1
|
Kempf ON, Helt TW, Johansen KB, Rittig C, Lundby-Christensen L, Frederiksen MS, Mathiesen P, Boas M, Nielsen PB, Ellermann A, Børch K, Petersen JJ, Petersen TH, Sønderskov CT, Andersen J, Nielsen RG, Jeppesen EM, Christensen VB. Paracetamol overdose in Danish children and adolescents during the Covid-19 restrictions. Dan Med J 2024; 71:A08230494. [PMID: 38704838 DOI: 10.61409/a08230494] [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] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
INTRODUCTION To assess the effect of long-term isolation on the mental state of Danish youth. This study aimed to investigate trends in paracetamol overdoses among people under 18 years of age in Denmark during Covid-19 restrictions as an indicator of mental health. METHODS All patients under the age of 18 years presenting with paracetamol overdose at one of the 18 paediatric departments in Denmark from 2016 to 2021 were included. They were identified in all Danish hospital databases using specific diagnostic codes. RESULTS From 2016 to 2021, a total of 3,217 people under 18 years of age were admitted for paracetamol overdose. Among these, 86% (n = 2,755) were girls and 14% (n = 462) were boys. During 2020, a slight (7%) decrease in admissions was observed among both boys and girls compared with the preceding four-year mean value. In 2021, the number of overdoses among girls exceeded by 35% the former all-time high from 2016. Furthermore, the number of overdoses among girls exceeded the pre-four-year period mean value by 43%. Among boys, an 8% increase was seen from the highest ever previous value recorded in 2019 and a 23% increase compared with the previous four-year mean value. CONCLUSIONS During the first year of restrictions, a slight decrease in paracetamol overdoses was observed, possibly associated with limited accessibility. The second year showed a considerable increase in paracetamol overdoses, which may imply an affected mental state among youth during the prolonged lockdown restrictions as seen in previous epidemics. Therefore, further studies are warranted to develop a pandemic preparedness plan to protect general mental health. FUNDING None. TRIAL REGISTRATION Not relevant.
Collapse
Affiliation(s)
- Oliver Nørholm Kempf
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet
| | - Thora Wesenberg Helt
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital - Rigshospitalet
| | - Klaus Birkelund Johansen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital
- Department of Emergency Medicine, Horsens Regional Hospital
| | | | | | | | - Pernille Mathiesen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Herlev Hospital
| | - Malene Boas
- Department of Paediatrics and Adolescent Medicine, Zealand University Hospital, Roskilde
| | - Preben Berg Nielsen
- Department of Paediatrics and Adolescent Medicine, University Hospital of Southern Denmark - Sønderjylland
| | - Annie Ellermann
- Department of Paediatrics and Adolescent Medicine, Holbaek Hospital
| | - Klaus Børch
- Department of Paediatrics and Adolescence Medicine, Copenhagen University Hospital - Hvidovre Hospital
| | - Jens Jakob Petersen
- Department of Paediatrics and Adolescent Medicine, University Hospital of Southern Denmark - South-West Jutland
| | - Thomas Houmann Petersen
- Department of Paediatrics and Adolescent Medicine, University Hospital of Southern Denmark - Lillebaelt
| | | | - Jesper Andersen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University hospital - North Zealand Hospital
| | | | - Eva Mosfeldt Jeppesen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet
| | - Vibeke Brix Christensen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet
| |
Collapse
|
2
|
Rothwell S, Amos CI, Miller FW, Rider LG, Lundberg IE, Gregersen PK, Vencovsky J, McHugh N, Limaye V, Selva‐O'Callaghan A, Hanna MG, Machado PM, Pachman LM, Reed AM, Molberg Ø, Benveniste O, Mathiesen P, Radstake T, Doria A, De Bleecker JL, De Paepe B, Maurer B, Ollier WE, Padyukov L, O'Hanlon TP, Lee A, Wedderburn LR, Chinoy H, Lamb JA. Identification of Novel Associations and Localization of Signals in Idiopathic Inflammatory Myopathies Using Genome-Wide Imputation. Arthritis Rheumatol 2023; 75:1021-1027. [PMID: 36580032 PMCID: PMC10238560 DOI: 10.1002/art.42434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 10/07/2022] [Accepted: 12/22/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The idiopathic inflammatory myopathies (IIMs) are heterogeneous diseases thought to be initiated by immune activation in genetically predisposed individuals. We imputed variants from the ImmunoChip array using a large reference panel to fine-map associations and identify novel associations in IIM. METHODS We analyzed 2,565 Caucasian IIM patient samples collected through the Myositis Genetics Consortium (MYOGEN) and 10,260 ethnically matched control samples. We imputed 1,648,116 variants from the ImmunoChip array using the Haplotype Reference Consortium panel and conducted association analysis on IIM and clinical and serologic subgroups. RESULTS The HLA locus was consistently the most significantly associated region. Four non-HLA regions reached genome-wide significance, SDK2 and LINC00924 (both novel) and STAT4 in the whole IIM cohort, with evidence of independent variants in STAT4, and NAB1 in the polymyositis (PM) subgroup. We also found suggestive evidence of association with loci previously associated with other autoimmune rheumatic diseases (TEC and LTBR). We identified more significant associations than those previously reported in IIM for STAT4 and DGKQ in the total cohort, for NAB1 and FAM167A-BLK loci in PM, and for CCR5 in inclusion body myositis. We found enrichment of variants among DNase I hypersensitivity sites and histone marks associated with active transcription within blood cells. CONCLUSION We found novel and strong associations in IIM and PM and localized signals to single genes and immune cell types.
Collapse
Affiliation(s)
- Simon Rothwell
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | | | - Frederick W. Miller
- Environmental Autoimmunity GroupNational Institute of Environmental Health Sciences, NIHBethesdaMaryland
| | - Lisa G. Rider
- Environmental Autoimmunity GroupNational Institute of Environmental Health Sciences, NIHBethesdaMaryland
| | - Ingrid E. Lundberg
- Division of Rheumatology, Department of Medicine, Solna, Karolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Peter K. Gregersen
- The Robert S. Boas Center for Genomics and Human GeneticsThe Feinstein InstituteManhassetNew York
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, First Medical FacultyCharles UniversityPragueCzech Republic
| | - Neil McHugh
- Department of Pharmacy and PharmacologyUniversity of BathBathUK
| | - Vidya Limaye
- Rheumatology Unit, Royal Adelaide Hospital and Discipline of MedicineAdelaide UniversityAdelaideAustralia
| | - Albert Selva‐O'Callaghan
- Internal Medicine Department, Vall d'Hebron General Hospital, Universitat Autonoma de BarcelonaBarcelonaSpain
| | - Michael G. Hanna
- Department of Neuromuscular Diseases, UCL Queen Square Institute of NeurologyUniversity College LondonLondonUK
| | - Pedro M. Machado
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, and Centre for Rheumatology, UCL Division of MedicineUniversity College LondonLondonUK
| | - Lauren M. Pachman
- Ann & Robert H. Lurie Children's Hospital of ChicagoNorthwestern University Feinberg School of MedicineChicagoIllinois
| | - Ann M. Reed
- Department of PediatricsDuke UniversityDurhamNorth Carolina
| | - Øyvind Molberg
- Department of RheumatologyOslo University HospitalOsloNorway
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Pitié‐Salpêtrière HospitalParisFrance
| | - Pernille Mathiesen
- Paediatric Department, Slagelse Hospital and Paediatric Rheumatology Unit, RigshospitaletCopenhagenDenmark
| | - Timothy Radstake
- Department of Rheumatology and Clinical ImmunologyUniversity Medical CenterUtrechtthe Netherlands
| | - Andrea Doria
- Rheumatology Unit, Department of MedicineUniversity of PadovaPadovaItaly
| | | | | | - Britta Maurer
- Department of Rheumatology and ImmunologyUniversity HospitalBernSwitzerland
| | - William E. Ollier
- Manchester Metropolitan University, School of Healthcare SciencesManchesterUK
| | - Leonid Padyukov
- Division of Rheumatology, Department of Medicine, Solna, Karolinska InstitutetKarolinska University HospitalStockholmSweden
| | - Terrance P. O'Hanlon
- Environmental Autoimmunity GroupNational Institute of Environmental Health Sciences, NIHBethesdaMaryland
| | - Annette Lee
- The Robert S. Boas Center for Genomics and Human GeneticsThe Feinstein InstituteManhassetNew York
| | - Lucy R. Wedderburn
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, and Arthritis Research UK Centre for Adolescent Rheumatology, UCL Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Hector Chinoy
- National Institute for Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, The University of Manchester, Manchester, UK, and Department of Rheumatology, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester Academic Health Science Centre, Salford, UK, and Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of ManchesterManchesterUK
| | - Janine A. Lamb
- Epidemiology and Public Health Group, Division of Population Health, Health Services Research & Primary Care, Faculty of Biology, Medicine and HealthUniversity of ManchesterManchesterUK
| | | |
Collapse
|
3
|
Viuff ACF, Bistrup L, Mathiesen P, Bjerager MO, Henriksen TB. [Greater vigilance in medication for children and adolescent is warranted in Denmark]. Ugeskr Laeger 2020; 182:V01200003. [PMID: 33215585] [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: 06/11/2023]
Abstract
Only 30% of medication used for children and adolescents and 10% of the medication used for neonates has been evaluated for use in these populations. Infants and children differ from adults regarding pharmacodynamic and -kinetics, but they also differ from each other due to e.g. age, weight, and body composition, as we argue in this review. There is only limited knowledge within this area leading to the use of off-label, extemporaneous and unlicensed medication. Greater national vigilance in medication for children and adolescent is warranted to secure better and safer medicine for newborns, infants, children and adolescents.
Collapse
|
4
|
Dahl OE, Andreassen G, Aspelin T, Müller C, Mathiesen P, Nyhus S, Abdelnoor M, Solhaug JH, Arnesen H. Prolonged Thromboprophylaxis Following Hip Replacement Surgery – Results of a Double-blind, Prospective, Randomised, Placebo-controlled Study with Dalteparin (Fragmin®). Thromb Haemost 2018. [DOI: 10.1055/s-0038-1655901] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryDiscontinuation of thromboprophylaxis a few days after surgery may unmask delayed hypercoagulability and contribute to late formation of deep venous thrombosis (DVT). To investigate whether thromboprophylaxis should be prolonged beyond the hospital stay, a prospective, double-blind randomised study was conducted in 308 patients. All patients received initial thromboprophylaxis with dalteparin, dextran and graded elastic stockings. On day 7, patients were randomised to receive dalteparin (Fragmin®) 5000IU once daily, or placebo, for 4 weeks. All patients were subjected to bilateral venography, perfusion ventilation scintigraphy and chest X-ray on days 7 and 35. Patients with venographically verified proximal DVT on day 7 were withdrawn from the randomised study to receive anticoagulant treatment. The overall prevalence of DVT on day 7 was 15.9%. On day 35, the prevalence of DVT was 31.7% in placebo-treated patients compared with 19.3% in dalteparin-treated patients (p = 0.034). The incidence of DVT from day 7 to day 35 was 25.8% in the placebo-treated group versus 11.8% in the dalteparin-treated group (p = 0.017). The incidence of symptomatic pulmonary embolism (PE) from day 7 to day 35 was 2.8% in the placebo-treated group compared with zero in the dalteparin-treated group. This included one patient who died from PE. No patients experienced serious complications related to the injections of dalteparin or placebo. This study shows that prolonged thromboprophylaxis with dalteparin, 5000 IU, once daily for 35 days significantly reduces the frequency of DVT and should be recommended for 5 weeks after hip replacement surgery.
Collapse
Affiliation(s)
- O E Dahl
- The Research Forum, Diakonhjemmet Hospital, Oslo, Norway
- Department of Orthopaedics, Diakonhjemmet Hospital, Oslo, Norway
| | - G Andreassen
- Department of Surgery, Diakonhjemmet Hospital, Oslo, Norway
| | - T Aspelin
- The Research Forum, Diakonhjemmet Hospital, Oslo, Norway
| | - C Müller
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway
| | - P Mathiesen
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway
| | - S Nyhus
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway
| | - M Abdelnoor
- The Research Forum, Diakonhjemmet Hospital, Oslo, Norway
| | - J-H Solhaug
- Department of Surgery, Diakonhjemmet Hospital, Oslo, Norway
| | - H Arnesen
- Department of Medicine, Ullevaal University Hospital, Diakonhjemmet Hospital, Oslo, Norway
| |
Collapse
|
5
|
McCann LJ, Pilkington CA, Huber AM, Ravelli A, Appelbe D, Kirkham JJ, Williamson PR, Aggarwal A, Christopher-Stine L, Constantin T, Feldman BM, Lundberg I, Maillard S, Mathiesen P, Murphy R, Pachman LM, Reed AM, Rider LG, van Royen-Kerkof A, Russo R, Spinty S, Wedderburn LR, Beresford MW. Development of a consensus core dataset in juvenile dermatomyositis for clinical use to inform research. Ann Rheum Dis 2017; 77:241-250. [PMID: 29084729 PMCID: PMC5816738 DOI: 10.1136/annrheumdis-2017-212141] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/23/2017] [Accepted: 10/01/2017] [Indexed: 01/07/2023]
Abstract
Objectives This study aimed to develop consensus on an internationally agreed dataset for juvenile dermatomyositis (JDM), designed for clinical use, to enhance collaborative research and allow integration of data between centres. Methods A prototype dataset was developed through a formal process that included analysing items within existing databases of patients with idiopathic inflammatory myopathies. This template was used to aid a structured multistage consensus process. Exploiting Delphi methodology, two web-based questionnaires were distributed to healthcare professionals caring for patients with JDM identified through email distribution lists of international paediatric rheumatology and myositis research groups. A separate questionnaire was sent to parents of children with JDM and patients with JDM, identified through established research networks and patient support groups. The results of these parallel processes informed a face-to-face nominal group consensus meeting of international myositis experts, tasked with defining the content of the dataset. This developed dataset was tested in routine clinical practice before review and finalisation. Results A dataset containing 123 items was formulated with an accompanying glossary. Demographic and diagnostic data are contained within form A collected at baseline visit only, disease activity measures are included within form B collected at every visit and disease damage items within form C collected at baseline and annual visits thereafter. Conclusions Through a robust international process, a consensus dataset for JDM has been formulated that can capture disease activity and damage over time. This dataset can be incorporated into national and international collaborative efforts, including existing clinical research databases.
Collapse
Affiliation(s)
- Liza J McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Clarissa A Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, University College London Hospital, London, UK
| | - Adam M Huber
- Division of Pediatric Rheumatology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Angelo Ravelli
- Division of Rheumatology, Università degli Studi di Genova and Istituto Giannina Gaslini Pediatria II-Reumatologia, Genoa, Italy
| | - Duncan Appelbe
- Department of Biostatistics, MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Jamie J Kirkham
- Department of Biostatistics, MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Department of Biostatistics, MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool, UK
| | - Amita Aggarwal
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | - Tamas Constantin
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Brian M Feldman
- Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ingrid Lundberg
- Department of Medicine, Rheumatology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Sue Maillard
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pernille Mathiesen
- Department of Paediatrics and Adolescent Medicine, Naestved Hospital, Region Zeeland, Naestved, Denmark
| | - Ruth Murphy
- Department of Dermatology, Royal Hallamshire Hospital, Sheffield, UK
| | - Lauren M Pachman
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of Rheumatology, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.,Centre for Clinical Immunology, The Stanley Manne Children's Research Centre, Chicago, Illinois, USA
| | - Ann M Reed
- Department of Paediatrics, Duke University, Durham, North Carolina, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, Bethesda, Maryland, USA
| | - Annet van Royen-Kerkof
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children's Hospital University Medical Centre, Utrecht, The Netherlands
| | - Ricardo Russo
- Department of Paediatric Immunology and Rheumatology, Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina
| | - Stefan Spinty
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Lucy R Wedderburn
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,Arthritis Research UK Centre for Adolescent Rheumatology, University College London, University College London Hospital, London, UK.,Infection, Immunology, and Rheumatology Section, UCL GOS Institute of Child Health, University College London, London, UK.,NIHR-Biomedical Research Centre at GOSH, London, UK
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| |
Collapse
|
6
|
Abstract
In Denmark, child primary care is taken care of by general practitioners who have 6 months of pediatric training as part of their specialty training and, therefore, are qualified to work as gatekeepers for the secondary health care at the hospitals. As new, more expensive, drugs are increasingly prescribed, corresponding expenses pose serious threats to the economy at 18 pediatric departments. We will highlight the new developments in pediatric education: skills training and training of clinical reasoning.
Collapse
Affiliation(s)
| | | | - Kirsten Lykke
- Research Unit for General Practice, Copenhagen University, København K, Denmark
| | - Thomas Balslev
- Department of Pediatrics, Regional Hospital Viborg, Viborg, and Center of Health Educations Education, Aarhus, Denmark
| |
Collapse
|
7
|
van der Stap DK, Rider LG, Alexanderson H, Huber AM, Gualano B, Gordon P, van der Net J, Mathiesen P, Johnson LG, Ernste FC, Feldman BM, Houghton KM, Singh-Grewal D, Kutzbach AG, Munters LA, Takken T. Proposal for a Candidate Core Set of Fitness and Strength Tests for Patients with Childhood or Adult Idiopathic Inflammatory Myopathies. J Rheumatol 2016; 43:169-76. [PMID: 26568594 PMCID: PMC4698199 DOI: 10.3899/jrheum.150270] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Currently there are no evidence-based recommendations regarding fitness and strength tests for patients with childhood or adult idiopathic inflammatory myopathies (IIM). This hinders clinicians and researchers in choosing the appropriate fitness- or muscle strength-related outcome measures for these patients. Through a Delphi survey, we aimed to identify a candidate core set of fitness and strength tests for children and adults with IIM. METHODS Fifteen experts participated in a Delphi survey that consisted of 5 stages to achieve a consensus. Using an extensive search of published literature and through the work of experts, a candidate core set based on expert opinion and clinimetrics properties was developed. Members of the International Myositis Assessment and Clinical Studies Group were invited to review this candidate core set during the final stage, which led to a final candidate core set. RESULTS A core set of fitness- and strength-related outcome measures was identified for children and adults with IIM. For both children and adults, different tests were identified and selected for maximal aerobic fitness, submaximal aerobic fitness, anaerobic fitness, muscle strength tests, and muscle function tests. CONCLUSION The core set of fitness- and strength-related outcome measures provided by this expert consensus process will assist practitioners and researchers in deciding which tests to use in patients with IIM. This will improve the uniformity of fitness and strength tests across studies, thereby facilitating the comparison of study results and therapeutic exercise program outcomes among patients with IIM.
Collapse
Affiliation(s)
- Djamilla K.D. van der Stap
- Faculty of Human Movement Sciences, Free University, Amsterdam, The Netherlands
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lisa G. Rider
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD
| | - Helene Alexanderson
- Department of Neurobiology, Care Science and Society, Division of Physical Therapy, Karolinska Institutet and the Physical Therapy Clinic, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Patrick Gordon
- Department of rheumatology, King’s College Hospital, London, UK
| | - Janjaap van der Net
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pernille Mathiesen
- Paediatric Rheumatology Clinic, Paediatric Department, Rigshospitalet, Copenhagen, Denmark
| | - Liam G. Johnson
- Institute of Sport, Exercise and Active Living (ISEAL), College of Sport and Exercise Science, Victoria University, Melbourne, Australia
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - Floranne C. Ernste
- Mayo Clinic in Rochester MN, Department of Internal Medicine, Division of Rheumatology
| | - Brian M. Feldman
- Departments of Pediatrics, Medicine and the Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Canada
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | | | - Davinder Singh-Grewal
- The Sydney Children's Hospitals Network Randwick and Westmead Campuses
- The University of Sydney, School of Paediatrics and Child Health
- The University of New South Wales, Discipline of Child and Maternal Health
- The University of Western Sydney Department of Paediatrics, Sydney, Australia
- The John Hunter Children’s Hospital, Newcastle Australia
| | - Abraham Garcia Kutzbach
- Director of the postgraduate Program of Rheumatology AGAR, School of Medicine University Francisco Marroquin, Guatemala
- Professor of Medicine and History of Medicine, School of Medicine University Francisco Marroquin, Guatemala
- Member of the executive Committee Hospital Herrera Llerandi Guatemala
| | - Li Alemo Munters
- Physical Therapy Clinic, Orthopedic/Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
- Division of Rheumatology and Immunology, Department of Medicine, Vanderbilt University, Nashville, USA
| | - Tim Takken
- Child Development & Exercise Center, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
8
|
Rothwell S, Cooper RG, Lundberg IE, Miller FW, Gregersen PK, Bowes J, Vencovsky J, Danko K, Limaye V, Selva-O'Callaghan A, Hanna MG, Machado PM, Pachman LM, Reed AM, Rider LG, Cobb J, Platt H, Molberg Ø, Benveniste O, Mathiesen P, Radstake T, Doria A, De Bleecker J, De Paepe B, Maurer B, Ollier WE, Padyukov L, O'Hanlon TP, Lee A, Amos CI, Gieger C, Meitinger T, Winkelmann J, Wedderburn LR, Chinoy H, Lamb JA. Dense genotyping of immune-related loci in idiopathic inflammatory myopathies confirms HLA alleles as the strongest genetic risk factor and suggests different genetic background for major clinical subgroups. Ann Rheum Dis 2015; 75:1558-66. [PMID: 26362759 DOI: 10.1136/annrheumdis-2015-208119] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 08/28/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The idiopathic inflammatory myopathies (IIMs) are a heterogeneous group of rare autoimmune diseases characterised by muscle weakness and extramuscular manifestations such as skin rashes and interstitial lung disease. We genotyped 2566 IIM cases of Caucasian descent using the Immunochip; a custom array covering 186 established autoimmune susceptibility loci. The cohort was predominantly comprised of patients with dermatomyositis (DM, n=879), juvenile DM (JDM, n=481), polymyositis (PM, n=931) and inclusion body myositis (n=252) collected from 14 countries through the Myositis Genetics Consortium. RESULTS The human leucocyte antigen (HLA) and PTPN22 regions reached genome-wide significance (p<5×10(-8)). Nine regions were associated at a significance level of p<2.25×10(-5), including UBE2L3, CD28 and TRAF6, with evidence of independent effects within STAT4. Analysis of clinical subgroups revealed distinct differences between PM, and DM and JDM. PTPN22 was associated at genome-wide significance with PM, but not DM and JDM, suggesting this effect is driven by PM. Additional suggestive associations including IL18R1 and RGS1 in PM and GSDMB in DM were identified. HLA imputation confirmed that alleles HLA-DRB1*03:01 and HLA-B*08:01 of the 8.1 ancestral haplotype (8.1AH) are most strongly associated with IIM, and provides evidence that amino acids within the HLA, such as HLA-DQB1 position 57 in DM, may explain part of the risk in this locus. Associations with alleles outside the 8.1AH reveal differences between PM, DM and JDM. CONCLUSIONS This work represents the largest IIM genetic study to date, reveals new insights into the genetic architecture of these rare diseases and suggests different predominating pathophysiology in different clinical subgroups.
Collapse
Affiliation(s)
- Simon Rothwell
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Robert G Cooper
- Department of Musculoskeletal Biology, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, UK
| | - Ingrid E Lundberg
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter K Gregersen
- The Robert S Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - John Bowes
- Centre for Genetics and Genomics, Arthritis Research UK, University of Manchester, Manchester, UK
| | - Jiri Vencovsky
- Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Katalin Danko
- Division of Clinical Immunology, Department of Internal Medicine, University of Debrecen, Debrecen, Hungary
| | - Vidya Limaye
- Royal Adelaide Hospital and University of Adelaide, Adelaide, South Australia, Australia
| | | | - Michael G Hanna
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Pedro M Machado
- MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
| | - Lauren M Pachman
- Northwestern University Feinberg School of Medicine and Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Ann M Reed
- Department of Pediatrics, Duke University, Durham, North Carolina, USA
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Joanna Cobb
- Arthritis Research UK, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Hazel Platt
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital, Oslo, Norway
| | | | | | - Timothy Radstake
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Andrea Doria
- Department of Medicine, University of Padova, Padova, Italy
| | - Jan De Bleecker
- Department of Neurology, Neuromuscular Reference Centre, Ghent University Hospital, Ghent, Belgium
| | - Boel De Paepe
- Department of Neurology, Neuromuscular Reference Centre, Ghent University Hospital, Ghent, Belgium
| | - Britta Maurer
- Department of Rheumatology and Center of Experimental Rheumatology, University Hospital Zurich, Zurich, Switzerland
| | - William E Ollier
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - Leonid Padyukov
- Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Terrance P O'Hanlon
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Science, National Institutes of Health, Bethesda, Maryland, USA
| | - Annette Lee
- The Robert S Boas Center for Genomics and Human Genetics, Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Christopher I Amos
- Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
| | - Christian Gieger
- Helmholtz Zentrum München, Deutsches Forschungszentrum für Gesundheit und Umwelt (GmbH), Neuherberg, Germany
| | - Thomas Meitinger
- Institute of Human Genetics, Technische Universität München, Munich, Germany Institute of Human Genetics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Juliane Winkelmann
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany Institute of Neurogenomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - Lucy R Wedderburn
- Arthritis Research UK Centre for Adolescent Rheumatology, and Institute of Child Health, University College London, London, UK
| | - Hector Chinoy
- National Institute of Health Research Manchester Musculoskeletal Biomedical Research Unit, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
| | - Janine A Lamb
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | | |
Collapse
|
9
|
Kristensen VA, Nielsen S, Herlin T, Mathiesen P. PReS-FINAL-2016: Bone mineral status in a long-term follow up of juvenile dermatomyositis patients. Pediatr Rheumatol Online J 2013. [PMCID: PMC4043479 DOI: 10.1186/1546-0096-11-s2-p29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
10
|
Mathiesen P, Enevold C, Lange T, Kornblit B, Nielsen S, Müller K. Toll-like receptor 2 polymorphism in juvenile dermatomyositis. Pediatr Rheumatol Online J 2011. [PMCID: PMC3194437 DOI: 10.1186/1546-0096-9-s1-o40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
11
|
Mathiesen P, Hegaard H, Herlin T, Zak M, Pedersen FK, Nielsen S. Long-term outcome in patients with juvenile dermatomyositis: a cross-sectional follow-up study. Scand J Rheumatol 2011; 41:50-8. [DOI: 10.3109/03009742.2011.608376] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
12
|
Dahl OE, Andreassen G, Aspelin T, Müller C, Mathiesen P, Nyhus S, Abdelnoor M, Solhaug JH, Arnesen H. Prolonged thromboprophylaxis following hip replacement surgery--results of a double-blind, prospective, randomised, placebo-controlled study with dalteparin (Fragmin). Thromb Haemost 1997; 77:26-31. [PMID: 9031444] [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: 02/03/2023]
Abstract
Discontinuation of thromboprophylaxis a few days after surgery may unmask delayed hypercoagulability and contribute to late formation of deep venous thrombosis (DVT). To investigate whether thromboprophylaxis should be prolonged beyond the hospital stay, a prospective, double-blind randomised study was conducted in 308 patients. All patients received initial thromboprophylaxis with dalteparin, dextran and graded elastic stockings. On day 7, patients were randomised to receive dalteparin (Fragmin) 5000 i.u. once daily, or placebo, for 4 weeks. All patients were subjected to bilateral venography, perfusion ventilation scintigraphy and chest X-ray on days 7 and 35. Patients with venographically verified proximal DVT on day 7 were withdrawn from the randomised study to receive anticoagulant treatment. The overall prevalence of DVT on day 7 was 15.9%. On day 35, the prevalence of DVT was 31.7% in placebo-treated patients compared with 19.3% in dalteparin-treated patients (p = 0.034). The incidence of DVT from day 7 to day 35 was 25.8% in the placebo-treated group versus 11.8% in the dalteparin-treated group (p = 0.017). The incidence of symptomatic pulmonary embolism (PE) from day 7 to day 35 was 2.8% in the placebo-treated group compared with zero in the dalteparin-treated group. This included one patient who died from PE. No patients experienced serious complications related to the injections of dalteparin or placebo. This study shows that prolonged thromboprophylaxis with dalteparin. 5000 IU, once daily for 35 days significantly reduces the frequency of DVT and should be recommended for 5 weeks after hip replacement surgery.
Collapse
Affiliation(s)
- O E Dahl
- Department of Orthopaedics, Ullevaal University Hospital, Oslo, Norway.
| | | | | | | | | | | | | | | | | |
Collapse
|