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Nicoară DM, Munteanu AI, Scutca AC, Brad GF, Jugănaru I, Bugi MA, Asproniu R, Mărginean O. Examining the Relationship between Systemic Immune-Inflammation Index and Disease Severity in Juvenile Idiopathic Arthritis. Cells 2024; 13:442. [PMID: 38474406 DOI: 10.3390/cells13050442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/17/2024] [Accepted: 03/02/2024] [Indexed: 03/14/2024] Open
Abstract
Juvenile Idiopathic Arthritis (JIA), the leading childhood rheumatic condition, has a chronic course in which persistent disease activity leads to long-term consequences. In the era of biologic therapy and tailored treatment, precise disease activity assessment and aggressive intervention for high disease activity are crucial for improved outcomes. As inflammation is a fundamental aspect of JIA, evaluating it reflects disease severity. Recently, there has been growing interest in investigating cellular immune inflammation indices such as the neutrophil-to-lymphocyte ratio (NLR) and systemic immune inflammation index (SII) as measures of disease severity. The aim of this retrospective study was to explore the potential of the SII in reflecting both inflammation and disease severity in children with JIA. The study comprised 74 JIA patients and 50 healthy controls. The results reveal a notable increase in median SII values corresponding to disease severity, exhibiting strong correlations with traditional inflammatory markers, including CRP and ESR (ρ = 0.714, ρ = 0.661), as well as the JADAS10 score (ρ = 0.690). Multiple regression analysis revealed the SII to be independently associated with JADAS10. Furthermore, the SII accurately distinguished patients with high disease activity from other severity groups (AUC = 0.827, sensitivity 81.5%, specificity 66%). These findings suggest that integrating the SII as an additional measure holds potential for assessing disease activity in JIA.
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Affiliation(s)
- Delia-Maria Nicoară
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Andrei-Ioan Munteanu
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Research Center for Disturbances of Growth and Development in Children BELIVE, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Alexandra-Cristina Scutca
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
| | - Giorgiana-Flavia Brad
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
| | - Iulius Jugănaru
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Research Center for Disturbances of Growth and Development in Children BELIVE, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Meda-Ada Bugi
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Ph.D. School Department, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
| | - Raluca Asproniu
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
| | - Otilia Mărginean
- Department XI Pediatrics, Discipline I Pediatrics, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
- Department of Pediatrics I, Children's Emergency Hospital "Louis Turcanu", 300011 Timisoara, Romania
- Research Center for Disturbances of Growth and Development in Children BELIVE, 'Victor Babeş' University of Medicine and Pharmacy of Timisoara, 300041 Timisoara, Romania
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Dimitrijevic Carlsson A, Wahlund K, Kindgren E, Frodlund M, Alstergren P. Increase in stress contributes to impaired jaw function in juvenile idiopathic arthritis: a two-year prospective study. Pediatr Rheumatol Online J 2024; 22:30. [PMID: 38409027 PMCID: PMC10898012 DOI: 10.1186/s12969-024-00966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 02/14/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Stress in patients with Juvenile Idiopathic Arthritis (JIA) has been found to be associated with orofacial pain, psychological distress, jaw dysfunction and loss of daily activities in a cross-sectional study. The aim of this study was to investigate the relations between stress and change of stress over time versus changes in orofacial pain, psychosocial factors and jaw function over a two-year period in patients with JIA. METHODS This is a two-year prospective follow-up study involving 40 JIA patients. At baseline (2015) the median age was 12 years and at two-year follow up (2018) 14 years. The JIA patients were examined clinically and with questionnaires at baseline and follow-up with the diagnostic criteria for temporomandibular disorders (DC/TMD) and completed the same set of DC/TMD questionnaires regarding orofacial pain symptoms and psychosocial factors. RESULTS Change in stress was associated with change in catastrophizing, psychological distress as well as limitation in general function and jaw function. CONCLUSIONS This study emphasizes the importance of maintaining a low stress level in patients with JIA since an increase in stress level over a two-year period seems to impair jaw function as well as psychological distress and catastrophizing.
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Affiliation(s)
- Alexandra Dimitrijevic Carlsson
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden.
- Centre for Oral Rehabilitation, Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
- Scandinavian Center for Orofacial Neurosciences, Malmö University, Malmö, Sweden.
| | - Kerstin Wahlund
- Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden
| | - Erik Kindgren
- Department of Pediatrics, Västervik Hospital, Västervik, Sweden
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Pediatrics, Skaraborg Hospital, Skövde, Sweden
| | - Martina Frodlund
- Rheumatology/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Alstergren
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences, Malmö University, Malmö, Sweden
- Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden
- Orofacial Pain Unit, Malmö University, Malmö, Sweden
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Beesley RP, Hyrich KL, Humphreys JH. The incidence and prevalence of Juvenile Idiopathic Arthritis differs between ethnic groups in England. Rheumatology (Oxford) 2023:kead700. [PMID: 38135502 DOI: 10.1093/rheumatology/kead700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 09/07/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
OBJECTIVES Juvenile Idiopathic Arthritis (JIA) is a heterogenous group of rare autoimmune disorders characterised by chronic joint inflammation of unknown aetiology with onset under 16years. Accurate estimates of disease rates help understand impacts on individuals and society, and provide evidence for health service planning and delivery. This study aimed to produce the first national estimates of incidence and prevalence by ethnic group using electronic health records. METHODS Data from the Clinical Practice Research Datalink (CPRD) Aurum, a primary care electronic health record database in England, were used to estimate the incidence and prevalence of JIA by ethnic group amongst children and young people aged under 16 years between 2003 and 2018, with cases validated using Hospital Episode Statistics (HES). Chi square was used to test the difference in proportions compared to the ethnic distribution of England. RESULTS A total of 424 incident cases of JIA were identified, 389 validated using HES records. Incidence of JIA was higher amongst those of White ethnic group (6.2 per 100,000 population) compared to Mixed (3.0 per 100,000), Asian (2.7 per 100,000) and Black (2.9 per 100,000) communities. The ethnic group distribution of cases differed significantly compared to the general population (p < 0.0001). CONCLUSION Incidence and prevalence of JIA differs between ethnic groups, and is different from the population. This is likely to be due to a combination of genetic and equity factors. Further research to understand the underlying cause of these differences is important, to enable targeted interventions and appropriate service provision.
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Affiliation(s)
- Richard P Beesley
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Jenny H Humphreys
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester, UK
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Stavrakidou M, Trachana M, Koutsonikoli A, Spanidou K, Hristara-Papadopoulou A. The Impact of a Physiotherapy Tele-Rehabilitation Program on the Quality of Care for Children with Juvenile Idiopathic Arthritis. Mediterr J Rheumatol 2023; 34:443-453. [PMID: 38282926 PMCID: PMC10815514 DOI: 10.31138/mjr.310823.tio] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 05/19/2023] [Accepted: 06/04/2023] [Indexed: 01/30/2024] Open
Abstract
Objectives To investigate the applicability and impact of a physiotherapy tele-rehabilitation program (TRP) on children with Juvenile Idiopathic Arthritis (JIA) and their families. Methods Thirty JIA patients, applying an individualized home-exercise program (HEP), were randomly divided in the tele-rehabilitation (TRG, n=15) and control group (CG, n=15). Each TRG patient participated in a 30-minute tele-session, under a paediatric physiotherapist's supervision, twice a week, for 12 weeks. Before and after the TRP (T1 and T2, respectively), all participants and a parent/guardian completed the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) questionnaire and a questionnaire regarding the HEP implementation and compliance. Residual disease was estimated at T1 and T2. At T2, TRG patients/parents completed a questionnaire evaluating the TRP. One month after T2, a reassessment of compliance with the HEP was performed. Results The patients' median age was 12.8 (8-16) years. At T2, the TRG patients performed the HEP significantly more frequently (p=0.023), for a longer time (p=0.034) and with less urging (p=0.004), compared to T1. Moreover, they exhibited significantly increased compliance with HEP (p=0.001), better functionality (p=0.008), better quality of life (p=0.007) and less pain (p=0.017). The CG patients showed no significant changes. Residual disease improved in both groups (TRG:p=0.002, CG:p=0.018), but more in the TRG (p=0.045). TRP's applicability and total benefit were rated as excellent by patients/parents. Finally, one month after T2, compliance with the HEP was still greater than at T1(p=0.001). Conclusion An interactive physiotherapy TRP can be implemented effectively for JIA patients, providing an additional tool for their rehabilitation.
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Affiliation(s)
- Maria Stavrakidou
- Asklepeio Physiotherapy Clinic, Thessaloniki, Greece
- First Department of Paediatrics, Paediatric Immunology and Rheumatology Referral Centre, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
- Department of Physiotherapy, International Hellenic University, Thessaloniki, Greece
| | - Maria Trachana
- First Department of Paediatrics, Paediatric Immunology and Rheumatology Referral Centre, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Artemis Koutsonikoli
- First Department of Paediatrics, Paediatric Immunology and Rheumatology Referral Centre, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
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Kohli AT, Hersh AO, Ponder L, Chan LHK, Rouster-Stevens KA, Tebo AE, Kugathasan S, Guthery SL, Bohnsack JF, Prahalad S. Prevalence of tissue transglutaminase antibodies and IgA deficiency are not increased in juvenile idiopathic arthritis: a case-control study. Pediatr Rheumatol Online J 2023; 21:110. [PMID: 37798643 PMCID: PMC10557180 DOI: 10.1186/s12969-023-00890-z] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/01/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The prevalence of Celiac Disease (CD) in Juvenile Idiopathic Arthritis (JIA) has been reported to be 0.1-7% in various small studies. As a result of the limited number of research and their inconclusive results there are no clear recommendations for routine CD screening in asymptomatic patients with JIA. Our aim is to estimate the prevalence of IgA deficiency and tissue transglutaminase (tTG) IgA in a cohort of JIA followed in two large academic medical centers. METHODS Serum was collected and stored from all subjects and analyzed in a reference laboratory for total IgA (Quantitative Nephelometry) and tTG IgA antibody levels (Semi-Quantitative Enzyme-Linked Immunosorbent Assay). Fisher's exact tests were performed for statistical significance. Risk estimates (odds ratios) with 95% confidence intervals were calculated. RESULTS 808 JIA cases and 140 controls were analyzed. Majority were non-Hispanic whites (72% vs. 68% p = 0.309). A total of 1.2% of cases were IgA deficient compared to none of the controls (p = 0.373). After excluding IgA deficient subjects, 2% of cases had tTG IgA ≥ 4u/mL compared to 3.6% of controls (p = 0.216) (OR = 0.5; 95% C.I = 0.1-1.4); and 0.8% of cases had tTG IgA > 10u/mL compared to 1.4% of controls (p = 0.627) (OR = 0.5; 95%C.I = 0.1-2.9). CONCLUSIONS Using the largest JIA cohort to date to investigate prevalence of celiac antibodies, the prevalence of positive tTG IgA was 0.8% and of IgA deficiency was 1.2%. The results did not demonstrate a higher prevalence of abnormal tTG IgA in JIA. The study did not support the routine screening of asymptomatic JIA patients for CD.
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Affiliation(s)
- Angela Taneja Kohli
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.
- Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Aimee O Hersh
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Lori Ponder
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lai Hin Kimi Chan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Kelly A Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Anne E Tebo
- University of Utah, Salt Lake City, UT, USA
- ARUP Laboratories, Salt Lake City, USA
| | - Subra Kugathasan
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Stephen L Guthery
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - John F Bohnsack
- Department of Pediatrics, Spencer F. Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
- Children's Healthcare of Atlanta, Atlanta, GA, USA
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Tonni I, Fossati G, Garo ML, Piancino MG, Cattalini M, Visconti L, Borghesi A. Temporomandibular joint involvement in patients with Juvenile Idiopathic Arthritis: comparison of ultrasonography and magnetic resonance imaging in assessing the periarticular space width. Oral Radiol 2023; 39:750-758. [PMID: 37400736 PMCID: PMC10504125 DOI: 10.1007/s11282-023-00696-5] [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: 02/22/2023] [Accepted: 06/09/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES This study aimed to compare the performance of Ultrasonography (US) and Magnetic Resonance Imaging (MRI) in assessing the Lateral Periarticular Space (LPAS) of Temporomandibular Joints (TMJs) in patients with Juvenile Idiopathic Arthritis (JIA). METHODS The LPAS width was evaluated in two different patient groups. In the JIA group, including 29 children (13 ± 2.8 years) with JIA, the LPAS width was measured with both MRI and US. In the healthy group, including 28 healthy children (12.6 ± 2.5 years), the LPAS width was measured only with US. Comparisons of LPAS width based on patient groups and TMJ contrast enhancement in MRI were evaluated by applying the Mann-Whitney U test. Correlation and agreement between MRI and US measurements in JIA group were tested using Spearman rank correlation and Bland-Altman method. RESULTS The LPAS width was significantly greater in the JIA group than in the healthy group. In the JIA group, the LPAS width was significantly greater in TMJs with moderate/severe enhancement than those with mild enhancement. A positive significant correlation between MRI and US measurements of LPAS width was found in the JIA group. In the same group, Bland-Altman method showed a good level of agreement between MRI and US measurements. CONCLUSION Although, US cannot replace MRI in the evaluation of TMJ in patients with JIA, US could be used as a supplementary imaging method to MRI in assessing the TMJ disease.
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Affiliation(s)
- Ingrid Tonni
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy.
| | - Giulia Fossati
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
| | - Maria Luisa Garo
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
| | - Maria Grazia Piancino
- Department of Surgical Sciences, C.I.R. Dental School, Orthodontic Division, Dental School, University of Turin-Italy, Via Nizza 230, 10126, Turin, Italy
| | - Marco Cattalini
- Pediatrics Clinic, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
| | - Luca Visconti
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
| | - Andrea Borghesi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, P.za Spedali Civili 1, 25123, Brescia, Italy
- Operational Unit 2nd Diagnostic Radiology, University of Brescia and ASST Spedali Civili of Brescia, Brescia, Italy
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Şahin N, Özdemir Çiçek S, Paç Kısaarslan A, Dursun İ, Poyrazoğlu MH, Düşünsel R. The effect of intra-articular steroid injection on the cartilage and tendon thicknesses in juvenile idiopathic arthritis. Mod Rheumatol 2023:road093. [PMID: 37757466 DOI: 10.1093/mr/road093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/17/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND AND AIM Intra-articular corticosteroid injection (IACI) is a safe first-line or adjunct therapy that can be used in any subtype of juvenile idiopathic arthritis (JIA). However, limited studies evaluated the effect of IACI on cartilage. As a result, our study aimed to examine the distal femoral cartilage thickness of patients with JIA who received IACI to the knee joint using ultrasound imaging. METHODS We randomly selected JIA patients who performed IACI in the knee joint. Baseline bilateral joint cartilage and tendons thickness were measured. Then, the articulary fluid was aspirated, and intra articulary steroid was injected during the same period. Six months after injection, the exact measurements were repeated. Exclusion criterias were that patients had IACI past six months of the baseline measurement and more than one IACI during the study period.. Distal femoral cartilage thickness, quadriceps tendon thickness, and distal and proximal patellar tendon thicknesses were compared at baseline (before IACI) and six months after IACI. RESULTS Thirty patients with JIA were included in the study, and 23 (76.7%) were female. The median age was 11 years (interquartile range (IQR), 6 to 14), and the median disease duration was 3.3 years (IQR, 5 months to 5 years). Subtypes of JIA were oligoarticular in 25 (83.3%), polyarticular in 2 (6.7%), enthesitis-related arthritis in 2 (6.7%), and juvenile psoriatic arthritis in 1 (3.3%). Distal femoral cartilage thickness was 2.96±0.79 mm at baseline and 2.85±0.70 mm at six months after IACI (p=0.35). Also, the tendon thicknesses were the similar at six months after baseline measurements. CONCLUSION Our findings reveal that knee IACI in patients with JIA did not significantly change cartilage and tendons thicknesses. This observation could indicate that IACIs have no detrimental effects on the cartilage and the tendons.
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Affiliation(s)
- Nihal Şahin
- Erciyes University, Department of Pediatric Rheumatology, Kayseri, Turkey
| | | | | | - İsmail Dursun
- Erciyes University, Department of Pediatric Nephrology, Kayseri, Turkey
| | | | - Ruhan Düşünsel
- Erciyes University, Department of Pediatric Rheumatology, Kayseri, Turkey
- Erciyes University, Department of Pediatric Nephrology, Kayseri, Turkey
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Hamad Saied M, van Straalen JW, de Roock S, de Joode-Smink GCJ, Verduyn Lunel FM, Swart JF, Wulffraat NM, Jansen MHA. Long-term immunoprotection after live attenuated measles-mumps-rubella booster vaccination in children with juvenile idiopathic arthritis. Vaccine 2023; 41:5477-5482. [PMID: 37516575 DOI: 10.1016/j.vaccine.2023.07.052] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/08/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Abstract
INTRODUCTION Vaccines, especially live attenuated vaccines, in children with JIA pose a great challenge due to both potential lower immunogenicity and safety as a result of immunosuppressive treatment. For many years, in the Netherlands, JIA patients receive a measles-mumps-rubella (MMR) booster vaccine at the age of nine years as part of the national immunization program. OBJECTIVES To study long-term humoral immunoprotection in a large cohort of JIA patients who received the MMR booster vaccine while being treated with immunomodulatory therapies at the Wilhelmina Children's Hospital in Utrecht, the Netherlands. METHODS MMR-specific IgG antibody concentrations in stored serum samples of vaccinated JIA patients were determined with chemiluminescent microparticle immunoassays (CMIA). Samples were analyzed five years after MMR booster vaccination and at last available follow-up visit using both crude and adjusted analyses. Additional clinical data were collected from electronic medical records. RESULTS In total, 236 samples from 182 patients were analyzed, including 67 samples that were available five years post-vaccination, and an additional 169 samples available from last visits with a median duration after vaccination of 6.9 years (IQR: 2.8-8.8). Twenty-eight patients were using biologic disease-modifying antirheumatic drugs (bDMARDS) of whom 96% anti-TNF agents and 4% tocilizumab. Percentages of protective antibody levels against measles after five years were significantly lower for patients who used bDMARD therapy at vaccination compared to patients who did not: 60% versus 86% (P = 0.03). For mumps (80% versus 94%) and rubella (60% versus 83%) this difference did not reach statistical significance (P = 0.11 and P = 0.07, respectively). Antibody levels post-vaccination decreased over time, albeit not significantly different between bDMARD users and non-bDMARD users. CONCLUSION The MMR booster vaccine demonstrated long-term immunogenicity in the majority of children with JIA from a large cohort, although lower percentages of protective measles antibody levels were observed in bDMARD users. Hence, it might be indicated to measure antibody levels at least five years after MMR booster vaccination in the latter group and advice an extra booster accordingly.
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Affiliation(s)
- Mohamad Hamad Saied
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Pediatrics, Carmel Medical Center, Technion Faculty of Medicine, Haifa, Israel.
| | - Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gerrie C J de Joode-Smink
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frans M Verduyn Lunel
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc H A Jansen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Tomé C, Oliveira-Ramos F, Campanilho-Marques R, Mourão AF, Sousa S, Marques C, Melo AT, Teixeira RL, Martins AP, Moeda S, Costa-Reis P, Torres RP, Bandeira M, Fonseca H, Gonçalves M, Santos MJ, Graca L, Fonseca JE, Moura RA. Children with extended oligoarticular and polyarticular juvenile idiopathic arthritis have alterations in B and T follicular cell subsets in peripheral blood and a cytokine profile sustaining B cell activation. RMD Open 2023; 9:e002901. [PMID: 37652558 PMCID: PMC10476142 DOI: 10.1136/rmdopen-2022-002901] [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: 11/28/2022] [Accepted: 07/03/2023] [Indexed: 09/02/2023] Open
Abstract
OBJECTIVES The main goal of this study was to characterise the frequency and phenotype of B, T follicular helper (Tfh) and T follicular regulatory (Tfr) cells in peripheral blood and the cytokine environment present in circulation in children with extended oligoarticular juvenile idiopathic arthritis (extended oligo JIA) and polyarticular JIA (poly JIA) when compared with healthy controls, children with persistent oligoarticular JIA (persistent oligo JIA) and adult JIA patients. METHODS Blood samples were collected from 105 JIA patients (children and adults) and 50 age-matched healthy individuals. The frequency and phenotype of B, Tfh and Tfr cells were evaluated by flow cytometry. Serum levels of APRIL, BAFF, IL-1β, IL-2, IL-4, IL-6, IL-10, IL-17A, IL-21, IL-22, IFN-γ, PD-1, PD-L1, sCD40L, CXCL13 and TNF were measured by multiplex bead-based immunoassay and/or ELISA in all groups included. RESULTS The frequency of B, Tfh and Tfr cells was similar between JIA patients and controls. Children with extended oligo JIA and poly JIA, but not persistent oligo JIA, had significantly lower frequencies of plasmablasts, regulatory T cells and higher levels of Th17-like Tfh cells in circulation when compared with controls. Furthermore, APRIL, BAFF, IL-6 and IL-17A serum levels were significantly higher in paediatric extended oligo JIA and poly JIA patients when compared with controls. These immunological alterations were not found in adult JIA patients in comparison to controls. CONCLUSIONS Our results suggest a potential role and/or activation profile of B and Th17-like Tfh cells in the pathogenesis of extended oligo JIA and poly JIA, but not persistent oligo JIA.
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Affiliation(s)
- Catarina Tomé
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Filipa Oliveira-Ramos
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Raquel Campanilho-Marques
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ana F Mourão
- Rheumatology Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Sandra Sousa
- Reumatology Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Cláudia Marques
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ana T Melo
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Rui L Teixeira
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Ana P Martins
- Pediatric Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Sofia Moeda
- Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Patrícia Costa-Reis
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Rita P Torres
- Rheumatology Department, Hospital de São Francisco Xavier, Centro Hospitalar Lisboa Ocidental, EPE, Lisbon, Portugal
| | - Matilde Bandeira
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Helena Fonseca
- Department of Pediatrics, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Miroslava Gonçalves
- Pediatric Surgery Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisbon, Portugal
| | - Maria J Santos
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Reumatology Department, Hospital Garcia de Orta, EPE, Almada, Portugal
| | - Luis Graca
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - João E Fonseca
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, EPE, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Rita A Moura
- Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
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10
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Pelassa S, Raggi F, Rossi C, Bosco MC. MicroRNAs in Juvenile Idiopathic Arthritis: State of the Art and Future Perspectives. Biology (Basel) 2023; 12:991. [PMID: 37508421 PMCID: PMC10376583 DOI: 10.3390/biology12070991] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
Juvenile Idiopathic Arthritis (JIA) represents the most common chronic pediatric arthritis in Western countries and a leading cause of disability in children. Despite recent clinical achievements, patient management is still hindered by a lack of diagnostic/prognostic biomarkers and targeted treatment protocols. MicroRNAs (miRNAs) are short non-coding RNAs playing a key role in gene regulation, and their involvement in many pathologies has been widely reported in the literature. In recent decades, miRNA's contribution to the regulation of the immune system and the pathogenesis of autoimmune diseases has been demonstrated. Furthermore, miRNAs isolated from patients' biological samples are currently under investigation for their potential as novel biomarkers. This review aims to provide an overview of the state of the art on miRNA investigation in JIA. The literature addressing the expression of miRNAs in different types of biological samples isolated from JIA patients was reviewed, focusing in particular on their potential application as diagnostic/prognostic biomarkers. The role of miRNAs in the regulation of immune responses in affected joints will also be discussed along with their potential utility as markers of patients' responses to therapeutic approaches. This information will be of value to investigators in the field of pediatric rheumatology, encouraging further research to increase our knowledge of miRNAs' potential for future clinical applications in JIA.
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Affiliation(s)
- Simone Pelassa
- UOC Rheumatology and Autoinflammatory Diseases, Department of Pediatric Sciences, Istituto Giannina Gaslini, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 16147 Genova, Italy
| | - Federica Raggi
- UOC Rheumatology and Autoinflammatory Diseases, Department of Pediatric Sciences, Istituto Giannina Gaslini, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 16147 Genova, Italy
| | - Chiara Rossi
- UOC Rheumatology and Autoinflammatory Diseases, Department of Pediatric Sciences, Istituto Giannina Gaslini, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 16147 Genova, Italy
| | - Maria Carla Bosco
- UOC Rheumatology and Autoinflammatory Diseases, Department of Pediatric Sciences, Istituto Giannina Gaslini, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), 16147 Genova, Italy
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11
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van Til JA, Kip MMA, Schatorjé EJH, Currie G, Twilt M, Benseler SM, Swart JF, Vastert SJ, Wulffraat N, Yeung RSM, Groothuis-Oudshoorn CGMK, Warta S, Marshall DA, IJzerman MJ. Withdrawing biologics in non-systemic JIA: what matters to pediatric rheumatologists? Pediatr Rheumatol Online J 2023; 21:69. [PMID: 37434157 DOI: 10.1186/s12969-023-00845-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/15/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE Approximately one third of children with JIA receive biologic therapy, but evidence on biologic therapy withdrawal is lacking. This study aims to increase our understanding of whether and when pediatric rheumatologists postpone a decision to withdraw biologic therapy in children with clinically inactive non-systemic JIA. METHODS A survey containing questions about background characteristics, treatment patterns, minimum treatment time with biologic therapy, and 16 different patient vignettes, was distributed among 83 pediatric rheumatologists in Canada and the Netherlands. For each vignette, respondents were asked whether they would withdraw biologic therapy at their minimum treatment time, and if not, how long they would continue biologic therapy. Statistical analysis included descriptive statistics, logistic and interval regression analysis. RESULTS Thirty-three pediatric rheumatologists completed the survey (40% response rate). Pediatric rheumatologists are most likely to postpone the decision to withdraw biologic therapy when the child and/or parents express a preference for continuation (OR 6.3; p < 0.001), in case of a flare in the current treatment period (OR 3.9; p = 0.001), and in case of uveitis in the current treatment period (OR 3.9; p < 0.001). On average, biologic therapy withdrawal is initiated 6.7 months later when the child or parent prefer to continue treatment. CONCLUSION Patient's and parents' preferences were the strongest driver of a decision to postpone biologic therapy withdrawal in children with clinically inactive non-systemic JIA and prolongs treatment duration. These findings highlight the potential benefit of a tool to support pediatric rheumatologists, patients and parents in decision making, and can help inform its design.
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Affiliation(s)
- Janine A van Til
- Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands
| | - Michelle M A Kip
- Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Ellen J H Schatorjé
- Department of Paediatric Rheumatology, St. Maartenskliniek, Nijmegen, the Netherlands
- Department of Paediatric Rheumatology and Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gillian Currie
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marinka Twilt
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Division of Rheumatology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Division of Rheumatology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Joost F Swart
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
- European Reference Network RITA (rare immunodeficiency autoinflammatory and autoimmune diseases network), Utrecht, The Netherlands
| | - Sebastiaan J Vastert
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
- European Reference Network RITA (rare immunodeficiency autoinflammatory and autoimmune diseases network), Utrecht, The Netherlands
| | - Nico Wulffraat
- Department of Pediatric Rheumatology, Division of Paediatrics, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
- European Reference Network RITA (rare immunodeficiency autoinflammatory and autoimmune diseases network), Utrecht, The Netherlands
| | - Rae S M Yeung
- Division of Rheumatology, The Hospital for Sick Children, Department of Paediatrics, Immunology and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - C G M Karin Groothuis-Oudshoorn
- Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands
| | - Sanne Warta
- Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Division of Rheumatology, Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maarten J IJzerman
- Department of Health Technology & Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, P.O. Box 217, Enschede, AE, The Netherlands.
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12
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Rossi-Semerano L, Ravagnani V, Collado P, Vojinovic J, Roth J, Magni-Manzoni S, Naredo E, D'Agostino MA, Jousse-Joulin S. Validity of ultrasonography in detecting enthesitis in children: A systematic literature review. Joint Bone Spine 2023; 90:105538. [PMID: 36754113 DOI: 10.1016/j.jbspin.2023.105538] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/25/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE A systematic review to assess the value of ultrasonography (US) for detecting enthesitis in juvenile idiopathic arthritis (JIA). METHODS PubMed and Embase databases were searched for articles published from January 1966 to May 2021; we selected those meeting the inclusion criteria according to the US definition of enthesitis and metric properties studied. We assessed the clinical features of the population, study design, the type and number of entheses examined, the definition and scoring system of US enthesitis and metric properties according to the OMERACT filter (truth, discrimination and feasibility). The quality of the studies was evaluated with the Quality Assessment of Diagnostic Accuracy Studies 2. RESULTS Five publications met the inclusion criteria (26 to 146 patients and 1 to 10 bilaterally examined entheses). All studies focused on lower-limb entheses. The elementary lesions included in the definition of adult enthesitis were generally assessed. Few studies reported US reliability and none evaluated sensitivity to change of US. US revealed entheseal abnormalities in 9.4 to 53% of JIA patients and 20 to 83% of enthesitis-related arthritis cases. No significant abnormalities were found in healthy children. US findings were poorly correlated with clinical examination. The overall quality of the studies was low, mainly because of the lack of a reference standard. CONCLUSION US is a sensitive tool to detect entheseal abnormalities in JIA. The current evidence highlights that a standardized US definition of enthesitis in children is lacking and US criteria and discriminant validity have not been established.
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Affiliation(s)
- Linda Rossi-Semerano
- Department of Pediatric Rheumatology, National Reference Centre for Auto-inflammatory Diseases and Amyloidosis of Inflammatory origin (CEREMAIA), Bicêtre hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France
| | | | - Paz Collado
- Department of Rheumatology, Hospital Universitario Severo Ochoa, University Alfoso X E1 Sabio, Madrid, Spain
| | - Jelena Vojinovic
- Clinic of Pediatrics, Clinical Center, Faculty of Medicine, University of Nis, Bul dr Zorana Djindjica 48, 18000 Nis, Serbia
| | - Johannes Roth
- Division of Pediatric Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H8L1, Canada
| | - Silvia Magni-Manzoni
- Pediatric Rheumatology Unit, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza Sant'Onofrio 4, 00165 Rome, Italy
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Sandrine Jousse-Joulin
- Department of Rheumatology, La Cavale Blanche University hospital, University Brest, Inserm, LBAI, UMR 1227, Brest, France.
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13
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Brandelli YN, Chambers CT, Mackinnon SP, Parker JA, Huber AM, Stinson JN, Wildeboer EM, Wilson JP, Piccolo O. A systematic review of the psychosocial factors associated with pain in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2023; 21:57. [PMID: 37328738 DOI: 10.1186/s12969-023-00828-5] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/22/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Pain is one of the most frequently reported experiences amongst children with Juvenile Idiopathic Arthritis (JIA); however, the management of JIA pain remains challenging. As pain is a multidimensional experience that is influenced by biological, psychological, and social factors, the key to effective pain management lies in understanding these complex relationships. The objective of this study is to systematically review the literature on psychosocial factors of children with JIA and their caregivers 1) associated with and 2) predictive of later JIA pain intensity, frequency, and sensitivity in children 0-17 years of age. METHODS The Joanna Briggs Institute methodology for etiology and risk and Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement guided the conduct and reporting of this review. Terms related to pain and JIA were searched in English without date restrictions across various databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and the Cochrane Central Register of Controlled Trials) in September 2021. Two independent reviewers identified, extracted data from, and critically appraised the included studies. Conflicts were resolved via consensus. RESULTS Of the 9,929 unique studies identified, 61 were included in this review and reported on 516 associations. Results were heterogeneous, likely due to methodological differences and moderate study quality. Results identified predominantly significant associations between pain and primary and secondary appraisals (e.g., more child pain beliefs, lower parent/child self-efficacy, lower child social functioning), parent/child internalizing symptoms, and lower child well-being and health-related quality of life. Prognostically, studies had 1-to-60-month follow-up periods. Fewer beliefs of harm, disability, and no control were associated with lower pain at follow-up, whereas internalizing symptoms and lower well-being were predictive of higher pain at follow-up (bidirectional relationships were also identified). CONCLUSIONS Despite the heterogeneous results, this review highlights important associations between psychosocial factors and JIA pain. Clinically, this information supports an interdisciplinary approach to pain management, informs the role of psychosocial supports, and provides information to better optimize JIA pain assessments and interventions. It also identifies a need for high quality studies with larger samples and more complex and longitudinal analyses to understand factors that impact the pain experience in children with JIA. TRIAL REGISTRATION PROSPERO CRD42021266716.
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Affiliation(s)
- Yvonne N Brandelli
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada.
| | - Christine T Chambers
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Sean P Mackinnon
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Jennifer A Parker
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Adam M Huber
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
- Division of Pediatric Rheumatology, IWK Health, Halifax, NS, Canada
| | - Jennifer N Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
- Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Emily M Wildeboer
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
| | - Jennifer P Wilson
- Cassie and Friends: A Society for Children with Juvenile Arthritis and Other Rheumatic Diseases, Vancouver, BC, Canada
| | - Olivia Piccolo
- Centre for Pediatric Pain Research, IWK Health Centre, 5859/5980 University Avenue, PO BOX 9700, Halifax, NS, B3K 6R8, Canada
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14
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Bethencourt-Baute JJ, Montero N, Zacarias AM, Nieto JC, López-Corbeto M, Boteanu A, Medrano M, Díaz-Cordovés Rego G, Vargas-Lebron C, Machín-García S, Expósito L, Cacheda AP, Bernabeu P, Veroz-González R, Fernández O, Enriquez Merayo E, Torrente-Segarra V, Fernández-Alba MD, Gamir ML, López-Robledillo JC, Antón J, Otero L, Bustabad S. Juvenile idiopathic arthritis in the young adult. Methodology, objectives, and initial data from the JUVENSER registry. Reumatol Clin (Engl Ed) 2023:S2173-5743(23)00101-6. [PMID: 37258400 DOI: 10.1016/j.reumae.2023.01.003] [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] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 06/02/2023]
Abstract
OBJECTIVES To describe the methodology, objectives, and initial data of the registry of young adult patients diagnosed with Juvenile Idiopathic Arthritis (JIA), JUVENSER. The main objective of the project is to know the sociodemographic and clinical characteristics, and disease activity of patients with JIA reaching the transition to adulthood. MATERIAL AND METHOD Longitudinal, prospective, multicentre study, including patients between 16 and 25 years old, with a diagnosis of JIA in any of its categories. The main objective is to determine the characteristics and activity of JIA in the young adult. It includes sociodemographic variables, clinical variables, disease activity and joint damage rates, data on the use of health resources, and treatments used. The total duration of the project will be 3 years. A cohort of 534 young adult patients was obtained. CONCLUSIONS The JUVENSER registry will constitute a cohort of young adults with JIA, which will allow the evaluation of the clinical characteristics and response to treatment of patients with disease onset in childhood, moving to adult clinics.
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Affiliation(s)
| | - Nuria Montero
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Andrea M Zacarias
- Unidad de Transición, Hospital Sant Joan de Déu. Hospital Clínic de Barcelona, Barcelona, Spain
| | - Juan Carlos Nieto
- Servicio de Reumatología, Hospital General Gregorio Marañón, Madrid, Spain
| | | | - Alina Boteanu
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marta Medrano
- Servicio de Reumatología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Carmen Vargas-Lebron
- Servicio de Reumatología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Sergio Machín-García
- Servicio de Reumatología, Complejo Hospitalario Insular Materno Infantil, Las Palmas de Gran Canaria, Spain
| | - Lorena Expósito
- Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Ana Paula Cacheda
- Servicio de Reumatología, Hospital Universitario Son Llàtzer, Mallorca, Spain
| | - Pilar Bernabeu
- Servicio de Reumatología, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Olaia Fernández
- Servicio de Reumatología, Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Vicenç Torrente-Segarra
- Servicio de Reumatología, Hospital Comarcal Alt Penedés Garraf, Vilafranca del Penedès, Spain
| | | | - María Luz Gamir
- Servicio de Reumatología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Jordi Antón
- Servicio de Reumatología, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Lucía Otero
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, Spain
| | - Sagrario Bustabad
- Servicio de Reumatología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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15
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Heckert SL, Hissink-Muller PCE, van den Berg JM, Schonenberg-Meinema D, van Suijlekom-Smit LWA, van Rossum MAJ, Koopman Y, Ten Cate R, Brinkman DMC, Huizinga TWJ, Allaart CF, Bergstra SA. Patterns of clinical joint inflammation in juvenile idiopathic arthritis. RMD Open 2023; 9:rmdopen-2022-002941. [PMID: 36927851 PMCID: PMC10030666 DOI: 10.1136/rmdopen-2022-002941] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 02/19/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES We studied patterns of joint inflammation in juvenile idiopathic arthritis (JIA) to assess whether joint activity recurs locally in the same joints. METHODS Joints of 91 patients of the BeSt for Kids study, a treat-to-target trial for children with recent-onset oligoarticular, rheumatoid factor-negative polyarticular and psoriatic JIA, were clinically assessed during 2 years (10 study visits). The association between joint inflammation at baseline and later inflammation in the same joint was assessed using a multilevel mixed-effects logistic regression model at joint level. With a Poisson model, the association between baseline joint inflammation and the number of study visits at which the same joint was recurrently inflamed was tested. RESULTS Of the 6097 joints studied, 15% (897) was clinically inflamed at baseline. In 42% (377/897) of those joints, inflammation recurred during follow-up. Joint inflammation at baseline was statistically significantly associated with joint inflammation during follow-up in the same joint (OR 3.9, 95% CI 3.5 to 4.4) and specifically with the number of episodes of recurrent joint inflammation (IRR 1.6, 95% CI 1.2 to 2.1). CONCLUSION In JIA, joint inflammation has the tendency to recur multiple times in joints that are clinically inflamed at disease onset. This indicates that local factors might play a role in the processes contributing to the occurrence of JIA flares.
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Affiliation(s)
- Sascha L Heckert
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Petra C E Hissink-Muller
- Paediatrics/Pediatric Rheumatology, Leiden University Medical Center Willem Alexander Childrens Hospital, Leiden, The Netherlands
| | - J Merlijn van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
| | | | - Marion A J van Rossum
- Department of Pediatrics, Emma Childrens' Hospital UMC, Amsterdam, The Netherlands
- Department of Pediatric Rheumatology, Amsterdam Rheumatology and Immunology Center, location Reade, Amsterdam, The Netherlands
| | - Yvonne Koopman
- Pediatrics, Haga Hospital Juliana Children's Hospital, Den Haag, The Netherlands
| | - Rebecca Ten Cate
- Paediatrics/Pediatric Rheumatology, Leiden University Medical Center Willem Alexander Childrens Hospital, Leiden, The Netherlands
| | - Danielle M C Brinkman
- Paediatrics/Pediatric Rheumatology, Leiden University Medical Center Willem Alexander Childrens Hospital, Leiden, The Netherlands
| | - Tom W J Huizinga
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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16
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de Oliveira RJ, Londe AC, de Souza DP, Marini R, Fernandes PT, Appenzeller S. Physical Activity Influences Health-Related Quality of Life in Adults with Juvenile Idiopathic Arthritis. J Clin Med 2023; 12:jcm12030771. [PMID: 36769423 PMCID: PMC9917453 DOI: 10.3390/jcm12030771] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/04/2022] [Accepted: 12/30/2022] [Indexed: 01/20/2023] Open
Abstract
This cross-sectional study aimed to evaluate the impact of physical activity and physical fitness on the health-related quality of life (HQoL) of adult patients with Juvenile Idiopathic Arthritis (JIA). Fifty-nine JIA patients and sixty healthy individuals participated in this study. All individuals had the following evaluations performed: body composition (electrical bioimpedance), physical fitness (6 min walk test (6MWT)), physical activity level (International Physical Activity Questionnaire (IPAQ)), and HQoL (Quality of Life Questionnaire in relation to Health-Short Form (SF36)). Thirty-nine (66%) JIA patients were considered sedentary compared with 15 (25%) in the control group (p < 0.01). JIA patients had a lower HQoL compared with the control group in all variables studied (p < 0.05). JIA patients who were very physically active had better HQoL conditions in the categories of functional capacity (p = 0.001), limitations by physical aspects (p = 0.003), and emotional aspects (p = 0.002) compared with sedentary patients. JIA patients had more cardiovascular abnormalities and walked shorter distances compared with healthy controls in the 6MWT. In conclusion, we observed that HQoL was reduced in adults with JIA. A high percentage of JIA patients were sedentary with lower physical fitness, but physically active patients had a better HQoL than sedentary patients. The duration of physical activity, rather than intensity, influenced the mental aspects of HQoL.
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Affiliation(s)
- Rodrigo Joel de Oliveira
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Ana Carolina Londe
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Débora Pessoa de Souza
- Graduate Program in Child and Adolescent Health, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 13083-970, Brazil
| | - Roberto Marini
- Department of Pediatrics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
| | - Paula Teixeira Fernandes
- Department of Sport Science, Faculty of Physical Education, University of Campinas (UNICAMP), Campinas 13083-851, Brazil
| | - Simone Appenzeller
- Department of Orthopedics, Rheumatology and Traumatology—School of Medical Sciences, University of Campinas (UNICAMP), Campinas 3083-970, Brazil
- Correspondence: ; Fax: +55-19-3289-1818
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17
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Peeters JGC, Boltjes A, Scholman RC, Vervoort SJ, Coffer PJ, Mokry M, Vastert SJ, van Wijk F, van Loosdregt J. Epigenetic changes in inflammatory arthritis monocytes contribute to disease and can be targeted by JAK inhibition. Rheumatology (Oxford) 2023:6982550. [PMID: 36625523 PMCID: PMC10396381 DOI: 10.1093/rheumatology/kead001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 11/08/2022] [Accepted: 12/01/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES How the local inflammatory environment regulates epigenetic changes in the context of inflammatory arthritis remains unclear. Here we assessed the transcriptional and active enhancer profile of monocytes derived from the inflamed joints of Juvenile Idiopathic Arthritis (JIA) patients, a model well-suited for studying inflammatory arthritis. METHODS RNA-sequencing and H3K27me3 chromatin immunoprecipitation sequencing (ChIP-seq) were used to analyze the transcriptional and epigenetic profile, respectively, of JIA synovial fluid-derived monocytes. RESULTS Synovial-derived monocytes display an activated phenotype, which is regulated on the epigenetic level. IFN signalling-associated genes are increased and epigenetically altered in synovial monocytes, indicating a driving role for IFN in establishing the local inflammatory phenotype. Treatment of synovial monocytes with the Janus-associated kinase (JAK) inhibitor ruxolitinib, which inhibits IFN signalling, transformed the activated enhancer landscape and reduced disease-associated gene expression, thereby inhibiting the inflammatory phenotype. CONCLUSION This study provides novel insights into epigenetic regulation of inflammatory arthritis patient-derived monocytes and highlights the therapeutic potential of epigenetic modulation for the treatment of inflammatory rheumatic diseases.
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Affiliation(s)
- Janneke G C Peeters
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arjan Boltjes
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rianne C Scholman
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Stephin J Vervoort
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul J Coffer
- Center for Molecular Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Michal Mokry
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Pediatric Gastroenterology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sebastiaan J Vastert
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Pediatric Rheumatology and Immunology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht University Utrecht, The Netherlands
| | - Femke van Wijk
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jorg van Loosdregt
- Center for Translational Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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18
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Ostrov BE. Reliability and reproducibility of antinuclear antibody testing in pediatric rheumatology practice. Front Med (Lausanne) 2023; 9:1071115. [PMID: 36714114 PMCID: PMC9875300 DOI: 10.3389/fmed.2022.1071115] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 12/13/2022] [Indexed: 01/11/2023] Open
Abstract
Antinuclear antibody (ANA) testing is common practice among health care practitioners when evaluating children and adolescents with non-specific symptoms including fatigue and aches and pains. When positive, ANA results often lead to referrals to pediatric rheumatologists as these antibodies may be key indicators for specific pediatric rheumatologic diagnoses. The reliability and reproducibility of ANA tests varies with assay techniques and validation and interpretation of results. In the following article, review of ANA testing in pediatrics is provided along with case examples that demonstrate the reliability and reproducibility of these results in specific scenarios common in the practice of pediatric rheumatology. Guidelines for more accurate utilization of ANA testing are presented with the aim to improve testing and interpretation by ordering clinicians.
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19
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Kim BH, Chang IB, Lee S, Oh BL, Hong IH. Incidence and Prevalence of Pediatric Noninfectious Uveitis in Korea: A Population-Based Study. J Korean Med Sci 2022; 37:e344. [PMID: 36536545 PMCID: PMC9763706 DOI: 10.3346/jkms.2022.37.e344] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Uveitis is less common in children than in adults; however, pediatric uveitis has a relatively severe disease course that affects the quality of life. Although it is important to understand the epidemiological characteristics of pediatric uveitis, few studies have been conducted in large populations without referral bias. This study investigated the nationwide incidence and prevalence of pediatric uveitis in South Korea according to period, age, anatomic type, and systemic associations. METHODS This nationwide population-based cohort study used data from the Korean National Health Insurance Service from 2002 to 2018. This study included patients younger than 19 years of age with noninfectious uveitis with at least three claims of diagnostic codes of uveitis on separate days with at least once claim of prescription codes of steroid and immunosuppressive agents. All the cases were classified as anterior or non-anterior uveitis, and the overall incidence and prevalence were estimated by age, sex, and period. Patients with noninfectious uveitis were categorized by the presence of associated systemic conditions. RESULTS A total of 10,862,616 patients over 128,688,078 person-years were evaluated from 2005 to 2016. Overall, 5,368 cases of anterior uveitis and 604 cases of non-anterior uveitis were identified. The incidence and prevalence of pediatric noninfectious uveitis were 4.64 per 100,000 person-years (95% confidence interval [CI], 4.52-4.76) and 8.25 per 100,000 persons (95% CI, 8.09-8.41). Both the incidence and prevalence of pediatric uveitis increased with age. Anterior uveitis accounted for 84.7% of pediatric noninfectious uveitis prevalent cases (6.99 per 100,000 persons). Cases of juvenile idiopathic arthritis (JIA)-associated uveitis accounted for 8.7% (926 cases) of pediatric noninfectious uveitis cases with a prevalence of 0.72 per 100,000 (95% CI, 0.67-0.77). The proportion of systemic associations was higher and JIA-related uveitis accounted for 11.2% (803 cases) of recurrent or chronic noninfectious uveitis cases with a prevalence of 0.62 per 100,000. CONCLUSION This is the first population-based study investigating the largest population of pediatric patients with uveitis in Korea. The nationwide incidence and prevalence of pediatric noninfectious uveitis in 2005-2016 were 4.64 per 100,000 person-years and 8.25 per 100,000, respectively. The proportion of JIA in pediatric noninfectious uveitis was 8.7%. These population-based study findings provide a better understanding of the public health burden and aid in the planning of health-care strategies for pediatric patients with uveitis.
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Affiliation(s)
- Bo Hee Kim
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | | | | | | | - In Hwan Hong
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, Hallym University Medical Center, Hwaseong, Korea.
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20
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Del Giudice E, de Roock S, Vastert SJ, Wulffraat NM, Swart JF, van Dijkhuizen EHP. Patients' and parents' satisfaction to improve patient care in JIA: factors determining acceptable symptom state measured with JAMAR. Rheumatology (Oxford) 2022; 62:1920-1925. [PMID: 36515484 DOI: 10.1093/rheumatology/keac658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 10/21/2022] [Accepted: 11/10/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To identify factors associated with patients' and parents' reported satisfaction in juvenile idiopathic arthritis (JIA), measured with the juvenile arthritis child and parent acceptable symptom state (JA-CASS and JA-PASS, respectively). METHODS A prospective cohort of 239 JIA patients and 238 parents in a tertiary centre who completed the juvenile arthritis multidimensional assessment report (JAMAR) was analysed cross-sectionally. Primary outcome was positive JA-CASS and JA-PASS, respectively. Items of the JAMAR, as well as JIA subtype, demographics and disease activity parameters were analyzed in univariate analysis. A multivariable logistic regression analysis was used to build models explaining the variance of the primary outcome as dependent variable. RESULTS 141 (59.0%) of 239 patients and 149 (62.6%) of 238 parents were satisfied with their or their child's current condition. For patients, determinants in the final model were a shorter duration of morning stiffness (p= 0.001), a lower age at disease onset (p= 0.044), a longer disease duration (p= 0.009) and higher rating of the patient's well-being measured on a visual analogue scale (VAS) (p= 0.004). For parents, determinants were the current state of disease activity (current state of persistent activity p= 0.002, relapse p< 0.005), problems at school (p= 0.002) and the items regarding quality of life (QoL) (p= 0.005). CONCLUSION Our data highlight the importance of patients' and parents' opinion in the evaluation of disease activity and support their integration into the shared decision-making in daily clinical practice to improve the quality of medical care.
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Affiliation(s)
- Emanuela Del Giudice
- Department of Paediatric Rheumatology, Wilhelmina Children's hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Paediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Latina, Italy
| | - Sytze de Roock
- Department of Paediatric Rheumatology, Wilhelmina Children's hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Sebastiaan J Vastert
- Department of Paediatric Rheumatology, Wilhelmina Children's hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children's hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Joost F Swart
- Department of Paediatric Rheumatology, Wilhelmina Children's hospital, University Medical Center Utrecht, Utrecht, Netherlands.,Faculty of Medicine, Utrecht University, Utrecht, Netherlands
| | - Evert H P van Dijkhuizen
- Department of Paediatric Rheumatology, Wilhelmina Children's hospital, University Medical Center Utrecht, Utrecht, Netherlands
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21
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Montag LJ, Horneff G, Hoff P, Klein A, Kallinich T, Foeldvari I, Seipelt E, Tatsis S, Peer Aries MD, Niewerth M, Klotsche J, Minden K. Medication burden in young adults with juvenile idiopathic arthritis: data from a multicentre observational study. RMD Open 2022; 8:rmdopen-2022-002520. [PMID: 36283758 PMCID: PMC9608545 DOI: 10.1136/rmdopen-2022-002520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the medication and disease burden of young adults with juvenile idiopathic arthritis (JIA). METHODS Young adults with JIA prospectively followed in the Juvenile Arthritis Methotrexate/Biologics long-term Observation reported on their health status and medication use. All medications taken (disease-modifying antirheumatic drugs (DMARDs)/prescription/over-the-counter drugs, but excluding most local therapies) classified according to the Anatomical Therapeutic Chemical Classification System were included in this analysis. Medication use at last follow-up was evaluated by sex, JIA category and time from symptom onset to the first biological DMARD (bDMARD) start. RESULTS A total of 1306 young adults (68% female) with JIA and a mean disease duration of 13.6±6 years were included in the study. Patients reported using on average 2.4±2.1 medicines and 1.5±1.7 non-DMARD medicines, respectively, at the last follow-up. Almost a quarter of the patients reported polypharmacy. The higher the number of medications used was, the higher the disease activity, pain and fatigue, and the lower the quality of life of patients. Medication usage differed significantly between sexes and JIA categories, being highest in patients with rheumatoid factor-positive polyarthritis and systemic JIA. The number of medications used was significantly associated with the time from symptom onset to bDMARD start. Patients taking opioids or antidepressants had a particularly high disease burden and had received bDMARDs an average of 2 years later than patients not taking these medications. CONCLUSION Medication use in adults with JIA varies depending on sex, JIA category, and the time between symptom onset and initiation of treatment with bDMARD.
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Affiliation(s)
- Laura J Montag
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Programme area Epidemiology and Health Services Research, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
| | - Gerd Horneff
- Department of Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany,Department of Paediatric and Adolescent Medicine, University Hospital Cologne, Cologne, Germany
| | - Paula Hoff
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Department of Rheumatology, MVZ Endokrinologikum Berlin, Berlin, Germany
| | - Ariane Klein
- Department of Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | - Tilmann Kallinich
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Programme area Pathophysiology of Rheumatic Inflammation, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
| | - Ivan Foeldvari
- Klinikum Eilbek, Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Eva Seipelt
- Immanuel Krankenhaus Berlin-Buch, Berlin, Germany
| | | | | | - Martina Niewerth
- Programme area Epidemiology and Health Services Research, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
| | - Jens Klotsche
- Programme area Epidemiology and Health Services Research, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
| | - Kirsten Minden
- Programme area Epidemiology and Health Services Research, Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany,Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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22
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Vincent HK, Sharififar S, Abdelmalik B, Lentini L, Chen C, Woolnough LU. Gait parameters, functional performance and physical activity in active and inactive Juvenile Idiopathic Arthritis. Gait Posture 2022; 98:226-232. [PMID: 36191581 DOI: 10.1016/j.gaitpost.2022.09.080] [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: 05/19/2022] [Revised: 08/04/2022] [Accepted: 09/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children with Juvenile Idiopathic Arthritis (JIA) may adopt different movement patterns and participate in physical activity during different states of disease. RESEARCH QUESTION Which specific features of gait and physical function performance differ among children with active or inactive JIA compared to healthy children? METHODS Forty-three children participated (14.5 ± 4.2 yrs; 60 % female). 3D-motion analysis methods were coupled with force measures from an instrumented treadmill captured gait mechanical measures. The 30-second Chair Rise Test (repetitions) and stair ascent-descent tests were performed, and the 11-point Wong-Baker face scale assessed pain after each test. RESULTS Compared to healthy controls children with active and inactive JIA had worse outcomes (12-21 % slower self-selected and fast walking speeds, 28-34 % slower stair navigation times, 28 % fewer chair rise repetitions in 30 s; all p < .05). Children with active JIA had 8-13 % slower gait speeds, 4 % fewer chair rise repetitions and 14-16 % slower stair navigation times. At faster walking speed, children with active JIA had less hip joint flexion/extension excursion in the sagittal plane during the gait cycle, produced higher leg stiffness, and demonstrated greater interlimb asymmetry in GRF vertical impulse during loading than healthy children (all p < .05). The Pedi-FABS subscore of "Duration: performing athletic activity for as long as you would like without stopping" was rated lower in children with active JIA compared to controls (p < .05). CONCLUSION Gait speed, specific load-bearing functional tasks and leg stiffness features of gait may be informative 'functional biomarkers' for assessing JIA burden and tracking treatment efficacy. Additional prospective studies are needed to determine how these features change over time with pain change, and understand impact on quality of life and physical activity participation.
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Affiliation(s)
- Heather K Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida, PO Box 112730, Gainesville, FL 32607, United States.
| | - Sharareh Sharififar
- Department of Physical Medicine and Rehabilitation, University of Florida, PO Box 112730, Gainesville, FL 32607, United States.
| | - Bishoy Abdelmalik
- Department of Physical Medicine and Rehabilitation, University of Florida, PO Box 112730, Gainesville, FL 32607, United States.
| | - Logan Lentini
- Department of Pediatrics, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States.
| | - Cong Chen
- Department of Orthopaedics, University of Florida, PO Box112727, Gainesville, FL 32611, United States.
| | - Leandra U Woolnough
- Department of Pediatrics, University of Florida, 1600 SW Archer Road, Gainesville, FL 32610, United States
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23
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Park J, Batthish M, Berard RA, Chédeville G, Proulx-Gauthier JP, Rumsey DG, Tucker LB, Wong S, Guzman J. Comparing Canadian pediatric rheumatology practice to the 2019 ACR Juvenile Idiopathic Arthritis guidelines. Results from the CAPRI Registry. Rheumatology (Oxford) 2022; 62:1616-1620. [PMID: 35977388 DOI: 10.1093/rheumatology/keac468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To identify differences between baseline Canadian JIA practices and the 2019 American College of Rheumatology guidelines for juvenile idiopathic arthritis (JIA Guidelines). METHODS Canadian pediatric rheumatologists were surveyed for their opinion on reasonable a priori target adherence rates for JIA Guideline recommendations. Then, prospectively collected data for 266 newly diagnosed children from 2017 to 2019 were analyzed to calculate observed adherence rates. Kaplan Meier survival curves were used to estimate the cumulative incidence of starting synthetic or biologic DMARDs for different patient groups. RESULTS Twenty-five of 61 (41%) eligible physicians answered the survey. Most survey respondents (64%) felt that adherence targets should vary depending on the strength of recommendation and quality of evidence, from a mean of 84% for strong recommendations with high quality evidence, to 29% for conditional recommendations with very low-quality evidence. Data showed 13/19 (68%) recommendations would have met proposed targets and 10/19 (53%) had ≥80% observed adherence. Exceptions were the use of subcutaneous over oral methotrexate (MTX) (53%) and infrequent treatment escalation from NSAIDs to biologic DMARDs in patients with sacroiliitis (31%) or enthesitis (0%). By 12 weeks, 95% of patients with polyarthritis received synthetic DMARD, 38% of patients with systemic JIA received biologic DMARD, and 22% of patients with sacroiliitis received biologic DMARD. CONCLUSION Canadian pediatric rheumatology practices were in line with many 2019 JIA Guidelines recommendations before their publication, except for frequent use of oral methotrexate and infrequent direct escalation from NSAIDs to biologic DMARDs in sacroiliitis and enthesitis.
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Affiliation(s)
- Jonathan Park
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Batthish
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | - Roberta A Berard
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montreal, Québec, Canada
| | | | - Dax G Rumsey
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Wong
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
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Udaondo C, Cámara C, Miguel Berenguel L, Alcobendas Rueda R, Muñoz Gómez C, Millán Longo C, Díaz – Delgado B, Falces-Romero I, Díaz Almirón M, Ochando J, Méndez – Echevarría A, Remesal Camba A, Calvo C. Humoral and cellular immune response to mRNA SARS-CoV-2 BNT162b2 vaccine in adolescents with rheumatic diseases. Pediatr Rheumatol Online J 2022; 20:64. [PMID: 35964130 PMCID: PMC9375068 DOI: 10.1186/s12969-022-00724-4] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data about safety and efficacy of the mRNA SARS-CoV-2 vaccine in adolescents with rheumatic diseases (RD) is scarce and whether these patients generate a sufficient immune response to the vaccine remains an outstanding question. OBJECTIVE To evaluate safety and humoral and cellular immunity of the BNT162b2 vaccine in adolescents 12 to 18 years with RD and immunosuppressive treatment compared with a healthy control group. METHODS Adolescents from 12 to 18 years with RD followed at Hospital La Paz in Madrid (n = 40) receiving the BNT162b2 mRNA vaccination were assessed 3 weeks after complete vaccination. Healthy adolescents served as controls (n = 24). Humoral response was measured by IgG antiSpike antibodies, and cellular response by the quantity of IFN-γ and IL-2 present in whole blood stimulated with SARS-CoV-2 Spike and M proteins. RESULTS There were no differences in spike-specific humoral or cellular response between groups (median IFN-γ response to S specific protein; 528.80 pg/ml in controls vs. 398.44 in RD patients, p 0.78, and median IL-2 response in controls: 635.68 pg/ml vs. 497.30 in RD patients, p 0.22. The most frequent diagnosis was juvenile idiopathic arthritis (26/40, 65%) followed by Lupus (6/40, 15%). 60% of cases (23/40) received TNF inhibitors and 35% (14/40) methotrexate. 40% of patients (26/64) had previous SARS-CoV-2 infection, 9 in the control group and 17 in the RD patients without differences. Of note, 70% of infections were asymptomatic. A higher IFN-γ production was found in COVID-19 recovered individuals than in naive subjects in both groups (controls: median 859 pg/ml in recovered patients vs. 450 in naïve p 0.017, and RD patients: 850 in recovered vs. 278 in naïve p 0.024). No serious adverse events or flares were reported following vaccination. CONCLUSIONS We conclude that standard of care treatment for adolescents with RD including TNF inhibitors and methotrexate did not affect the humoral and the cellular immunity to BNT162b2 mRNA vaccination compared to a healthy control group. The previous contact with SARS-CoV-2 was the most relevant factor in the immune response.
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Affiliation(s)
- Clara Udaondo
- Paediatric Rheumatology Unit, Hospital Infantil La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. .,La Paz Institute of Biomedical Research (IdiPAZ), 28046, Madrid, Spain. .,CIBERINFEC, Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Carmen Cámara
- La Paz Institute of Biomedical Research (IdiPAZ), 28046 Madrid, Spain ,grid.81821.320000 0000 8970 9163Department of Immunology, Hospital La Paz, 28046 Madrid, Spain
| | - Laura Miguel Berenguel
- grid.81821.320000 0000 8970 9163Department of Immunology, Hospital La Paz, 28046 Madrid, Spain
| | - Rosa Alcobendas Rueda
- grid.81821.320000 0000 8970 9163Paediatric Rheumatology Unit, Hospital Infantil La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Celia Muñoz Gómez
- grid.81821.320000 0000 8970 9163Paediatric Rheumatology Unit, Hospital Infantil La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Claudia Millán Longo
- grid.81821.320000 0000 8970 9163Paediatric Rheumatology Unit, Hospital Infantil La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Blanca Díaz – Delgado
- grid.81821.320000 0000 8970 9163Paediatric Rheumatology Unit, Hospital Infantil La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Iker Falces-Romero
- La Paz Institute of Biomedical Research (IdiPAZ), 28046 Madrid, Spain ,grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III (ISCIII), Madrid, Spain ,Microbiology and Parasitology Department, Hospital La Paz, 28046 Madrid, Spain
| | - Mariana Díaz Almirón
- La Paz Institute of Biomedical Research (IdiPAZ), 28046 Madrid, Spain ,grid.81821.320000 0000 8970 9163Biostatistics, Hospital La Paz, 28046 Madrid, Spain
| | - Jordi Ochando
- grid.413448.e0000 0000 9314 1427National Microbiology Centre, Instituto de Salud Carlos III, 28220 Madrid, Spain
| | - Ana Méndez – Echevarría
- La Paz Institute of Biomedical Research (IdiPAZ), 28046 Madrid, Spain ,grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III (ISCIII), Madrid, Spain ,grid.81821.320000 0000 8970 9163Paediatric and Infectious Diseases Department, Hospital La Paz, 28046 Madrid, Spain ,Paediatric Translational Network in Infectious Diseases (RITIP), Madrid, Spain
| | - Agustín Remesal Camba
- grid.81821.320000 0000 8970 9163Paediatric Rheumatology Unit, Hospital Infantil La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain
| | - Cristina Calvo
- La Paz Institute of Biomedical Research (IdiPAZ), 28046 Madrid, Spain ,grid.413448.e0000 0000 9314 1427CIBERINFEC, Instituto de Salud Carlos III (ISCIII), Madrid, Spain ,grid.81821.320000 0000 8970 9163Paediatric and Infectious Diseases Department, Hospital La Paz, 28046 Madrid, Spain ,Paediatric Translational Network in Infectious Diseases (RITIP), Madrid, Spain
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Branco J, Amorim M, Conde M. A novel variant of DeSanto-Shinawi Syndrome with joint manifestations. Eur J Med Genet 2022; 65:104534. [PMID: 35636632 DOI: 10.1016/j.ejmg.2022.104534] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/09/2022] [Accepted: 05/26/2022] [Indexed: 11/19/2022]
Abstract
The clinical features associated with WAC haploinsufficiency include recognizable dysmorphic facial features, variable degrees of developmental delay and intellectual disability that were recently delineated as DeSanto-Shinawi syndrome (OMIM 616708). We describe a patient with DeSanto-Shinawi syndrome caused by a novel frameshift variant in WAC gene (NM_016628.4(WAC):c.1689del (p.Phe563Leufs*6)). As noted in cases previously reported, our patient phenotype included facial dysmorphism, intellectual disability, behavioral problems, feeding difficulties, hirsutism, constipation and astigmatism. She also had limited range of motion of joints since birth and Juvenile Idiopathic Arthritis diagnosed at eleven years old. Although in the last years some additional features were reported in DeSanto-Shinawi syndrome, joint manifestations have not been previously described. As limited range of motion of joints was reported since birth with no correlation with arthritis onset, it could be a new clinical feature. Polyarthritis in this patient can be only a coincidence, since there is a first degree relative with psoriasis, or might be related to WAC mutation. Indeed, WAC encodes a protein that plays a vital role in autophagy. It has already been demonstrated that WAC haploinsufficiency leads to increased autophagy and, according to different authors, increased autophagy may display a pathogenic role in several autoimmune disorders such as Rheumatoid Arthritis and Juvenile Idiopathic Arthritis. Thus, WAC haploinsufficiency may have contributed to autoimmune disorder in this patient.
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Affiliation(s)
- Joana Branco
- Pediatric Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal.
| | - Marta Amorim
- Genetic Service, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
| | - Marta Conde
- Pediatric Rheumatology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, EPE, Lisboa, Portugal
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26
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Heshin-Bekenstein M, Ziv A, Toplak N, Hagin D, Kadishevich D, Butbul YA, Saiag E, Kaufman A, Shefer G, Sharon O, Pel S, Elkayam O, Uziel Y. Safety and immunogenicity of BNT162b2 mRNA COVID-19 vaccine in adolescents with rheumatic diseases treated with immunomodulatory medications. Rheumatology (Oxford) 2022; 61:4263-4272. [PMID: 35179569 PMCID: PMC9383463 DOI: 10.1093/rheumatology/keac103] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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: 01/09/2022] [Revised: 02/06/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Adolescents with juvenile-onset autoimmune inflammatory rheumatic diseases (AIIRD) could be at-risk for disease flare secondary to SARS-CoV-2 infection or to withholding anti-inflammatory therapy. While vaccination can protect against COVID-19, safety and immunogenicity data regarding anti-SARS-CoV-2 vaccines among adolescents with AIIRD are limited. This international, prospective, multicentre study evaluated the safety and immunogenicity of the BNT162b2 anti-SARS-CoV-2 vaccine among adolescents and young adults with juvenile-onset AIIRD, 80% of whom are on chronic immunomodulatory therapy. METHODS Vaccine side effects, disease activity, and short-term efficacy were evaluated after 3 months in 91 patients. Anti-spike S1/S2 IgG antibody levels were evaluated in 37 patients and 22 controls, 2-9 weeks after the second dose. RESULTS Ninety-one patients and 40 healthy controls were included. Safety profile was good, with 96.7% (n = 88) of patients reporting mild or no side-effects, and no change in disease activity. However, 3 patients had transient acute symptoms: 2 following the first vaccination (renal failure and pulmonary haemorrhage) and 1 following the second dose (mild lupus flare vs viral infection). Seropositivity rate was 97.3% in the AIIRD group compared with 100% among controls. However, anti-S1/S2 antibody titres were significantly lower in the AIIRD group compared with controls (242 ± 136.4 vs 387.8 ± 57.3 BAU/ml, respectively; p< 0.0001). No cases of COVID-19 were documented during the 3-month follow-up. CONCLUSION Vaccination of juvenile-onset AIIRD patients demonstrated good short-term safety and efficacy, high seropositivity rate, but lower anti-S1/S2 antibody titres compared with healthy controls. These results should encourage vaccination of adolescents with juvenile-onset AIIRD, even while on immunomodulation.
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Affiliation(s)
- Merav Heshin-Bekenstein
- Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Ziv
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
| | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - David Hagin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Allergy and Clinical Immunology Unit, Department of Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Yonatan A Butbul
- Pediatric Rheumatology Unit, Rambam Medical Center, Haifa, Israel
| | - Esther Saiag
- Hospital Management, Information and Operation Branch, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alla Kaufman
- Pediatric Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Gabi Shefer
- Department of Endocrinology Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Orli Sharon
- Department of Endocrinology Metabolism and Hypertension, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Sara Pel
- Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ori Elkayam
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Rheumatology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yosef Uziel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Israel
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27
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García-Rodríguez F, Gamboa-Alonso A, Jiménez-Hernández S, Ochoa-Alderete L, Barrientos-Martínez VA, Alvarez-Villalobos NA, Luna-Ruíz GA, Peláez-Ballestas I, Villarreal-Treviño AV, de la O-Cavazos ME, Rubio-Pérez N. Economic impact of Juvenile Idiopathic Arthritis: a systematic review. Pediatr Rheumatol Online J 2021; 19:152. [PMID: 34627296 PMCID: PMC8502332 DOI: 10.1186/s12969-021-00641-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) requires complex care that generate elevated costs, which results in a high economic impact for the family. The aim of this systematic review was to collect and cluster the information currently available on healthcare costs associated with JIA after the introduction of biological therapies. METHODS We comprehensively searched in MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Databases for studies from January 2000 to March 2021. Reviewers working independently and in duplicate appraised the quality and included primary studies that report total, direct and/or indirect costs related to JIA for at least one year. The costs were converted to United States dollars and an inflationary adjustment was made. RESULTS We found 18 eligible studies including data from 6,540 patients. Total costs were reported in 10 articles, ranging from $310 USD to $44,832 USD annually. Direct costs were reported in 16 articles ($193 USD to $32,446 USD), showing a proportion of 55 to 98 % of total costs. Those costs were mostly related to medications and medical appointments. Six studies reported indirect costs ($117 USD to $12,385 USD). Four studies reported costs according to JIA category observing the highest in polyarticular JIA. Total and direct costs increased up to three times after biological therapy initiation. A high risk of reporting bias and inconsistency of the methodology used were found. CONCLUSION The costs of JIA are substantial, and the highest are derived from medication and medical appointments. Indirect costs of JIA are underrepresented in costs analysis.
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Affiliation(s)
- Fernando García-Rodríguez
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Augusto Gamboa-Alonso
- Plataforma INVEST Medicina UANL-KER Unit Mayo Clinic (KER Unit México), Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Sol Jiménez-Hernández
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Lucero Ochoa-Alderete
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Valeria Alejandra Barrientos-Martínez
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | | | | | | | - Ana Victoria Villarreal-Treviño
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Manuel Enrique de la O-Cavazos
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico
| | - Nadina Rubio-Pérez
- Department of Pediatrics, Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Madero y Gonzalitos SN, Col. Mitras Centro, C.P. 64460, Monterrey, Mexico.
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28
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Turk M, Hayworth J, Nevskaya T, Pope J. The frequency of uveitis in patients with adult versus childhood spondyloarthritis. RMD Open 2021; 6:rmdopen-2020-001196. [PMID: 32868451 PMCID: PMC7507733 DOI: 10.1136/rmdopen-2020-001196] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 05/04/2020] [Accepted: 08/01/2020] [Indexed: 12/15/2022] Open
Abstract
Objectives This meta-analysis investigated the frequency of ocular involvement in childhood and adult spondyloarthritis (SpA). Methods A systematic review of the literature was conducted. Medline, Web of Science and Cochrane databases were searched upto October 2018 identifying publications related to SpA, including ankylosing spondylitis (AS) with ocular conditions (OC) (uveitis, iritis, retinitis, chorioretinitis and other ocular involvement). The rates of OC were extracted and random effects models estimated their frequency. Heterogeneity was evaluated using I2. Inclusion criteria were studies in SpA of either children or adults who included a frequency of OC. Results 3164 studies were identified, and 41 analysed which included frequencies of uveitis/iritis. Other OC were too infrequent to analyse. A pooled random effects model showed that the prevalence of uveitis was 24% in adult AS (23 studies, 11 943 patients), 10% in adult psoriatic arthritis (PsA) (9 studies, 1817) and 17% in undifferentiated adult SpA (9 studies, 6568 patients). In juveniles with AS, the prevalence of uveitis was 27% (8 studies, 927 patients), in juvenile PsA it was 16% (5 studies, N=498) and in juvenile undifferentiated SpA, uveitis occurred in 7% (2 studies, 1531 patients). In all evaluated SpA subgroups, there were no statistical differences in the frequency of uveitis between juveniles and adults. Conclusions Uveitis in adult versus child-onset SpA is similar in AS but more common in adult-onset undifferentiated SpA, and less frequent in adult-onset PsA compared to child-onset PsA, but the differences were not significant.
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Affiliation(s)
| | | | - Tatiana Nevskaya
- Medicine, Division of Rheumatology, Western University, London, Canada
| | - Janet Pope
- Medicine, Division of Rheumatology, Western University, London, Canada
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29
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Srinivasalu H, Treemarcki EB, Redmond C. Advances in Juvenile Spondyloarthritis. Curr Rheumatol Rep 2021; 23:70. [PMID: 34255209 DOI: 10.1007/s11926-021-01036-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To provide an overview of recent studies on pathogenesis, diagnosis, and management of juvenile spondyloarthritis (JSpA). RECENT FINDINGS Recent studies show differences in gut microbiome in patients with JSpA in comparison to healthy controls. There is increased recognition of the impact of the innate immune system on disease pathology. Normative reference on MRI of sacroiliac (SI) joints in children is now available. However, there is significant variability in interpretation of MRI of SI joints in children and a need for standardization. NSAIDs, physical therapy, and Tumor Necrosis Factor Inhibitors (TNFi) remain the mainstay of management for patients with JIA who have polyarthritis, sacroiliitis, and/or enthesitis as per recent ACR guidelines. Newer therapeutic options beyond TNFi are needed to manage patients who fail TNFi. This review highlights some of the recent advances in our knowledge of JSpA pathophysiology, diagnosis, and treatment. It also identifies areas in need of further research and standardization to improve our understanding and outcomes in JSpA.
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30
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Tonni I, Borghesi A, Tonesi S, Fossati G, Ricci F, Visconti L. An ultrasound protocol for temporomandibular joint in juvenile idiopathic arthritis: a pilot study. Dentomaxillofac Radiol 2021; 50:20200399. [PMID: 34233508 DOI: 10.1259/dmfr.20200399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES As it is well known, the diagnosis of temporomandibular joint (TMJ) involvement in patients affected by Juvenile Idiopathic Arthritis (JIA) is important to avoid the impairment of mandibular growth. In this context, Magnetic Resonance Imaging (MRI) is the gold-standard for detection of TMJ involvement, however it is expensive and requires patients' collaboration. The aim of this study was to evaluate if ultrasound may be used as an alternative tool to investigate the acute signs of TMJ involvement in JIA patients. METHODS Lateral periarticular space (LPAS) and joint effusion were evaluated by ultrasound in a study Group A of 8 JIA children (11.6±3.5 years old) with 14 TMJs involved, as confirmed by MRI, and in a control Group B of 7 healthy children (9.3±1.2 years old) without temporomandibular disorders (TMD). The LPAS width values were compared between the two groups using the Mann-Whitney test. The ultrasound images of the JIA group were then matched with the corresponding MR images; the Spearman Rank Correlation test and the Bland-Altman test were used to evaluate the differences. RESULTS The LPAS values in Group A were statistically significantly higher than those in Group B (p < 0.001). There was no overlap of the LPAS values confidence intervals (CIs) between the two groups. No signs of joint effusion were identified in groups A and B. The Spearman test applied to the values of LPAS measured in ultrasound and the corresponding MR images showed a proportional positive correlation with a ρ of 0.623 and a p < 0.05. CONCLUSIONS Ultrasound can detect differences in the TMJ features between JIA patients and healthy patients and it might be used as a follow-up tool in the assessment of TMJ involvement in subject affected by JIA.
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Affiliation(s)
- Ingrid Tonni
- Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Andrea Borghesi
- Department of Radiology, Medical School, University of Brescia, Brescia, Italy
| | - Silvia Tonesi
- Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Giulia Fossati
- Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Francesca Ricci
- Paediatric Immunology and Rheumatology Unit, University of Brescia, Brescia, Italy
| | - Luca Visconti
- Orthodontics, Dental School, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
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31
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Fischer J, Dirks J, Klaussner J, Haase G, Holl-Wieden A, Hofmann C, Hackenberg S, Girschick H, Morbach H. Clonally expanded PD-1 hi CXCR5 - CD4 + peripheral T helper cells promote differentiation of CD21 lo/- CD11c + double negative B cells in the joints of ANA+ JIA patients. Arthritis Rheumatol 2021; 74:150-162. [PMID: 34196496 DOI: 10.1002/art.41913] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/18/2021] [Accepted: 06/29/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVES Antinuclear antibody (ANA) positive Juvenile Idiopathic Arthritis (JIA) is characterized by synovial B cell hyperactivity, but the precise role of CD4+ T cells in promoting local B cell activation is unknown. The objective of this study is to unravel the phenotype and function of synovial CD4+ T cells that promote the aberrant B cell activation in JIA. METHODS Flow cytometric analysis was performed to compare the phenotype and cytokine pattern of synovial fluid (SF) PD-1hi CD4+ T cells with tonsil TFH cells. TCRVB next generation sequencing was applied to analyze T cell subsets for signs of clonal expansion. The functional impact of these T cell subsets on B cells was dissected in in vitro co-cultures. RESULTS Multidimensional flow-cytometric analysis revealed the expansion of IL-21 and IFN-γ co-expressing PD-1hi CXCR5- HLA-DR+ CD4+ T cells that accumulate in the joints of ANA+ JIA patients. These T cells exhibited signs of clonal expansion with restricted TCR clonotypes. Phenotypically they resembled peripheral T helper (TPH ) cells with an extrafollicular chemokine receptor pattern and high T-bet and Blimp-1 but low Bcl-6 expression. SF TPH cells particularly skewed B cell differentiation towards a CD21lo/- CD11c+ phenotype by provision of IL-21 and IFN-γ in vitro and correlated with the appearance of SF CD21lo/- CD11c+ CD27- IgM- double-negative B cells (BDN ) in situ. CONCLUSION Clonally expanded CD4+ TPH cells accumulate in the joints of ANA+ JIA patients and particularly promote CD21lo/- CD11c+ BDN cell differentiation The expansion of TPH and BDN cells might reflect the autoimmune response present in the joints of ANA+ JIA patients.
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Affiliation(s)
- Jonas Fischer
- Pediatric Immunology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Johannes Dirks
- Pediatric Immunology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Julia Klaussner
- Pediatric Immunology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Gabriele Haase
- Pediatric Immunology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Annette Holl-Wieden
- Pediatric Rheumatology and Osteology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Christine Hofmann
- Pediatric Rheumatology and Osteology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
| | - Stephan Hackenberg
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Würzburg, Würzburg, Germany
| | - Hermann Girschick
- Children's Hospital, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Henner Morbach
- Pediatric Immunology, Department of Pediatrics, University of Würzburg, Würzburg, Germany.,Pediatric Rheumatology and Osteology, Department of Pediatrics, University of Würzburg, Würzburg, Germany
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32
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Lovell DJ, Brunner HI, Reiff AO, Jung L, Jarosova K, Němcová D, Mouy R, Sandborg C, Bohnsack JF, Elewaut D, Gabriel C, Higgins G, Kone-Paut I, Jones OY, Vargová V, Chalom E, Wouters C, Lagunes I, Song Y, Martini A, Ruperto N. Long-term outcomes in patients with polyarticular juvenile idiopathic arthritis receiving adalimumab with or without methotrexate. RMD Open 2021; 6:rmdopen-2020-001208. [PMID: 32665432 PMCID: PMC7425194 DOI: 10.1136/rmdopen-2020-001208] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/27/2020] [Accepted: 06/01/2020] [Indexed: 11/05/2022] Open
Abstract
Objectives Long-term safety and efficacy of adalimumab among patients with juvenile idiopathic arthritis (JIA) was evaluated through 6 years of treatment. Methods Children aged 4–17 years with polyarticular JIA were enrolled in a phase III, randomised-withdrawal, double-blind, placebo-controlled trial consisting of a 16-week open-label lead-in period, 32-week randomised double-blind period and 360-week long-term extension. Patients were stratified by baseline methotrexate use. Adverse events (AEs) were monitored, and efficacy assessments included JIA American College of Rheumatology (JIA ACR) 30%, 50%, 70% or 90% responses and the proportions of patients achieving 27-joint Juvenile Arthritis Disease Activity Score (JADAS27) low disease activity (LDA, ≤3.8) and inactive disease (ID, ≤1). Results Of 171 patients enrolled, 62 (36%) completed the long-term extension. Twelve serious infections in 11 patients were reported through 592.8 patient-years of exposure. No cases of congestive heart failure-related AEs, demyelinating disease, lupus-like syndrome, malignancies, tuberculosis or deaths were reported. JIA ACR 30/50/70/90 responses and JADAS27 LDA were achieved in 66% to 96% of patients at week 104, and 63 (37%) patients achieved clinical remission (JADAS27 ID sustained for ≥6 continuous months) during the study. Attainment of JIA ACR 50 or higher and JADAS27 LDA or ID in the initial weeks were the best predictors of clinical remission. Mean JADAS27 decreased from baseline, 22.5 (n=170), to 2.5 (n=30) at week 312 (observed analysis). Conclusions Through 6 years of exposure, adalimumab was well tolerated with significant clinical response (up to clinical remission) and a relatively low retention rate.
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Affiliation(s)
- Daniel J Lovell
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, PRCSG Coordinating Center, Cincinnati, Ohio, USA
| | - Hermine I Brunner
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical Center, PRCSG Coordinating Center, Cincinnati, Ohio, USA
| | - Andreas O Reiff
- Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, California, USA.,Division of Rheumatology, Children's Hospital of Los Angeles, Los Angeles, California, USA
| | - Lawrence Jung
- Department of Rheumatology, Children's National Medical Center for Cancer and Immunology Research, Washington, District of Columbia, USA
| | - Katerina Jarosova
- Institute of Rheumatology, Prague, Czech Republic.,Department of Rheumatology, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Dana Němcová
- Department of Pediatrics and Adolescent Medicine, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Richard Mouy
- Pediatric Rheumatology, Univeristé Paris-Descartes and Hôpital Necker-Enfants Malades, Paris, France
| | - Christy Sandborg
- Pediatric Rheumatology, Lucile Packard Children's Hospital at Stanford, Palo Alto, California, USA
| | - John F Bohnsack
- Department of Pediatrics, Division of Allergy, Immunology and Pediatric Rheumatology, University of Utah, Salt Lake City, Utah, USA
| | - Dirk Elewaut
- Rheumatology, University Hospital Gent, Gent, Belgium.,VIB Center for Inflammation Research, Gent University, Gent, Belgium
| | - Christos Gabriel
- Pediatric Rheumatology, Children's Hospital of the King's Daughters, Norfolk, Virginia, USA
| | - Gloria Higgins
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology and CEREMAI, Hôpital De Bicêtre, National Reference Centre for Auto-inflammatory Diseases, Le Kremlin-Bicêtre, Paris, France
| | - Olcay Y Jones
- Pediatric Rheumatology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | | | - Elizabeth Chalom
- Pediatric-Rheumatology, Saint Barnabas Medical Center, Livingston, New Jersey, USA
| | - Carine Wouters
- Pediatric Immunology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Yanna Song
- AbbVie Inc, North Chicago, Illinois, USA
| | - Alberto Martini
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI),, Università degli Studi di Genova, Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia-PRINTO, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Tolend M, Junhasavasdikul T, Cron RQ, Inarejos Clemente EJ, von Kalle T, Kellenberger CJ, Koos B, Miller E, van Rossum MA, Saurenmann RK, Spiegel L, Stimec J, Twilt M, Tzaribachev N, Abramowicz S, Appenzeller S, Arvidsson LZ, Guleria S, Jaremko JL, Kirkhus E, Larheim TA, Meyers AB, Panwar J, Resnick CM, Shelmerdine SC, Feldman BM, Doria AS. Discrete Choice Experiment on a Magnetic Resonance Imaging Scoring System for Temporomandibular Joints in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2021; 74:308-316. [PMID: 33555146 DOI: 10.1002/acr.24577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 11/20/2020] [Accepted: 02/04/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the relative importance weights of items and grades of a newly developed additive outcome measure called the juvenile idiopathic arthritis (JIA) magnetic resonance imaging (MRI) scoring system for temporomandibular joints (TMJ, JAMRIS-TMJ). METHODS An adaptive partial-profile discrete choice experiment (DCE) survey using the 1000Minds platform was independently completed by members of an expert group consisting of radiologists and non-radiologist clinicians to determine the group-averaged relative weights for JAMRIS-TMJ. Subsequently, an image-based vignette ranking exercise was done, during which experts individually rank-ordered 14 patient vignettes for disease severity while blinded to the weights and unrestricted to JAMRIS-TMJ assessment criteria. Validity of the weighted JAMRIS-TMJ was tested by comparing the consensus-graded, DCE-weighted JAMRIS-TMJ score of the vignettes with their unrestricted image-based ranks provided by the experts. RESULTS Nineteen experts completed the DCE survey and 21 completed the vignette ranking exercise. Synovial thickening and joint enhancement showed higher weights per raw score compared to bone marrow items and effusion in the inflammatory domain, while erosions and condylar flattening showed non-linear and higher weights compared to disk abnormalities in the damage domain. The weighted JAMRIS-TMJ score of the vignettes correlated highly with the ranks from the unrestricted comparison method, with median Spearman's rho of 0.92 (intra-quartile range: 0.87-0.95) for the inflammation and 0.93 (0.90-0.94) for the damage domain. CONCLUSIONS A DCE survey was used to quantify the importance weights of the items and grades of the JAMRIS-TMJ. The weighted score showed high convergent validity with an unrestricted, holistic vignette ranking method.
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Affiliation(s)
- Mirkamal Tolend
- The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | | | - Randy Q Cron
- Children's of Alabama, Birmingham, AL, United States
| | | | | | | | - Bernd Koos
- University Hospital Tübingen, Tübingen, Germany
| | | | - Marion A van Rossum
- Emma Children's Hospital, Academic Medical Centre, and Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands
| | | | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Marinka Twilt
- Alberta Children's Hospital, and University of Calgary, Calgary, Alberta, Canada
| | | | - Shelly Abramowicz
- Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA, United States
| | | | | | | | | | | | | | - Arthur B Meyers
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Jyoti Panwar
- Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Ruperto N, Brunner HI, Ramanan AV, Horneff G, Cuttica R, Henrickson M, Anton J, Boteanu AL, Penades IC, Minden K, Schmeling H, Hufnagel M, Weiss JE, Pardeo M, Nanda K, Roth J, Rubio-Pérez N, Hsu JC, Wimalasundera S, Wells C, Bharucha K, Douglass W, Bao M, Mallalieu NL, Martini A, Lovell D, De Benedetti F. Subcutaneous dosing regimens of tocilizumab in children with systemic or polyarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 60:4568-4580. [PMID: 33506875 PMCID: PMC8487273 DOI: 10.1093/rheumatology/keab047] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/09/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives To determine s.c. tocilizumab (s.c.-TCZ) dosing regimens for systemic JIA (sJIA) and polyarticular JIA (pJIA). Methods In two 52-week phase 1 b trials, s.c.-TCZ (162 mg/dose) was administered to sJIA patients every week or every 2 weeks (every 10 days before interim analysis) and to pJIA patients every 2 weeks or every 3 weeks with body weight ≥30 kg or <30 kg, respectively. Primary end points were pharmacokinetics, pharmacodynamics and safety; efficacy was exploratory. Comparisons were made to data from phase 3 trials with i.v. tocilizumab (i.v.-TCZ) in sJIA and pJIA. Results Study participants were 51 sJIA patients and 52 pJIA patients aged 1–17 years who received s.c.-TCZ. Steady-state minimum TCZ concentration (Ctrough) >5th percentile of that achieved with i.v.-TCZ was achieved by 49 (96%) sJIA and 52 (100%) pJIA patients. In both populations, pharmacodynamic markers of disease were similar between body weight groups. Improvements in Juvenile Arthritis DAS-71 were comparable between s.c.-TCZ and i.v.-TCZ. By week 52, 53% of sJIA patients and 31% of pJIA patients achieved clinical remission on treatment. Safety was consistent with that of i.v.-TCZ except for injection site reactions, reported by 41.2% and 28.8% of sJIA and pJIA patients, respectively. Infections were reported in 78.4% and 69.2% of patients, respectively. Two sJIA patients died; both deaths were considered to be related to TCZ. Conclusion s.c.-TCZ provides exposure and risk/benefit profiles similar to those of i.v.-TCZ. S.c. administration provides an alternative administration route that is more convenient for patients and caregivers and that has potential for in-home use. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904292 and NCT01904279
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Affiliation(s)
- Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia-PRINTO, Genoa, Italy
| | - Hermine I Brunner
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany.,Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Rubén Cuttica
- Rheumatology Section, Hospital Pedro de Elizalde, Buenos Aires, Argentina
| | - Michael Henrickson
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jordi Anton
- Hospital Sant Joan de Déu, Universitat de Barcelona, Unidad de Reumatología Pediátrica, Esplugues de Llobregat (Barcelona), Spain
| | | | | | - Kirsten Minden
- German Rheumatism Research Centre Berlin, and Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Heinrike Schmeling
- Department of Pediatrics, Alberta Children's Hospital and Cumming School of Medicine/University of Calgary, Alberta, Canada
| | - Markus Hufnagel
- University Medical Center Freiburg, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases and Rheumatology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Jennifer E Weiss
- Hackensack University Medical Center, Pediatric Rheumatology, Hackensack, NJ, USA
| | - Manuela Pardeo
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Johannes Roth
- University of Ottawa and Division of Pediatric Dermatology & Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nadina Rubio-Pérez
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Pediatria, Hospital Universitario "Dr. J. E. González", Monterrey, NL, Mexico
| | - Joy C Hsu
- Roche Innovation Center, New York, NY, USA
| | | | | | | | | | - Min Bao
- Genentech, South San Francisco, CA, USA
| | | | - Alberto Martini
- Università degli Studi di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Genoa, Italy
| | - Daniel Lovell
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Armaroli G, Klein A, Ganser G, Ruehlmann MJ, Dressler F, Hospach A, Minden K, Trauzeddel R, Foeldvari I, Kuemmerle-Deschner J, Weller-Heinemann F, Urban A, Horneff G. Long-term safety and effectiveness of etanercept in JIA: an 18-year experience from the BiKeR registry. Arthritis Res Ther 2020; 22:258. [PMID: 33121528 PMCID: PMC7597050 DOI: 10.1186/s13075-020-02326-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/22/2020] [Indexed: 01/22/2023] Open
Abstract
Background At present, etanercept represents the most commonly prescribed biologic agent for juvenile idiopathic arthritis (JIA) treatment. Children and adolescents with JIA are often treated with etanercept over long periods, sometimes even into adulthood. The objectives of this analysis were to determine the long-term safety of etanercept compared to a biologic-naïve cohort and to assess the long-term treatment response upon continuous etanercept exposure using data from the German biologics registry (BiKeR). Methods JIA patients newly exposed to etanercept were documented in the BiKeR registry from January 2001 to March 2019, and baseline characteristics, effectiveness, and safety parameters were analysed. Response to treatment was assessed according to 10-joint Juvenile Arthritis Disease Activity Score (JADAS10), JADAS-defined minimal disease activity and remission, JIA-American College of Rheumatology (ACR) improvement criteria, and ACR-inactive disease definition. Safety assessments were based on adverse event (AE) reports. Results A total of 2725 new etanercept users with a diagnosis of JIA were registered. Of these, etanercept was received as a first-line biologic by 95.8% and as monotherapy without concomitant methotrexate by 31.5%. After nine years on continuous treatment, 68.1% of patients presented minimal disease activity, 43.1% JADAS-defined remission on drug, and 36.6% ACR-inactive disease. JIA-ACR30/50/70/90 response rates were still 82/79/71/54% after nine years of treatment. Overall, 2053 AEs (34.3/100PY), including 226 serious AEs (SAE, 3.8/100PY), were observed upon etanercept, compared to 1345 AEs [35.6/100PY; p = 0.3] and 52 SAEs (1.4/100PY; p = 0.0001) in the biologic-naïve cohort. Respective exposure-adjusted rates for etanercept and biologic-naïve patients were 0.9/100PY and 0.2/100PY (p = 0.0001) for serious infections, 0.4/100PY and 0.1/100PY (p = 0.01) for zoster reactivation, 0.3/100PY and 0.03/100PY (p = 0.015) for inflammatory bowel disease, and 1.9/100PY and 1.4/100PY (p = 0.09) for uveitis. Three and two malignancies were documented in the etanercept and biologic-naïve groups, as well as three and one deaths, respectively. Conclusions No new safety signal was observed, especially no increased risk for malignancies or autoimmune disorders other than inflammatory bowel disease. However, SAEs and serious infections, though infrequent, were more often reported on etanercept than in biologic-naïve patients. In addition, etanercept demonstrated a long-term maintenance of clinical benefits up to nine years of continuous treatment.
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Affiliation(s)
- Giulia Armaroli
- Division of Paediatric Rheumatology, Sankt Augustin Asklepios Children's Hospital, 53757 Sankt Augustin, Germany.
| | - Ariane Klein
- Division of Paediatric Rheumatology, Sankt Augustin Asklepios Children's Hospital, 53757 Sankt Augustin, Germany.,Cologne University, Medical School, Cologne, Germany
| | - Gerd Ganser
- Division of Paediatric Rheumatology, Northwest German Rheumatology Center, St. Josef Stift, Sendenhorst, Germany
| | | | - Frank Dressler
- Division of Paediatric Pulmonology, Allergology and Immunology, Hannover Medical School, Hannover, Germany
| | - Anton Hospach
- Division of Paediatric Rheumatology, Olgahospital, Stuttgart, Germany
| | - Kirsten Minden
- German Rheumatism Research Center, Charité University Hospital, Berlin, Germany
| | - Ralf Trauzeddel
- Department of Paediatrics, Berlin-Buch Helios Hospital, Berlin, Germany
| | - Ivan Foeldvari
- Paediatric Rheumatology Medical Center, Hamburg, Germany
| | | | | | - Andreas Urban
- Department of Paediatrics, St. Marien Hospital, Amberg, Germany
| | - Gerd Horneff
- Division of Paediatric Rheumatology, Sankt Augustin Asklepios Children's Hospital, 53757 Sankt Augustin, Germany.,Cologne University, Medical School, Cologne, Germany
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Romão VC, Cordeiro I, Macieira C, Oliveira-Ramos F, Romeu JC, Rosa CM, Saavedra MJ, Saraiva F, Vieira-Sousa E, Fonseca JE. Rheumatology practice amidst the COVID-19 pandemic: a pragmatic view. RMD Open 2020; 6:e001314. [PMID: 32584782 PMCID: PMC7425193 DOI: 10.1136/rmdopen-2020-001314] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/07/2020] [Accepted: 06/08/2020] [Indexed: 12/15/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has come with many challenges for healthcare providers and patients alike. In addition to the direct burden it has placed on societies and health systems, it had a significant impact in the care of patients with chronic diseases, as healthcare resources were deployed to fight the crisis, and major travel and social restrictions were adopted. In the field of rheumatology, this has required notable efforts from departments and clinicians to adapt to the novel status quo and assure the follow-up of patients with rheumatic and musculoskeletal diseases. In the present viewpoint, we provide a practical approach to tackle this reality. Key measures include setting up preventive team management strategies, optimising communication with patients and reorganising patient care in all its dimensions. We then anticipate the nuances of rheumatology practice as restrictive measures are progressively lifted, while an effective vaccine is still pending. This includes the need to reimpose the same strategy as further waves unfold. Finally, we look ahead and address the lessons we can incorporate into post-COVID-19 rheumatology.
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Affiliation(s)
- Vasco C Romão
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Inês Cordeiro
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Carla Macieira
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Filipa Oliveira-Ramos
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - José Carlos Romeu
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Carlos Miranda Rosa
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
| | - Maria João Saavedra
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Fernando Saraiva
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Elsa Vieira-Sousa
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - João Eurico Fonseca
- Rheumatology Department, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon Academic Medical Centre, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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Staats K, Tremoulet AH, Harvey H, Burns JC, Donofrio-Odmann JJ. A Four-Year-Old with History of Kawasaki Disease Presenting in Acute Shock. PREHOSP EMERG CARE 2020; 25:281-288. [PMID: 32250719 DOI: 10.1080/10903127.2020.1745339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We present a case in which emergency medical services (EMS) intervened on a critically ill child with known giant coronary aneurysms as sequela to her severe complicated Kawasaki disease. This patient's severe shock ultimately ended in cardiac arrest and death. We discuss the keys to recognition, and critical importance to early intervention of pediatric shock in prehospital care. We also detail the cardiac ramifications of Kawasaki disease, steps for prompt identification of high risk complaints in these patients, and opportunities for treatment.
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Tarkiainen M, Tynjälä P, Vähäsalo P, Kröger L, Aalto K, Lahdenne P. Health-related quality of life during early aggressive treatment in patients with polyarticular juvenile idiopathic arthritis: results from randomized controlled trial. Pediatr Rheumatol Online J 2019; 17:80. [PMID: 31842940 DOI: 10.1186/s12969-019-0370-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 09/24/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) may cause significant impairment in health-related quality of life (HrQoL), despite effective therapies. The aim of this study was to assess HrQoL during first-year treatment in patients with new-onset polyarticular JIA, and to compare treatment strategies. METHODS In ACUTE-JIA Study, 60 patients with new-onset JIA were randomized to receive either infliximab with methotrexate (IFX+MTX); a triple therapy of methotrexate, hydroxychloroquine, and sulfasalazine (Triple); or methotrexate monotherapy (MTX). Efficacy was measured with American College of Rheumatology pediatric (ACRp) score, and juvenile arthritis disease activity score (JADAS). HrQoL was evaluated with Child Health Questionnaire (CHQ), which includes physical and psychosocial summary scores (PhS and PsS). Linear mixed models were utilized to compare groups over time. RESULTS In the whole group of 60 patients, mean physical summary score (PhS) improved from 26.2 (SD 8.7) at week 0 to 49.7 (SD 13.2) at week 54 (p=0.046). Mean improvement of PhS was 20.3 (95% CI -15.5 to 56.2); 22.6 (-19.5 to 64.7); and 26.6 (-12.1 to 65.3) in IFX+MTX, Triple, and MTX, respectively. Changes in psychosocial summary score (PsS) were smaller: from 51.0 (SD 8.5) to 54.7 (6.3) (p=0.019) in all patients. No differences between the three treatment groups were detected in either of the measures. In multivariate analyses, Child Health Assessment Questionnaire (CHAQ), pain VAS, and time spent in inactive disease contributed to improvement in PhS; gender and CHAQ to PsS. CONCLUSIONS HrQol improved during the first year on therapy for JIA irrespective of the treatment strategy. The timing of change in the different dimensions of HrQoL varied; improvement occurred earlier in physical than psychosocial domains of HrQol. TRIAL REGISTRATION This study was registered within the Hospital District of Helsinki and Uusimaa (http://www.hus.fi) clinical trials, number 211864 in October 2002, and later on with ClinicalTrials.gov, number NCT01015547.
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Khan S, Mancini J, Hopper C, Rennick JE. Perceptions of Methotrexate Intolerance and Its Impact on Daily Life in School-Age Children with Juvenile Idiopathic Arthritis. J Pediatr Nurs 2019; 48:49-54. [PMID: 31254860 DOI: 10.1016/j.pedn.2019.06.004] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 06/05/2019] [Accepted: 06/06/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Methotrexate (MTX) is a disease modifying anti-rheumatic drug commonly used to treat children with Juvenile Idiopathic Arthritis (JIA). Unfortunately, half of children taking MTX will experience MTX intolerance, which includes distressing gastrointestinal and behavioural symptoms associated with weekly MTX treatment. This qualitative study aimed to explore the perceptions of school-age children with JIA experiencing MTX intolerance, how they managed MTX intolerance, and how it impacted their daily life. DESIGN AND METHODS An interpretive descriptive design was used. Twelve children participated in one individual 30-minute semi-structured interview using a storyboard technique to elicit their perceptions through storytelling. Interview transcripts and observational data collected during the interviews were analyzed using inductive content analysis. RESULTS Children described MTX intolerance as extremely challenging. Three themes emerged from the data: (1) "No kid likes taking MTX". This theme was comprised of two subthemes related to: (a) associative MTX intolerance; namely, "Talking about it sometimes makes me feel sick"; and (b) anticipatory MTX intolerance, "Before [I take it], I have a little stomach ache". Other themes included: (2) The importance of strategies and routines; and (3) Working hard to live with MTX intolerance. CONCLUSIONS This study sheds new light on MTX intolerance as perceived by school-aged children with JIA. Results highlight the importance of providing families and healthcare professionals with the necessary information for early recognition of MTX intolerance and optimizing care through the development of early intervention strategies. PRACTICE IMPLICATIONS Study findings highlight the importance of prioritizing early identification and prevention of MTX intolerance.
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Affiliation(s)
- Sarah Khan
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Jacqueline Mancini
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada.
| | - Charlene Hopper
- The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
| | - Janet E Rennick
- Ingram School of Nursing, Faculty of Medicine, McGill University, Montreal, Quebec, Canada; The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.
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Scott D, Scott C, Jelsma J, Abraham D, Verstraete J. Validity and feasibility of the self-report EQ-5D-Y as a generic Health-Related Quality of Life outcome measure in children and adolescents with Juvenile Idiopathic Arthritis in Western Cape, South Africa. S Afr J Physiother 2019; 75:1335. [PMID: 31392295 PMCID: PMC6676980 DOI: 10.4102/sajp.v75i1.1335] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 02/03/2019] [Accepted: 04/23/2019] [Indexed: 01/10/2023] Open
Abstract
Background Health-Related Quality of Life (HRQoL) data together with clinical findings allow for monitoring of intervention efficacy and the effect on HRQoL. Children with Juvenile Idiopathic Arthritis (JIA) experience symptoms often persisting into adulthood, emphasising the need to track HRQoL. Objectives The aim of this study was to investigate psychometric properties of the EuroQol five-dimensional youth questionnaire (EQ-5D-Y) in children with JIA. Methods A cross-sectional, analytical study design was used. Children 8 to 15 years were recruited, completing the self-report EQ-5D-Y and two other HRQoL questionnaires. Known group validity was established by comparing the effect size between children with different disease severities. Concurrent validity was tested using Kruskal–Wallis to compare the ranking of scores on different questionnaires. Feasibility was assessed by number of missing responses and time to complete each questionnaire. Results All questionnaires were able to distinguish between children with different JIA severity. There was a significant difference in ranking of most Juvenile Arthritis Multidimensional Assessment Report dimension scores across EQ-5D-Y levels, (p < 0.05), indicating concurrent validity. There was poor concurrent validity with the PedsQL dimensions tested with EQ-5D-Y, except for ‘pain’ (p = 0.001). The EQ-5D-Y was the quickest to complete with no missing values. Conclusion This study showed that the EQ-5D-Y is valid and feasible in measuring HRQoL in JIA children and adequately responsive to detect change over time. Clinical implications It is quick and easy to use in a busy clinical setting, allowing for effective JIA management monitoring.
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Affiliation(s)
- Desiree Scott
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christiaan Scott
- Department of Paediatrics, Paediatric Rheumatology, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
| | - Jennifer Jelsma
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Deepthi Abraham
- Department of Paediatrics and Child Health, Faculty of Health Sciences, Tygerberg Hospital, University of Stellenbosch, Cape Town, South Africa
| | - Janine Verstraete
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Dumaine C, Bekkar S, Belot A, Cabrera N, Malik S, von Scheven A, Carbasse A, Woerner A, Wouters C, Bouayed K, Pillet P, Schroeder S, Hofer M, Hentgen V. Infectious adverse events in children with Juvenile Idiopathic Arthritis treated with Biological Agents in a real-life setting: Data from the JIRcohorte. Joint Bone Spine 2020; 87:49-55. [PMID: 31369865 DOI: 10.1016/j.jbspin.2019.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/17/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The main objective of our study is to assess the infectious adverse events occurring in juvenile idiopathic arthritis (JIA) children treated with biological agents. METHODS Patients were selected from the retrospective module of the JIRcohorte, data concerning the period between January 2001 and August 2015. All infectious adverse events (IAE) were retrieved. For every infectious side effect, the date, the severity, the need for a hospitalization, the type of pathogen and the affected organ were noted. Incidence rates were expressed in number of events per 100 person-years (100p-y), and OR were calculated. RESULTS Six hundred seventy-seven patients with JIA were included in the study. A total of 3075.4 person-years of exposure were analyzed. One hundred eighty-four infectious events were described (6.0 events/100 p-y): 15.5/100 p-y with tocilizumab (TCZ), 9.6/100 p-y with Canakinumab (CAN), 7.4/100 p-y with abatacept (ABA), 6.9/100 p-y with Golimumab (GOL), 6.7/100 p-y with Anakinra (ANA), 6.3/100 p-y with Infliximab, 4.8/100 p-y with Etanercept, and 3.7/100 p-y with Adalimumab. Risk of developing an infection was significantly higher with IL-6 antagonists or IL-1 antagonists than with TNF-inhibitor. Forty point eight percent of the infectious adverse events (IAE) affected the upper respiratory tract or the Ear, nose and throat (ENT) system. Twelve infectious adverse events were described as severe or very severe (0.4/100p-y). No case of tuberculosis or death was reported. CONCLUSION Infectious complications with biologics occurring in children treated for JIA are rare, and in most of the cases have a mild or moderate severity, affecting mainly the upper respiratory tract or the ENT.
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Moghadam SH, Tavasoli AR, Modaresi M, Ziaee V. Farber disease: report of three cases with joint involvement mimicking juvenile idiopathic arthritis. J Musculoskelet Neuronal Interact 2019; 19:521-525. [PMID: 31789304 PMCID: PMC6944811] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Farber disease is a rare recessive autosomal disorder presented with three main features of joint involvement, subcutaneous nodules and hoarseness. Hereby we describe three new cases of Farber disease. All three cases were first misdiagnosed as juvenile idiopathic arthritis (JIA) due to the presentation of joint swelling. Addition of hoarseness and subcutaneous nodules to the initial joint swelling questioned the diagnosis of JIA and further evaluations led to the diagnosis of Farber disease. The first case was a 4-year old girl in whom a novel genetic mutation in ASAH1 gene was found. The second patient was a 4-year old girl presented with joint swelling at 7 month of age. The third patient was a 9-month boy complicated with severe respiratory distress. All patients were treated with symptomatic and supportive care. Two cases died due to respiratory ailure and infection, but one patient follow up for 2 years after diagnosis. Farber disease should be considered as differential diagnosis in children with early onset of poly articular involvement with subcutaneous nodules and/or hoarseness.
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Affiliation(s)
| | - Ali Reza Tavasoli
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran,Myelin Disorders Clinic, Children’s Medical Center, Pediatric Center of Excellence, Tehran, Iran
| | - Mohammadreza Modaresi
- Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran,Pediatric Pulmonnary Disease and Sleep Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Ziaee
- Children’s Medical Center, Pediatrics Center of Excellence, Tehran, Iran,Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran,Pediatric Rheumatology Research Group, Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding author: Vahid Ziaee, MD; Division of Pediatric Rheumatology, Children’s Medical Center, No. 62 Dr. Gharib St., Keshavarz Blvd, Tehran 14194, IR Iran E-mail:
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Gillispie M, Muscal E, Rama J, Falco C, Brown A. Pediatric Rheumatology Curriculum for the Pediatrics Resident: A Case-Based Approach to Learning. MedEdPORTAL 2018; 14:10767. [PMID: 30800967 PMCID: PMC6342410 DOI: 10.15766/mep_2374-8265.10767] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/16/2018] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Pediatric rheumatologic disease occurs more frequently than several other chronic pediatric diseases but is often underrecognized. It is estimated that in the US, one in 250 children has some form of juvenile arthritis and 300,000 children have a form of rheumatologic disease. However, there are only approximately 400 practicing pediatric rheumatologists nationwide. METHODS Kern's six-step method was used to develop a pediatric rheumatology curriculum based on respondents' perceived lack of training and comfort with four key areas: workup, musculoskeletal exam, laboratory interpretation, and referral to rheumatology. These cases were developed for second-year pediatric and second- and third-year internal medicine-pediatric residents rotating with the service. The curriculum was composed of four 30-minute case discussions as well as an observed musculoskeletal exam session. RESULTS In 2017, weekly case study sessions reached 34 trainees. Survey results from these trainees are representative of our overall results and reveal that learners felt the content of the cases helped increase comfort with compiling pertinent history and information of symptoms consistent with autoimmune disease, recognizing physical exam findings of autoimmune disease, ordering and interpreting laboratory studies in children with concerns for autoimmune disease, and referring to pediatric rheumatology. DISCUSSION This case-based curriculum exposed residents to presentations of the more common autoimmune diseases encountered in the pediatric population. The curriculum helps fill a gap in pediatric training through increased exposure to this subset of chronic diseases and expands physical examination skills not typically taught in general pediatrics.
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Affiliation(s)
- Miriah Gillispie
- Fellow, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
| | - Eyal Muscal
- Associate Professor, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
- Associate Professor, Department of Neurology, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
| | - Jennifer Rama
- Assistant Professor, Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine at Texas Children's Hospital
| | - Carla Falco
- Assistant Professor, Department of Pediatrics, Section of Hospital Medicine, Baylor College of Medicine at Texas Children's Hospital
| | - Amanda Brown
- Assistant Professor, Department of Pediatrics, Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine at Texas Children's Hospital
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Rashed AM, Abdel-Wahab N, Moussa EMM, Hammam N. Association of hand grip strength with disease activity, disability and quality of life in children and adolescents with Juvenile Idiopathic Arthritis. Adv Rheumatol 2018; 58:11. [PMID: 30657067 DOI: 10.1186/s42358-018-0012-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) affects wrist and hand joints leading to decrease hand function and patients' daily living activities. The assessment of hand grip strength (HGS) in children and adolescents with JIA is of major importance, and the association of HGS with JIA disease activity, disability and quality of life has not been explored. The primary objective of this study was to evaluate hand grip strength (HGS) in children and adolescents with Juvenile Idiopathic Arthritis (JIA) compared to matched healthy peers. The secondary objective was to explore the relationship between HGS and JIA disease activity, disability, and quality of life. METHODS This study involved 23 patients with JIA and 46 age and sex matched healthy controls. Hand held dynamometer was used to evaluate HGS for all study participants. Anthropometric parameters for all study participants were measured. Disease activity, physical function, and quality of life were assessed for the JIA group using juvenile arthritis disease activity score (JADAS-27), juvenile arthritis functionality scale (JAFS), and pediatric quality of life inventory (PedsQL) respectively. Laboratory marker of inflammation, erythrocyte sedimentation rate (ESR), and plain radiography of hands were performed for all patients. RESULTS Hand grip strength of children and adolescents with JIA was significantly weaker compared to matched controls (p < 0.001). Hand grip strength had a significant inverse correlation with JADAS-27 (r = - 0.467, p = 0.025), JAFS (r = - 0.650, p = 0.001) and a significant direct correlation with PedsQL (r = 0.438, p = 0.036). In addition, HGS was negatively correlated with ESR and duration of morning stiffness (r = - 0.489, p = 0.018 and r = - 0.201, p = 0.359, respectively). HGS was detected as an independent predictor of disease activity, disability, and quality of life in JIA patients in multivariate linear regression. CONCLUSIONS Assessment of HGS could be a simple non-invasive tool for assessing disease activity, disability and quality of life in JIA patients in clinical practice.
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Affiliation(s)
- Ahmed Mohammed Rashed
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Noha Abdel-Wahab
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt.,Section of Rheumatology and Clinical Immunology, Department of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ehab M M Moussa
- Department of Radiology, Assiut University Hospitals, Assiut, Egypt
| | - Nevin Hammam
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Assiut University, Assiut, Egypt. .,Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Corbett Hall, 8205 114 Street, Edmonton, AB, T6G2G4, Canada.
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Ramanan AV, Dick AD, Jones AP, Guly C, Hardwick B, Hickey H, Lee R, McKay A, Beresford MW. A phase II trial protocol of Tocilizumab in anti-TNF refractory patients with JIA-associated uveitis (the APTITUDE trial). BMC Rheumatol 2018; 2:4. [PMID: 30886955 PMCID: PMC6390576 DOI: 10.1186/s41927-018-0010-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/17/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children. Children with JIA are at risk of intraocular inflammation (uveitis). In the initial stages of mild-moderate inflammation uveitis is asymptomatic. Most children with mild-moderate uveitis are managed on topical steroid drops with or without systemic methotrexate (MTX). When children with moderate-severe uveitis are refractory to MTX, monoclonal anti-tumour necrosis factor agents have been trialled, interim analysis data showed positive results. However, several children with severe recalcitrant disease or non-responsive to anti-tumour necrosis factor agents remain and are at greater risk of significant ocular complications and visual loss. Further evidence of alternative therapies is needed with evidence of a potential role of anti-interleukin-6 agents in the management of severe refractory uveitis. METHODS The trial will be conducted following a two-stage Simon design. The trial will register at least 22 patients aged 2 to 18 years with active JIA-associated uveitis, who have taken MTX for at least 12 weeks and have failed an anti-TNF agent. It will take place in 7 centres across the UK. All participants will be treated for 6 months, with follow up of 9 months from registration. Participants will receive a stable dose of MTX and those weighing ≥30 kg will be dosed with 162 mg of Tocilizumab every 2 weeks and participants weighing < 30 kg dosed with 162 mg of Tocilizumab every 3 weeks. Primary outcome is treatment response at 12 weeks. Adverse events will be collected up to 30 calendar days following treatment cessation. DISCUSSION This is a novel adaptive design study of subcutaneous IL-6 inhibition in anti-TNF refractory JIA associated uveitis which will be able to determine if further research should be conducted. This is the first trial to look at ophthalmology outcomes in the efficacy of Tocilizumab in uveitis.This is the first paediatric clinical trial to assess the clinical effectiveness and safety of tocilizumab with MTX in JIA associated uveitis. TRIALS REGISTRATION The Trial is registered on the ISRCTN registry (ISRCTN95363507) on the 10/06/2015 and EU Clinical Trials Register on the 03/07/2015 (EudraCT Number: 2015-001323-23).
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Affiliation(s)
- Athimalaipet V. Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew D. Dick
- Bristol Eye Hospital, Bristol, UK
- School of Clinical Sciences, University of Bristol, UCL Institute of Ophthalmology and National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, Bristol, London UK
| | - Ashley P. Jones
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | | | - Ben Hardwick
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Helen Hickey
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Richard Lee
- Bristol Eye Hospital, Bristol, UK
- School of Clinical Sciences, University of Bristol, UCL Institute of Ophthalmology and National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, Bristol, London UK
| | - Andrew McKay
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Michael W. Beresford
- Department of Women’s and Children’s, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - The APTITUDE Trial Management Group
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Eye Hospital, Bristol, UK
- School of Clinical Sciences, University of Bristol, UCL Institute of Ophthalmology and National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, Bristol, London UK
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
- Department of Women’s and Children’s, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
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Beukelman T, Xie F, Chen L, Horton DB, Lewis JD, Mamtani R, Mannion MM, Saag KG, Curtis JR. Risk of malignancy associated with paediatric use of tumour necrosis factor inhibitors. Ann Rheum Dis 2018; 77:1012-1016. [PMID: 29440001 DOI: 10.1136/annrheumdis-2017-212613] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 01/28/2018] [Accepted: 01/30/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine whether tumour necrosis factor inhibitor (TNFi) use is associated with an increased rate of incident malignancy compared with no TNFi use in the treatment of juvenile idiopathic arthritis (JIA), paediatric inflammatory bowel disease (pIBD) and paediatric plaque psoriasis (pPsO). METHODS We performed a retrospective cohort study of administrative claims data from the USA from 2000 to 2014. Exposure to TNFi was considered permanent from the first observed exposure onward. The malignancy outcome was defined by diagnosis codes with evidence of cancer treatment. We calculated standardised incidence ratios (SIRs) comparing the observed number of malignancies to the expected numbers according to cancer surveillance data. We used multivariable Cox proportional hazards models to estimate adjusted HRs (aHRs) for incident malignancy. RESULTS We identified 15 598 children with TNFi use and 73 839 children with no TNFi use (30 703 and 121 801 person-years of follow-up, respectively). We identified 15 malignancies among children with TNFi use (SIR 2.9 (1.6 to 4.9)) and 42 malignancies among children without TNFi use (SIR 2.1 (1.5 to 2.9)). The aHR was 1.58 (0.88 to 2.85) for TNFi use versus no TNFi use. In pIBD, TNFi use with thiopurine use was associated with a higher SIR (6.0 (1.2 to 17.5)) compared with TNFi use without thiopurine use (2.5 (0.7 to 6.4)). CONCLUSION Children diagnosed with JIA, pIBD and pPsO had an increased rate of malignancy compared with the general population, but treatment with TNFi did not appear to significantly further increase the risk compared with no TNFi use. More data are needed about the long-term risks of TNFi use.
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Affiliation(s)
- Timothy Beukelman
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Fenglong Xie
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lang Chen
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daniel B Horton
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - James D Lewis
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ronac Mamtani
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Melissa M Mannion
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kenneth G Saag
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jeffrey R Curtis
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rose-Davis B, Stringer E, Abidi S, Abidi SSR. Interactive Dialogue-Based Patient Education for Juvenile Idiopathic Arthritis Using Argument Theory. Stud Health Technol Inform 2018; 247:546-550. [PMID: 29678020] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Families of children with Juvenile Idiopathic Arthritis need a way to interact with Patient Education Materials (PEM) so that learning occurs at their own pace, on topics that are relevant to them. This paper proposes a novel, dialogue-based approach to address these needs. Using an extended version of Toulmin's model of argument as a theory-based classification method, we digitized paper-based PEM to render an interactive dialogue. The dialogue allows the user to explore a topic with respect to their interests and apprehensions as opposed to providing a static, generic document.
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Affiliation(s)
- Benjamin Rose-Davis
- NICHE Research Group, Faculty of Computer Science, Dalhousie University, Canada
| | | | - Samina Abidi
- NICHE Research Group, Faculty of Computer Science, Dalhousie University, Canada
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Quartier P, Baptiste A, Despert V, Allain-Launay E, Koné-Paut I, Belot A, Kodjikian L, Monnet D, Weber M, Elie C, Bodaghi B. ADJUVITE: a double-blind, randomised, placebo-controlled trial of adalimumab in early onset, chronic, juvenile idiopathic arthritis-associated anterior uveitis. Ann Rheum Dis 2017; 77:1003-1011. [PMID: 29275333 DOI: 10.1136/annrheumdis-2017-212089] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 11/24/2017] [Accepted: 11/29/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To assess the efficacy and safety of adalimumab on uveitis in patients with early onset, chronic, juvenile idiopathic arthritis (JIA)-associated or idiopathic anterior uveitis and an inadequate response to topical steroids and methotrexate (MTX). METHODS Patients aged 4 years or more with ocular inflammation quantified by laser flare photometry (LFP) ≥30 photon units/ms were double-blindly randomised (1:1) to 2 groups, one treated with placebo and one with adalimumab subcutaneously at a dose of 24 mg/m2 in patients aged <13 years, 40 mg in the others, every other week. The primary outcome was response at month 2 (M2) defined as a 30% reduction of inflammation on LFP in the assessable eye with more severe baseline inflammation and no worsening on slit lamp examination. From M2 to M12, all patients received adalimumab. RESULTS At M2, among 31 patients included in intention-to-treat analysis, there were 9/16 responders on adalimumab and 3/15 on placebo (P=0.038, Χ2 test; relative risk=2.81, 95% CI 0.94 to 8.45; risk difference: 36.3%, 95% CI 2.1 to 60.6); there was no significant difference using the Standardised Uveitis Nomenclature classification criteria of improvement. Thirty patients continued the trial after M2 and received adalimumab (open-label phase), 29 reached M12. There were seven serious adverse events none related to study treatment. CONCLUSIONS This trial is in favour of using adalimumab in patients with early onset, chronic anterior uveitis, which is in most cases associated with JIA, in case of inadequate response to topical therapy and MTX. LFP could be a valuable tool to assess early treatment efficacy. TRIAL REGISTRATION NUMBER NCT01385826.
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Affiliation(s)
- Pierre Quartier
- Pediatric Immunology-Hematology and Rheumatology Unit, Necker-Enfants Malades University Hospital, Assistance Publique-Hopitaux de Paris, Paris, France.,Imagine Institute, Paris, France.,Paris Descartes University, Paris, France.,Pediatric Rheumatology and Systemic Auto-immune Diseases, RAISE National Reference Centre, Rennes, France
| | - Amandine Baptiste
- Clinical Research Unit/CIC Paris Descartes, Necker-Enfants Malades-Cochin University Hospital, Paris, France
| | | | | | - Isabelle Koné-Paut
- Pediatric Rheumatology Department, Kremlin-Bicêtre, Assistance Publique-Hopitaux de Paris, University of Paris-Sud, Orsay, France
| | - Alexandre Belot
- Pediatric Rheumatology and Systemic Auto-immune Diseases, RAISE National Reference Centre, Rennes, France.,Pediatric Nephrology, Rheumatology, Dermatology, University of Lyon, INSERM U1111, Lyon, France
| | | | - Dominique Monnet
- Paris Descartes University, Paris, France.,UMR-CNRS 52, University Hospital Cochin, Assistance Publique-Hopitaux de Paris, Nantes, France
| | - Michel Weber
- Department of Ophthalmology, University Hospital Hotel Dieu, Nantes, France
| | - Caroline Elie
- Clinical Research Unit/CIC Paris Descartes, Necker-Enfants Malades-Cochin University Hospital, Paris, France
| | - Bahram Bodaghi
- Department of Ophthalmology, University Hospital Pitie-Salpetriere, Paris, France
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Stefanska AM, Distlerová D, Musaus J, Olski TM, Dunder K, Salmonson T, Mentzer D, Müller-Berghaus J, Hemmings R, Veselý R. Extrapolation in the development of paediatric medicines: examples from approvals for biological treatments for paediatric chronic immune-mediated inflammatory diseases. Arch Dis Child 2017; 102:952-957. [PMID: 28554892 DOI: 10.1136/archdischild-2016-312259] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 04/18/2017] [Accepted: 04/23/2017] [Indexed: 11/04/2022]
Abstract
The European Union (EU) Paediatric Regulation requires that all new medicinal products applying for a marketing authorisation (MA) in the EU provide a paediatric investigation plan (PIP) covering a clinical and non-clinical trial programme relating to the use in the paediatric population, unless a waiver applies. Conducting trials in children is challenging on many levels, including ethical and practical issues, which may affect the availability of the clinical evidence. In scientifically justified cases, extrapolation of data from other populations can be an option to gather evidence supporting the benefit-risk assessment of the medicinal product for paediatric use. The European Medicines Agency (EMA) is working on providing a framework for extrapolation that is scientifically valid, reliable and adequate to support MA of medicines for children. It is expected that the extrapolation framework together with therapeutic area guidelines and individual case studies will support future PIPs. Extrapolation has already been employed in several paediatric development programmes including biological treatment for immune-mediated diseases. This article reviews extrapolation strategies from MA applications for products for the treatment of juvenile idiopathic arthritis, paediatric psoriasis and paediatric inflammatory bowel disease. It also provides a summary of extrapolation advice expressed in relevant EMA guidelines and initiatives supporting the use of alternative approaches in paediatric medicine development.
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Affiliation(s)
| | | | | | | | - Kristina Dunder
- European Medicines Agency, London, UK.,Läkemedelsverket, Medical Products Agency, Uppsala, Sweden
| | - Tomas Salmonson
- European Medicines Agency, London, UK.,Läkemedelsverket, Medical Products Agency, Uppsala, Sweden
| | - Dirk Mentzer
- European Medicines Agency, London, UK.,Paul-Ehrlich Institut, Langen, Germany
| | - Jan Müller-Berghaus
- European Medicines Agency, London, UK.,Paul-Ehrlich Institut, Langen, Germany
| | - Robert Hemmings
- European Medicines Agency, London, UK.,Medicines and Healthcare Products Regulatory Agency, London, UK
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Kobus A, Kierklo A, Zalewska A, Kuźmiuk A, Szajda SD, Ławicki S, Bagińska J. Unstimulated salivary flow, pH, proteins and oral health in patients with Juvenile Idiopathic Arthritis. BMC Oral Health 2017; 17:94. [PMID: 28577525 PMCID: PMC5457734 DOI: 10.1186/s12903-017-0386-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 05/25/2017] [Indexed: 02/07/2023] Open
Abstract
Background There have been inconsistent conclusions regarding salivary abnormalities and their effect on oral health of Juvenile Idiopathic Arthritis (JIA) patients. The purpose of the study was to evaluate the flow rate and selected biochemical parameters of unstimulated whole saliva in correlation to oral health in JIA children. Methods Thirty-four JIA patients and 34 age- and sex-matched controls not affected by JIA (C) were divided into two groups: with mixed and permanent dentition. DMFT/dmft, gingival and simplified oral hygiene indices were evaluated. Salivary flow rate, pH, lysozyme, lactoferrin, salivary protein concentrations and peroxidase activity were assessed. Results The salivary flow rate was significantly lower in the total JIA group (0.41 ml/min) as compared with the C (0.51 ml/min) and in the permanent dentition of JIA children (0.43 ml/min) as compared with the C (0.61 ml/min). A significantly lower pH was observed in total (6.74), mixed (6.7) and permanent (6.76) dentition of JIA groups in comparison to the C (7.25, 7.21, 7.28 respectively). The specific activity of peroxidase was significantly higher in JIA patients (total 112.72 IU/l, mixed dentition 112.98 IU/l, permanent dentition 112.5 IU/l) than in the C group (total 70.03 IU/l, mixed dentition 71.83 IU/l, permanent dentition 68.61 IU/l). The lysozyme concentration in JIA patients (total and permanent dentition groups) was significantly higher than in the C group. There were no significant differences in lactoferrin and salivary protein concentrations. There were no statistically significant differences in oral status between JIA patients and C, respectively: DMFT = 5.71, dmft = 3.73, OHI-S = 0.95, GI = 0.25 and DMFT 5.71, dmft = 3.73, OHI-S = 0.85, GI = 0.24. The specific activity of peroxidase in the unstimulated whole saliva was inversely correlated with the GI index, whereas the salivary lysozyme concentration was inversely correlated with the dmft index in JIA patients. Conclusion In the course of JIA occur a reduction of the resting salivary flow rate and a decrease of saliva pH. In spite of this, no differences in the clinical oral status between the JIA children population and the control group were found. The mobilisation of salivary peroxidase and lysozyme contributes to the maintenance of healthy oral tissues.
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Affiliation(s)
- Agnieszka Kobus
- Department of Dentistry Propaedeutics, Medical University of Bialystok, ul. Waszyngtona 15A, 15-274, Bialystok, Poland.
| | - Anna Kierklo
- Department of Dentistry Propaedeutics, Medical University of Bialystok, ul. Waszyngtona 15A, 15-274, Bialystok, Poland
| | - Anna Zalewska
- Department of Conservative Dentistry, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24A, 15-274, Bialystok, Poland
| | - Anna Kuźmiuk
- Department of Pediatric Dentistry, Medical University of Bialystok, ul. Waszyngtona 15A, 15-274, Bialystok, Poland
| | - Sławomir Dariusz Szajda
- Department of Psychiatry, Medical University of Bialystok, Plac Brodowicza 1, 16-070, Choroszcz, Poland
| | - Sławomir Ławicki
- Department of Biochemical Diagnostics, Medical University of Bialystok, ul. M. Sklodowskiej-Curie 24A, 15-274, Bialystok, Poland
| | - Joanna Bagińska
- Department of Dentistry Propaedeutics, Medical University of Bialystok, ul. Waszyngtona 15A, 15-274, Bialystok, Poland
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