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Mansfield LM, Lapidus SK, Romero SN, Moorthy LN, Adler-Shohet FC, Hollander M, Cherian J, Twilt M, Lionetti G, Mohan S, DeLaMora PA, Durrant KL, Muskardin TW, Correia Marques M, Onel KB, Dedeoglu F, Gutierrez MJ, Schulert G. Corrigendum: Increase in pediatric recurrent fever evaluations during the first year of the COVID-19 pandemic in North America. Front Pediatr 2023; 11:1323946. [PMID: 38027299 PMCID: PMC10658707 DOI: 10.3389/fped.2023.1323946] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2023.1240242.].
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Affiliation(s)
- Leanne M. Mansfield
- Department of Pediatric Rheumatology, Hospital for Special Surgery, New York, United States
- Department of Pediatrics, Weill Cornell Medicine, Cornell University, New York, United States
| | - Sivia K. Lapidus
- Joseph M. Sanzari Children’s Hospital, Hackensack, United States
| | | | - Lakshmi N. Moorthy
- Department of Pediatrics, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, United States
| | | | - Matthew Hollander
- Department of Pediatrics, Larner College of Medicine, University of Vermont, Burlington, United States
| | - Julie Cherian
- Department of Pediatrics, Stony Brook Children’s Hospital, Stony Brook, United States
| | | | - Geraldina Lionetti
- Department of Pediatrics, School of Medicine, University of California San Francisco, San Francisco, United States
| | - Smriti Mohan
- Department of Pediatrics, C. S. Mott Children’s Hospital, Ann Arbor, United States
| | - Patricia A. DeLaMora
- Department of Pediatrics, School of Medicine, New York Medical College, Valhalla, United States
| | | | | | - Mariana Correia Marques
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIH), Bethesda, United States
| | - Karen B. Onel
- Department of Pediatric Rheumatology, Hospital for Special Surgery, New York, United States
- Department of Pediatrics, Weill Cornell Medicine, Cornell University, New York, United States
| | - Fatma Dedeoglu
- Division of Immunology, Boston Children’s Hospital, Harvard Medical School, Boston, United States
- Department of Pediatrics, Harvard Medical School, Boston, United States
| | - Maria J. Gutierrez
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, United States
| | - Grant Schulert
- Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, United States
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Mansfield LM, Lapidus SK, Romero SN, Moorthy LN, Adler-Shohet FC, Hollander M, Cherian J, Twilt M, Lionetti G, Mohan S, DeLaMora PA, Durrant KL, Muskardin TW, Correia Marques M, Onel KB, Dedeoglu F, Gutierrez MJ, Schulert G. Increase in pediatric recurrent fever evaluations during the first year of the COVID-19 pandemic in North America. Front Pediatr 2023; 11:1240242. [PMID: 37601132 PMCID: PMC10435740 DOI: 10.3389/fped.2023.1240242] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/21/2023] [Indexed: 08/22/2023] Open
Abstract
The impact of the COVID-19 pandemic on new diagnoses of recurrent fevers and autoinflammatory diseases is largely unknown. The Childhood Arthritis and Rheumatology Research Alliance (CARRA) PFAPA/AID Working Group aimed to investigate the impact of the COVID-19 pandemic on the number of pediatric patients evaluated for recurrent fevers and autoinflammatory diseases in North America. The absolute number of new outpatient visits and the proportion of these visits attributed to recurrent fever diagnoses during the pre-pandemic period (1 March 2019-29 February 2020) and the first year of the COVID-19 pandemic (1 March 2020-28 February 2021) were examined. Data were collected from 27 sites in the United States and Canada. Our results showed an increase in the absolute number of new visits for recurrent fever evaluations in 21 of 27 sites during the COVID-19 pandemic compared to the pre-pandemic period. The increase was observed across different geographic regions in North America. Additionally, the proportion of new visits to these centers for recurrent fever in relation to all new patient evaluations was significantly higher during the first year of the pandemic, increasing from 7.8% before the pandemic to 10.9% during the pandemic year (p < 0.001). Our findings showed that the first year of the COVID-19 pandemic was associated with a higher number of evaluations by pediatric subspecialists for recurrent fevers. Further research is needed to understand the reasons behind these findings and to explore non-infectious triggers for recurrent fevers in children.
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Affiliation(s)
- Leanne M. Mansfield
- Department of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, United States
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Sivia K. Lapidus
- Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center and Hackensack Meridian Health, Hackensack, NJ, United States
| | - Samira Nazzar Romero
- Department of Rheumatology, Nemours Children’s Hospital, Orlando, FL, United States
| | - Lakshmi N. Moorthy
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | | | - Matthew Hollander
- Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, VT, United States
| | - Julie Cherian
- Department of Pediatrics, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Marinka Twilt
- Alberta Children’s Hospital, University of Calgary, Calgary, AB, Canada
| | - Geraldina Lionetti
- Department of Pediatrics, University of California San Francisco, Benioff Children's Hospitals, San Francisco, CA, United States
| | - Smriti Mohan
- Department of Pediatrics, University of Michigan, CS Mott Children’s Hospital, Ann Arbor, MI, United States
| | | | | | | | - Mariana Correia Marques
- National Institute for Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Karen B. Onel
- Department of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, United States
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, United States
| | - Fatma Dedeoglu
- Division of Immunology, Department of Medicine, Boston Children’s Hospital, Boston, MA, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Maria J. Gutierrez
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Grant Schulert
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
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3
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Gorelik M, Chung SA, Ardalan K, Binstadt BA, Friedman K, Hayward K, Imundo LF, Lapidus SK, Kim S, Son MB, Sule S, Tremoulet AH, Van Mater H, Yildirim-Toruner C, Langford CA, Maz M, Abril A, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Merkel PA, Rhee RL, Seo P, Stone JH, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot M, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, Mustafa RA. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease. Arthritis Rheumatol 2022; 74:586-596. [PMID: 35257501 DOI: 10.1002/art.42041] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 10/18/2021] [Accepted: 12/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To provide evidence-based recommendations and expert guidance for the management of Kawasaki disease (KD), focusing on clinical scenarios more commonly addressed by rheumatologists. METHODS Sixteen clinical questions regarding diagnostic testing, treatment, and management of KD were developed in the Patient/Population, Intervention, Comparison, and Outcomes (PICO) question format. Systematic literature reviews were conducted for each PICO question. We used the Grading of Recommendations, Assessment, Development and Evaluation method to assess the quality of evidence and formulate recommendations. Each recommendation required consensus from at least 70% of the Voting Panel. RESULTS We present 1 good practice statement, 11 recommendations, and 1 ungraded position statement to guide the management of KD and clinical scenarios of suspected KD. These recommendations for KD are focused on situations in which input from rheumatologists may be requested by other managing specialists, such as in cases of treatment-refractory, severe, or complicated KD. The good practice statement affirms that all patients with KD should receive initial treatment with intravenous immunoglobulin (IVIG). In addition, we developed 7 strong and 4 conditional recommendations for the management of KD or suspected KD. Strong recommendations include prompt treatment of incomplete KD, treatment with aspirin, and obtaining an echocardiogram in the setting of unexplained macrophage activation syndrome or shock. Conditional recommendations include use of IVIG with other adjuvant agents for patients with KD and high-risk features of IVIG resistance and/or coronary artery aneurysms. These recommendations endorse minimizing risk to the patient by using established therapy promptly at disease onset and identifying situations in which adjunctive therapy may be warranted. CONCLUSION These recommendations provide guidance regarding diagnostic strategies, use of pharmacologic agents, and use of echocardiography in patients with suspected or confirmed KD.
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Affiliation(s)
- Mark Gorelik
- Columbia University School of Medicine, New York, New York
| | | | - Kaveh Ardalan
- Duke University School of Medicine, Durham, North Carolina
| | | | - Kevin Friedman
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristen Hayward
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington
| | - Lisa F Imundo
- Columbia University School of Medicine, New York, New York
| | - Sivia K Lapidus
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Susan Kim
- University of California, San Francisco
| | - Mary Beth Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | - Mehrdad Maz
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | | | - Philip Seo
- Johns Hopkins Medical Institute, Baltimore, Maryland
| | | | - Robert P Sundel
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Ann Warner
- Saint Luke's Health System, Kansas City, Missouri
| | | | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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4
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Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, Behrens EM, Kernan KF, Schulert GS, Seo P, Son MBF, Tremoulet AH, VanderPluym C, Yeung RSM, Mudano AS, Turner AS, Karp DR, Mehta JJ. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 3. Arthritis Rheumatol 2022; 74:e1-e20. [PMID: 35118829 PMCID: PMC9011620 DOI: 10.1002/art.42062] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/22/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To provide guidance on the management of Multisystem Inflammatory Syndrome in Children (MIS-C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of SARS-CoV-2 infection. Recommendations are also provided for children with hyperinflammation during COVID-19, the acute, infectious phase of SARS-CoV-2 infection. METHODS The Task Force is composed of 9 pediatric rheumatologists and 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS-C and hyperinflammation in COVID-19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved anonymous voting and webinar discussion. A 9-point scale was used to determine the appropriateness of each statement (median scores of 1-3 for inappropriate, 4-6 for uncertain, and 7-9 for appropriate). Consensus was rated as low, moderate, or high based on dispersion of the votes. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, which were prespecified before voting. RESULTS The guidance was approved in June 2020 and updated in November 2020 and October 2021, and consists of 41 final guidance statements accompanied by flow diagrams depicting the diagnostic pathway for MIS-C and recommendations for initial immunomodulatory treatment of MIS-C. CONCLUSION Our understanding of SARS-CoV-2-related syndromes in the pediatric population continues to evolve. This guidance document reflects currently available evidence coupled with expert opinion, and will be revised as further evidence becomes available.
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Affiliation(s)
| | - Scott W. Canna
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
| | - Kevin G. Friedman
- Boston Children's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Mark Gorelik
- Morgan Stanley Children’s Hospital and Columbia UniversityNew YorkNew York
| | - Sivia K. Lapidus
- Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center and Hackensack Meridian School of MedicineHackensackNew Jersey
| | - Hamid Bassiri
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
| | - Edward M. Behrens
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
| | - Kate F. Kernan
- University of Pittsburgh School of MedicinePittsburghPennsylvania
| | - Grant S. Schulert
- Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of MedicineCincinnatiOhio
| | - Philip Seo
- Johns Hopkins University School of MedicineBaltimoreMaryland
| | - Mary Beth F. Son
- Boston Children's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Adriana H. Tremoulet
- University of California San Diego and Rady Children’s Hospital San DiegoCalifornia
| | | | - Rae S. M. Yeung
- The Hospital for Sick Children and University of TorontoTorontoOntarioCanada
| | | | | | - David R. Karp
- University of Texas Southwestern Medical CenterDallas
| | - Jay J. Mehta
- Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
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5
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Gorelik M, Chung SA, Ardalan K, Binstadt BA, Friedman K, Hayward K, Imundo LF, Lapidus SK, Kim S, Son MB, Sule S, Tremoulet AH, Van Mater H, Yildirim-Toruner C, Langford CA, Maz M, Abril A, Guyatt G, Archer AM, Conn DL, Full KA, Grayson PC, Ibarra MF, Merkel PA, Rhee RL, Seo P, Stone JH, Sundel RP, Vitobaldi OI, Warner A, Byram K, Dua AB, Husainat N, James KE, Kalot M, Lin YC, Springer JM, Turgunbaev M, Villa-Forte A, Turner AS, Mustafa RA. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease. Arthritis Care Res (Hoboken) 2022; 74:538-548. [PMID: 35257507 DOI: 10.1002/acr.24838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/02/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To provide evidence-based recommendations and expert guidance for the management of Kawasaki disease (KD), focusing on clinical scenarios more commonly addressed by rheumatologists. METHODS Sixteen clinical questions regarding diagnostic testing, treatment, and management of KD were developed in the Patient/Population, Intervention, Comparison, and Outcomes (PICO) question format. Systematic literature reviews were conducted for each PICO question. We used the Grading of Recommendations, Assessment, Development and Evaluation method to assess the quality of evidence and formulate recommendations. Each recommendation required consensus from at least 70% of the Voting Panel. RESULTS We present 1 good practice statement, 11 recommendations, and 1 ungraded position statement to guide the management of KD and clinical scenarios of suspected KD. These recommendations for KD are focused on situations in which input from rheumatologists may be requested by other managing specialists, such as in cases of treatment-refractory, severe, or complicated KD. The good practice statement affirms that all patients with KD should receive initial treatment with intravenous immunoglobulin (IVIG). In addition, we developed 7 strong and 4 conditional recommendations for the management of KD or suspected KD. Strong recommendations include prompt treatment of incomplete KD, treatment with aspirin, and obtaining an echocardiogram in the setting of unexplained macrophage activation syndrome or shock. Conditional recommendations include use of IVIG with other adjuvant agents for patients with KD and high-risk features of IVIG resistance and/or coronary artery aneurysms. These recommendations endorse minimizing risk to the patient by using established therapy promptly at disease onset and identifying situations in which adjunctive therapy may be warranted. CONCLUSION These recommendations provide guidance regarding diagnostic strategies, use of pharmacologic agents, and use of echocardiography in patients with suspected or confirmed KD.
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Affiliation(s)
- Mark Gorelik
- Columbia University School of Medicine, New York, New York
| | | | - Kaveh Ardalan
- Duke University School of Medicine, Durham, North Carolina
| | | | - Kevin Friedman
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Kristen Hayward
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington
| | - Lisa F Imundo
- Columbia University School of Medicine, New York, New York
| | - Sivia K Lapidus
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Susan Kim
- University of California, San Francisco
| | - Mary Beth Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Adriana H Tremoulet
- Rady Children's Hospital and University of California, San Diego, San Diego, California
| | | | | | | | - Mehrdad Maz
- University of Kansas Medical Center, Kansas City
| | | | | | | | | | | | - Peter C Grayson
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
| | | | | | | | - Philip Seo
- Johns Hopkins Medical Institute, Baltimore, Maryland
| | | | - Robert P Sundel
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Ann Warner
- Saint Luke's Health System, Kansas City, Missouri
| | | | | | | | | | | | | | | | | | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
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6
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Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, Behrens EM, Ferris A, Kernan KF, Schulert GS, Seo P, Son MBF, Tremoulet AH, Yeung RSM, Mudano AS, Turner AS, Karp DR, Mehta JJ. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 2. Arthritis Rheumatol 2021; 73:e13-e29. [PMID: 33277976 PMCID: PMC8559788 DOI: 10.1002/art.41616] [Citation(s) in RCA: 250] [Impact Index Per Article: 83.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide guidance on the management of Multisystem Inflammatory Syndrome in Children (MIS-C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Recommendations are also provided for children with hyperinflammation during coronavirus disease 2019 (COVID-19), the acute, infectious phase of SARS-CoV-2 infection. METHODS The Task Force was composed of 9 pediatric rheumatologists and 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS-C and hyperinflammation in COVID-19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved anonymous voting and webinar discussion. A 9-point scale was used to determine the appropriateness of each statement (median scores of 1-3 for inappropriate, 4-6 for uncertain, and 7-9 for appropriate). Consensus was rated as low, moderate, or high based on dispersion of the votes. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, which were prespecified before voting. RESULTS The first version of the guidance was approved in June 2020, and consisted of 40 final guidance statements accompanied by a flow diagram depicting the diagnostic pathway for MIS-C. The document was revised in November 2020, and a new flow diagram with recommendations for initial immunomodulatory treatment of MIS-C was added. CONCLUSION Our understanding of SARS-CoV-2-related syndromes in the pediatric population continues to evolve. This guidance document reflects currently available evidence coupled with expert opinion, and will be revised as further evidence becomes available.
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Affiliation(s)
- Lauren A. Henderson
- Lauren A. Henderson, MD, MMSc, Kevin G. Friedman, MD, Mary Beth F. Son, MD: Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott W. Canna
- Scott W. Canna, MD: UPMC Children’s Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin G. Friedman
- Lauren A. Henderson, MD, MMSc, Kevin G. Friedman, MD, Mary Beth F. Son, MD: Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark Gorelik
- Mark Gorelik, MD: Morgan Stanley Children’s Hospital and Columbia University, New York, New York
| | - Sivia K. Lapidus
- Sivia K. Lapidus, MD: Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Hamid Bassiri
- Hamid Bassiri, MD, PhD, Edward M. Behrens, MD, Jay J. Mehta, MD: Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
| | - Edward M. Behrens
- Hamid Bassiri, MD, PhD, Edward M. Behrens, MD, Jay J. Mehta, MD: Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
| | - Anne Ferris
- Anne Ferris, MBBS: Columbia University Irving Medical Center, New York, New York
| | - Kate F. Kernan
- Kate F. Kernan, MD: University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Grant S. Schulert
- Grant S. Schulert, MD: Cincinnati Children’s Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Philip Seo
- Philip Seo, MD, MHS: Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Beth F. Son
- Lauren A. Henderson, MD, MMSc, Kevin G. Friedman, MD, Mary Beth F. Son, MD: Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Adriana H. Tremoulet
- Adriana H. Tremoulet, MD, MAS: University of California San Diego and Rady Children’s Hospital, San Diego, California
| | - Rae S. M. Yeung
- Rae S. M. Yeung, MD, PhD: The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Amy S. Mudano
- Amy S. Mudano, MPH: University of Alabama at Birmingham
| | - Amy S. Turner
- Amy S. Turner: American College of Rheumatology, Atlanta, Georgia
| | - David R. Karp
- David R. Karp, MD, PhD: University of Texas Southwestern Medical Center, Dallas
| | - Jay J. Mehta
- Hamid Bassiri, MD, PhD, Edward M. Behrens, MD, Jay J. Mehta, MD: Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
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7
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Henderson LA, Friedman KG, Son MBF, Kernan KF, Canna SW, Gorelik M, Lapidus SK, Ferris A, Schulert GS, Seo P, Tremoulet AH, Yeung RSM, Karp DR, Bassiri H, Behrens EM, Mehta JJ. Reply. Arthritis Rheumatol 2021; 73:1342-1343. [PMID: 33586355 DOI: 10.1002/art.41689] [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] [Received: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/07/2022]
Affiliation(s)
| | - Kevin G Friedman
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Mary Beth F Son
- Boston Children's Hospital and Harvard Medical School, Boston, MA
| | - Kate F Kernan
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Scott W Canna
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Mark Gorelik
- Morgan Stanley Children's Hospital and Columbia University, New York, NY
| | - Sivia K Lapidus
- Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, NJ
| | - Anne Ferris
- Columbia University Irving Medical Center, New York, NY
| | - Grant S Schulert
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, OH
| | - Philip Seo
- Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Rae S M Yeung
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - David R Karp
- University of Texas Southwestern Medical Center, Dallas, TX
| | - Hamid Bassiri
- Children's Hospital of Philadelphia and University of Pennsylvania, Perelman School of Medicine
| | - Edward M Behrens
- Children's Hospital of Philadelphia and University of Pennsylvania, Perelman School of Medicine
| | - Jay J Mehta
- Children's Hospital of Philadelphia and University of Pennsylvania, Perelman School of Medicine
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8
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Henderson LA, Canna SW, Friedman KG, Gorelik M, Lapidus SK, Bassiri H, Behrens EM, Ferris A, Kernan KF, Schulert GS, Seo P, F Son MB, Tremoulet AH, Yeung RSM, Mudano AS, Turner AS, Karp DR, Mehta JJ. American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 1. Arthritis Rheumatol 2020; 72:1791-1805. [PMID: 32705809 PMCID: PMC7405113 DOI: 10.1002/art.41454] [Citation(s) in RCA: 270] [Impact Index Per Article: 67.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/21/2020] [Indexed: 12/15/2022]
Abstract
Objective To provide guidance on the management of multisystem inflammatory syndrome in children (MIS‐C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2) infection, and to provide recommendations for children with hyperinflammation during coronavirus disease 2019 (COVID‐19), the acute, infectious phase of SARS–CoV‐2 infection. Methods A multidisciplinary task force was convened by the American College of Rheumatology (ACR) to provide guidance on the management of MIS‐C associated with SARS–CoV‐2 and hyperinflammation in COVID‐19. The task force was composed of 9 pediatric rheumatologists, 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS‐C and hyperinflammation in COVID‐19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved 2 rounds of anonymous voting and 2 webinars. A 9‐point scale was used to determine the appropriateness of each statement (median scores of 1–3 for inappropriate, 4–6 for uncertain, and 7–9 for appropriate), and consensus was rated as low, moderate, or high based on dispersion of the votes along the numeric scale. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, as prespecified prior to voting. Results The ACR task force approved a total of 128 guidance statements addressing the management of MIS‐C and hyperinflammation in pediatric COVID‐19. These statements were refined into 40 final clinical guidance statements, accompanied by a flow diagram depicting the diagnostic pathway for MIS‐C. Conclusion Our understanding of SARS–CoV‐2–related syndromes in the pediatric population continues to evolve. The guidance provided in this “living document” reflects currently available evidence, coupled with expert opinion, and will be revised as further evidence becomes available.
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Affiliation(s)
- Lauren A Henderson
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Scott W Canna
- UPMC Children's Hospital of Pittsburgh and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kevin G Friedman
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Mark Gorelik
- Morgan Stanley Children's Hospital and Columbia University, New York, New York
| | - Sivia K Lapidus
- Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | - Hamid Bassiri
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
| | - Edward M Behrens
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
| | - Anne Ferris
- Columbia University Irving Medical Center, New York, New York
| | - Kate F Kernan
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Grant S Schulert
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Philip Seo
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mary Beth F Son
- Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Amy S Turner
- American College of Rheumatology, Atlanta, Georgia
| | - David R Karp
- University of Texas Southwestern Medical Center, Dallas
| | - Jay J Mehta
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine
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9
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Zhao Y, Wu EY, Oliver MS, Cooper AM, Basiaga ML, Vora SS, Lee TC, Fox E, Amarilyo G, Stern SM, Dvergsten JA, Haines KA, Rouster-Stevens KA, Onel KB, Cherian J, Hausmann JS, Miettunen P, Cellucci T, Nuruzzaman F, Taneja A, Barron KS, Hollander MC, Lapidus SK, Li SC, Ozen S, Girschick H, Laxer RM, Dedeoglu F, Hedrich CM, Ferguson PJ. Consensus Treatment Plans for Chronic Nonbacterial Osteomyelitis Refractory to Nonsteroidal Antiinflammatory Drugs and/or With Active Spinal Lesions. Arthritis Care Res (Hoboken) 2018; 70:1228-1237. [PMID: 29112802 DOI: 10.1002/acr.23462] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 10/31/2017] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To develop standardized treatment regimens for chronic nonbacterial osteomyelitis (CNO), also known as chronic recurrent multifocal osteomyelitis (CRMO), to enable comparative effectiveness treatment studies. METHODS Virtual and face-to-face discussions and meetings were held within the CNO/CRMO subgroup of the Childhood Arthritis and Rheumatology Research Alliance (CARRA). A literature search was conducted, and CARRA membership was surveyed to evaluate available treatment data and identify current treatment practices. Nominal group technique was used to achieve consensus on treatment plans for CNO refractory to nonsteroidal antiinflammatory drug (NSAID) monotherapy and/or with active spinal lesions. RESULTS Three consensus treatment plans (CTPs) were developed for the first 12 months of therapy for CNO patients refractory to NSAID monotherapy and/or with active spinal lesions. The 3 CTPs are methotrexate or sulfasalazine, tumor necrosis factor inhibitors with optional methotrexate, and bisphosphonates. Short courses of glucocorticoids and continuation of NSAIDs are permitted for all regimens. Consensus was achieved on these CTPs among CARRA members. Consensus was also reached on subject eligibility criteria, initial evaluations that should be conducted prior to the initiation of CTPs, and data items to collect to assess treatment response. CONCLUSION Three consensus treatment plans were developed for pediatric patients with CNO refractory to NSAIDs and/or with active spinal lesions. Use of these CTPs will provide additional information on efficacy and will generate meaningful data for comparative effectiveness research in CNO.
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Affiliation(s)
- Yongdong Zhao
- Seattle Children's Hospital, University of Washington, Seattle
| | | | - Melissa S Oliver
- Stanford Children's Health, Stanford University, Palo Alto, California
| | | | | | | | - Tzielan C Lee
- Stanford Children's Health, Stanford University, Palo Alto, California
| | - Emily Fox
- Children's Mercy, Kansas City, Missouri
| | - Gil Amarilyo
- Schneider Children's Medical Center of Israel, Petach Tikva Israel, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Kathleen A Haines
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
| | | | - Karen B Onel
- Hospital for Special Surgery, New York, New York
| | - Julie Cherian
- Stony Brook Children's Hospital, Stony Brook, New York
| | - Jonathan S Hausmann
- Boston Children's Hospital and Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Angela Taneja
- Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Karyl S Barron
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
| | | | | | - Suzanne C Li
- Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, Hackensack, New Jersey
| | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | | | - Ronald M Laxer
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Christian M Hedrich
- Children's Hospital Dresden, University Medical Center Carl Gustav Carus, TU Dresden, Dresden, Germany, and Institute of Translational Medicine, University of Liverpool, and Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
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10
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Westwell-Roper C, Lubieniecka JM, Brown KL, Morishita KA, Mammen C, Wagner-Weiner L, Yen E, Li SC, O’Neil KM, Lapidus SK, Brogan P, Cimaz R, Cabral DA. Clinical practice variation and need for pediatric-specific treatment guidelines among rheumatologists caring for children with ANCA-associated vasculitis: an international clinician survey. Pediatr Rheumatol Online J 2017; 15:61. [PMID: 28784150 PMCID: PMC5545848 DOI: 10.1186/s12969-017-0191-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 08/01/2017] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Because pediatric antineutrophil cytoplasmic antibody-associated vasculitis is rare, management generally relies on adult data. We assessed treatment practices, uptake of existing clinical assessment tools, and interest in pediatric treatment protocols among rheumatologists caring for children with granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA). METHODS A needs-assessment survey developed by an international working group of pediatric rheumatologists and two nephrologists was circulated internationally. Data were summarized with descriptive statistics. Pearson's chi-square tests were used in inferential univariate analyses. RESULTS The 209 respondents from 36 countries had collectively seen ~1600 children with GPA/MPA; 144 had seen more than two in the preceding 5 years. Standardized and validated clinical assessment tools to score disease severity, activity, and damage were used by 59, 63, and 36%, respectively; barriers to use included lack of knowledge and limited perceived utility. Therapy varied significantly: use of rituximab rather than cyclophosphamide was more common among respondents from the USA (OR = 2.7 [1.3-5.5], p = 0.0190, n = 139), those with >5 years of independent practice experience (OR = 3.8 [1.3-12.5], p = 0.0279, n = 137), and those who had seen >10 children with GPA/MPA in their careers (OR = 4.39 [2.1-9.1], p = 0.0011, n = 133). Respondents who had treated >10 patients were also more likely to continue maintenance therapy for at least 24 months (OR = 3.0 [1.4-6.4], p = 0.0161, n = 127). Ninety six percent of respondents believed in a need for pediatric-specific treatment guidelines; 46% supported adaptation of adult guidelines while 69% favoured guidelines providing a limited range of treatment options to allow comparison of effectiveness through a registry. CONCLUSIONS These data provide a rationale for developing pediatric-specific consensus treatment guidelines for GPA/MPA. While pediatric rheumatologist uptake of existing clinical tools has been limited, guideline uptake may be enhanced if outcomes of consensus-derived treatment options are evaluated within the framework of an international registry.
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Affiliation(s)
- Clara Westwell-Roper
- 0000 0001 2288 9830grid.17091.3eClinical Professor, Division of Rheumatology, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Room K4-119 4480 Oak Street Vancouver, Vancouver, BC V6H 3V4 Canada
| | | | - Kelly L. Brown
- 0000 0001 2288 9830grid.17091.3eClinical Professor, Division of Rheumatology, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Room K4-119 4480 Oak Street Vancouver, Vancouver, BC V6H 3V4 Canada
| | - Kimberly A. Morishita
- 0000 0001 2288 9830grid.17091.3eClinical Professor, Division of Rheumatology, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Room K4-119 4480 Oak Street Vancouver, Vancouver, BC V6H 3V4 Canada
| | - Cherry Mammen
- 0000 0001 2288 9830grid.17091.3eClinical Professor, Division of Rheumatology, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Room K4-119 4480 Oak Street Vancouver, Vancouver, BC V6H 3V4 Canada
| | | | - Eric Yen
- 0000 0000 9632 6718grid.19006.3eUniversity of California – Los Angeles, Los Angeles, CA USA
| | - Suzanne C. Li
- Joseph M. Sanzari Children’s Hospital, Hackensack, NJ USA
| | - Kathleen M. O’Neil
- 0000 0000 9682 4709grid.414923.9Riley Hospital for Children at IU Health, Indianapolis, IN USA
| | - Sivia K. Lapidus
- 0000 0000 9759 4781grid.416113.0Morristown Medical Center, Morristown, NJ USA
| | - Paul Brogan
- grid.420468.cGreat Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Rolando Cimaz
- 0000 0004 1757 8562grid.413181.eOspedale Pediatrico Meyer Firenze, Florence, Italy
| | - David A. Cabral
- 0000 0001 2288 9830grid.17091.3eClinical Professor, Division of Rheumatology, Department of Pediatrics, University of British Columbia, BC Children’s Hospital, Room K4-119 4480 Oak Street Vancouver, Vancouver, BC V6H 3V4 Canada
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11
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Brunner HI, Higgins GC, Klein-Gitelman MS, Lapidus SK, Olson JC, Onel K, Punaro M, Ying J, Giannini EH. Minimal clinically important differences of disease activity indices in childhood-onset systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62:950-9. [PMID: 20589695 DOI: 10.1002/acr.20154] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To determine the minimal clinically important differences (MCIDs) of validated measures of systemic lupus erythematosus (SLE) disease activity in childhood-onset SLE. METHODS Childhood-onset SLE patients (n = 98) were followed every 3 months for up to 7 visits (n = 623 total visits). Disease activity measures (European Consensus Lupus Activity Measure, Systemic Lupus Erythematosus Disease Activity Index, Systemic Lupus Activity Measure, British Isles Lupus Assessment Group, and Responder Index for Lupus Erythematosus [RIFLE]) were completed at the time of each visit. Physician-rated changes in the disease course (clinically relevant improvement, no change, clinically relevant worsening) between visits served as the criterion standard. RESULTS MCIDs defined by mean change scores with improvement and worsening, or those based on the standard error of measurement with stable disease, were both small and did not discriminate well between disease courses (detection rates for improvement or worsening were all <55%). MCIDs based on discriminant and classification analyses yielded similar results. Alternative MCIDs, defined by a 70% predicted probability of improvement or worsening as per the discrimination analysis, were larger but underestimated the proportion of patients with change. The RIFLE only correctly identified 26% and 8% of episodes of clinically important worsening and improvement of childhood-onset SLE, respectively. CONCLUSION The MCIDs of childhood-onset SLE disease activity measures are often small but similar to those reported for adults with SLE. Therefore, even small changes in disease activity scores can be clinically relevant. Low correct detection rates of these MCID thresholds for changes in disease course support the notion that worsening and improvement with childhood-onset SLE, or its response to therapy, is unlikely to be captured adequately by validated measures of disease activity alone.
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Affiliation(s)
- Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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12
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Brunner HI, Klein-Gitelman MS, Higgins GC, Lapidus SK, Levy DM, Eberhard A, Singer N, Olson JC, Onel K, Punaro M, Schanberg L, von Scheven E, Ying J, Giannini EH. Toward the development of criteria for global flares in juvenile systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62:811-20. [PMID: 20535792 PMCID: PMC3049164 DOI: 10.1002/acr.20126] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To develop a definition of global flare in juvenile systemic lupus erythematosus (SLE) and derive candidate criteria for measuring juvenile SLE flares. METHODS Pediatric rheumatologists answered 2 Delphi questionnaires to achieve consensus on a common definition of juvenile SLE flare and identify variables for use in candidate flare criteria. The diagnostic accuracy of these candidate flare criteria was tested with data from juvenile SLE patients (n = 98; 623 visits total). Physician-rated change in the juvenile SLE course (worsening, yes/no) between visits served as the criterion standard. RESULTS There was 96% consensus that a "a flare is a measurable worsening of juvenile SLE disease activity in at least one organ system, involving new or worse signs of disease that may be accompanied by new or worse SLE symptoms. Depending on the severity of the flare, more intensive therapy may be required." Variables suggested for use in flare criteria were: physician-rated disease activity (V1), patient well-being, protein:creatinine ratio, a validated disease activity index (V2), the Child Health Questionnaire physical summary score (V3), anti-double-stranded DNA antibodies, erythrocyte sedimentation rate, and complement levels. Using multiple logistic regression, several candidate flare criteria were derived with area under the receiver operating characteristic curve (AUC) as high as 0.92 (sensitivity >or=85%, specificity >or=85%); classification and regression tree analysis suggested that V1, V2, and V3 suffice to identify juvenile SLE flares (AUC 0.81; sensitivity = 64%, specificity = 86%). CONCLUSION Consensus about a definition of global disease flare for juvenile SLE has been obtained and promising candidate flare criteria have been developed. These will need further assessment of their ease of use and accuracy in prospective study.
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Affiliation(s)
- Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229-3039, USA.
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13
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Brunner HI, Higgins GC, Wiers K, Lapidus SK, Olson JC, Onel K, Punaro M, Ying J, Klein-Gitelman MS, Giannini EH. Prospective validation of the provisional criteria for the evaluation of response to therapy in childhood-onset systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62:335-44. [PMID: 20391479 PMCID: PMC2946212 DOI: 10.1002/acr.20103] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To prospectively validate the provisional criteria for the evaluation of response to therapy in children with systemic lupus erythematosus (SLE). METHODS In this multicenter study, childhood-onset SLE patients (n = 98; 81 girls, 17 boys, 50% white, 88% non-Hispanic) were followed every 3 months for up to 7 visits (total number of visits 623). The 5 childhood-onset SLE core response variables were obtained at the time of each visit: 1) physician assessment of overall disease activity, 2) parent assessment of patient well-being, 3) Child Health Questionnaire, 4) proteinuria, and 5) global disease activity measure score, as measured by the European Consensus Lupus Activity Measure (ECLAM), the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), or the Systemic Lupus Activity Measure (SLAM). Physician-rated relevant changes in the disease course (clinically relevant improvement, no change in disease, or worsening) between visits served as the criterion standard. Mixed models were used to assess the diagnostic accuracy of the 4 highest-ranked provisional definitions of response to therapy. RESULTS There were 89 episodes of clinically relevant improvement between 2 consecutive visits, and 448 episodes without improvement. Irrespective of the choice of the global disease activity measure (ECLAM, SLAM, SLEDAI), sensitivities of all 4 highest-ranked definitions were low (all < or =31%), whereas their specificities were excellent (all >88%). Using logistic models, alternative definitions can be developed with both 80% sensitivity and specificity. CONCLUSION The provisional criteria of response to therapy in childhood-onset SLE may have considerably lower sensitivity than previously reported. Additional validation in clinical trials is necessary to further evaluate the measurement properties of the provisional Paediatric Rheumatology International Trials Organisation/American College of Rheumatology criteria for response to therapy in children with SLE.
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Affiliation(s)
- Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, William Rowe Division of Rheumatology, E 4010, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA.
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