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Sloan EE, Kmetova K, NaveenKumar SK, Kluge L, Chong E, Hoy CK, Yalavarthi S, Sarosh C, Baisch J, Walters L, Nassi L, Fuller J, Turnier JL, Pascual V, Wright TB, Madison JA, Knight JS, Zia A, Zuo Y. Non-criteria antiphospholipid antibodies and calprotectin as potential biomarkers in pediatric antiphospholipid syndrome. Clin Immunol 2024; 261:109926. [PMID: 38355030 DOI: 10.1016/j.clim.2024.109926] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 02/03/2024] [Indexed: 02/16/2024]
Abstract
Our study aimed to evaluate the presence, clinical associations, and potential mechanistic roles of non-criteria antiphospholipid antibodies (aPL) and circulating calprotectin, a highly stable marker of neutrophil extracellular trap release (NETosis), in pediatric APS patients. We found that 79% of pediatric APS patients had at least one non-criteria aPL at moderate-to-high titer. Univariate logistic regression demonstrated that positive anti-beta-2 glycoprotein I domain 1 (anti-D1) IgG (p = 0.008), anti-phosphatidylserine/prothrombin (aPS/PT) IgG (p < 0.001), and aPS/PT IgM (p < 0.001) were significantly associated with venous thrombosis. Positive anti-D1 IgG (p < 0.001), aPS/PT IgG (p < 0.001), and aPS/PT IgM (p = 0.001) were also associated with non-thrombotic manifestations of APS, such as thrombocytopenia. Increased levels of calprotectin were detected in children with APS. Calprotectin correlated positively with absolute neutrophil count (r = 0.63, p = 0.008) and negatively with platelet count (r = -0.59, p = 0.015). Mechanistically, plasma from pediatric APS patients with high calprotectin levels impaired platelet viability in a dose-dependent manner.
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Affiliation(s)
- Elizabeth E Sloan
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Scottish Rite for Children, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA
| | - Katarina Kmetova
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Lyndsay Kluge
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily Chong
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Claire K Hoy
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Srilakshmi Yalavarthi
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Cyrus Sarosh
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Jeanine Baisch
- Gale and Ira Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY, USA
| | | | - Lorien Nassi
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Scottish Rite for Children, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA
| | - Julie Fuller
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Scottish Rite for Children, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA
| | - Jessica L Turnier
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Virginia Pascual
- Gale and Ira Drukier Institute for Children's Health, Weill Cornell Medicine, New York, NY, USA
| | - Tracey B Wright
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA; Scottish Rite for Children, Dallas, TX, USA; Children's Medical Center, Dallas, TX, USA
| | - Jacqueline A Madison
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Pediatric Rheumatology, Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Jason S Knight
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ayesha Zia
- Children's Medical Center, Dallas, TX, USA; Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Yu Zuo
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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Weiss PF, Brandon TG, Ryan ME, Treemarcki EB, Armendariz S, Wright TB, Godiwala C, Stoll ML, Xiao R, Lovell D. Development and Validation of a Juvenile Spondyloarthritis Disease Flare Measure: Ascertaining Flare in Patients With Inactive Disease. Arthritis Care Res (Hoboken) 2023; 75:373-380. [PMID: 34363343 PMCID: PMC8818809 DOI: 10.1002/acr.24763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Our objective was to develop and validate a composite disease flare definition for juvenile spondyloarthritis (SpA) that would closely approximate the clinical decision made to reinitiate or not reinitiate systemic therapy after therapy de-escalation. METHODS Retrospective chart reviews of children with SpA who underwent systemic therapy de-escalation of biologic or conventional disease-modifying antirheumatic drugs were used to develop and validate the flare outcome. Data on independent cohorts for development (1 center) and validation (4 centers) were collected from large tertiary health care systems. Core measure thresholds and candidate disease flare outcomes were assessed using sensitivity, specificity, positive predictive values (PPVs) and negative predictive values (NPVs), and the receiver operating characteristic (ROC) area under the curve (AUC), with physician assessment of active disease plus re-initiation of standard dose of systemic therapy as the reference standard. RESULTS Of the candidate definitions, clinically meaningful worsening in ≥3 of the following 5 core measures performed best: caregiver/patient assessment of well-being; physician assessment of disease activity; caregiver/patient assessment of pain, physical function, and active joint count. The ROC AUC was 0.91, PPV 87.5%, NPV 98.1%, sensitivity 82.4%, and specificity 98.7%. Cronbach's α was 0.81, signifying internal consistency, and factor analysis demonstrated that the outcome measured 1 construct. The Juvenile SpA Flare measure had face validity according to 21 surveyed pediatric rheumatologists. Juvenile SpA Flare had an ROC AUC of 0.85, a PPV of 92.3%, and an NPV of 96.8% in the validation cohort. CONCLUSION There is initial support for the validity of the Juvenile SpA Flare measure as a tool to identify disease flare in juvenile SpA patients de-escalating therapy, and the measure is potentially applicable in clinical practice, observational studies, and therapeutic trials.
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Affiliation(s)
- Pamela F Weiss
- University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia
| | | | - Meghan E Ryan
- University of Minnesota Masonic Children's Hospital, Minneapolis
| | | | | | - Tracey B Wright
- University of Texas Southwestern Medical Center and Scottish Rite Hospital for Children, Dallas
| | | | | | - Rui Xiao
- University of Pennsylvania, Philadelphia
| | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Stoll ML, DeQuattro K, Li Z, Sawhney H, Weiss PF, Nigrovic PA, Wright TB, Schikler K, Edelheit B, Morrow CD, Reveille JD, Brown MA, Gensler LS. Correction: Stoll et al. Impact of HLA-B27 and Disease Status on the Gut Microbiome of the Offspring of Ankylosing Spondylitis Patients. Children 2022, 9, 569. Children 2022; 9:children9081158. [PMID: 36010158 PMCID: PMC9406925 DOI: 10.3390/children9081158] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Matthew L. Stoll
- Department of Pediatrics, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA
- Correspondence:
| | - Kimberly DeQuattro
- Department of Medicine, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Zhixiu Li
- Centre for Genomics and Personalized Health, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia;
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
| | - Henna Sawhney
- Division of Global Migration and Quarantine, Center for Disease Control, Washington, DC 30329, USA;
| | - Pamela F. Weiss
- Department of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Peter A. Nigrovic
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Division of Immunology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Tracey B. Wright
- Department of Pediatrics, University of Texas at Southwestern, Dallas, TX 75390, USA;
| | - Kenneth Schikler
- Department of Pediatrics, University of Louisville, Louisville, KY 40292, USA;
| | - Barbara Edelheit
- Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT 06106, USA;
| | - Casey D. Morrow
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - John D. Reveille
- Department of Internal Medicine, University of Texas at Houston, Houston, TX 77030, USA;
| | - Matthew A. Brown
- Genomics England, London EC1M 6BQ, UK;
- Guy’s and St Thomas’ NIHR Biomedical Research Centre, King’s College, London SE1 7EH, UK
| | - Lianne S. Gensler
- Department of Medicine, Division of Rheumatology, University of California at San Francisco, San Francisco, CA 94143, USA;
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Stoll ML, DeQuattro K, Li Z, Sawhney H, Weiss PF, Nigrovic PA, Wright TB, Schikler K, Edelheit B, Morrow CD, Reveille JD, Brown MA, Gensler LS. Impact of HLA-B27 and Disease Status on the Gut Microbiome of the Offspring of Ankylosing Spondylitis Patients. Children 2022; 9:children9040569. [PMID: 35455612 PMCID: PMC9030797 DOI: 10.3390/children9040569] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 12/17/2022]
Abstract
Multiple studies have shown the microbiota to be abnormal in patients with spondyloarthritis (SpA). The purpose of this study was to explore the genetic contributions of these microbiota abnormalities. We analyzed the impact of HLA-B27 on the microbiota of children at risk for SpA and compared the microbiota of HLA-B27+ pediatric offspring of ankylosing spondylitis (AS) patients with that of HLA-B27+ children with SpA. Human DNA was obtained from the offspring for determination of HLA-B27 status and polygenic risk score (PRS). Fecal specimens were collected from both groups for sequencing of the V4 region of the 16S ribosomal RNA gene. Among the offspring of AS patients, there was slight clustering by HLA-B27 status. After adjusting for multiple comparisons, five operational taxonomic units (OTUs) representing three unique taxa distinguished the HLA-B27+ from negative children: Blautia and Coprococcus were lower in the HLA-B27+ offspring, while Faecalibacterium prausnitzii was higher. HLA-B27+ offspring without arthritis were compared to children with treatment-naïve HLA-B27+ SpA. After adjustments, clustering by diagnosis was present. A total of 21 OTUs were significantly associated with diagnosis state, including Bacteroides (higher in SpA patients) and F. prausnitzii (higher in controls). Thus, our data confirmed associations with B. fragilis and F. prausnitzii with juvenile SpA, and also suggest that the mechanism by which HLA-B27 is associated with SpA may not involve alterations of the microbiota.
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Affiliation(s)
- Matthew L. Stoll
- Department of Pediatrics, University of Alabama at Birmingham (UAB), Birmingham, AL 35233, USA
- Correspondence:
| | - Kimberly DeQuattro
- Department of Medicine, Division of Rheumatology, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Zhixiu Li
- Centre for Genomics and Personalized Health, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia;
- Faculty of Health, School of Biomedical Sciences, Queensland University of Technology (QUT), Brisbane, QLD 4000, Australia
| | - Henna Sawhney
- Division of Global Migration and Quarantine, Center for Disease Control, Washington, DC 30329, USA;
| | - Pamela F. Weiss
- Department of Pediatrics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
- Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Peter A. Nigrovic
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women’s Hospital, Boston, MA 02115, USA;
- Division of Immunology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Tracey B. Wright
- Department of Pediatrics, University of Texas at Southwestern, Dallas, TX 75390, USA;
| | - Kenneth Schikler
- Department of Pediatrics, University of Louisville, Louisville, KY 40292, USA;
| | - Barbara Edelheit
- Department of Pediatrics, Connecticut Children’s Medical Center, Hartford, CT 06106, USA;
| | - Casey D. Morrow
- Department of Cell, Developmental and Integrative Biology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - John D. Reveille
- Department of Internal Medicine, University of Texas at Houston, Houston, TX 77030, USA;
| | - Matthew A. Brown
- Genomics England, London EC1M 6BQ, UK;
- Guy’s and St Thomas’ NIHR Biomedical Research Centre, King’s College, London SE1 7EH, UK
| | - Lianne S. Gensler
- Department of Medicine, Division of Rheumatology, University of California at San Francisco, San Francisco, CA 94143, USA;
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Abstract
PURPOSE OF REVIEW Childhood Sjogren's syndrome (cSS) is a rare, chronic autoimmune disease characterized by inflammation of the exocrine glands. cSS is underrecognized because of differences in clinical presentation compared with adults. Until recently, publications describing clinical manifestations in cSS were limited to case reports and case series with small numbers of patients. Diagnostic studies to assess glandular symptoms in adults, are less commonly obtained in children. RECENT FINDINGS Recent cohort studies describe presenting diagnostic clinical features in large populations of cSS and demonstrate how current classification criteria, used in adults, are not applicable to children. Recurrent parotitis is the consistent predominant manifestation that is inversely correlated with age. Novel salivary biomarkers and salivary gland ultrasonography are important objective measure, which may improve diagnosis and disease monitoring. Standardized treatment recommendations are needed. SUMMARY Findings from large cohort studies provide a framework for the future development of diagnostic criteria for cSS. Such criteria should incorporate objective measures that are easily obtained in children. Future research to improve understanding of the application of novel biomarkers and imaging and developing consensus on treatment recommendations is needed.
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Affiliation(s)
- Tracey B Wright
- Division of Rheumatology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
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Cooper JC, Rouster-Stevens K, Wright TB, Hsu JJ, Klein-Gitelman MS, Ardoin SP, Schanberg LE, Brunner HI, Eberhard BA, Wagner-Weiner L, Mehta J, Haines K, McCurdy DK, Phillips TA, Huang Z, von Scheven E. Pilot study comparing the childhood arthritis and rheumatology research alliance consensus treatment plans for induction therapy of juvenile proliferative lupus nephritis. Pediatr Rheumatol Online J 2018; 16:65. [PMID: 30348175 PMCID: PMC6196456 DOI: 10.1186/s12969-018-0279-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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: 05/23/2018] [Accepted: 09/19/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To reduce treatment variability and facilitate comparative effectiveness studies, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) published consensus treatment plans (CTPs) including one for juvenile proliferative lupus nephritis (LN). Induction immunosuppression CTPs outline treatment with either monthly intravenous (IV) cyclophosphamide (CYC) or mycophenolate mofetil (MMF) in conjunction with one of three corticosteroid (steroid) CTPs: primarily oral, primarily IV or mixed oral/IV. The acceptability and in-practice use of these CTPs are unknown. Therefore, the primary aims of the pilot study were to demonstrate feasibility of adhering to the LN CTPs and delineate barriers to implementation in clinical care in the US. Further, we aimed to explore the safety and effectiveness of the treatments for induction therapy. METHODS Forty-one patients were enrolled from 10 CARRA sites. Patients had new-onset biopsy proven ISN/RPS class III or IV proliferative LN, were starting induction therapy with MMF or IV CYC and high-dose steroids and were followed for up to 24 months. Routine clinical data were collected at each visit. Provider reasons for CTP selection were assessed at baseline. Adherence to the CTPs was evaluated by provider survey and medication logs. Complete and partial renal responses were reported at 6 months. RESULTS The majority of patients were female (83%) with a mean age of 14.7 years, SD 2.8. CYC was used more commonly than MMF for patients with ISN/RPS class IV LN (vs. class III), those who had hematuria, and those with adherence concerns. Overall adherence to the immunosuppression induction CTPs was acceptable with a majority of patients receiving the target MMF (86%) or CYC (63%) dose. However, adherence to the steroid CTPs was poor (37%) with large variability in dosing. Renal response endpoints were exploratory and did not show a significant difference between CYC and MMF. CONCLUSIONS Overall, the immunosuppression CTPs were followed as intended in the majority of patients however, adherence to the steroid CTPs was poor indicating revision is necessary. In addition, our pilot study revealed several sources of treatment selection bias that will need to be addressed in for future comparative effectiveness research.
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Affiliation(s)
- Jennifer C Cooper
- University of California, San Francisco, 550 16th Street, 5th Floor, San Francisco, CA, 94158, USA.
| | - Kelly Rouster-Stevens
- 0000 0001 0941 6502grid.189967.8Emory University School of Medicine/Children’s Healthcare of Atlanta, 2015 Uppergate Dr, Atlanta, GA 30322 USA
| | - Tracey B Wright
- Texas Scottish Rite Children’s Hospital, 5323 Harry Hines Blvd, Dallas, TX 75390 USA
| | - Joyce J Hsu
- 0000000419368956grid.168010.eStanford University, 725 Welch Rd, Palo Alto, CA 94304 USA
| | - Marisa S Klein-Gitelman
- 0000 0004 0388 2248grid.413808.6Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Ave, Chicago, IL 60611 USA
| | - Stacy P Ardoin
- 0000 0001 2285 7943grid.261331.4Ohio State University College of Medicine, 480 Medical Center Dr. S-2056, Columbus, OH 43210 USA
| | - Laura E Schanberg
- 0000000100241216grid.189509.cDuke University Medical Center, 2100 Erwin Rd, Durham, NC 27705 USA
| | - Hermine I Brunner
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229 USA
| | - B Anne Eberhard
- Cohen Children’s Hospital Medical Center, 1991 Marcus Ave, Lake Success, NY 11042 USA
| | - Linda Wagner-Weiner
- 0000 0000 8736 9513grid.412578.dUniversity of Chicago Hospitals, 5841 S. Maryland Ave, MC 5044, Chicago, IL 60637 USA
| | - Jay Mehta
- 0000000121791997grid.251993.5Children’s Hospital at Montefiore/Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY 10467 USA
| | - Kathleen Haines
- 0000 0004 0407 6328grid.239835.6Hackensack University Medical Center, 30 Prospect Ave, Hackensack, NJ 07601 USA
| | - Deborah K McCurdy
- 0000 0000 9632 6718grid.19006.3eUniversity of California, 200 UCLA Medical Plaza, Los Angeles, 90095 CA USA
| | - Thomas A Phillips
- 0000000100241216grid.189509.cDuke University Medical Center, 2400 Pratt, St. Durham, NC 27705 USA
| | - Zhen Huang
- 0000000100241216grid.189509.cDuke University Medical Center, 2400 Pratt, St. Durham, NC 27705 USA
| | - Emily von Scheven
- 0000 0001 2297 6811grid.266102.1University of California, San Francisco, 550 16th Street, 5th Floor, San Francisco, CA 94158 USA
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Weiss PF, Xiao R, Brandon TG, Pagnini I, Wright TB, Beukelman T, Morgan-DeWitt E, Feudtner C. Comparative Effectiveness of Tumor Necrosis Factor Agents and Disease-modifying Antirheumatic Therapy in Children with Enthesitis-related Arthritis: The First Year after Diagnosis. J Rheumatol 2017; 45:107-114. [PMID: 28916542 DOI: 10.3899/jrheum.170251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 07/06/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To characterize the effect of anti-tumor necrosis factor (TNF) therapy compared to conventional synthetic disease-modifying antirheumatic drugs (csDMARD) in children with enthesitis-related arthritis (ERA) over the first year after diagnosis. METHODS We conducted a multicenter retrospective comparative effectiveness study of children diagnosed with ERA. We estimated the effect of anti-TNF therapy on clinical variables (active joint count, tender entheses count) and patient-reported pain and global assessment of disease activity over the first year after diagnosis using state-of-the-art comparative effectiveness analytic methods. RESULTS During the study period, 217 patients newly diagnosed with ERA had a total of 965 clinic visits the first year after disease diagnosis. Children [median age 11.6 yrs, interquartile range 10-14] were treated with anti-TNF monotherapy (n = 33, 15.2%), csDMARD monotherapy (n = 73, 33.6%), or both (n = 52, 23.9%) in the first year after disease diagnosis. There was a statistically significant improvement in the primary outcome, active joint count, over time in children who received an anti-TNF drug versus those who did not (p = 0.03). Additionally, use of anti-TNF therapy versus no anti-TNF therapy was associated with less patient-reported pain (p < 0.01) and improved disease activity over time as assessed by the clinical Juvenile Arthritis Disease Activity Score (p < 0.01). The magnitude of estimated effect on clinical outcomes was uniformly greater, with the exception of tender entheses count, in children treated with an anti-TNF drug versus a csDMARD. CONCLUSION During the first year after diagnosis, anti-TNF exposure was associated with benefits for several clinically meaningful outcomes in children with enthesitis-related arthritis.
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Affiliation(s)
- Pamela F Weiss
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy. .,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Rui Xiao
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Timothy G Brandon
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Ilaria Pagnini
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Tracey B Wright
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Timothy Beukelman
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Esi Morgan-DeWitt
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
| | - Chris Feudtner
- From the Department of Pediatric Rheumatology, Department of Pediatrics, and Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; University of Texas Southwestern, Texas Scottish Rite Hospital for Children, Dallas, Texas; University of Alabama, Birmingham, Alabama; Cincinnati Children's Hospital, Cincinnati, Ohio, USA; University of Florence and Anna Meyer Children's Hospital, Florence, Italy.,P.F. Weiss, MD, MSCE, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine; R. Xiao, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine; T.G. Brandon, MPH, Department of Pediatrics, Division of Rheumatology, The Children's Hospital of Philadelphia; I. Pagnini, MD, University of Florence and Anna Meyer Children's Hospital; T.B. Wright, MD, MSCE, Texas Scottish Rite Hospital for Children; T. Beukelman, MD, MSCE, University of Alabama; E. Morgan-DeWitt, MD, MSCE, Cincinnati Children's Hospital; C. Feudtner, MD, PhD, Department of Pediatrics, Division of General Pediatrics, The Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine
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9
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Brunner HI, Bennett MR, Abulaban K, Klein-Gitelman MS, O'Neil KM, Tucker L, Ardoin SP, Rouster-Stevens KA, Onel KB, Singer NG, Anne Eberhard B, Jung LK, Imundo L, Wright TB, Witte D, Rovin BH, Ying J, Devarajan P. Development of a Novel Renal Activity Index of Lupus Nephritis in Children and Young Adults. Arthritis Care Res (Hoboken) 2017; 68:1003-11. [PMID: 26473509 DOI: 10.1002/acr.22762] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 09/15/2015] [Accepted: 10/13/2015] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Noninvasive estimation of the degree of inflammation seen on kidney biopsy with lupus nephritis (LN) remains difficult. The objective of this study was to develop a Renal Activity Index for Lupus (RAIL) that, based solely on laboratory measures, accurately reflects histologic LN activity. METHODS We assayed traditional LN laboratory tests and 16 urine biomarkers (UBMs) in children (n = 47) at the time of kidney biopsy. Histologic LN activity was measured by the National Institutes of Health activity index (NIH-AI) and the tubulointerstitial activity index (TIAI). High LN-activity status (versus moderate/low) was defined as NIH-AI scores >10 (versus ≤10) or TIAI scores >5 (versus ≤5). RAIL algorithms that predicted LN-activity status for both NIH-AI and TIAI were derived by stepwise multivariate logistic regression, considering traditional biomarkers and UBMs as candidate components. The accuracy of the RAIL for discriminating by LN-activity status was determined. RESULTS The differential excretion of 6 UBMs (neutrophil gelatinase-associated lipocalin, monocyte chemotactic protein 1, ceruloplasmin, adiponectin, hemopexin, and kidney injury molecule 1) standardized by urine creatinine was considered in the RAIL. These UBMs predicted LN-activity (NIH-AI) status with >92% accuracy and LN-activity (TIAI) status with >80% accuracy. RAIL accuracy was minimally influenced by concomitant LN damage. Accuracies between 71% and 85% were achieved without standardization of the UBMs. The strength of these UBMs to reflect LN-activity status was confirmed by principal component and linear discriminant analyses. CONCLUSION The RAIL is a robust and highly accurate noninvasive measure of LN activity. The measurement properties of the RAIL, which reflect the degree of inflammatory changes as seen on kidney biopsy, will require independent validation.
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Affiliation(s)
- Hermine I Brunner
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Michael R Bennett
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Khalid Abulaban
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Marisa S Klein-Gitelman
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Kathleen M O'Neil
- Riley Hospital for Children at IU Health, Indiana University School of Medicine, Indianapolis
| | - Lori Tucker
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Karen B Onel
- Comer Children's Hospital, University of Chicago School of Medicine, Chicago, Illinois
| | - Nora G Singer
- Rainbow Babies and Children's Hospital/Case Medical Center and MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - B Anne Eberhard
- Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park
| | | | - Lisa Imundo
- Columbia University Medical Center, New York, New York
| | | | - David Witte
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Brad H Rovin
- Ohio State University Wexner Medical Center, Columbus
| | - Jun Ying
- University of Cincinnati, Cincinnati, Ohio
| | - Prasad Devarajan
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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Gmuca S, Xiao R, Brandon TG, Pagnini I, Wright TB, Beukelman T, Morgan EM, Weiss PF. Multicenter inception cohort of enthesitis-related arthritis: variation in disease characteristics and treatment approaches. Arthritis Res Ther 2017; 19:84. [PMID: 28464909 PMCID: PMC5414167 DOI: 10.1186/s13075-017-1297-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [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: 01/23/2017] [Accepted: 04/07/2017] [Indexed: 12/20/2022] Open
Abstract
Background Enthesitis-related arthritis (ERA) is a specific subtype of juvenile idiopathic arthritis (JIA) defined according to the International League of Associations for Rheumatology (ILAR) criteria. We aimed to characterize the clinical features and treatment regimens in an inception cohort of children with ERA. Methods We performed a retrospective, cross-sectional, multicenter cohort study including subjects diagnosed with ERA between 1989 and 2012. Patients all fulfilled the ILAR criteria for ERA within 3 months of initial presentation to the rheumatology clinic. Differences in the prevalence of clinical criteria across study sites and by human leukocyte antigen (HLA)-B27 status were assessed using the Wilcoxon rank-sum or chi-square test, as appropriate. Results Two hundred thirty-four children met the inclusion criteria. Their median age at diagnosis was 11.6 years, and 59% were HLA-B27-positive. Sixty-nine percent had enthesitis and arthritis at the time of diagnosis. Seventy-eight percent had a pauciarticular onset. The prevalence of all ILAR criteria at diagnosis, except arthritis and acute anterior uveitis, differed significantly across sites (all p < 0.01). Medication use varied significantly across sites for children with peripheral arthritis (p < 0.001), but not for sacroiliitis or enthesitis only. Nonsteroidal anti-inflammatory drugs and disease-modifying antirheumatic drugs were the most commonly prescribed treatments, with anti-TNF agents primarily being initiation for sacroiliitis. HLA-B27 positivity was associated with male sex, higher active joint count, sacroiliitis, and higher disease activity at disease onset. Conclusions The majority of children had a pauciarticular onset, and several statistically significant clinical differences based on HLA-B27 status were identified. The observed heterogeneity in clinical presentation across sites reflects either true differences in patient populations or differences in how the ILAR criteria are being applied.
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Affiliation(s)
- Sabrina Gmuca
- Division of Rheumatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rui Xiao
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Timothy G Brandon
- Division of Rheumatology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Ilaria Pagnini
- University of Florence and Anna Meyer Children's Hospital, Florence, Italy
| | - Tracey B Wright
- University of Texas Southwestern Medical Center and Texas Scottish Rite Hospital of Children, Dallas, TX, USA
| | | | - Esi M Morgan
- Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Pamela F Weiss
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA. .,Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Wood Building, Fourth Floor, Philadelphia, PA, 19104, USA.
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11
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Wright TB, Punaro M. Paediatric systemic lupus erythematosus: insights from translational research. Rheumatology (Oxford) 2017; 56:i24-i31. [DOI: 10.1093/rheumatology/kew447] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Indexed: 01/06/2023] Open
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12
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Weiss PF, Colbert RA, Xiao R, Feudtner C, Beukelman T, DeWitt EM, Pagnini I, Wright TB, Wallace CA. Development and retrospective validation of the juvenile spondyloarthritis disease activity index. Arthritis Care Res (Hoboken) 2015; 66:1775-82. [PMID: 25047959 DOI: 10.1002/acr.22411] [Citation(s) in RCA: 55] [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: 03/17/2014] [Accepted: 07/15/2014] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To develop and validate the Juvenile Spondyloarthritis Disease Activity Index (JSpADA) for use in clinical practice and research. METHODS Using modified Delphi consensus techniques, 10 items were selected by participants in the international pediatric rheumatology listserv, the Childhood Arthritis and Rheumatology Research Alliance, and the listserv for the pediatric section of the American College of Rheumatology. Validation was performed in a retrospective multicenter cohort of 244 children. RESULTS In total, 106 physicians representing 14 countries completed the initial questionnaire. Completion rates for the subsequent questionnaires were 84%, 75%, and 77% of the original respondents. Ten items exceeded 80% consensus: arthritis, enthesitis, patient pain assessment, inflammatory markers, morning stiffness, clinical sacroiliitis, uveitis, back mobility, and patient and physician assessments of disease activity. After item analysis, 2 items were eliminated (patient and physician assessments of disease activity). Factor analysis identified 3 primary domains that explained 58% of the variance: peripheral disease, axial disease, and uveitis. The Cronbach's α coefficient was 0.66. The JSpADA had high or moderate correlations with the Juvenile Arthritis Disease Activity Score (r = 0.81), patient and physician assessments of disease activity (r = 0.70 and r = 0.66, respectively), and the Childhood Health Assessment Questionnaire (r = 0.56). The JSpADA discriminated well between subjects with active versus inactive disease (P < 0.001) and was responsive to improvement or worsening in disease activity over time (P < 0.001). CONCLUSION Using international input and consensus formation techniques, we developed and validated the first disease activity assessment for juvenile spondyloarthritis. Future studies should validate the JSpADA in a prospective multicenter cohort.
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Affiliation(s)
- Pamela F Weiss
- University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia
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13
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Rigdon D, Gotte AC, Punaro MG, Wright TB. Clinical and immunological response to pneumococcal vaccination in pediatric systemic lupus erythematosus. Arthritis Res Ther 2012. [PMCID: PMC3467533 DOI: 10.1186/ar3990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Wright TB, Shults J, Leonard MB, Zemel BS, Burnham JM. Hypovitaminosis D is associated with greater body mass index and disease activity in pediatric systemic lupus erythematosus. J Pediatr 2009; 155:260-5. [PMID: 19446841 DOI: 10.1016/j.jpeds.2009.02.033] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 12/30/2008] [Accepted: 02/13/2009] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine whether pediatric systemic lupus erythematosus (SLE) is associated with alterations in the vitamin D-parathyroid hormone (PTH) axis and to assess the relation between vitamin D deficiency and SLE activity. STUDY DESIGN 25-hydroxy vitamin D [25(OH)D], 1,25-dihydroxy vitamin D [1,25(OH)2D], and intact PTH were measured in subjects with SLE (n = 38) and healthy controls (n = 207), ages 5 to 21 years. Vitamin D status and its relation with disease activity were assessed using multivariable logistic and linear regression. RESULTS Severe vitamin D deficiency (25(OH)D <10 ng/ml) was observed in a significantly higher proportion of subjects with SLE (36.8% vs 9.2%, P < .001). In SLE, the odds ratio (OR) for severe deficiency was 2.37 (P = .09), adjusting for age, sex, race, and season. However, for each 1 SD greater body mass index (BMI) z-score, 25(OH)D levels were 4.2 ng/mL lower (P = .01) in SLE, compared with controls. Adjusting for 25(OH)D levels, SLE was associated with significantly lower 1,25(OH)2D (P < .001) and intact PTH levels (P = .03). Greater SLE disease activity index scores were observed in those with 25(OH)D <20 ng/mL (P = .01). CONCLUSIONS SLE was associated with vitamin D deficiency, particularly among those subjects with SLE who were overweight. Future studies should assess the effect of vitamin D supplementation on skeletal and nonskeletal outcomes in SLE.
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Affiliation(s)
- Tracey B Wright
- Department Of Pediatrics, Division of Rheumatology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Arsenescu R, Bruno MEC, Rogier EW, Stefka AT, McMahan AE, Wright TB, Nasser MS, de Villiers WJS, Kaetzel CS. Signature biomarkers in Crohn's disease: toward a molecular classification. Mucosal Immunol 2008; 1:399-411. [PMID: 19079204 DOI: 10.1038/mi.2008.32] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In an effort to develop a molecular classification scheme for Crohn's disease (CD), mucosal biopsies from 69 CD patients and 28 normal controls were analyzed for expression of the RelA subunit of nuclear factor (NF)-kappaB, A20 (a negative regulator of NF-kappaB), polymeric immunoglobulin receptor (pIgR), tumor necrosis factor (TNF), and interleukin (IL)-8. Principal component analysis was used to classify individuals into three subsets based on patterns of biomarker expression. Set 1 included normal subjects and CD patients with mild disease and good responses to therapy, thus defining "normal" biomarker expression. CD patients in set 2, characterized by low expression of all five biomarkers, had moderate to severe disease and poor responses to immunosuppressive and anti-TNF therapy. Patients in set 3, characterized by low expression of RelA, A20, and pIgR, normal TNF and elevated IL-8, had acute inflammation that responded well to therapy. Classification of CD patients by these biomarkers may predict disease behavior and responses to therapy.
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Affiliation(s)
- R Arsenescu
- Division of Digestive Diseases & Nutrition, Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA.
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Wright TB, Bertino RB, Bishop AF, Brady TM, Castaneda F, Berkman WA, Finnegan MF. Complications of laparoscopic cholecystectomy and their interventional radiologic management. Radiographics 1993; 13:119-28. [PMID: 8426914 DOI: 10.1148/radiographics.13.1.8426914] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Cholelithiasis and cholecystitis are encountered throughout the world and are responsible for the majority of cholecystectomies performed. Treatment has traditionally consisted of open cholecystectomy, but laparoscopic cholecystectomy is currently a popular alternative. Laparoscopic cholecystectomy offers several benefits over the open procedure, but it also has its own set of complications. Complications include those of laparoscopy (abdominal wall bleeding, omental bleeding, abdominal vessel injury, retroperitoneal vessel injury, gastrointestinal perforation, bladder perforation, solid visceral injury, and infection) and those of cholecystectomy (gallbladder fossa bleeding, bile duct injury, bile leakage, and infection). The literature suggests that the total complication rate for the laparoscopic procedure compares favorably with that of the open procedure, but this may apply only to surgeons who have accomplished numerous laparoscopic procedures and not to those who have just completed a training course and are performing their first few procedures. With the growing success of the laparoscopic procedure, it is essential that the radiologist be knowledgeable about the radiographic manifestations and interventional radiologic management of potential complications, since the radiologist can significantly affect patient care.
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Affiliation(s)
- T B Wright
- Department of Radiology, University of Illinois College of Medicine, Peoria 61605
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