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Vassis S, Sabljic S, Noeldeke B, Sefidroodi M, Küseler A, Klit Pedersen T, Stoustrup P. Effects of orthopedic treatment (distraction splint) on dentofacial deformities in patients with juvenile idiopathic arthritis. Eur J Orthod 2024; 46:cjae005. [PMID: 38376495 DOI: 10.1093/ejo/cjae005] [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] [Indexed: 02/21/2024]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) frequently affects the temporomandibular joint (TMJ), which can alter mandibular growth and development and result in dentofacial deformities. OBJECTIVE To assess the outcomes of orthopedic treatment with distraction splint (DS) in patients with JIA-related dentofacial deformity. METHODS The retrospective study involved 30 patients with JIA and unilateral TMJ involvement, another study group of 20 patients with JIA and bilateral TMJ involvement, and a control group of 18 non-JIA orthodontic patients with Class II and III malocclusions. The inclusion criteria were DS treatment and cone-beam computed tomography (CBCT) scans before (T0) and 2 years after treatment (T1). Dentofacial morphology and deformity were evaluated based on a validated three-dimensional CBCT-based morphometric analysis. Intergroup differences in outcome measures were compared at T0 and T1, and intragroup changes between T0 and T1 were assessed using the Kruskal-Wallis test. RESULTS Initial evaluations at T0 revealed significant differences between the unilateral and bilateral JIA groups and the control group for three out of eight dentofacial deformity variables: inter-side difference in total posterior mandibular height, mandibular axial angle, and posterior/anterior face height (ratio). At follow-up (T1), significant inter-group differences were only observed in total posterior mandibular height indicating that intergroup differences were less pronounced after splint treatment. Assessing inter-group changes between T0 and T1 showed that all parameters remained constant except posterior/anterior face height ratio, which significantly decreased between T0 and T1. CONCLUSIONS The findings demonstrate the potential of DS treatment for patients with JIA and unilateral or bilateral TMJ involvement to generally support normal dentofacial growth or at least limit further deterioration of dentofacial deformities.
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Affiliation(s)
- Stratos Vassis
- Section of Orthodontics, Aarhus University, Vennelyst Blvd 9, 8000 Aarhus, Denmark
| | - Sanja Sabljic
- Section of Orthodontics, Aarhus University, Vennelyst Blvd 9, 8000 Aarhus, Denmark
| | - Beatrice Noeldeke
- Department of Economics, Leibniz University Hannover, Am Königsworther Platz 1, 30167 Hannover, Germany
| | | | - Annelise Küseler
- Section of Orthodontics, Aarhus University, Vennelyst Blvd 9, 8000 Aarhus, Denmark
| | - Thomas Klit Pedersen
- Section of Orthodontics, Aarhus University, Vennelyst Blvd 9, 8000 Aarhus, Denmark
| | - Peter Stoustrup
- Section of Orthodontics, Aarhus University, Vennelyst Blvd 9, 8000 Aarhus, Denmark
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Hu X, Ren J, Wang P, Chen W, Shen W, Li Y, Xiao T, Dai Y, Sang Y. Adherence to exercise therapy among children and adolescents with Juvenile idiopathic arthritis: a scoping review. Disabil Rehabil 2024; 46:1502-1514. [PMID: 37125688 DOI: 10.1080/09638288.2023.2200261] [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: 08/06/2022] [Accepted: 04/02/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE To identify parameters and measurement methods of exercise therapy adherence, as well as barriers and facilitators affecting adherence among children and adolescents with juvenile idiopathic arthritis (JIA). METHODS Studies were eligible for inclusion if patients were 0-18 years of age, had JIA, and the focus of the research was on exercise therapy patterns, measurement/parameters of exercise adherence, and barriers/facilitators for exercise adherence. Two reviewers independently identified and categorized the barriers and facilitators to exercise therapy adherence using the International Classification of Functioning, Disability, and Health (ICF). RESULTS Twenty articles were included in this review. Among patients with JIA, 29%-99% adhered to exercise therapy. The most commonly measured parameters of adherence were session completion and behavior component, with a self-report log serving as the most common means of assessment. Time pressure, symptoms related to JIA, lack of enjoyment, and insufficient motivation were the main barriers. Facilitators were commonly identified as adequate motivation, effective symptoms management, and social support. CONCLUSIONS Future interventions should consider the identified factors to promote exercise engagement in children and adolescents with JIA. Strategies for promoting exercise adherence in children and adolescents with JIA is needed.
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Affiliation(s)
- Xinmiao Hu
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jing Ren
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ping Wang
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wenjian Chen
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Shen
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Li
- Department of Critical Care Medicine, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tiantian Xiao
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Dai
- Department of Nephrology and Rheumatology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yan Sang
- Department of Nursing, Department of Computer Technology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Huang HYR, Wireko AA, Miteu GD, Khan A, Roy S, Ferreira T, Garg T, Aji N, Haroon F, Zakariya F, Alshareefy Y, Pujari AG, Madani D, Papadakis M. Advancements and progress in juvenile idiopathic arthritis: A Review of pathophysiology and treatment. Medicine (Baltimore) 2024; 103:e37567. [PMID: 38552102 PMCID: PMC10977530 DOI: 10.1097/md.0000000000037567] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a chronic clinical condition characterized by arthritic features in children under the age of 16, with at least 6 weeks of active symptoms. The etiology of JIA remains unknown, and it is associated with prolonged synovial inflammation and structural joint damage influenced by environmental and genetic factors. This review aims to enhance the understanding of JIA by comprehensively analyzing relevant literature. The focus lies on current diagnostic and therapeutic approaches and investigations into the pathoaetiologies using diverse research modalities, including in vivo animal models and large-scale genome-wide studies. We aim to elucidate the multifactorial nature of JIA with a strong focus towards genetic predilection, while proposing potential strategies to improve therapeutic outcomes and enhance diagnostic risk stratification in light of recent advancements. This review underscores the need for further research due to the idiopathic nature of JIA, its heterogeneous phenotype, and the challenges associated with biomarkers and diagnostic criteria. Ultimately, this contribution seeks to advance the knowledge and promote effective management strategies in JIA.
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Affiliation(s)
- Helen Ye Rim Huang
- Faculty of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Goshen David Miteu
- School of Biosciences, Biotechnology, University of Nottingham, Nottingham, UK
- Department of Biochemistry, Caleb University Lagos, Lagos, Nigeria
| | - Adan Khan
- Kent and Medway Medical School, Canterbury, Kent, UK
| | - Sakshi Roy
- School of Medicine, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Tomas Ferreira
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Tulika Garg
- Government Medical College and Hospital Chandigarh, Chandigarh, India
| | - Narjiss Aji
- Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco
| | - Faaraea Haroon
- Faculty of Public Health, Health Services Academy, Islamabad, Pakistan
| | - Farida Zakariya
- Faculty of Pharmaceutical Sciences, Ahmadu Bello University Zaria, Zaria, Nigeria
| | - Yasir Alshareefy
- School of Medicine, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Anushka Gurunath Pujari
- Faculty of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, Ontario, Canada
| | - Djabir Madani
- UCD Lochlann Quinn School of Business and Sutherland School of Law, University College Dublin, Dublin, Ireland
| | - Marios Papadakis
- Department of Surgery II, University Hospital Witten-Herdecke, University of Witten-Herdecke, Wuppertal, Germany
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Liu WY, Li HM, Jiang H, Zhang WK. Effect of exercise training on heath, quality of life, exercise capacity in juvenile idiopathic arthritis: a meta-analysis of randomized controlled trials. Pediatr Rheumatol Online J 2024; 22:33. [PMID: 38438855 PMCID: PMC10910763 DOI: 10.1186/s12969-024-00967-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/21/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE Little is known about the efficacy and safety of exercise training on juvenile idiopathic arthritis (JIA). This study aims to investigate the effect of exercise on health, quality of life, and different exercise capacities in individuals with JIA. METHOD A comprehensive search of Medline, Embase, Web of Science, and the Cochrane Library was conducted from database inception to October, 2023. Included studies were randomized controlled trials (RCTs) reporting the effects of exercise on JIA patients. Two independent reviewers assessed the literature quality using the Cochrane Collaboration's risk of bias tool. Standardized mean differences (SMD) were combined using random or fixed effects models. The level of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULT Five RCTs met the inclusion criteria, containing 216 female participants and 90 males. The meta-analysis results showed that exercise had no significant effect on JIA patients based on the Child Health Assessment Questionnaire (CHAQ) (SMD=-0.32, 95%CI: -0.83, 0.19; I2 = 73.2%, P = 0.011) and Quality of Life (QoL) (SMD = 0.27, 95%CI: -0.04, 0.58; I2 = 29.4%, P = 0.243) and no significant effect on peak oxygen uptake (VO2peak). However, exercise significantly reduced visual analog scale (VAS) pain scores in JIA patients (SMD = 0.50, 95%CI: -0.90, -0.10; I2 = 50.2%, P = 0.134). The quality of evidence assessed by GRADE was moderate to very low. CONCLUSION Exercise does not significantly affect the quality of life and exercise capacity in JIA patients but may relieve pain. More RCTs are needed in the future to explore the effects of exercise on JIA.
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Affiliation(s)
- Wen-Yu Liu
- Weifang Institute of Technology, Weifang, Shandong, China
- Dongshin University, Rojo, South Jeolla, South Korea
| | - Hui-Min Li
- Yantai Gold College, Yantai, Shandong, China
| | - Hao Jiang
- Weifang Institute of Technology, Weifang, Shandong, China
| | - Wen-Kui Zhang
- Dongshin University, Rojo, South Jeolla, South Korea.
- Universiti Malaysia Sarawak, East Malaysian Borneo, Sarawak, Malaysia.
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Wood S, Branch J, Vasquez P, DeGuzman MM, Brown A, Sagcal-Gironella AC, Singla S, Ramirez A, Vogel TP. Th17/1 and ex-Th17 cells are detected in patients with polyarticular juvenile arthritis and increase following treatment. Pediatr Rheumatol Online J 2024; 22:32. [PMID: 38431635 PMCID: PMC10908086 DOI: 10.1186/s12969-024-00965-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/11/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND A better understanding of the pathogenesis of polyarticular juvenile idiopathic arthritis (polyJIA) is needed to aide in the development of data-driven approaches to guide selection between therapeutic options. One inflammatory pathway of interest is JAK-STAT signaling. STAT3 is a transcription factor critical to the differentiation of inflammatory T helper 17 cells (Th17s). Previous studies have demonstrated increased STAT3 activation in adult patients with rheumatoid arthritis, but less is known about STAT3 activation in polyJIA. We hypothesized that Th17 cells and STAT3 activation would be increased in treatment-naïve polyJIA patients compared to pediatric controls. METHODS Blood from 17 patients with polyJIA was collected at initial diagnosis and again if remission was achieved (post-treatment). Pediatric healthy controls were also collected. Peripheral blood mononuclear cells were isolated and CD4 + T cell subsets and STAT activation (phosphorylation) were evaluated using flow cytometry. Data were analyzed using Mann-Whitney U and Wilcoxon matched-pairs signed rank tests. RESULTS Treatment-naïve polyJIA patients had increased Th17 cells (CD3 + CD4 + interleukin(IL)-17 +) compared to controls (0.15% v 0.44%, p < 0.05), but Tregs (CD3 + CD4 + CD25 + FOXP3 +) from patients did not differ from controls. Changes in STAT3 phosphorylation in CD4 + T cells following ex vivo stimulation were not significantly different in patients compared to controls. We identified dual IL-17 + and interferon (IFN)γ + expressing CD4 + T cells in patients, but not controls. Further, both Th17/1 s (CCR6 + CD161 + IFNγ + IL-17 +) and ex-Th17s (CCR6 + CD161 + IFNγ + IL-17neg) were increased in patients' post-treatment (Th17/1: 0.3% v 0.07%, p < 0.05 and ex-Th17s: 2.3% v 1.4%, p < 0.05). The patients with the highest IL-17 expressing cells post-treatment remained therapy-bound. CONCLUSIONS Patients with polyJIA have increased baseline Th17 cells, potentially reflecting higher tonic STAT3 activation in vivo. These quantifiable immune markers may identify patients that would benefit upfront from pathway-focused biologic therapies. Our data also suggest that inflammatory CD4 + T cell subsets not detected in controls but increased in post-treatment samples should be further evaluated as a tool to stratify patients in remission on medication. Future work will explore these proposed diagnostic and prognostic biomarkers.
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Affiliation(s)
- Stephanie Wood
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
- Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
| | - Justin Branch
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
- Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
| | - Priscilla Vasquez
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
| | - Marietta M DeGuzman
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
| | - Amanda Brown
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
| | - Anna Carmela Sagcal-Gironella
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
| | - Saimun Singla
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
| | - Andrea Ramirez
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA
| | - Tiphanie P Vogel
- Division of Rheumatology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA.
- Center for Human Immunobiology, Texas Children's Hospital, 1102 Bates Street Suite 330, Houston, TX, 77030, USA.
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Sarac DC, Bayraktar D, Ozer Kaya D, Altug Gucenmez O, Oskay D. The effects of inspiratory muscle training on cardiorespiratory functions in juvenile idiopathic arthritis: A randomized controlled trial. Pediatr Pulmonol 2024; 59:562-573. [PMID: 38038160 DOI: 10.1002/ppul.26783] [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: 07/26/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Although inspiratory muscle training (IMT) has proven effective in adult rheumatic diseases, its impact on juvenile idiopathic arthritis (JIA) remains unexplored. The present study aimed to investigate the effects of IMT in children with JIA. METHODS Thirty-three children (13-18 years) with JIA were divided into two groups as exercise (n = 17) and control (n = 16). The exercise group performed IMT at home daily for 8 weeks. The initial IMT load was set as 60% of maximal inspiratory pressure (PImax ) and increased by %10 of the initial load every 2 weeks. The control group received no additional intervention. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1 ), FVC/FEV1 , PImax , and maximal expiratory pressure (PEmax ) were evaluated. Peak oxygen consumption (VO2max ), metabolic equivalents (METs), and maximal heart rate were measured with cardiopulmonary exercise test. Functional capacity and quality of life were assessed with 6-min walk distance and Pediatric Quality of Life Inventory 3.0 Arthritis Module. All participants were evaluated at baseline and post-treatment. RESULTS FVC ( ↑ 0.20 (95% CI: 0.07/0.32) liters), FEV1 ( ↑ 0.14 (95% CI: 0.02/0.25) liters), PImax (↑19.11 (95% CI: 9.52/28.71) cmH2 O), PEmax (↑12.41 (95% CI: 3.09/21.72) cmH2 O), VO2peak (↑158.29 (95% CI: 63.85/252.73) ml/min), and METs (↑0.92 (95% CI: 0.34/1.49) [ml/kg/min]) significantly improved only in the exercise group (p < .05). The difference over time in FVC, FEV1 , PImax , VO2peak , and METs were significantly higher in exercise group compared to control group (p < .05). CONCLUSIONS IMT seems to be an effective option for improving respiratory functions and aerobic exercise capacity in JIA.
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Affiliation(s)
- Devrim Can Sarac
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Deniz Bayraktar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Derya Ozer Kaya
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Izmir Katip Celebi University, Izmir, Turkiye
| | - Ozge Altug Gucenmez
- Clinic of Pediatric Rheumatology, University of Health Sciences Dr. Behcet Uz Pediatric Diseases and Surgery Training and Research Hospital, Izmir, Turkiye
| | - Deran Oskay
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkiye
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Şahin N, Sönmez HE, Aktay Ayaz N, Sözeri B. Addressing the unmet needs of transitional care in juvenile idiopathic arthritis. Rheumatology (Oxford) 2024; 63:619-629. [PMID: 37774006 PMCID: PMC10907819 DOI: 10.1093/rheumatology/kead518] [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: 05/23/2023] [Revised: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVES We aimed to comprehensively analyse the available literature to identify the unmet requirements in transitional programs tailored specifically for patients diagnosed with JIA. METHODS According to published guidance on narrative reviews, a systematic review of the literature on transitional care in rheumatology was conducted. Pertinent documents were collected from reputable databases, such as Web of Science, Scopus, and MEDLINE/PubMed. The search encompassed literature published from the inception of each database until January 2023. RESULTS In this study, a comprehensive analysis of the findings of 34 studies was conducted. Among these, 12 studies focused on assessing the readiness of adolescents and young adults diagnosed with JIA. Additionally, 18 studies examined the effectiveness of structured transition programs in terms of adherence and satisfaction. Finally, 4 studies investigated disease-related outcomes in this population. CONCLUSION The need for transitioning children with rheumatic diseases to adult rheumatology services for continued care is clearly evident. However, the absence of established best practice guidelines presents a challenge in facilitating this transition effectively. Although several scoring systems have been proposed to ensure organized and seamless transfers, a consensus has not yet been reached. Furthermore, the socio-economic and cultural variations across countries further complicate the development of universal guidelines for transitioning children with rheumatic diseases. To address these concerns, our objective in conducting this literature review was to emphasize the significance of this issue and identify the specific requirements based on the unmet needs in the transition process.
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Affiliation(s)
- Nihal Şahin
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Ümraniye Research and Training Hospital, Istanbul, Turkey
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Kisa EP, Tarakcı E, Leblebici G, Ozdincler AR, Kasapcopur O. Exercise programs for scoliosis in juvenile idiopathic arthritis: a randomized-controlled study. Rheumatol Int 2024; 44:441-449. [PMID: 37668835 DOI: 10.1007/s00296-023-05439-7] [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: 07/07/2023] [Accepted: 08/17/2023] [Indexed: 09/06/2023]
Abstract
By improving core strength and stability, children with JIA can experience increased endurance, reduced pain, and improved posture. No study was found that investigated the effectiveness of 3-Dimension (3D) exercises in JIA. This study aimed to compare the effectiveness of structured 3D exercises with that of a conventional exercise program specially planned for children with JIA who have scoliosis. This was a prospective, randomized-controlled study. Structured 3D scoliosis exercises for Group 1 (n: 25) and conventional exercises for the Group 2 (n: 25) were applied for 24 weeks. The angle of trunk rotation (ATR) by scoliometer, scoliosis angle by Cobb angle, pain by a numerical rating scale (NRS), respiratory functions by spirometry, and perception of cosmetic deformity by The Walter Reed visual assessment scale (WRVAS) were evaluated. ATR, Cobb angle, and pain in Group I showed significant improvement compared to Group II. While the sub-parameters of WRVAS and increased significantly in both groups, the improvement in Group I was found to be greater between the groups. While FVC (%) and FEV1 (%) results within the group were significant in both groups. 3D exercises and conventional exercises are an effective and feasible method in the treatment of scoliosis in these children. Despite the curative effect of both methods, 3D exercises have been proven in this study to be more effective on Cobb angle, ATR, WRAS, and respiratory parameters.
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Affiliation(s)
- Eylul Pinar Kisa
- Division of Physiotherapy and Rehabilitation, Biruni University, Faculty of Health Science, Istanbul, Turkey.
| | - Ela Tarakcı
- Division of Physiotherapy and Rehabilitation, Istanbul University-Cerrahpaşa, Faculty of Health Science, Istanbul, Turkey
| | - Gokce Leblebici
- Division of Physiotherapy and Rehabilitation, Istanbul Medeniyet University, Faculty of Health Science, Istanbul, Turkey
| | - Arzu Razak Ozdincler
- Division of Physiotherapy and Rehabilitation, Biruni University, Faculty of Health Science, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, Istanbul, Turkey
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Zhang M, Li J, Su Y, Guo G, Chen N. Effects of a home-based exercise combined yoga and resistance training in enthesitis-related arthritis in China: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e078549. [PMID: 38382959 PMCID: PMC10882405 DOI: 10.1136/bmjopen-2023-078549] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Enthesitis-related arthritis (ERA) is a category of juvenile idiopathic arthritis (JIA). The complications of JIA include pain, muscle weakness, limited movement and worsening quality of life. Yoga is an effective exercise therapy for rheumatoid arthritis and may have similar benefits for JIA. Considering the limitation of yoga for strengthening muscles, combined yoga and resistance training (CYRT) may compensate for the shortcomings and provide more benefits for JIA patients. Despite this, there is currently a lack of studies investigating the effectiveness of CYRT for JIA patients. Due to the inaccessibility of traditional exercise therapy, home-based exercise is needed. The study aims to assess the effectiveness of home-based CYRT on JIA. METHODS AND ANALYSIS This is a 12-week randomised single-blind controlled trial study. 60 patients with ERA will be randomised into two groups: the home-based exercise group (HBE) and the health education (HE) group. The HBE group (n=30) will perform the CYRT programme 3 times a week at home for 12 weeks and receive HE. The HE group (n=30) will only receive HE. The outcomes include primary outcome (pain levels) and secondary outcomes (lower limb muscle strength, motion range of joint, aerobic fitness, function ability, fatigue levels, mental health, quality of life and blood biomarkers). The assessments will be conducted at baseline, postintervention (12 weeks) and follow-up (24 weeks). Data will be analysed by intention to treat. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine in December 2023 (approval no. XHEC-C-2023-059-3). This study will require informed consent from all subjects and guardians of children under 18 years of age. The findings will be published in a peer-reviewed journal and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2300073446.
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Affiliation(s)
- Mei Zhang
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jiaoyu Li
- Department of Pediatric Nephrology and Rheumatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yue Su
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guimei Guo
- Department of Pediatric Nephrology and Rheumatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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Saidi O, Rochette E, Merlin E, Duché P. Pathways of sleep disturbances in juvenile idiopathic arthritis and recommendations for clinical management approaches: A critical review. Sleep Med Rev 2024; 73:101870. [PMID: 37897844 DOI: 10.1016/j.smrv.2023.101870] [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: 06/06/2023] [Revised: 10/11/2023] [Accepted: 10/18/2023] [Indexed: 10/30/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease affecting young people. It has a profound impact on their physical, mental and social lives, leading to long-term disability. With the growing awareness of the importance of sleep in all areas of functioning in young people, an emerging literature has drawn attention to the role of sleep in the pathogenesis of JIA. Sleep disturbances in children and adolescents with JIA arise from a wide range of symptoms and pathways, leading to a vicious cycle that exacerbates subclinical inflammation, symptoms and disease progression. Putative factors contributing to sleep disturbances include chronic inflammation, JIA-associated sleep disorders, JIA symptoms (e.g. pain), psychological comorbidities and potential circadian disruption, which may be exacerbated by the transition to adolescence. Here, we review these pathways and advocate key strategies and alternatives for sleep management in young people with JIA in clinical settings. We identify gaps in knowledge and suggest future directions to improve our understanding of JIA sleep disorders, including clinical trials investigating potential strategies to improve sleep health in this young population.
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Affiliation(s)
- Oussama Saidi
- Laboratory "Impact of Physical Activity on Health" (IAPS), Toulon University, F-83041, Toulon, France.
| | - Emmanuelle Rochette
- Laboratory "Impact of Physical Activity on Health" (IAPS), Toulon University, F-83041, Toulon, France; Department of Pediatrics, Clermont-Ferrand University Hospital, F-63000, Clermont-Ferrand, France; INSERM, CIC 1405, CRECHE Unit, Clermont Auvergne University, F-63000, Clermont-Ferrand, France
| | - Etienne Merlin
- Department of Pediatrics, Clermont-Ferrand University Hospital, F-63000, Clermont-Ferrand, France; INSERM, CIC 1405, CRECHE Unit, Clermont Auvergne University, F-63000, Clermont-Ferrand, France
| | - Pascale Duché
- Laboratory "Impact of Physical Activity on Health" (IAPS), Toulon University, F-83041, Toulon, France.
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Sözeri B, Şahin N, Açarı C, Avar Aydın PO, Baba O, Bağlan E, Bakkaloğlu S, Bakırcı S, Bilginer Y, Bozkaya BY, Çağlayan Ş, Çakan M, Çakmak F, Coşkuner T, Demir F, Demirkan FG, Doğantan Ş, Adıgüzel Dündar H, Ersözlü ED, Gücenmez S, Gürler O, İşgüder R, Küçük A, Kalyoncu M, Kılıç L, Kılıç SŞ, Kısaoğlu H, Paç Kısaarslan A, Kızıldağ Z, Kurtuluş D, Özdel S, Öztürk K, Şenol P, Tanatar A, Taşkın SN, Tuncer Kuru F, Türkuçar S, Ulu K, Ünsal E, Yazıcı A, Gezgin Yıldırım D, Yüksel S, Kasapçopur Ö, Özen S, Aktay Ayaz N, Sönmez HE. Towards a standardized program of transitional care for adolescents with juvenile idiopathic arthritis for Turkey: a national survey study. Pediatr Rheumatol Online J 2024; 22:7. [PMID: 38167070 PMCID: PMC10762787 DOI: 10.1186/s12969-023-00943-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a prevalent childhood chronic arthritis, often persisting into adulthood. Effective transitional care becomes crucial as these patients transition from pediatric to adult healthcare systems. Despite the concept of transitional care being recognized, its real-world implementation remains inadequately explored. This study aims to evaluate the thoughts and practices of healthcare providers regarding transitional care for JIA patients. METHODS A cross-sectional survey was conducted among pediatric and adult rheumatologists in Turkey. Based on the American Academy of Pediatrics' six core elements of transitional care, the survey included 86 questions. The respondents' demographic data, attitudes towards transitional care, and practical implementation were assessed. RESULTS The survey included 48 rheumatologists, with 43.7% having a transition clinic. The main barriers to establishing transition programs were the absence of adult rheumatologists, lack of time, and financial constraints. Only 23.8% had a multidisciplinary team for transition care. Participants agreed on the importance of coordination and cooperation between pediatric and adult healthcare services. The timing of the transition process varied, with no consensus on when to initiate or complete it. Participants advocated for validated questionnaires adapted to local conditions to assess transition readiness. CONCLUSIONS The study sheds light on the challenges and perspectives surrounding transitional care for JIA patients in Turkey. Despite recognized needs and intentions, practical implementation remains limited due to various barriers. Cultural factors and resource constraints affect the transition process. While acknowledging the existing shortcomings, the research serves as a ground for further efforts to improve transitional care and ensure better outcomes for JIA patients transitioning into adulthood.
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Affiliation(s)
- Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Nihal Şahin
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ceyhun Açarı
- Department of Pediatric Rheumatology, Faculty of Medicine, Inönü University, Malatya, Turkey
| | | | - Ozge Baba
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Esra Bağlan
- Department of Pediatric Rheumatology, Etlik State Hospital, Ankara, Turkey
| | - Sevcan Bakkaloğlu
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sibel Bakırcı
- Department of Rheumatology, Antalya State Hospital, Antalya, Turkey
| | - Yelda Bilginer
- Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Burcu Yücel Bozkaya
- Department of Pediatric Rheumatology, Samsun Research and Training Hospital, Samsun, Turkey
| | - Şengül Çağlayan
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, Zeynep Kamil Research and Training Hospital, Istanbul, Turkey
| | - Figen Çakmak
- Department of Pediatric Rheumatology, Başakşehir Çam and Sakura State Hospital, Istanbul, Turkey
| | - Taner Coşkuner
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Acıbadem Hospital, Istanbul, Turkey
| | - Fatma Gül Demirkan
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Şeyda Doğantan
- Department of Pediatric Rheumatology, Mersin City Hospital, Mersin, Turkey
| | - Hatice Adıgüzel Dündar
- Department of Pediatric Rheumatology, Behçet Uz Research and Training Hospital, Izmir, Turkey
| | - Emine Duygu Ersözlü
- Department of Rheumatology, Adana City Research and Training Hospital, Adana, Turkey
| | - Sercan Gücenmez
- Department of Rheumatology, Izmir Atatürk Research and Training Hospital, Izmir, Turkey
| | - Oğuz Gürler
- Department of Rheumatology, Medikal Park Hospital, Samsun, Turkey
| | - Rana İşgüder
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Adem Küçük
- Department of Rheumatology, Faculty of Medicine, Konya Selçuk University, Konya, Turkey
| | - Mukaddes Kalyoncu
- Department of Pediatric Rheumatology, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Levent Kılıç
- Department of Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Sara Şebnem Kılıç
- Department of Pediatric Rheumatology, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Hakan Kısaoğlu
- Department of Pediatric Rheumatology, Kayseri City Hospital, Kayseri, Turkey
| | - Ayşenur Paç Kısaarslan
- Department of Pediatric Rheumatology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Zehra Kızıldağ
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Duygu Kurtuluş
- Department of Physical Therapy and Rehabilitation, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Semanur Özdel
- Department of Pediatric Rheumatology, Etlik State Hospital, Ankara, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Göztepe Research and Training Hospital, Istanbul, Turkey
| | - Pelin Şenol
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ayşe Tanatar
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sema Nur Taşkın
- Department of Pediatric Rheumatology, Eskişehir City Hospital, Eskişehir, Turkey
| | - Fatma Tuncer Kuru
- Department of Rheumatology, Osmaniye State Hospital, Osmaniye, Turkey
| | - Serkan Türkuçar
- Department of Pediatric Rheumatology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Kadir Ulu
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Erbil Ünsal
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Ayten Yazıcı
- Department of Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Deniz Gezgin Yıldırım
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Selçuk Yüksel
- Department of Pediatric Rheumatology, Faculty of Medicine, Onsekiz Mart University, Çanakkele, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, Istanbul University-Cerrahpaşa, Cerrahpaşa Medical School, Istanbul, Turkey
| | - Seza Özen
- Department of Pediatric Rheumatology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey.
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Mikola K, Rebane K, Kautiainen H, Aalto K. Transition readiness among finnish adolescents with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2023; 21:149. [PMID: 38129898 PMCID: PMC10740281 DOI: 10.1186/s12969-023-00938-0] [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: 08/22/2023] [Accepted: 12/05/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND With chronic diseases, the responsibility for care transfers to adult clinics at some point. Juvenile idiopathic arthritis (JIA) is the most common persistent rheumatic condition in children. A successful transition requires sufficient self-management skills to manage one´s chronic condition and all the tasks involved. In this study, we evaluated transition readiness in Finnish patients with JIA. We aimed to find practical tools to support a successful transition and to study the possible consequences of an unsuccessful transition. METHODS The usefulness of a specific questionnaire, which was administered to 83 JIA patients, was evaluated in this study. We also gathered information from their first adult clinic visit to assess the success of their transition and its relation to disease activity. RESULTS In 55 (71%) patients, the transition was estimated to be successful. We were able to determine a cut-off score in the questionnaire for a successful transition: the best estimate for a successful transition is when the score is 24 or more. At the first adult clinic visit, an unsuccessful transition was evident in its effect on disease outcome. If the transition was defined as successful, the DAS28 was better. CONCLUSION We found the questionnaire to be a useful tool for evaluating transition readiness. Determination of a successful transition helped us identify those adolescents who needed more profound support to improve their self-management skills and thus enhance their transition process. An unsuccessful transition was shown to negatively impact on disease outcomes.
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Affiliation(s)
- Katriina Mikola
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, 00290, Helsinki, Finland.
| | - Katariina Rebane
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, 00290, Helsinki, Finland
| | - Hannu Kautiainen
- Kuopio University Hospital, Primary Health Care Unit Kuopio, Pohjois-Savo, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Kristiina Aalto
- New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Stenbackinkatu 9, 00290, Helsinki, Finland
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Rongo R, Michelotti A, Pedersen TK, Resnick CM, Stoustrup P. Management of temporomandibular joint arthritis in children and adolescents: An introduction for orthodontists. Orthod Craniofac Res 2023; 26 Suppl 1:151-163. [PMID: 37226648 DOI: 10.1111/ocr.12676] [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: 01/31/2023] [Accepted: 05/02/2023] [Indexed: 05/26/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common inflammatory rheumatic disease of childhood. JIA can affect any joint and the temporomandibular joint (TMJ) is one of the joints most frequently involved. TMJ arthritis impacts mandibular growth and development and can result in skeletal deformity (convex profile and facial asymmetry), and malocclusion. Furthermore, when TMJs are affected, patients may present with pain at joint and masticatory muscles and dysfunction with crepitus and limited jaw movement. This review aims to describe the role of orthodontists in the management of patients with JIA and TMJ involvement. This article is an overview of evidence for the diagnosis and treatment of patients with JIA and TMJ involvement. Screening for the orofacial manifestation of JIA is important for orthodontists to identify TMJ involvement and related dentofacial deformity. The treatment protocol of JIA with TMJ involvement requires an interdisciplinary collaboration including orthopaedic/orthodontic treatment and surgical interventions for the management of growth disturbances. Orthodontists are also involved in the management of orofacial signs and symptoms; behavioural therapy, physiotherapy and occlusal splints are the suggested treatments. Patients with TMJ arthritis require specific expertise from an interdisciplinary team with members knowledgeable in JIA care. Since disorders of mandibular growth often appear during childhood, the orthodontist could be the first clinician to see the patient and can play a crucial role in the diagnosis and management of JIA patients with TMJ involvement.
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Affiliation(s)
- Roberto Rongo
- Department of Neurosciences, Reproductive sciences and Oral Sciences, School of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Ambrosina Michelotti
- Department of Neurosciences, Reproductive sciences and Oral Sciences, School of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Thomas Klit Pedersen
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
- Department of Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA, USA
- Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Peter Stoustrup
- Department of Dentistry and Oral Health, Section of Orthodontics, Aarhus University, Aarhus, Denmark
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Kembe J, Regardt M. Experiences of participation in activities among girls with juvenile idiopathic arthritis: A qualitative study. J Child Health Care 2023; 27:599-611. [PMID: 35403449 PMCID: PMC10676619 DOI: 10.1177/13674935221083167] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to describe how girls with juvenile idiopathic arthritis (JIA) experience participation in activities in relation to their disease. Semi-structured interviews of eight girls with JIA in ages 12-15 were recorded and transcribed as a whole. Data have been analysed with qualitative content analysis. Participation was influenced by disease symptoms, which could result in absence and exclusion from participation in activities. The experience of participation was affected by the participant's choice of using strategies and making adjustments during activities. Social environment could both increase and decrease participation through treatment and type of knowledge about the disease. Also the physical environment could affect participation due to the climate or road and ground conditions. We could conclude that the experience of participation among girls with JIA was affected by disease symptoms, perceptions of selves, disease and the use of strategies, and also the social and physical environment. This indicates the need to address participation in clinical practice and the importance to include different health professionals, teachers and other personnel involved in the child's schooling.
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Affiliation(s)
- Johanna Kembe
- Women´s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| | - Malin Regardt
- Women´s Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, care sciences and society Division of Occupational Therapy, Karolinska Institutet, Stockholm, Sweden
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Bingham CA, Harris JG, Qiu T, Gilbert M, Vora SS, Yildirim-Toruner C, Ferraro K, Lovell DJ, Taylor J, Mannion ML, Weiss JE, Laxer RM, Shishov M, Oberle EJ, Gottlieb BS, Lee TC, Pan N, Burnham JM, Fair DC, Batthish M, Hazen MM, Spencer CH, Morgan EM. Pediatric Rheumatology Care and Outcomes Improvement Network's Quality Measure Set to Improve Care of Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2023; 75:2442-2452. [PMID: 37308458 DOI: 10.1002/acr.25168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the selection, development, and implementation of quality measures (QMs) for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network using quality improvement methods and leveraging QMs to drive improved outcomes across a JIA population since 2011. METHODS An American College of Rheumatology-endorsed multistakeholder process previously selected initial process QMs. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome QMs. A committee of rheumatologists and data analysts developed operational definitions. QMs were programmed and validated using patient data. Measures are populated by registry data, and performance is displayed on automated statistical process control charts. PR-COIN centers use rapid-cycle quality improvement approaches to improve performance metrics. The QMs are revised for usefulness, to reflect best practices, and to support network initiatives. RESULTS The initial QM set included 13 process measures concerning standardized measurement of disease activity, collection of patient-reported outcome assessments, and clinical performance measures. Initial outcome measures were clinical inactive disease, low pain score, and optimal physical functioning. The revised QM set has 20 measures and includes additional measures of disease activity, data quality, and a balancing measure. CONCLUSION PR-COIN has developed and tested JIA QMs to assess clinical performance and patient outcomes. The implementation of robust QMs is important to improve quality of care. PR-COIN's set of JIA QMs is the first comprehensive set of QMs used at the point-of-care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.
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Affiliation(s)
- Catherine A Bingham
- Penn State Children's Hospital and Penn State College of Medicine, Hershey, Pennsylvania
| | - Julia G Harris
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Tingting Qiu
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Sheetal S Vora
- Levine Children's Hospital and Atrium Health, Charlotte, North Carolina
| | | | - Kerry Ferraro
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Janalee Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Jennifer E Weiss
- Hackensack University Medical Center and Hackensack Meridian Health, Hackensack, New Jersey
| | - Ronald M Laxer
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | - Edward J Oberle
- Nationwide Children's Hospital and The Ohio State University, Columbus
| | - Beth S Gottlieb
- Cohen Children's Medical Center of New York and Zucker School of Medicine at Hofstra/Northwell, Queens, New York
| | - Tzielan C Lee
- Stanford Medicine Children's Health, Stanford University, Stanford, California
| | - Nancy Pan
- Hospital for Special Surgery and Cornell University, New York, New York
| | - Jon M Burnham
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Danielle C Fair
- Medical College of Wisconsin and Children's Wisconsin, Milwaukee
| | - Michelle Batthish
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | | | | | - Esi M Morgan
- Seattle Children's Hospital and the University of Washington, Seattle
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Currie GR, Kennedy BL, S M B, R S M Y, J F S, S J V, N M W, M M A K, MacKean G, Marshall DA. Managing juvenile idiopathic arthritis within the context of their life: What we learnt from children and youth living with juvenile idiopathic arthritis and their parents. Musculoskeletal Care 2023; 21:1248-1260. [PMID: 37596866 DOI: 10.1002/msc.1805] [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: 06/30/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/20/2023]
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and causes short- and long-term disability. Optimal management requires pharmacologic and non-pharmacologic interventions. Few studies have explored the youth and family experience of the management of JIA. This study's objective was to explore the management experience of youth with JIA and their parents. METHODS This qualitative study used semi-structured interviews with youth 12-18 years of age with JIA receiving biological medication and parents of children with JIA on biological medication. Participants were recruited in clinics using convenience sampling. A thematic analysis approach was employed for data analysis. RESULTS Nine youth and 14 parents participated. Four themes were identified that encompassed an overarching theme of participants managing JIA within the context of their life: aspects of life affected by JIA and its management, lived experience with JIA management, medication decision-making, and involvement in decision-making. Juvenile idiopathic arthritis management is situated within the context of their life but is normally (outside acute events) not central. CONCLUSION Two dimensions were added to those in the literature: parents' overall approaches to health and the sense of urgency surrounding decision-making. Our findings reinforce the importance of person- and family-centred care in paediatric rheumatology. That is, identifying what matters most to youth and their parents given their current life circumstances to provide a foundation for discussions of how they want to manage their JIA.
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Affiliation(s)
- G R Currie
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - B L Kennedy
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Benseler S M
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yeung R S M
- Departments of Paediatrics, Immunology and Medical Science, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Swart J F
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Vastert S J
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Wulffraat N M
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Kip M M A
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Gail MacKean
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - D A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Gheshlaghi N, Thomas M, Trehan N, Harrison M, De Vera MA. Reporting of determinants of health inequities and participant characteristics in randomized controlled trials of juvenile idiopathic arthritis in Canada: a scoping review. Pediatr Rheumatol Online J 2023; 21:134. [PMID: 37932754 PMCID: PMC10629131 DOI: 10.1186/s12969-023-00917-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) is the most common form of childhood inflammatory arthritis. The disease burden of JIA is substantial as patients require specialized medical practitioners for diagnosis and chronic treatments that are both costly and time intensive. Discrepancies in access to care due to health inequities such as socioeconomic status or geographic location may lead to vastly different health outcomes. As research informs advances in care, is important to consider inclusion and diversity in JIA research. METHODS We reviewed and synthesized randomized controlled trials for juvenile idiopathic arthritis, the most common type of arthritis among children and adolescents, in Canada with the aim of characterizing participants and identifying how determinants of health inequities are reported. To do so, we searched Medline (1990 to July 2022), Embase (1990 to July 2022), and CENTRAL (inception to July 2022) for articles meeting all of the following criteria: Canadian randomized controlled trials evaluating pharmacological or non-pharmacological interventions on juvenile idiopathic arthritis populations. Data extraction was guided by the Campbell and Cochrane Equity Methods Group's PROGRESS-Plus framework on determinants that lead to health inequities (e.g., Place of residence; Race; Occupation; Gender/Sex; Religion; Education; Socioeconomic status; and Social capital). RESULTS Of 4,074 unique records, 5 were deemed eligible for inclusion. From these determinants of health inequities, Gender/Sex and Age were the only that were reported in all studies with most participants being female and 12.6 years old on average. In addition, Race, Socioeconomic status, Education and Features of relationships were each reported once in three different studies. Lastly, Place of residence, Occupation, Religion, Social Capital and Time-dependent relationships were not reported at all. CONCLUSIONS This scoping review suggests limited reporting on determinants of health inequities in randomized controlled trials for JIA in Canada and a need for a reporting framework that reflects typical characteristics of juvenile patient populations.
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Affiliation(s)
- Niloofar Gheshlaghi
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, V6T 1Z3, Vancouver, BC, Canada
| | - Megan Thomas
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, V6T 1Z3, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Natasha Trehan
- Faculty of Science, University of Ottawa, Ottawa, ON, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, V6T 1Z3, Vancouver, BC, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, V6T 1Z3, Vancouver, BC, Canada.
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.
- Arthritis Research Canada, Vancouver, BC, Canada.
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada.
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18
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Vassis S, Resnick CM, Nørgaard M, Strawn KM, Grove H, Noeldeke B, Herlin T, Pedersen TK, Stoustrup PB. Impact of physiotherapy on orofacial manifestations of juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2023; 21:116. [PMID: 37828517 PMCID: PMC10571390 DOI: 10.1186/s12969-023-00900-0] [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: 08/01/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Physiotherapy appears as a promising therapy option for patients with Juvenile Idiopathic Arthritis (JIA) [1, 2], but the effects of physiotherapy and jaw exercises on JIA-related orofacial symptoms remain unknown [3]. The aim of this proof-of-concept study was to assess the impact of orofacial physiotherapy and home-exercise programs in patients with JIA and temporomandibular joint (TMJ) involvement. METHODS Twelve patients with JIA and TMJ involvement received a treatment of physiotherapy, complemented by prescribed home exercises spanning over eight weeks. Orofacial symptoms and dysfunction were monitored pre-treatment, during treatment, after treatment, and at a three-months follow-up. RESULTS Orofacial pain frequency and intensity significantly decreased during the course of the treatment (p = 0.009 and p = 0.006), with further reductions observed at the three-month follow-up (p = 0.007 and p = 0.002). During treatment, the mandibular function improved significantly in terms of maximal mouth opening capacity, laterotrusion, and protrusion. CONCLUSIONS This proof-of-concept study shows favourable effects of physiotherapy and home excercises in the management of JIA-related orofacial symptoms and dysfunctions.
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Affiliation(s)
- Stratos Vassis
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Blvd. 9, Aarhus C, DK-8000, Denmark.
| | - Cory M Resnick
- Department of Oral and Maxillofacial Surgery, Harvard Medical School, 188 Longwood Avenue, Boston, MA, 02115, United States of America
| | - Mette Nørgaard
- Department of Physiotherapy, Aarhus University Hospital, Skejby, Denmark, Palle Juul- Jensens Boulevard 103, Aarhus N, 8200, Denmark
| | - Kathleen M Strawn
- Department of Physical and Occupational Therapy, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, United States of America
| | - Helle Grove
- Mårslet Fysioterapi & Traeningscenter, Hørretvej 16 C, Mårslet, 8320, Denmark
| | - Beatrice Noeldeke
- Leibniz University Hannover, Welfengarten 1, 30167, Hannover, Germany
| | - Troels Herlin
- Department of Clinical Medicine, Department of Paediatrics, Aarhus University, Palle Juul- Jensens Boulevard 103, Aarhus N, 8200, Denmark
| | - Thomas Klit Pedersen
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Blvd. 9, Aarhus C, DK-8000, Denmark
| | - Peter Bangsgaard Stoustrup
- Section of Orthodontics, Department of Dentistry and Oral Health, Aarhus University, Vennelyst Blvd. 9, Aarhus C, DK-8000, Denmark
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19
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Abstract
Juvenile idiopathic arthritis (JIA) comprises a group of heterogenous disorders characterized by childhood-onset chronic joint inflammation. It is the most common rheumatologic disease in the pediatric population and an important cause of chronic illness in children. Early recognition and treatment are vital to prevent sequelae of uncontrolled inflammation on the developing skeleton. JIA can have significant complications that general pediatricians should be aware of, especially uveitis, which can be insidious and asymptomatic in very young children, and macrophage activation syndrome, which can be life-threatening if not recognized and appropriately treated. Although advances have been made in the past few decades, the etiology of JIA remains incompletely understood. Efforts are underway to refine the classification of JIA. The currently accepted classification scheme identifies subsets of JIA that are important clinically in terms of prognosis and tailoring treatment approaches. However, it is limited in identifying homogenous groups of children with early childhood onset and antinuclear antibody positivity, which may have different pathogenic mechanisms that could be important in developing more targeted and effective treatment approaches in the future. Treatment strategies for JIA have changed significantly in recent years with the availability of multiple newer targeted therapies, often modeled after medications used in adult-onset forms of arthritis. These treatments, and likely many others to come, have markedly improved symptom control and reduced complications in patients with JIA.
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Affiliation(s)
- Andrew M Long
- Division of Pediatric Rheumatology, Golisano Children's Hospital, Rochester, NY
- Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
| | - Bethany Marston
- Division of Pediatric Rheumatology, Golisano Children's Hospital, Rochester, NY
- Division of Allergy, Immunology, and Rheumatology, University of Rochester Medical Center, Rochester, NY
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20
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Andev RS, Jacklin C, Bosworth A, Dubey S. Accessing care during the pandemic: A UK wide survey of people with rheumatoid arthritis and adult juvenile inflammatory arthritis during the COVID-19 pandemic. Musculoskeletal Care 2023; 21:908-915. [PMID: 37160717 DOI: 10.1002/msc.1772] [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: 04/12/2023] [Revised: 04/16/2023] [Accepted: 04/21/2023] [Indexed: 05/11/2023]
Abstract
COVID-19 drastically changed healthcare delivery models for rheumatology services. We sought to understand the impact of these changes for patients with Rheumatoid Arthritis (RA) and adult Juvenile Inflammatory Arthritis (AJIA) in established patients and those newly diagnosed during the pandemic. RESULTS: Of the 316 participants, a significant proportion regularly used analgesics (45.4%, n = 119), corticosteroids (17.9%, n = 47) and Non-Steroidal Anti-Inflammatory Drugs [(NSAIDs) (36.6%, n = 96)]. Two thirds of participants (66.5%, n = 210) did not know their Disease Activity Score-28 (DAS28). Of the remaining third, moderate disease activity (12%, n = 38) was most reported. We found that 16.8% (n = 53) felt their condition was managed well during the pandemic. The remainder felt more negatively. For the newly diagnosed cohort, 34.5% (n = 10) delayed seeking GP help because of COVID-19 concerns. Once assessed, a quarter (24.1%, n = 7) were referred to rheumatology after 4 or more consultations. We found 47% (n = 77) expressed positive opinions on remote consultations, whereas 36% (n = 59) had concerns. The lack of clinical examination (42.5%, n = 25) was flagged. Changing the dynamic from health worker to a patient centred approach was the most wished for improvement (20.3%, n = 64). CONCLUSIONS: Most participants did not know their disease activity status, which is of concern. With a push towards patient-centred and patient-led care, education and supported self-management is critically important. There is high use of NSAIDs and corticosteroids. Pathways of care underwent change with subsequent delays in specialist assessment. The introduction of patient-initiated follow-up (PIFU) and virtual consultations further distances healthcare professionals from patients and could affect outcomes.
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Affiliation(s)
- Rajinder Singh Andev
- Department of Rheumatology, Oxford University Hospitals NHS FT, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Clare Jacklin
- National Rheumatoid Arthritis Society, Maidenhead, Berkshire, UK
| | - Ailsa Bosworth
- National Rheumatoid Arthritis Society, Maidenhead, Berkshire, UK
| | - Shirish Dubey
- Department of Rheumatology, Oxford University Hospitals NHS FT, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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21
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Glerup M, Tagkli A, Küseler A, Christensen AE, Verna C, Bilgrau AE, Nørholt SE, Herlin T, Pedersen TK, Stoustrup P. Incidence of Orofacial Manifestations of Juvenile Idiopathic Arthritis From Diagnosis to Adult Care Transition: A Population-Based Cohort Study. Arthritis Rheumatol 2023; 75:1658-1667. [PMID: 36806745 DOI: 10.1002/art.42481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 12/29/2022] [Accepted: 02/14/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE To estimate the cumulative incidences of orofacial conditions related to temporomandibular joint (TMJ) juvenile idiopathic arthritis (JIA) between diagnosis in childhood to transition into adult care, and to identify features in JIA associated with TMJ involvement. METHODS A population-based cohort analysis was conducted of patients with JIA involving longitudinal data on orofacial health from 2000 to 2018. Regardless of TMJ status, the patients were referred to the Regional Specialist Craniofacial Clinic of Western Denmark for routine orofacial examinations. Data collection included information about disease-specific background characteristics, TMJ involvement, JIA-induced dentofacial deformity, and orofacial symptoms and dysfunction. RESULTS A total of 613 patients were followed up with a mean clinical TMJ observation time of 4.0 years. From JIA onset to transition into adult care, the cumulative incidence of patients with JIA involvement of the TMJ was 30.1%. Furthermore, 20.6% of the cohort had developed arthritis-induced dentofacial deformity. A substantial proportion of the cohort experienced several events with orofacial symptoms (23.5%) and dentofacial dysfunction (52%). Young age at diagnosis (<9 years), female gender, and antinuclear antibody positivity were significantly associated with TMJ involvement. CONCLUSION Orofacial signs and symptoms were frequent findings in children and adolescents with JIA. TMJ involvement was seen in 30.1% of the cohort; and 20.6% of the total cohort developed JIA-related dentofacial deformity before transition into adult care. This is the first population-based study in the era of available biologic treatments to document these frequent orofacial complications in children with JIA.
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Affiliation(s)
- Mia Glerup
- Pediatric Rheumatology Clinic, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | - Carlalberta Verna
- Department of Pediatric Oral Health and Orthodontics, UZB University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Anders E Bilgrau
- Department of Mathematical Sciences, Aalborg University, Aalborg, Denmark
| | - Sven Erik Nørholt
- Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, and Section of Oral Surgery and Oral Pathology, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Troels Herlin
- Pediatric Rheumatology Clinic, Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas K Pedersen
- Section of Orthodontics, Aarhus University, and Department of Oral and Maxillofacial Surgery, Aarhus University Hospital, Aarhus, Denmark
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22
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Wilson N, Whittaker K, Arnott J, Burke L, Beresford MW, Peak M. Stuck in transit: A qualitative study of the transitional care needs of young people with epilepsy and juvenile idiopathic arthritis. J Child Health Care 2023; 27:435-449. [PMID: 35235476 PMCID: PMC10472714 DOI: 10.1177/13674935221074777] [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] [Indexed: 11/15/2022]
Abstract
Transition services for young people with long-term conditions often fall short. This qualitative study explored perspectives on service features that enable effective transition in epilepsy and juvenile idiopathic arthritis. Patients, parents, clinicians and service commissioners took part in semi-structured interviews (n = 18). Thematic analysis was used to identify key features, barriers and facilitators of effective transition across participant groups. Analysis led to the development of nine sub-themes which mapped to overarching domains of communication, capability, continuity and capacity. Findings include the need for age appropriate communication, the link between parental dependence, self-care and patient knowledge, the value of service integration for continuity and the impact of capacity on flexible and age appropriate transition services.
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Affiliation(s)
- Neil Wilson
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Karen Whittaker
- Visiting Fellow, School of Nursing, University of Central Lancashire, Preston, UK
| | - Janine Arnott
- Faculty of Health and Care, University of Central Lancashire, Preston, UK
| | - Lauren Burke
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
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23
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Toupin-April K, Gaboury I, Proulx L, Huber AM, Duffy CM, Morgan EM, Li LC, Stringer E, Connelly M, Weiss JE, Gibbon M, Sachs H, Sivakumar A, Sirois A, Sirotich E, Trehan N, Abrahams N, Cohen JS, Cavallo S, Hindi TE, Ragusa M, Légaré F, Brinkman WB, Fortin PR, Décary S, Lee R, Gmuca S, Paterson G, Tugwell P, Stinson JN. "I'd like more options!": Interviews to explore young people and family decision-making needs for pain management in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2023; 21:74. [PMID: 37491246 PMCID: PMC10369758 DOI: 10.1186/s12969-023-00849-0] [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: 04/05/2023] [Accepted: 06/14/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is a common pediatric rheumatic condition and is associated with symptoms such as joint pain that can negatively impact health-related quality of life. To effectively manage pain in JIA, young people, their families, and health care providers (HCPs) should be supported to discuss pain management options and make a shared decision. However, pain is often under-recognized, and pain management discussions are not optimal. No studies have explored decision-making needs for pain management in JIA using a shared decision making (SDM) model. We sought to explore families' decision-making needs with respect to pain management among young people with JIA, parents/caregivers, and HCPs. METHODS We conducted semi-structured virtual or face-to-face individual interviews with young people with JIA 8-18 years of age, parents/caregivers and HCPs using a qualitative descriptive study design. We recruited participants online across Canada and the United States, from a hospital and from a quality improvement network. We used interview guides based on the Ottawa Decision Support Framework to assess decision-making needs. We audiotaped, transcribed verbatim and analyzed interviews using thematic analysis. RESULTS A total of 12 young people (n = 6 children and n = 6 adolescents), 13 parents/caregivers and 11 HCPs participated in interviews. Pediatric HCPs were comprised of rheumatologists (n = 4), physical therapists (n = 3), rheumatology nurses (n = 2) and occupational therapists (n = 2). The following themes were identified: (1) need to assess pain in an accurate manner; (2) need to address pain in pediatric rheumatology consultations; (3) need for information on pain management options, especially nonpharmacological approaches; (4) importance of effectiveness, safety and ease of use of treatments; (5) need to discuss young people/families' values and preferences for pain management options; and the (6) need for decision support. Themes were similar for young people, parents/caregivers and HCPs, although their respective importance varied. CONCLUSIONS Findings suggest a need for evidence-based information and communication about pain management options, which would be addressed by decision support interventions and HCP training in pain and SDM. Work is underway to develop such interventions and implement them into practice to improve pain management in JIA and in turn lead to better health outcomes.
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Affiliation(s)
- Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- Institut du Savoir Montfort, Ottawa, ON Canada
| | - Isabelle Gaboury
- Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Ottawa, ON Canada
| | - Adam M. Huber
- Division of Rheumatology, IWK Health Centre, Halifax, NS Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Ciarán M. Duffy
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- Department of Pediatrics, Faculty of Medicine, Ottawa, ON Canada
| | - Esi M. Morgan
- Division of Rheumatology, Seattle Children’s Hospital, Seattle, Washington USA
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA USA
| | - Linda C. Li
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC Canada
- Arthritis Research Canada, Vancouver, BC Canada
| | - Elizabeth Stringer
- Division of Rheumatology, IWK Health Centre, Halifax, NS Canada
- Department of Pediatrics, Dalhousie University, Halifax, NS Canada
| | - Mark Connelly
- Department of Pediatrics, Children’s Mercy Kansas City, Kansas City, MO USA
| | - Jennifer E. Weiss
- Division of Rheumatology, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ USA
| | - Michele Gibbon
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
| | - Hannah Sachs
- Public Health Agency of Canada, Ottawa, ON Canada
| | - Aditi Sivakumar
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- Queen’s University, ON Ottawa, Canada
| | | | - Emily Sirotich
- Canadian Arthritis Patient Alliance, New Haven, CT USA
- Yale University School of Medicine, New Haven, CT USA
| | | | - Naomi Abrahams
- Faculty of Social Sciences, University of Ottawa, Ottawa, ON Canada
| | - Janice S. Cohen
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON Canada
- Behavioural Neurosciences and Consultation Liaison Team, Mental Health, Children’s Hospital of Eastern Ontario, Ottawa, ON Canada
- School of Psychology, Faculty of Social Sciences, University of Ottawa, ON Ottawa, Canada
| | - Sabrina Cavallo
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montréal, QC Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montréal, QC Canada
- Research Centre of the Sainte-Justine University Hospital, Montreal, QC Canada
| | - Tania El Hindi
- Statistics Canada, Government of Canada, Ottawa, ON Canada
| | - Marco Ragusa
- The Ottawa Hospital, University of Ottawa, Ottawa, ON Canada
| | - France Légaré
- Department of Family and Emergency Medicine, Université Laval, Québec City, QC Canada
- VITAM, Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux de la Capitale Nationale, Québec City, QC Canada
| | - William B. Brinkman
- Cincinnati Children’s Hospital Medical Center, OH Cincinnati, USA
- College of Medicine, Department of Pediatrics, University of Cincinnati, Cincinnati, OH United States
| | - Paul R. Fortin
- Université Laval, QC, Canada
- CHU de Québec, Québec City, QC Canada
| | - Simon Décary
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC Canada
- Research Center of the Centre Hospitalier de l’Université de Sherbrooke, Sherbrooke, QC Canada
| | - Rebecca Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Sabrina Gmuca
- Division of Rheumatology, Children’s Hospital of Philadelphia, Philadelphia, PA USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Gail Paterson
- Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Ottawa, ON Canada
| | - Peter Tugwell
- School of Epidemiology and Community Medicine, Department of Medicine, University of Ottawa, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- WHO Collaborating Centre for Knowledge Translation and Health Technology Assessment in Health Equity, Bruyère Research Institute, Ottawa, ON Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON Canada
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON Canada
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24
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Chausset A, Lambert C, Belot A, Merlin E, Cannizzaro E, Kone-Paut I, Ballot C, Devauchelle V, Poignant S, Carlomagno R, Lohse A, Barbier C, Despert V, Carbasse A, Sparsa L, Adank E, Vanoni F, Reumaux H, Pillet P, Kaiser D, Hofer M, Freychet C, Schott AM. Individual and environmental determinants associated with longer times to access pediatric rheumatology centers for patients with juvenile idiopathic arthritis, a JIR cohort study. Pediatr Rheumatol Online J 2023; 21:24. [PMID: 36918902 PMCID: PMC10015663 DOI: 10.1186/s12969-023-00809-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Despite guidelines, poor access to appropriate care for juvenile idiopathic arthritis (JIA) patients remains a global issue. Prompt referral to a pediatric rheumatology (PR) center and effective care is known to be critical for changing the natural history of the disease and improving long-term prognosis. This project assesses socio-economic factors of delayed referral to a pediatric rheumatologist (PRst) for JIA patients in France and Switzerland within the Juvenile Inflammatory Rheumatism (JIR) Cohort. METHODS All patients diagnosed with JIA, presenting at one center of the JIRcohort in France or Switzerland with additional data on referral pathway were included. Patient characteristics at first visit to the PR center, dates of visits to healthcare providers during referral, and parent characteristics were extracted from the JIRcohort database. RESULTS Two hundred fifty children were included. The overall median time to first PR assessment was 2.4 months [1.3; 6.9] and ranged widely across the JIA subtypes, from 1.4 months [0.6; 3.8] for children with systemic juvenile idiopathic arthritis (sJIA) to 5.3 months [2.0; 19.1] for children with enthesitis-related arthritis (ERA). A diagnosis of ERA and an appointment with an orthopedist during the referral pathway were significantly associated with a longer time before the first PR visit (hazard ratio HR 0.50 [95% CI: 0.29; 0.84]) and HR 0.68 [95% CI: 0.49; 0.93], respectively) in multivariable analysis. Having a mother with a post-graduate educational attainment level was tendentially associated with a shorter time before the first PR visit, (HR 1.32 [95% CI: 0.99; 1.78]). CONCLUSIONS Time to first PRst visit was most often short compared to other studies and close to the British recommendations. However, this time remained too long for many patients. We observed no social inequities in access to a PRst, but we show the need to improve effective pathway and access to a PR center for JIA patients.
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Affiliation(s)
- Aurélie Chausset
- CRECHE Unit, INSERM CIC 1405, Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand, France.
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France.
- Pédiatrie, CHU Estaing, 1 Place Lucie & Raymond Aubrac, Clermont-Fd cedex1, 63003, France.
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology, HFME, Hospices Civils de Lyon, National Referee Centre RAISE & INSERM U1111, Lyon University, Lyon, France
| | - Etienne Merlin
- CRECHE Unit, INSERM CIC 1405, Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Elvira Cannizzaro
- Department of Rheumatology, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Isabelle Kone-Paut
- Department of Pediatrics & Pediatric Rheumatology, Centre de référence maladies auto-inflammatoires rares et amylose inflammatoire (CEREMAIA), Bicêtre University, Paris Sud Hospital, Le Kremlin-Bicêtre, France
| | - Claire Ballot
- Pediatric Hematology, Jean-Minjoz Hospital, Besançon, France
| | - Valérie Devauchelle
- Rheumatology Department, CHU Brest and Brest University, INSERM UMR 1227, Brest, France
| | | | - Raffaella Carlomagno
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- University Hospital, Geneva, Switzerland
| | - Anne Lohse
- Department of Rheumatology, Nord Franche-Comté Hospital, Belfort, France
| | | | | | - Aurélia Carbasse
- Department of Pediatrics, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | | | - Eva Adank
- Department of Pediatrics, Kantonsspital Graubünden, Chur, Switzerland
| | - Federica Vanoni
- Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Héloise Reumaux
- Pediatric Rheumatology, Lille University Hospital, Lille, France
| | - Pascal Pillet
- Department of Pediatrics, Hôpital des Enfants, CHRU Bordeaux, Bordeaux, France
| | - Daniela Kaiser
- Department of Pediatrics, Centre Hospitalier Cantonal Luzern, Lucerne, Switzerland
| | - Michael Hofer
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- University Hospital, Geneva, Switzerland
| | - Caroline Freychet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France
- Pediatric Nephrology, Rheumatology, Dermatology, HFME, Hospices Civils de Lyon, National Referee Centre RAISE & INSERM U1111, Lyon University, Lyon, France
- Pediatrics, CHU Saint-Etienne, Saint-Etienne, France
| | - Anne-Marie Schott
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France
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25
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Stoustrup P, Resnick CM, Abramowicz S, Pedersen TK, Michelotti A, Küseler A, Koos B, Verna C, Nordal EB, Granquist EJ, Halbig JM, Kristensen KD, Kaban LB, Arvidsson LZ, Spiegel L, Stoll ML, Lerman MA, Glerup M, Defabianis P, Frid P, Alstergren P, Cron RQ, Ringold S, Nørholt SE, Peltomaki T, Larheim TA, Herlin T, Peacock ZS, Kellenberger CJ, Twilt M. Management of Orofacial Manifestations of Juvenile Idiopathic Arthritis: Interdisciplinary Consensus-Based Recommendations. Arthritis Rheumatol 2023; 75:4-14. [PMID: 36041065 PMCID: PMC10100353 DOI: 10.1002/art.42338] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 08/08/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023]
Abstract
Involvement of the temporomandibular joint (TMJ) is common in juvenile idiopathic arthritis (JIA). TMJ arthritis can lead to orofacial symptoms, orofacial dysfunction, and dentofacial deformity with negative impact on quality of life. Management involves interdisciplinary collaboration. No current recommendations exist to guide clinical management. We undertook this study to develop consensus-based interdisciplinary recommendations for management of orofacial manifestations of JIA, and to create a future research agenda related to management of TMJ arthritis in children with JIA. Recommendations were developed using online surveying of relevant stakeholders, systematic literature review, evidence-informed generation of recommendations during 2 consensus meetings, and Delphi study iterations involving external experts. The process included disciplines involved in the care of orofacial manifestations of JIA: pediatric rheumatology, radiology, orthodontics, oral and maxillofacial surgery, orofacial pain specialists, and pediatric dentistry. Recommendations were accepted if agreement was >80% during a final Delphi study. Three overarching management principles and 12 recommendations for interdisciplinary management of orofacial manifestations of JIA were outlined. The 12 recommendations pertained to diagnosis (n = 4), treatment of TMJ arthritis (active TMJ inflammation) (n = 2), treatment of TMJ dysfunction and symptoms (n = 3), treatment of arthritis-related dentofacial deformity (n = 2), and other aspects related to JIA (n = 1). Additionally, a future interdisciplinary research agenda was developed. These are the first interdisciplinary recommendations to guide clinical management of TMJ JIA. The 3 overarching principles and 12 recommendations fill an important gap in current clinical practice. They emphasize the importance of an interdisciplinary approach to diagnosis and management of orofacial manifestations of JIA.
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Affiliation(s)
| | - Cory M. Resnick
- Department of Plastic and Oral SurgeryBoston Children's HospitalBostonMassachusetts
| | - Shelly Abramowicz
- Division of Oral and Maxillofacial Surgery, Departments of Surgery and PediatricsEmory University School of MedicineAtlantaGeorgia
| | - Thomas K. Pedersen
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | | | - Annelise Küseler
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Bernd Koos
- Department of OrthodonticsUniversity Hospital TübingenTübingenGermany
| | - Carlalberta Verna
- Department of Pediatric Oral Health and OrthodonticsUZB University Center for Dentistry Basel, University of BaselBaselSwitzerland
| | - Ellen B. Nordal
- Department of Pediatrics, University Hospital of North Norway and the Pediatric Research Group, Department of Clinical MedicineUiT The Arctic University of NorwayTromsøNorway
| | - Eric J. Granquist
- Department of Oral and Maxillofacial Surgery, School of Dental MedicineUniversity of PennsylvaniaPhiladelphia
| | - Josefine Mareile Halbig
- The Public Dental Health Competence Centre of North Norway, and the Department of Clinical Medicine, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | | | - Leonard B. Kaban
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | - Linda Z. Arvidsson
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Lynn Spiegel
- The Hospital for Sick ChildrenUniversity of TorontoTorontoOntarioCanada
| | | | - Melissa A. Lerman
- Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvania
| | - Mia Glerup
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | | | - Paula Frid
- Department of Otorhinolaryngology, Division of Oral and Maxillofacial Surgery, University Hospital of North Norway, Public Dental Service Competence Centre of North Norway, and Department of Clinical DentistryUiT The Arctic University of NorwayTromsøNorway
| | - Per Alstergren
- Faculty of Odontology, Orofacial Pain UnitMalmö UniversityMalmöSweden
| | | | | | - Sven Erik Nørholt
- Section of Orthodontics and Department of Oral and Maxillofacial SurgeryAarhus University HospitalAarhusDenmark
| | - Timo Peltomaki
- Faculty of Medicine and Health Technology, and Department of Ear and Oral Diseases, Tampere University, Tampere, Finland, and Institute of Dentistry, Faculty of Health Sciences, University of Eastern Finland and Department of Oral and Maxillofacial Diseases, Kuopio University HospitalKuopioFinland
| | - Tore A. Larheim
- Department of Maxillofacial RadiologyInstitute of Clinical Dentistry, University of OsloOsloNorway
| | - Troels Herlin
- Department of Pediatrics and Adolescent MedicineAarhus University HospitalAarhusDenmark
| | - Zachary S. Peacock
- Massachusetts General Hospital, Harvard School of Dental MedicineBostonMassachusetts
| | | | - Marinka Twilt
- Alberta Children's Hospital and University of CalgaryCalgaryAlbertaCanada
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van Straalen JW, van Stigt Thans M, Wulffraat NM, de Roock S, Swart JF. A Diagnostic Prediction Model for Separating Juvenile Idiopathic Arthritis and Chronic Musculoskeletal Pain Syndrome. J Pediatr 2022; 251:164-171.e6. [PMID: 35460700 DOI: 10.1016/j.jpeds.2022.04.029] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/08/2022] [Accepted: 04/15/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To develop and validate a diagnostic prediction model that can distinguish between juvenile idiopathic arthritis (JIA) and chronic musculoskeletal pain syndrome (CMPS) based on patient-reported outcomes. STUDY DESIGN This retrospective cohort study evaluated whether the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) performs well in distinguishing JIA from CMPS. We analyzed JAMARs completed by 287 patients at their first visit to the pediatric rheumatology department of Wilhelmina Children's Hospital in Utrecht, The Netherlands. Relevant JAMAR items for predicting a diagnosis of JIA were selected in a penalized multivariable model suitable for clinical application. The model was subsequently validated with new data from the same center. RESULTS A total of 196 JAMARs (97 JIA, 99 CMPS) were collected in the model development data, and 91 JAMARs (48 JIA, 43 CMPS) were collected in the validation data. Variables in the prediction model that were strongest associated with a diagnosis of JIA instead of CMPS were asymmetric pain/swelling in the shoulder (OR, 2.34), difficulty with self-care (OR, 2.41), skin rash (OR, 2.07), and asymmetric/pain swelling in the knee (OR, 2.29). Calibration and discrimination (area under the receiver operating characteristic curve, 0.83; 95% CI, 0.74-0.92) of the model in the validation data were good. CONCLUSIONS Several items from the JAMAR questionnaire can potentially distinguish JIA from CMPS in patients with corresponding symptoms. We present an easy-to-use, adjusted, and validated model to separate these 2 diagnoses early at presentation based on patient-reported outcomes to facilitate proper referral and treatment.
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Affiliation(s)
- Joeri W van Straalen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Faculty of Medicine, Utrecht University, Utrecht, The Netherlands.
| | - Martine van Stigt Thans
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sytze de Roock
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
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Azab AR, Kamel FH, Basha MA, Alrawaili SM, Aloraini GS, Hassan SM, Ewais NF, Elnaggar RK. Impact of Clinical Pilates Exercise on Pain, Cardiorespiratory Fitness, Functional Ability, and Quality of Life in Children with Polyarticular Juvenile Idiopathic Arthritis. Int J Environ Res Public Health 2022; 19:ijerph19137793. [PMID: 35805451 PMCID: PMC9265800 DOI: 10.3390/ijerph19137793] [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] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 06/20/2022] [Accepted: 06/22/2022] [Indexed: 11/30/2022]
Abstract
Objective: This study intended to examine the effects of Pilates exercise on pain, cardiorespiratory fitness, functional ability, and quality of life in children with polyarticular juvenile idiopathic arthritis. Methods: Forty children with polyarticular JIA aged 10−14 years old were randomly allocated into two groups: the control group (n = 20) received conventional physical therapy (CPT), and the experimental group (n = 20) received clinical Pilates exercises combined with CPT. Patients in both groups received their program three times/week for 3 months. Pain, cardiorespiratory fitness, functional ability, and quality of life were assessed through the visual analogue scale, cardiopulmonary exercise test, 6 min walk test, and PedsQL scale, respectively, just before and after treatment. Results: Pain (p = 0.001), cardiorespiratory markers (all p < 0.05), functional ability (p = 0.002), and overall quality of life (p = 0.007) improved significantly in the experimental groups compared to the control group. Conclusion: Incorporating Pilates exercises into CPT is likely more effective for decreasing pain intensity, improving cardiorespiratory fitness, augmenting functional ability, and promoting quality of life in children with JIA than CPT alone.
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Affiliation(s)
- Alshimaa R. Azab
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (S.M.A.); (R.K.E.)
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
- Correspondence:
| | - FatmaAlzahraa H. Kamel
- Department of Physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt;
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah 51452, Saudi Arabia; (M.A.B.); (S.M.H.)
| | - Maged A. Basha
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah 51452, Saudi Arabia; (M.A.B.); (S.M.H.)
- Department of Physical Therapy, ElSahel Teaching Hospital, General Organization for Teaching Hospitals and Institutes, Cairo 11697, Egypt
| | - Saud M. Alrawaili
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (S.M.A.); (R.K.E.)
| | - Ghfren S. Aloraini
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Prince Sattam University, Al-Kharj 11942, Saudi Arabia;
| | - Sahar M. Hassan
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraidah 51452, Saudi Arabia; (M.A.B.); (S.M.H.)
- Department of Physical Therapy, Cairo University Hospitals, Cairo University, Cairo 4240310, Egypt
| | - Najlaa F. Ewais
- Department of Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt;
| | - Ragab K. Elnaggar
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; (S.M.A.); (R.K.E.)
- Department of Physical Therapy for Pediatrics, Faculty of Physical Therapy, Cairo University, Giza 12613, Egypt
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Fellas A, Singh-Grewal D, Chaitow J, Santos D, Clapham M, Coda A. Effect of customised preformed foot orthoses on gait parameters in children with juvenile idiopathic arthritis: A multicentre randomised clinical trial. Gait Posture 2022; 95:93-99. [PMID: 35468489 DOI: 10.1016/j.gaitpost.2022.04.017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 04/09/2022] [Accepted: 04/18/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) can experience significant physical impairment of the lower extremity. Prolonged joint disease and symptoms may cause gait alterations such as reduced walking speed and increased plantar pressures in diseased areas of their feet. There is limited robust clinical trials investigating the effect of non-invasive mechanical therapies such as foot orthoses (FOs) on improving gait parameters in children with JIA. RESEARCH QUESTION Are customised preformed FOs effective in improving gait parameters in children with JIA? METHODS A multicentre, parallel design, single-blinded randomised clinical trial was used to assess the gait impacts of customised preformed FOs on children with JIA. Children with a diagnosis of JIA, exhibiting lower limb symptoms and aged 5-18 were eligible. The trial group received a low-density full length, Slimflex Simple device which was customised chair side and the control group received a sham device. Peak pressure and pressure time integrals were used as the main gait outcomes and were measured using portable Tekscan gait analysis technology at baseline, 3 and 6 months. Differences at each follow-up were assessed using the Wilcoxon rank sum test. RESULTS 66 participants were recruited. Customised preformed FOs were effective in altering plantar pressures in children with JIA versus a control device. Reductions of peak pressures and pressure time integrals in the heel, forefoot and 5th metatarsophalangeal joint were statistically significant in favour of the trial group. This was associated with statistically significant increased midfoot contact with the trial device at baseline, 3 and 6-month data collections. The trial intervention was safe and well accepted by participants, which is reflected in the high retention rate (92%). SIGNIFICANCE Clinicians may prescribe customised preformed FOs in children with JIA to deflect pressure from painful joints and redistribute from high pressure areas such as the rearfoot and forefoot.
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Affiliation(s)
- Antoni Fellas
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia.
| | - Davinder Singh-Grewal
- The Sydney Children's Hospital Network Randwick, and Westmead, Australia; University of Sydney Discipline of Paediatrics and Child Health, Sydney, Australia; University of New South Wales, School of Women's and Children's Health, Australia
| | - Jeffrey Chaitow
- The Sydney Children's Hospital Network Randwick, and Westmead, Australia
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh EH21 6UU, UK
| | | | - Andrea Coda
- School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, Australia
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Li CF, Huang YF, Wang ZH, Zheng YY, Huang W, Zhang Y, Zhao Y. [Recommendations of diagnosis and treatment of juvenile idiopathic arthritis in China]. Zhonghua Nei Ke Za Zhi 2022; 61:142-156. [PMID: 35090249 DOI: 10.3760/cma.j.cn112138-20210929-00666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
The common clinical subtypes of juvenile idiopathic arthritis (JIA) include systemic onset juvenile idiopathic arthritis (SOJIA), oligoarthritis/polyarthritis juvenile idiopathic arthritis and juvenile spondyloarthritis. Juvenile idiopathic arthritis has no specific diagnostic index, and needs to be differentiated from infectious diseases and malignant diseases. The onset of SOJIA is rapid, the disease progresses rapidly, and it is easy to be complicated with macrophage activation syndrome (MAS) which is life-threatening. The experience of pediatric rheumatologists in dealing with JIA is still insufficient, and the standardized diagnosis and treatment level of this disease needs to be further improved. Based on the experience and guidelines of diagnosis and treatment in China and abroad, we formulated this diagnosis and treatment standard, aiming at standardizing the diagnosis and treatment of the subtypes of JIA and MAS, so as to reduce the incidence of disability and serious complications and improve the prognosis.
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Affiliation(s)
- C F Li
- Department of Rheumatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Y F Huang
- Department of Rheumatology and Immunology, Guangxi Academy of Medical Sciences, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, China
| | - Z H Wang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Baotou Medical College, Science and Technology University of Inner Mongolia, Baotou 014010, China
| | - Y Y Zheng
- Department of Clinical Immunology, Xijing Hospital, the Fourth Military Medical University, Xi'an 710032, China
| | - W Huang
- Department of Rheumatology and Clinical Immunology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou 570311, China
| | - Y Zhang
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Sever and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, National Clinical Research Center for Dermatologic and Immunologic Diseases, State Key Laboratory of Complex Sever and Rare Diseases, Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing 100730, China
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30
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Sahni J, Lamberghini F. Dental Management in Juvenile Idiopathic Arthritis. J Dent Child (Chic) 2022; 89:18-23. [PMID: 35337395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. It can involve the temporomandibular joint (TMJ) at onset; however, this is frequently overlooked until later stages when pain and dysfunction occur. The purpose of this paper is to discuss the case of a 14-year-old female with malocclusion and TMJ pain who presented for orthodontic treatment. The orthodontist referred her to the orofacial pain specialist to rule out TMJ dysfunction before starting care. After a comprehensive evaluation, the patient was diagnosed with JIA. Dentists can play a key role in the initial detection of systemic diseases causing TMJ pathology. This case report outlines the main orofacial signs and symptoms a dentist needs to be familiar with for the prompt identification of JIA, further reiterating the importance of an early diagnosis for a better prognosis and quality of life of a young patient with JIA.
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Affiliation(s)
- Jasjot Sahni
- Dr. Sahni, Assistant Professor, Department of Oral Medicine and Diagnostic Sciences, College of Dentistry, University ofIllinois Chicago, Chicago,Ill., USA
| | - Flavia Lamberghini
- Dr. Lamberghini, Assistant Professor, Department of Pediatric Dentistry, College of Dentistry, University ofIllinois Chicago, Chicago,Ill., USA
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31
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Leksell E, Eriksson C, Ernberg M, Hedenberg-Magnusson B. Facilitating Care of Children with Juvenile Idiopathic Arthritis, Orofacial Pain, and Dysfunction: An Interview Study of Specialized Health Professionals. J Oral Facial Pain Headache 2022; 35:278-287. [PMID: 34990496 DOI: 10.11607/ofph.2850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS (1) To deepen knowledge on how specialized health care professionals (HCPs) reflect on encounters with children diagnosed with juvenile idiopathic arthritis (JIA) and (2) to outline a theory for orofacial care. METHODS Grounded theory was used to discover the psychosocial processes involved in communication between HCPs, children, and parents, and this information was used to develop a theory about these processes. Using classic grounded theory, a total of 20 interviews with HCPs were analyzed. RESULTS One main concern, "secure health and biopsychosocial development," permeated all care. A core category was identified as "create a responsive interaction with the child and family." The data that supported this core category helped to explain how the HCP responded to a patient to promote orofacial health. Based on the dentist's responses to the child, eight subcategories were identified: (1) secure confidential relationships; (2) convey disease-specific knowledge; (3) communicate healthy findings and form mutual insights at examination; (4) encourage health-promoting behaviors; (5) ensure follow-up; (6) share perspectives; (7) guide parenting; and (8) improve knowledge and networks. CONCLUSION How the dentist shall best understand the needs of a child diagnosed with JIA requires further evaluation. To promote oral health, the child must feel safe, confirmed, and supported with knowledge. Also, further studies are needed on the dentist's collaboration with the pediatrician and the physiotherapist for contributing to overall health.
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Abstract
Health and health care disparities in pediatric rheumatology are prevalent among socially disadvantaged and marginalized populations based on race/ethnicity, socioeconomic position, and geographic region. These groups are more likely to experience greater disease severity, morbidity, mortality, decreased quality of life, and poor mental health outcomes, which are in part due to persistent structural and institutional barriers, including decreased access to quality health care. Most of the research on health and health care disparities in pediatric rheumatology focuses on juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus; there are significant gaps in the literature assessing disparities associated with other pediatric rheumatic diseases. Understanding the underlying causes of health care disparities will ultimately inform the development and implementation of innovative policies and interventions on a federal, local, and individual level.
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Affiliation(s)
- Alisha M Akinsete
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA. https://twitter.com/@akinsetemd
| | - Jennifer M P Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA. https://twitter.com/@jmpwoo
| | - Tamar B Rubinstein
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA.
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Reiser C, Zeltner NA, Rettenbacher B, Baumgaertner P, Huemer M, Huemer C. Explaining juvenile idiopathic arthritis to paediatric patients using illustrations and easy-to-read texts: improvement of disease knowledge and adherence to treatment. Pediatr Rheumatol Online J 2021; 19:158. [PMID: 34749738 PMCID: PMC8574941 DOI: 10.1186/s12969-021-00644-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/17/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is the leading chronic rheumatic disease in childhood. To achieve adherence to therapy, in-depth understanding of disease and treatment options are important. OBJECTIVE Development of specifically designed illustrations and standardised, easy-to-read texts for children and adolescents with JIA. Education materials were tested for comprehensibility and content validity. We hypothesised that children would be able to increase their knowledge about JIA after presentation of materials. METHODS The illustrations were designed by a graphic artist and the informative texts consecutively transformed to easy-to-read language. The materials appear as a modular system to allow individualized information for each patient. The illustrations and texts were tested for knowledge gain and improvement of self-efficacy in children affected by JIA/ rheumatic diseases and controls. Health-related quality of life (HRQoL) was tested as an overall assessment of patients' well-being. RESULTS 46 controls (71% female) and 38 patients (48% female) with a median age of 11 years were tested in a standardised setting. In both groups knowledge gain was significant (controls: t (44) = 11.08, p < 0.001, d = 1.65; patients: t (37) = 7.48, p < 0.001, d = 1.21). The control group had a significantly higher enhancement of disease knowledge compared to patients' group (p = .046) The follow-up testing was only performed in one school class (20 controls) due to Covid-19 pandemic with significant improvement compared to the pre-test results (p = .002). The enhancement of self-efficacy through the teaching session was significantly higher in the patients' group. No impairment of HRQoL was seen. CONCLUSION Explaining juvenile rheumatic diseases and therapeutic strategies is an important task in paediatric rheumatology. To avoid incomprehensible explanations in medical jargon, illustrations and easy-to-read texts were developed. Standardised presentation of the newly created materials resulted in a significant improvement of disease knowledge in patients and controls in addition to an enhancement of self-efficacy in patients.
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Affiliation(s)
| | - Nina A Zeltner
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland
| | | | - Petra Baumgaertner
- RWU Hochschule Ravensburg-Weingarten, University of Applied Sciences, Weingarten, Germany
| | - Martina Huemer
- Department of Paediatrics, LKH Bregenz, Bregenz, Austria
- Division of Metabolism and Children's Research Center, University Children's Hospital, Zurich, Switzerland
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Jouret M, Rinkin C, Seghaye MC, Malaise MG. [About a pediatric patients cohort followed in the adult rheumatology department of CHU Liège]. Rev Med Liege 2021; 76:741-745. [PMID: 34632743] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We realized an observational retrospective study about pediatric patients (between 1 to 18 years) followed at the CHU Liège in an adult rheumatologic service during the last 14 years. This study identified 102 patients who developed the first symptoms during infancy, identifying 39 different diseases. Mainly, we identify cases of idiopathic juvenile arthritis, rheumatoid arthritis, spondylarthropathies, systemic lupus erythematosus, systemic vasculitis, connective tissue diseases, bone diseases, and phosphocalcic metabolic disorders. These observations highlight the difficulties to classify inflammatory articular diseases in young patients. Furthermore, this article may be helpful to identify some specificities in the pediatric population who suffers from rheumatologic diseases and some essential factors to make an optimal transition to adult medicine.
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Affiliation(s)
- M Jouret
- Service de Pédiatrie, CHU Liège, Belgique
| | - C Rinkin
- Service de Rhumatologie, CHU Liège, Belgique
| | - M C Seghaye
- Faculté de Médecine, ULiège; Service de Pédiatrie, CHU Liège, Belgique
| | - M G Malaise
- Faculté de Médecine, ULiège; Service de Rhumatologie, CHU Liège, Belgique
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Sahin S, Acari C, Sonmez HE, Kilic FZ, Sag E, Dundar HA, Adrovic A, Demir S, Barut K, Bilginer Y, Sozeri B, Unsal E, Ozen S, Kasapcopur O. Frequency of juvenile idiopathic arthritis and associated uveitis in pediatric rheumatology clinics in Turkey: A retrospective study, JUPITER. Pediatr Rheumatol Online J 2021; 19:134. [PMID: 34425847 PMCID: PMC8383412 DOI: 10.1186/s12969-021-00613-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 06/13/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA), is the most common pediatric rheumatologic disorder with unknown etiology. Currently, no population-based data are available regarding the distribution of categories and frequency of uveitis in patients with JIA in Turkey. The purpose of this study was to evaluate the frequency of JIA-associated uveitis (JIAU) and distribution of JIA categories in a Turkish JIA cohort. METHODS This was a retrospective study of 500 randomized patients in four pediatric rheumatology clinics in Turkey. RESULTS Oligoarticular JIA (oJIA) was the most common JIA disease category in this study cohort (38.8%). The frequencies of the other categories were as follows: enthesitis-related arthritis (ERA), 23.2%; rheumatoid factor (RF)-negative polyarthritis, 15.6%; systemic arthritis, 12.2%; juvenile psoriatic arthritis, 5.2%; undifferentiated arthritis, 2.8%; and RF-positive polyarthritis, 2.2%. JIA-associated uveitis was observed in 6.8% of patients at a mean (Standard Deviation, SD) age of 9.1 (3.8) years over a mean JIA disease duration of 4 (1.9) years. Uveitis developed after joint disease, with a mean (SD) duration of 1.8 (1.9) years. Patients with oJIA had the highest rate of uveitis (12.9%) followed by patients with ERA (5.2%) and polyarticular RF-negative disease (3.8%). Compared with persistent oJIA, the extended oJIA category had a > 3-fold higher risk of uveitis (11.3% vs 27.7%; odds ratio, 3.38 [95% Confidence Interval, 1.09-10.4]). The most frequently administered drug after development of uveitis was tumor necrosis factor-alpha inhibitors (38.2%). Five patients (14.7%) had uveitis-related complications that required surgical intervention. CONCLUSIONS Turkish pediatric patients with JIA experience a lower frequency of oJIA and higher frequency of ERA than their white European counterparts; the occurrence of uveitis is also somewhat lower than expected. Geographic and ethnic factors may affect these differences and need further investigation.
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Affiliation(s)
- Sezgin Sahin
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey
| | - Ceyhun Acari
- Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | | | | | - Erdal Sag
- Hacettepe University, School of Medicine, Ankara, Turkey
| | | | - Amra Adrovic
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey
| | - Selcan Demir
- Hacettepe University, School of Medicine, Ankara, Turkey
| | - Kenan Barut
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey
| | - Yelda Bilginer
- Hacettepe University, School of Medicine, Ankara, Turkey
| | - Betul Sozeri
- Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Erbil Unsal
- Dokuz Eylul University, School of Medicine, Izmir, Turkey
| | - Seza Ozen
- Hacettepe University, School of Medicine, Ankara, Turkey
| | - Ozgur Kasapcopur
- Istanbul University-Cerrahpasa, School of Medicine, Koca Mustafapaşa Cd. No:53, Fatih, 34098, Istanbul, Turkey.
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Rapley T, May C, Smith N, Foster HE. 'Snakes & Ladders': factors influencing access to appropriate care for children and young people with suspected juvenile idiopathic arthritis - a qualitative study. Pediatr Rheumatol Online J 2021; 19:43. [PMID: 33757545 PMCID: PMC7986503 DOI: 10.1186/s12969-021-00531-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 03/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many children and young people with juvenile idiopathic arthritis (JIA) experience delay in diagnosis and access to right care. The reasons for delay are multi-factorial and influenced by patient and family, clinician and organisational factors. Our aim was to explore the experiences of care, from initial symptoms to initial referral to paediatric rheumatology. METHODS We analysed one-to-one and joint qualitative interviews with families of children with JIA (n = 36) presenting to a regional paediatric rheumatology service in the UK. We interviewed 51 family members (including mothers, fathers, patients, grandmothers and an aunt) and 10 health professionals (including orthopaedic surgeons, paediatricians, paediatric immunologist, General Practitioner and nurse) and a teacher involved in the care pathway of these JIA patients. Interviews were audio-recorded and analysed according to the standard procedures of rigorous qualitative analysis - coding, constant comparison, memoing and deviant case analysis. RESULTS The median age of the children was 6 years old (range 1-17), with a spread of JIA subtypes. The median reported time to first PRh MDT visit from symptom onset was 22 weeks (range 4-364 weeks). Three key factors emerged in the pathways to appropriate care: (i) the persistence of symptoms (e.g. 'change' such as limp or avoidance of previously enjoyed activities); (ii) the persistence of parents help-seeking actions (e.g. repeat visits to primary and hospital care with concern that their child is not 'normal'; iii) the experience and skills of health professionals resulting in different trajectories (e.g. no-real-concern-at-this-point or further-investigation-is-required). JIA was more likely to be considered amongst health practitioner if they had prior experiences of a child with JIA (moreso with a 'protracted pathway') or exposure to paediatric rheumatology in their training. Conversely JIA was more likely to be overlooked if the child had comorbidity such as learning disability or a chronic illness. CONCLUSIONS Care pathways are often 'turbulent' prior to a diagnosis of JIA with physical and emotional distress for families. There is need for greater awareness about JIA amongst health care professionals and observations of change (from family and non-health care professionals such as teachers) are key to trigger referral for paediatric rheumatology opinion.
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Affiliation(s)
- Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, NE7 7XA, Newcastle upon Tyne, United Kingdom.
| | - Carl May
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, WC1H 9SH, London, United Kingdom
| | - Nicola Smith
- Translational and Clinical Research Institute, Newcastle University, NE2 4HH, Newcastle upon Tyne, United Kingdom
| | - Helen E Foster
- Population and Health Sciences Institute, Newcastle University, NE2 4HH, Newcastle upon Tyne, United Kingdom
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Viscuso D, Storari M, Aprile M, Denotti G. Temporomandibular Disorders and Juvenile Idiopathic Arthritis: Scoping review with a case report. Eur J Paediatr Dent 2020; 21:303-308. [PMID: 33337907 DOI: 10.23804/ejpd.2020.21.04.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUD Juvenile Idiopathic Arthritis (JIA) encompasses a wide range of mostly idiopathic autoimmune arthritis which affect growing individuals. Temporomandibular disorders are a diffuse spectrum of diseases which involve temporomandibular joint (TMJ) and associated structures. However, much more need to be defined in order to detect and manage these conditions. Albeit satisfying evidences exist about their impact on the adult population, there is great lack of information in children. The current study has been developed in order to overview what it is known about these disorders and their mutual interactions. A case report as support to the scientific evidence has been further described. CASE REPORT A 7-year-old patient affected by an undifferentiated form of JIA developed arthritis to TMJs, complaining pain and functional impairments. After 2 years, the follow-up with combined pharmacological therapies and a modified oral stabilisation appliance shows no objective worsening of the joints' structures. However, the more complex symptomatic management of inflammation highlights the need for further knowledge. CONCLUSION The present study shows that both literature and clinical activity highlight a strong relationship between JIA and TMDs, that can affect the quality of life of children and adolescents. Diagnosis and management of these conditions are extremely complex, thus additional studies and evidence are needed. However, the need of an interdisciplinary approach between rheumatologists, paediatricians and dentists has been demonstrated.
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Affiliation(s)
- D Viscuso
- University of Cagliari, Department of Surgical Sciences, Dental School Medicine
| | - M Storari
- University of Cagliari, Department of Surgical Sciences, Dental School Medicine
| | - M Aprile
- University of Cagliari, Department of Surgical Sciences, Dental School Medicine
| | - G Denotti
- University of Cagliari, Department of Surgical Sciences, Dental School Medicine
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Ailioaie LM, Litscher G. Molecular and Cellular Mechanisms of Arthritis in Children and Adults: New Perspectives on Applied Photobiomodulation. Int J Mol Sci 2020; 21:ijms21186565. [PMID: 32911717 PMCID: PMC7554967 DOI: 10.3390/ijms21186565] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/05/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/13/2022] Open
Abstract
Juvenile idiopathic arthritis and adult rheumatoid arthritis are two major groups with chronic joint pain and inflammation, extra-articular manifestations, and high risk of comorbidities, which can cause physical and ocular disability, as well as create great socio-economic pressure worldwide. The pathogenesis of arthritis manifested in childhood and adulthood is multifactorial, unclear, and overly complex, in which immunity plays an important role. Although there are more and more biological agents with different mechanisms of action for the treatment of arthritis, the results are not as expected, because there are partial responses or non-responsive patients to these compounds, high therapeutic costs, side effects, and so on; therefore, we must turn our attention to other therapeutic modalities. Updating knowledge on molecular and cellular mechanisms in the comparative pathogenesis of chronic arthritis in both children and adults is necessary in the early and correct approach to treatment. Photobiomodulation (PBM) represents a good option, offering cost-effective advantages over drug therapy, with a quicker, more positive response to treatment and no side effects. The successful management of PBM in arthritis is based on the clinician’s ability to evaluate correctly the inflammatory status of the patient, to seek the optimal solution, to choose the best technology with the best physical parameters, and to select the mode of action to target very precisely the immune system and the molecular signaling pathways at the molecular level with the exact amount of quantum light energy in order to obtain the desired immune modulation and the remission of the disease. Light is a very powerful tool in medicine because it can simultaneously target many cascades of immune system activation in comparison with drugs, so PBM can perform very delicate tasks inside our cells to modulate cellular dysfunctions, helping to initiate self-organization phenomena and finally, healing the disease. Interdisciplinary teams should work diligently to meet these needs by also using single-cell imaging devices for multispectral laser photobiomodulation on immune cells.
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Affiliation(s)
- Laura Marinela Ailioaie
- Department of Medical Physics, Alexandru Ioan Cuza University, 11 Carol I Boulevard, 700506 Iaşi, Romania;
- Ultramedical & Laser Clinic, 83 Arcu Street, 700135 Iaşi, Romania
| | - Gerhard Litscher
- Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine, Research Unit for Complementary and Integrative Laser Medicine, and Traditional Chinese Medicine (TCM) Research Center Graz, Medical University of Graz, Auenbruggerplatz 39, 8036 Graz, Austria
- Correspondence: ; Tel.: +43-316-385-83907
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Strickler AL, Cifuentes D, Mihovilovic K, Vergara F, Grez M, Rivera V. [Change of diagnosis and diagnostic category in patients with juvenile idiopathic arthritis within 7 years of follow-up]. Rev Chil Pediatr 2020; 91:521-528. [PMID: 33399728 DOI: 10.32641/rchped.v91i4.1376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 04/27/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION At least 50% of pediatric patients with Juvenile Idiopathic Arthritis (JIA) will require continued fo llow-up in adult rheumatology. The present International League of Associations for Rheumatology (ILAR) classification, currently under revision, differs from its classification of inflammatory arthritis in adults. Category changes have been reported in 10.8% of patients during follow-up. OBJECTIVE To analyze JIA patients in follow-up for at least 7 years to detect diagnosis changes during transition to adult care, identifying factors of poor functional prognosis. PATIENTS AND METHOD Retrospective study based on medical records of JIA patients seen at the pediatric polyclinic of the Puerto Montt Hospital between 2005 and 2017, who were monitored for at least 7 years. Descriptive analysis was performed according to clinical variables: diagnostic category, evolution before diagnosis, clinical and serological activity, and evolution before starting drug therapy. RESULTS We evaluated 18 pa tients, corresponding to 3 patients with persistent oligoarticular arthritis (OA), 1 with extended OA, 4 with polyarticular arthritis (PA) rheumatoid factor (RF) negative, 4 with PA RF positive, 5 with syste mic JIA, and 1 with psoriatic arthritis, all have had follow-up more than 7 years. 11 out of 18 patients transitioned to adult care. Three out of 11 patients changed diagnosis to Rheumatoid Arthritis (RA) plus another autoimmune disease such as Sjögren's Syndrome + Systemic Lupus Erythematosus, Immune thrombocytopenia, or unclassified autoimmune disease, and 5 out of 11 children changed ILAR category from OA to Juvenile Rheumatoid Arthritis, extended OA to PA RF negative, and 3 from Systemic arthritis to PA RF negative. Age of onset, polyarticular forms, delay in diagnosis, and the start of therapy were associated with sequelae and persistent inflammation. CONCLUSIONS Eight of the eleven JIA patients who transitioned to adult care changed their diagnosis or presented other autoimmune diseases. Some factors of poor prognosis must improve.
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MESH Headings
- Adolescent
- Aftercare
- Arthritis, Juvenile/classification
- Arthritis, Juvenile/complications
- Arthritis, Juvenile/diagnosis
- Arthritis, Juvenile/therapy
- Arthritis, Psoriatic/complications
- Arthritis, Psoriatic/diagnosis
- Arthritis, Psoriatic/therapy
- Arthritis, Rheumatoid/classification
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnosis
- Arthritis, Rheumatoid/therapy
- Disease Progression
- Female
- Follow-Up Studies
- Humans
- Lupus Erythematosus, Systemic/complications
- Lupus Erythematosus, Systemic/diagnosis
- Lupus Erythematosus, Systemic/therapy
- Male
- Prognosis
- Purpura, Thrombocytopenic, Idiopathic/complications
- Purpura, Thrombocytopenic, Idiopathic/diagnosis
- Purpura, Thrombocytopenic, Idiopathic/therapy
- Retrospective Studies
- Transition to Adult Care
- Young Adult
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Affiliation(s)
- Alexis L Strickler
- Escuela de Medicina, Departamento de Pediatría, Universidad San Sebastián, Puerto Montt, Chile
| | - Daniela Cifuentes
- Escuela de Medicina, Departamento de Pediatría, Universidad San Sebastián, Puerto Montt, Chile
| | - Krasna Mihovilovic
- Escuela de Medicina, Departamento de Pediatría, Universidad San Sebastián, Puerto Montt, Chile
| | - Francisca Vergara
- Escuela de Medicina, Departamento de Pediatría, Universidad San Sebastián, Puerto Montt, Chile
| | - Mónica Grez
- Hospital Dr. Eduardo Schütz Schroeder, Puerto Montt, Chile
| | - Viviana Rivera
- Escuela de Medicina, Departamento de Salud Pública, Universidad San Sebastián, Puerto Montt, Chile
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Malcová H, Dallos T, Bouchalova K, Brejchová I, Brichová M, Bušányová B, Fabianová J, Fráňová J, Furdová A, Jarošová K, Kobrová K, Kostolná B, Košková E, Lokaj M, Macků M, Melocíková J, Michaličková M, Minxová L, Moravčíková D, Němcová D, Pískovský T, Říhová E, Schüller M, Skalická E, Svozílková P, Tomčíková D, Vargová V, Vrtíková E, Doležalová P, Heissigerová J. Recommendations for the Management of Uveitis Associated With Juvenile Idiopathic Arthritis: The Czech and Slovak adaptation of SHARE Initiative. Cesk Slov Oftalmol 2020; 76:1-15. [PMID: 33086847 DOI: 10.31348/2020/7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in children and uveitis is its most important extra-articular manifestation. Evidence-based recommendations are available only to a limited extent and therefore JIA associated uveitis management is mostly based on physicians experience. Consequently, treatment practices differ widely, both nationally and internationally. Therefore, an effort to optimize and publish recommendations for the care of children and young adults with rheumatic diseases was launched in 2012 as part of the international project SHARE (Single Hub and Access Point for Pediatric Rheumatology in Europe) to facilitate clinical practice for paediatricians and (paediatric) rheumatologists. The aim of this work was to translate published international SHARE recommendations for the diagnosis and treatment of JIA associated uveitis and to adapt them for use in the Czech and Slovak Republics. International recommendations were developed according to the standard methodology of the European League against Rheumatism (EULAR) by a group of nine experienced paediatric rheumatologists and three experts in ophthalmology. It was based on a systematic literature review and evaluated in the form of an online survey and subsequently discussed using a nominal group technique. Recommendations were accepted if > 80% agreement was reached (including all three ophthalmologists). A total of 22 SHARE recommendations were accepted: 3 on diagnosis, 5 on disease activity assessment, 12 on treatment and 2 on future recommendations. Translation of the original text was updated and modified with data specific to the czech and slovak health care systems and supplemented with a proposal for a protocol of ophthalmological dispensarization of paediatric JIA patients and a treatment algorithm for JIA associated uveitis. Conclusion: The aim of the SHARE initiative is to improve and standardize care for paediatric patients with rheumatic diseases across Europe. Therefore, recommendations for the diagnosis and treatment of JIA-associated uveitis have been formulated based on the evidence and agreement of leading European experts in this field.
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O'Higgins S, Stinson J, Ahola Kohut S, Caes L, Heary C, McGuire BE. Lending an Ear: iPeer2Peer plus Teens Taking Charge online self-management to empower adolescents with arthritis in Ireland: protocol for a pilot randomised controlled trial. BMJ Open 2019; 9:e027952. [PMID: 31843817 PMCID: PMC7008438 DOI: 10.1136/bmjopen-2018-027952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) negatively affects adolescents' everyday activities. To address the need for innovative, effective, convenient, low-cost psychosocial self-management programmes, we developed an Irish version of Canadian Teens Taking Charge (TTC) and integrated it with Skype-based peer support iPeer2Peer (iP2P). OBJECTIVES To explore the feasibility and preliminary outcome impact (effectiveness) of an integrated iP2P and Irish TTC, via three-arm (treatment as usual, TTC and iP2P-TTC) pilot randomised controlled trial (RCT); and determine feasibility and sample size for a full RCT. To ensure active involvement of adolescents with JIA via a Young Person Advisory Panel and examine how participants experienced the study. Finally, to see if TTC and iP2P with TTC reduce costs for families. METHODS AND ANALYSIS Recruitment of 60 families will be ongoing until July 2019, via healthcare professionals and support groups. Analysis will consist of single-blinded (outcome assessment), three-arm pilot RCT, using online questionnaires, with assessments at baseline (T1), after intervention (T2) and 3 months post-intervention (T3). The primary outcomes on feasibility with comparisons of TTC and iP2P-TTC on fidelity, acceptability and satisfaction, engagement and degrees of tailoring. The secondary outcomes will be self-management and self-efficacy and a range of health-related quality-of-life factors, pain indicators and costs.Participants from the intervention groups will be invited to share their perspectives on the process in semistructured interviews. Quantitative data will be analysed using SPSS V.21 and the audio-taped and transcribed qualitative data will be analysed using qualitative content analysis. DISSEMINATION Via journal articles, conference presentations, co-delivered by key stakeholders when possible, launch of accessible, effective and sustainable Internet self-management and peer support for Irish adolescents with JIA. TRIAL REGISTRATION NUMBER ISRCTN13535901; Pre-results.
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Affiliation(s)
- Siobhan O'Higgins
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Galway, Ireland
| | - Jennifer Stinson
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sara Ahola Kohut
- Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Medical Psychiatry Alliance, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, Scotland, UK
| | - Caroline Heary
- School of Psychology, National University of Ireland, Galway, Ireland
| | - Brian E McGuire
- Centre for Pain Research, School of Psychology, National University of Ireland, Galway, Galway, Ireland
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Barber CE, Lix LM, Lacaille D, Marshall DA, Kroeker K, Benseler S, Twilt M, Schmeling H, Barnabe C, Hazlewood GS, Bykerk V, Homik J, Thorne JC, Burt J, Mosher D, Katz S, Shiff NJ. Testing population-based performance measures identifies gaps in juvenile idiopathic arthritis (JIA) care. BMC Health Serv Res 2019; 19:572. [PMID: 31412858 PMCID: PMC6694666 DOI: 10.1186/s12913-019-4379-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 07/30/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The study evaluates Performance Measures (PMs) for Juvenile Idiopathic Arthritis (JIA): The percentage of patients with new onset JIA with at least one visit to a pediatric rheumatologist in the first year of diagnosis (PM1); and the percentage of patients with JIA under rheumatology care seen in follow-up at least once per year (PM2). METHODS Validated JIA case ascertainment algorithms were used to identify cases from provincial health administrative databases in Manitoba, Canada in patients < 16 years between 01/04/2005 and 31/03/2015. PM1: Using a 3-year washout period, the percentage of incident JIA patients with ≥1 visit to a pediatric rheumatologist in the first year was calculated. For each fiscal year, the proportion of patients expected to be seen in follow-up who had a visit were calculated (PM2). The proportion of patients with gaps in care of > 12 and > 14 months between consecutive visits were also calculated. RESULTS One hundred ninety-four incident JIA cases were diagnosed between 01/04/2008 and 03/31/2015. The median age at diagnosis was 9.1 years and 71% were female. PM1: Across the years, 51-81% of JIA cases saw a pediatric rheumatologist within 1 year. PM2: Between 58 and 78% of patients were seen in yearly follow-up. Gaps > 12, and > 14, months were observed once during follow-up in 52, and 34%, of cases, and ≥ twice in 11, and 5%, respectively. CONCLUSIONS Suboptimal access to pediatric rheumatologist care was observed which could lead to diagnostic and treatment delays and lack of consistent follow-up, potentially negatively impacting patient outcomes.
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Affiliation(s)
- Claire E.H. Barber
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Lisa M. Lix
- University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3 Canada
| | - Diane Lacaille
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
- Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Deborah A. Marshall
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Kristine Kroeker
- George & Fay Yee Centre for Healthcare Innovation, 3rd floor, 753 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
| | - Susanne Benseler
- Alberta Children’s Hospital, 28 Oki Drive, Calgary, T3B 6A8 AB Canada
| | - Marinka Twilt
- Alberta Children’s Hospital, 28 Oki Drive, Calgary, T3B 6A8 AB Canada
| | | | - Cheryl Barnabe
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Glen S. Hazlewood
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, 535 E 70th St, New York, NY USA
| | - Joanne Homik
- 3A Medicine Clinic, Third Floor, Edmonton Clinic, 11400 University Ave, Edmonton, AB T6G 1Z1 Canada
| | | | - Jennifer Burt
- Rheumatology Services, St. Clare’s Mercy Hospital, 154 LeMarchant Road, St. John’s, NL A1C 5B8 Canada
| | - Dianne Mosher
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Steven Katz
- Third Floor, Edmonton Clinic, 11400 University Ave, Edmonton, AB T6G 1Z1 Canada
| | - Natalie J. Shiff
- Department of Community Health & Epidemiology, University of Saskatchewan, Box 7, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
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O’Sullivan G, O’Higgins S, Caes L, Saetes S, McGuire BE, Stinson J. Self-management needs of Irish adolescents with Juvenile Idiopathic Arthritis (JIA): how can a Canadian web-based programme meet these needs? Pediatr Rheumatol Online J 2018; 16:68. [PMID: 30409209 PMCID: PMC6225653 DOI: 10.1186/s12969-018-0287-0] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Juvenile Idiopathic Arthritis (JIA) affects over 1000 children and adolescents in Ireland, potentially impacting health-related quality-of-life. Accessible self-management strategies, including Internet-based interventions, can support adolescents in Ireland where specialist rheumatology care is geographically-centralised within the capital city. This study interviewed adolescents with JIA, their parents, and healthcare professionals to (i) explore the self-management needs of Irish adolescents; and (ii) evaluate the acceptability of an adapted version of a Canadian JIA self-management programme (Teens Taking Charge: Managing Arthritis Online, or TTC) for Irish users. METHODS Focus groups and interviews were conducted with Irish adolescents with JIA (N = 16), their parents (N = 13), and Irish paediatric healthcare professionals (HCPs; N = 22). Adolescents were aged 12-18 (Mage = 14.19 years), and predominantly female (62.5%). Participants identified the needs of adolescents with JIA and evaluated the usefulness of the TTC programme. Data were analysed using a thematic analysis approach. RESULTS Five themes emerged: independent self-management; acquiring skills and knowledge to manage JIA; unique challenges of JIA in Ireland; views on web-based interventions; and understanding through social support. Adolescents acknowledged the need for independent self-management and gradually took additional responsibilities to achieve this goal. However, they felt they lacked information to manage their condition independently. Parents and adolescents emphasised the need for social support and felt a peer-support scheme could provide additional benefit to adolescents if integrated within the TTC programme. All participants endorsed the TTC programme to gain knowledge about JIA and offered suggestions to make the programme relevant to Irish users. CONCLUSIONS There is scope for providing easily-accessible, accurate information to Irish families with JIA. The acceptability of adapting an existing JIA self-management intervention for Irish users was confirmed.
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Affiliation(s)
- Grace O’Sullivan
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Siobhán O’Higgins
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Line Caes
- Division of Psychology; Faculty of Natural Sciences, University of Stirling, Stirling, Scotland, UK
| | - Sophia Saetes
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Brian E. McGuire
- Centre for Pain Research; School of Psychology, College of Arts, Social Sciences & Celtic Studies, Galway, NUI Ireland
| | - Jennifer Stinson
- The Hospital for Sick Children, Toronto, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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Conti F, Pontikaki I, D'Andrea M, Ravelli A, De Benedetti F. Patients with juvenile idiopathic arthritis become adults: the role of transitional care. Clin Exp Rheumatol 2018; 36:1086-1094. [PMID: 29652654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
Most juvenile idiopathic arthritis (JIA) patients need to attend adult rheumatology centres to continue the clinical management of their disease and to receive adequate long-term treatment. Transition from the paediatric to the adult health care team is a critical moment in the clinical history of these patients, but unfortunately, about 50% of the transfer processes to adult rheumatology are not successful, putting these patients at high risk of unfavourable outcomes. There are several obstacles to the success of transitional care for JIA patients, such as the absence of specific criteria for the assessment of disease activity, the lack of specific treatment recommendations for JIA adult patients, the poor adolescent-specific training for adult rheumatologists, and the shortage of resources. The improvement in the transition process in medical care has become a priority in many health care systems, but not many studies evaluating transition models, and common methodologies for measuring transition outcomes are available. The aim of this review is to identify and describe the models of transitional care in JIA, providing insights and recommendations to develop effective transitional care models in this disease.
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Affiliation(s)
- Fabrizio Conti
- Rheumatology Unit, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Italy.
| | - Irene Pontikaki
- Reumatologia dell'Età Evolutiva, UC di Reumatologia, ASST-Pini-CTO, Università di Milano, Italy
| | | | - Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
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Sherman G, Nemet D, Moshe V, Consolaro A, Ravelli A, Ruperto N, Uziel Y. Disease activity, overweight, physical activity and screen time in a cohort of patients with juvenile idiopathic arthritis. Clin Exp Rheumatol 2018; 36:1110-1116. [PMID: 29600947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Physical activity is an important part of children's health and social development. Juvenile idiopathic arthritis (JIA) can lead to decreased physical activity and quality of life. This study characterised clinical aspects, physical activity rates, obesity, and screen time in a group of JIA patients. METHODS Ninety-seven JIA patients in the Paediatric Rheumatology Clinic at Meir Medical Center were evaluated over a 6-month period and compared by statistical methods to 98 age-matched healthy controls. Information on disease activity, type and amount of physical activity (using the Modified Godin Leisure-Time Exercise Questionnaire), and daily screen time hours were collected. RESULTS Among the JIA patients, 56% had oligoarthritis, 22% polyarthritis and 17% systemic disease. Disease activity among all JIA sub-groups was low (average of 1.7/10), two-thirds of patients had disease activity lower than 3, only 4% over 5, and 56% were in clinical remission. Obesity rates in the patient and control groups were 21.5% and 19.4%, respectively. Physical activity levels were similar in both groups. Age at onset of disease and physical activity rate were negatively correlated (r=-0.288, p=0.004). Total weekly leisure activity of the control group was higher (46.9 vs. 38.4 hours, respectively), while daily screen time was similar (3.2 vs. 2.9 hours, respectively). CONCLUSIONS Physical activity, obesity rates and screen time hours were similar between JIA patients and controls. This lack of difference could be attributed to clinical remission following early, aggressive, treat-to-target therapy.
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Affiliation(s)
- Gilad Sherman
- Paediatric Rheumatology Unit, Department of Paediatrics, Meir Medical Center, Kfar Saba; and Sackler School of Medicine, Tel Aviv University, Israel
| | - Dan Nemet
- Sackler School of Medicine, Tel Aviv University; and Department of Paediatrics, Paediatric Child Health Sport Center, Meir Medical Center, Kfar Saba, Israel
| | - Veronica Moshe
- Paediatric Rheumatology Unit, Department of Paediatrics, Meir Medical Center, Kfar Saba; and Sackler School of Medicine, Tel Aviv University, Israel
| | | | - Angelo Ravelli
- Istituto G. Gaslini, Pediatria II-Reumatologia, Genova, Italy
| | | | - Yosef Uziel
- Paediatric Rheumatology Unit, Department of Paediatrics, Meir Medical Center, Kfar Saba; and Sackler School of Medicine, Tel Aviv University, Israel.
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46
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Malattia C, Tzaribachev N, van den Berg JM, Magni-Manzoni S. Juvenile idiopathic arthritis - the role of imaging from a rheumatologist's perspective. Pediatr Radiol 2018; 48:785-791. [PMID: 29766250 DOI: 10.1007/s00247-017-4014-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 10/11/2017] [Indexed: 10/17/2022]
Abstract
Alongside recent advances in treatment strategies for juvenile idiopathic arthritis (JIA), paediatric rheumatologists have taken increasing interest in the use of imaging. Magnetic resonance imaging (MRI) and musculoskeletal ultrasound, by providing more detailed information on disease activity than clinical examination and conventional radiography (CR), have become helpful diagnostic and managerial tools. The growing skeleton, however, with changing appearances over time, is still challenging in the establishment of valid scoring systems for pathological changes. Defining child- and age-specific reference standards is therefore a highly prioritized issue. The aim of this article is to raise awareness among radiologists of the substantial role that imaging can play to optimize the management of JIA patients and to describe the state-of-the-art validation process of imaging as an outcome measure. A closer collaboration between radiologists and pediatric rheumatologists is crucial to define a scheduled workflow for imaging in JIA.
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Affiliation(s)
- Clara Malattia
- Istituto Giannina Gaslini, Pediatria II, Reumatologia, Largo Gaslini, 5, 16147, Genoa, Italy.
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), University of Genova, Genoa, Italy.
| | | | - J Merlijn van den Berg
- Department of Pediatric Hematology, Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital AMC University of Amsterdam, Amsterdam, The Netherlands
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Nielsen S, Herlin T, Estmann Christensen A, Zak M, Myrup C, Glerup M, Consolaro A, Bovis F, Ruperto N. The Danish version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Rheumatol Int 2018; 38:131-138. [PMID: 29637339 PMCID: PMC5893706 DOI: 10.1007/s00296-018-3946-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 11/25/2022]
Abstract
The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient-reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Danish language. The reading comprehension of the questionnaire was tested in ten JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability and construct validity (convergent and discriminant validity). A total of 303 JIA patients (7.9% systemic, 35% oligoarticular, 22.1% RF negative polyarthritis, 35% other categories) and 99 healthy children, were enrolled in three centres. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the Danish version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.
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Affiliation(s)
- Susan Nielsen
- Paediatric Rheumatology Unit, Børnereumatologiskambulatorium, afsnit 4272, BørneUngeKlinikken, Juliane Marie Centret, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Marek Zak
- Paediatric Rheumatology Unit, Børnereumatologiskambulatorium, afsnit 4272, BørneUngeKlinikken, Juliane Marie Centret, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Charlotte Myrup
- Paediatric Rheumatology Unit, Børnereumatologiskambulatorium, afsnit 4272, BørneUngeKlinikken, Juliane Marie Centret, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Mia Glerup
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
- Dipartimento di Pediatria, Università di Genova, Genoa, Italy
| | - Francesca Bovis
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
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48
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Hofer M, von Scheven-Gête A, Santos M, Quartier P, Wouters C, Vanoni F, Saurenmann RK, Consolaro A, Bovis F, Ruperto N. The Swiss French version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Rheumatol Int 2018; 38:379-386. [PMID: 29637354 PMCID: PMC5893739 DOI: 10.1007/s00296-018-3981-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 11/27/2022]
Abstract
The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Swiss French language. The reading comprehension of the questionnaire was tested in ten JIA parents and patients. Each participating centre was asked to collect demographic, clinical data, and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach’s alpha, interscale correlations, test–retest reliability, and construct validity (convergent and discriminant validity). A total of 98 JIA patients (3.1% systemic, 43.9% oligoarticular, 16.3% RF negative polyarthritis, 36.7% other categories), and 64 healthy children were enrolled in a paediatric rheumatology centre. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the Swiss French version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.
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Affiliation(s)
- Michael Hofer
- Unité Romande d′Immuno-Rhumatologie Pediatrique, CHUV, University of Lausanne, Lausanne, Switzerland
- Unité Romande d′Immuno-Rhumatologie Pediatrique, University of Geneva, Geneva, Switzerland
| | - Annette von Scheven-Gête
- Unité Romande d′Immuno-Rhumatologie Pediatrique, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Matthieu Santos
- Unité Romande d′Immuno-Rhumatologie Pediatrique, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Pierre Quartier
- Université Paris-Descartes, Institut IMAGINE, Centre de Référence National Pour les Rhumatismes Inflammatoires et les Maladies Auto-Immunes Systémiques Rares de l’Enfant (RAISE), Unité d’Immunologie, Hématologie et Rhumatologie Pédiatrique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Carine Wouters
- UZ Leuven-Universitair Ziekenhuis, Reumatologie-Campus Gasthuisberg, Leuven, Belgium
| | - Federica Vanoni
- Dipartimento di Pediatria, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Rotraud K. Saurenmann
- Kantonsspital Winterthur, Pediatric and Adolescent Medicine, Winterthur, Switzerland
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini, 5, 16147 Genoa, Italy
- Dipartimento di Pediatria, Università di Genova, Genoa, Italy
| | - Francesca Bovis
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini, 5, 16147 Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini, 5, 16147 Genoa, Italy
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49
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Flato B, Rygg M, Nordal EB, Røisland M, Ødegård HB, Hoftun GB, Songstad NT, Consolaro A, Bovis F, Ruperto N. The Norwegian version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Rheumatol Int 2018; 38:291-298. [PMID: 29637327 PMCID: PMC5893693 DOI: 10.1007/s00296-018-3963-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 11/27/2022]
Abstract
The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient-reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Norwegian language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic and clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the 3 Likert assumptions, floor/ceiling effects, internal consistency, Cronbach's alpha, interscale correlations, test-retest reliability, and construct validity (convergent and discriminant validity). A total of 301 JIA patients (3.3% systemic, 41.2% oligoarticular, 25.9% RF negative polyarthritis, and 29.6% other categories) and 74 healthy children were enrolled in three centres. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the Norwegian version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.
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Affiliation(s)
- Berit Flato
- Department of Rheumatology and Medical Faculty, Oslo University Hospital and University of Oslo, Postboks 4950, Nydalen, 0424 Oslo, Norway
- Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Oslo, Norway
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs University Hospital of Trondheim, Trondheim, Norway
| | - Ellen Berit Nordal
- Department of Pediatrics, University Hospital of Northern Norway, Tromsö, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsö, Norway
| | - Mona Røisland
- Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Oslo, Norway
| | - Hanne Beate Ødegård
- Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Oslo, Norway
| | - Gry Børmark Hoftun
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs University Hospital of Trondheim, Trondheim, Norway
| | - Nils Thomas Songstad
- Department of Pediatrics, University Hospital of Northern Norway, Tromsö, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsö, Norway
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
- Dipartimento di Pediatria, Università di Genova, Genoa, Italy
| | - Francesca Bovis
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
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50
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Toplak N, Avcin T, Camernik M, Hren M, Sever M, Consolaro A, Bovis F, Ruperto N. The Slovene version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Rheumatol Int 2018; 38:363-369. [PMID: 29637345 PMCID: PMC5893708 DOI: 10.1007/s00296-018-3974-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 12/03/2022]
Abstract
The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Slovene language. The reading comprehension of the questionnaire was tested in 10 JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the 3 Likert assumptions, floor/ceiling effects, internal consistency, Cronbach’s alpha, interscale correlations, test–retest reliability, and construct validity (convergent and discriminant validity). A total of 100 JIA patients (7.0% systemic, 47.0% oligoarticular, 22.0% RF negative polyarthritis, 24.0% other categories) and 120 healthy children, were enrolled. The JAMAR components discriminated well healthy subjects from JIA patients, except for the Health-Related Quality of Life, Psychosocial Health subscales. All JAMAR components revealed good psychometric performances. In conclusion, the Slovene version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.
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Affiliation(s)
- Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center Ljubljana, Bohoriceva 20, 1525 Ljubljana, Slovenia
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center Ljubljana, Bohoriceva 20, 1525 Ljubljana, Slovenia
| | - Maja Camernik
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center Ljubljana, Bohoriceva 20, 1525 Ljubljana, Slovenia
| | - Mateja Hren
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center Ljubljana, Bohoriceva 20, 1525 Ljubljana, Slovenia
| | - Mateja Sever
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center Ljubljana, Bohoriceva 20, 1525 Ljubljana, Slovenia
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
- Dipartimento di Pediatria, Università di Genova, Genoa, Italy
| | - Francesca Bovis
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147 Genoa, Italy
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