receptor antagonist allows unopposed action of interleukin-1, resulting in life-threatening systemic inflammation with skin and bone involvement. (ClinicalTrials.gov number, NCT00059748.)
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Affiliation(s)
- Ivona Aksentijevich
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, Bethesda, MD 20892, USA
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32
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Nguyen D, Leistritz DF, Turner L, MacGregor D, Ohson K, Dancey P, Martin GM, Oshima J. Collagen expression in fibroblasts with a novel LMNA mutation. Biochem Biophys Res Commun 2006; 352:603-8. [PMID: 17150192 PMCID: PMC1867458 DOI: 10.1016/j.bbrc.2006.11.070] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2006] [Accepted: 11/10/2006] [Indexed: 02/05/2023]
Abstract
Laminopathies are a group of genetic disorders caused by LMNA mutations; they include muscular dystrophies, lipodystrophies, and progeroid syndromes. We identified a novel heterozygous LMNA mutation, L59R, in a patient with the general appearance of mandibuloacral dysplasia and progeroid features. Examination of the nuclei of dermal fibroblasts revealed the irregular morphology characteristic of LMNA mutant cells. The nuclear morphological abnormalities of LMNA mutant lymphoblastoid cell lines were less prominent compared to those of primary fibroblasts. Since it has been reported that progeroid features are associated with increased extracellular matrix in dermal tissues, we compared a subset of these components in fibroblast cultures from LMNA mutants with those of control fibroblasts. There was no evidence of intracellular accumulation or altered mobility of collagen chains, or altered conversion of procollagen to collagen, suggesting that skin fibroblast-mediated matrix production may not play a significant role in the pathogenesis of this particular laminopathy.
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Affiliation(s)
- Desiree Nguyen
- Department of Pathology, University of Washington, Seattle, WA 98195, USA
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33
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Dancey P, Constantin E, Duffy CM, Scuccimarri R. Lupus cystitis in association with severe gastrointestinal manifestations in an adolescent. J Rheumatol 2005; 32:178-80. [PMID: 15630745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Lupus cystitis is a rare interstitial inflammatory disease of the bladder seen in systemic lupus erythematosus that usually occurs in association with gastrointestinal manifestations, and occasionally with central nervous system involvement. There are few reported pediatric cases. We describe this entity as the presenting manifestations of lupus in an adolescent female.
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MESH Headings
- Adolescent
- Antirheumatic Agents/therapeutic use
- Azathioprine/therapeutic use
- Cystitis, Interstitial/complications
- Cystitis, Interstitial/drug therapy
- Cystitis, Interstitial/pathology
- Drug Therapy, Combination
- Female
- Gastrointestinal Diseases/complications
- Gastrointestinal Diseases/drug therapy
- Gastrointestinal Diseases/pathology
- Humans
- Hydroxychloroquine/therapeutic use
- Immunosuppressive Agents/therapeutic use
- Injections, Intravenous
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/drug therapy
- Lupus Erythematosus, Systemic/pathology
- Methylprednisolone/administration & dosage
- Methylprednisolone/therapeutic use
- Pulse Therapy, Drug
- Tomography, X-Ray Computed
- Treatment Outcome
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Affiliation(s)
- Paul Dancey
- Division of Rheumatology, Montreal Children's Hospital, McGill University Health Center, McGill University, Montreal, Quebec, Canada
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