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Smith EMD, Aggarwal A, Ainsworth J, Al-Abadi E, Avcin T, Bortey L, Burnham J, Ciurtin C, Hedrich CM, Kamphuis S, Lambert L, Levy DM, Lewandowski L, Maxwell N, Morand E, Özen S, Pain CE, Ravelli A, Saad Magalhaes C, Pilkington C, Schonenberg-Meinema D, Scott C, Tullus K, Beresford MW. Defining remission in childhood-onset lupus: PReS-endorsed consensus definitions by an international task force. Clin Immunol 2024; 263:110214. [PMID: 38604255 DOI: 10.1016/j.clim.2024.110214] [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: 01/23/2024] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To derive childhood-onset SLE (cSLE) specific remission definitions for future treat-to-target (T2T) trials, observational studies, and clinical practice. METHODS The cSLE International T2T Task Force conducted Delphi surveys exploring paediatric perspectives on adult-onset SLE remission targets. A modified nominal group technique was used to discuss, refine, and agree on the cSLE remission target criteria. RESULTS The Task Force proposed two definitions of remission: 'cSLE clinical remission on steroids (cCR)' and 'cSLE clinical remission off steroids (cCR-0)'. The common criteria are: (1) Clinical-SLEDAI-2 K = 0; (2) PGA score < 0.5 (0-3 scale); (4) stable antimalarials, immunosuppressive, and biologic therapy (changes due to side-effects, adherence, weight, or when building up to target dose allowed). Criterion (3) in cCR is the prednisolone dose ≤0.1 mg/kg/day (maximum 5 mg/day), whereas in cCR-0 it is zero. CONCLUSIONS cSLE definitions of remission have been proposed, maintaining sufficient alignment with the adult-SLE definition to facilitate life-course research.
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Affiliation(s)
- E M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - A Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - J Ainsworth
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Al-Abadi
- Department of Paediatric Rheumatology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - T Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Slovenia
| | - L Bortey
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J Burnham
- Department of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - C Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - S Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - L Lambert
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - D M Levy
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - L Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - N Maxwell
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Morand
- Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - S Özen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - C E Pain
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - C Saad Magalhaes
- Paediatric Rheumatology Division, Botucatu Medical School, Sao Paulo State, University (UNESP), Sao Paulo, Brazil
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious diseases, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - C Scott
- Department of Pediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - K Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Renaudineau Y, Charras A, Natoli V, Fusaro M, Smith EMD, Beresford MW, Hedrich CM. Type I interferon associated epistasis may contribute to early disease-onset and high disease activity in juvenile-onset lupus. Clin Immunol 2024; 262:110194. [PMID: 38508295 DOI: 10.1016/j.clim.2024.110194] [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: 12/04/2023] [Revised: 03/01/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
Pathologic type I interferon (T1IFN) expression is a key feature in systemic lupus erythematosus (SLE) that associates with disease activity. When compared to adult-onset disease, juvenile-onset (j)SLE is characterized by increased disease activity and damage, which likely relates to increased genetic burden. To identify T1IFN-associated gene polymorphisms (TLR7, IRAK1, miR-3142/miR-146a, IRF5, IRF7, IFIH1, IRF8, TYK2, STAT4), identify long-range linkage disequilibrium and gene:gene interrelations, 319 jSLE patients were genotyped using panel sequencing. Coupling phenotypic quantitative trait loci (QTL) analysis identified 10 jSLE QTL that associated with young age at onset (<12 years; IRAK1 [rs1059702], TLR7 [rs3853839], IFIH1 [rs11891191, rs1990760, rs3747517], STAT4 [rs3021866], TYK2 [rs280501], IRF8 [rs1568391, rs6638]), global disease activity (SLEDAI-2 K >10; IFIH1 [rs1990760], STAT4 [rs3021866], IRF8 [rs903202, rs1568391, rs6638]), and mucocutaneous involvement (TLR7 [rs3853839], IFIH1 [rs11891191, rs1990760]). This study suggests T1IFN-associated polymorphisms and gene:gene interrelations in jSLE. Genotyping of jSLE patients may allow for individualized treatment and care.
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Affiliation(s)
- Yves Renaudineau
- Immunology Department Laboratory, Referral Medical Biology Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France; INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | - Amandine Charras
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Valentina Natoli
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Università degli Studi di Genova, Dipartimento di Neuroscienze, riabilitazione, oftalmologia, genetica e scienze materno-infantili, DINOGMI, Genoa, Italy
| | - Mathieu Fusaro
- Immunology Department Laboratory, Referral Medical Biology Laboratory, Institut Fédératif de Biologie, Toulouse University Hospital Center, France; INFINITy, Toulouse Institute for Infectious and Inflammatory Diseases, INSERM U1291, CNRS U5051, University Toulouse III, Toulouse, France
| | - Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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Charras A, Hofmann SR, Cox A, Schulze F, Russ S, Northey S, Liu X, Fang Y, Haldenby S, Hartmann H, Bassuk AG, Carvalho A, Sposito F, Grinstein L, Rösen-Wolff A, Meyer-Bahlburg A, Beresford MW, Lainka E, Foell D, Wittkowski H, Girschick HJ, Morbach H, Uebe S, Hüffmeier U, Ferguson PJ, Hedrich CM. P2RX7 gene variants associate with altered inflammasome assembly and reduced pyroptosis in chronic nonbacterial osteomyelitis (CNO). J Autoimmun 2024; 144:103183. [PMID: 38401466 DOI: 10.1016/j.jaut.2024.103183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/01/2024] [Accepted: 02/13/2024] [Indexed: 02/26/2024]
Abstract
Chronic nonbacterial osteomyelitis (CNO), an autoinflammatory bone disease primarily affecting children, can cause pain, hyperostosis and fractures, affecting quality-of-life and psychomotor development. This study investigated CNO-associated variants in P2RX7, encoding for the ATP-dependent trans-membrane K+ channel P2X7, and their effects on NLRP3 inflammasome assembly. Whole exome sequencing in two related transgenerational CNO patients, and target sequencing of P2RX7 in a large CNO cohort (N = 190) were conducted. Results were compared with publicly available datasets and regional controls (N = 1873). Findings were integrated with demographic and clinical data. Patient-derived monocytes and genetically modified THP-1 cells were used to investigate potassium flux, inflammasome assembly, pyroptosis, and cytokine release. Rare presumably damaging P2RX7 variants were identified in two related CNO patients. Targeted P2RX7 sequencing identified 62 CNO patients with rare variants (32.4%), 11 of which (5.8%) carried presumably damaging variants (MAF <1%, SIFT "deleterious", Polyphen "probably damaging", CADD >20). This compared to 83 of 1873 controls (4.4%), 36 with rare and presumably damaging variants (1.9%). Across the CNO cohort, rare variants unique to one (Median: 42 versus 3.7) or more (≤11 patients) participants were over-represented when compared to 190 randomly selected controls. Patients with rare damaging variants more frequently experienced gastrointestinal symptoms and lymphadenopathy while having less spinal, joint and skin involvement (psoriasis). Monocyte-derived macrophages from patients, and genetically modified THP-1-derived macrophages reconstituted with CNO-associated P2RX7 variants exhibited altered potassium flux, inflammasome assembly, IL-1β and IL-18 release, and pyroptosis. Damaging P2RX7 variants occur in a small subset of CNO patients, and rare P2RX7 variants may represent a CNO risk factor. Observations argue for inflammasome inhibition and/or cytokine blockade and may allow future patient stratification and individualized care.
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Affiliation(s)
- Amandine Charras
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Sigrun R Hofmann
- Department of Pediatrics, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Allison Cox
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Felix Schulze
- Department of Pediatrics, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Susanne Russ
- Department of Pediatrics, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Sarah Northey
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Xuan Liu
- Centre of Genome Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK
| | - Yongxiang Fang
- Centre of Genome Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK
| | - Sam Haldenby
- Centre of Genome Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool, UK
| | - Hella Hartmann
- Light Microscopy Facility, Centre for Regenerative Therapies, Technische Universität Dresden, Germany
| | - Alexander G Bassuk
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Ana Carvalho
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Francesca Sposito
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Lev Grinstein
- Department of Pediatrics, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Rösen-Wolff
- Department of Pediatrics, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Germany
| | - Almut Meyer-Bahlburg
- Pediatric Rheumatology and Immunology, Department of Pediatrics, University Medicine Greifswald, Greifswald, Germany
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Elke Lainka
- Department of Pediatrics II, University Hospital Essen, University of Duisburg-Essen, Essen, Germany on behalf of the German Autoinflammatory Disease Network (AID Net), Germany
| | - Dirk Foell
- Department for Pediatric Rheumatology & Immunology, University Hospital Münster, Germany on behalf of the German Autoinflammatory Disease Network (AID Net), Germany
| | - Helmut Wittkowski
- Department for Pediatric Rheumatology & Immunology, University Hospital Münster, Germany on behalf of the German Autoinflammatory Disease Network (AID Net), Germany
| | | | - Henner Morbach
- Department of Pediatrics, University Hospital Würzburg, Germany
| | - Steffen Uebe
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Ulrike Hüffmeier
- Institute of Human Genetics, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Polly J Ferguson
- Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Christian M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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4
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Md Yusof MY, Smith EMD, Ainsworth S, Armon K, Beresford MW, Brown M, Cherry L, Edwards CJ, Flora K, Gilman R, Griffiths B, Gordon C, Howard P, Isenberg D, Jordan N, Kaul A, Lanyon P, Laws PM, Lightsone L, Lythgoe H, Mallen CD, Marks SD, Maxwell N, Moraitis E, Nash C, Pepper RJ, Pilkington C, Psarras A, Rostron H, Skeates J, Skeoch S, Tremarias D, Wincup C, Zoma A, Vital EM. Management and treatment of children, young people and adults with systemic lupus erythematosus: British Society for Rheumatology guideline scope. Rheumatol Adv Pract 2023; 7:rkad093. [PMID: 38058676 PMCID: PMC10695902 DOI: 10.1093/rap/rkad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/20/2023] [Indexed: 12/08/2023] Open
Abstract
The objective of this guideline is to provide up-to-date, evidence-based recommendations for the management of SLE that builds upon the existing treatment guideline for adults living with SLE published in 2017. This will incorporate advances in the assessment, diagnosis, monitoring, non-pharmacological and pharmacological management of SLE. General approaches to management as well as organ-specific treatment, including lupus nephritis and cutaneous lupus, will be covered. This will be the first guideline in SLE using a whole life course approach from childhood through adolescence and adulthood. The guideline will be developed with people with SLE as an important target audience in addition to healthcare professionals. It will include guidance related to emerging approved therapies and account for National Institute for Health and Care Excellence Technology Appraisals, National Health Service England clinical commissioning policies and national guidance relevant to SLE. The guideline will be developed using the methods and rigorous processes outlined in 'Creating Clinical Guidelines: Our Protocol' by the British Society for Rheumatology.
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Affiliation(s)
- Md Yuzaiful Md Yusof
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Eve M D Smith
- Department of Women’s and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Kate Armon
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Michael W Beresford
- Department of Women’s and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | | | - Lindsey Cherry
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Christopher J Edwards
- Musculoskeletal Research Unit, NIHR Southampton Clinical Research Facility, University Hospital Southampton, Southampton, UK
| | - Kalveer Flora
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, Harrow, UK
| | - Rebecca Gilman
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | | | - David Isenberg
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Natasha Jordan
- Department of Adolescent Rheumatology, St James’s Hospital and Children’s Health Ireland, Dublin, Ireland
| | - Arvind Kaul
- Department of Rheumatology, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Peter Lanyon
- Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Philip M Laws
- Department of Dermatology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Liz Lightsone
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
| | - Hanna Lythgoe
- Department of Paediatric Rheumatology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Christian D Mallen
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Keele, UK
| | - Stephen D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Elena Moraitis
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
- Infection, Immunity and Inflammation Department, University College of London Great Ormond Street Institute of Child Health, London, UK
| | - Clare Nash
- Pharmacy Department, Sheffield Children’s NHS Foundation Trust, Sheffield, UK
| | - Ruth J Pepper
- Department of Renal Medicine, Royal Free Hospital, London, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Antonios Psarras
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Heather Rostron
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- Leeds Children’s Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jade Skeates
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Sarah Skeoch
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - Chris Wincup
- Department of Clinical and Academic Rheumatology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Asad Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK
| | - Edward M Vital
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Zaripova LN, Midgley A, Christmas SE, Beresford MW, Pain C, Baildam EM, Oldershaw RA. Mesenchymal Stem Cells in the Pathogenesis and Therapy of Autoimmune and Autoinflammatory Diseases. Int J Mol Sci 2023; 24:16040. [PMID: 38003230 PMCID: PMC10671211 DOI: 10.3390/ijms242216040] [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: 09/04/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 11/26/2023] Open
Abstract
Mesenchymal stem cells (MSCs) modulate immune responses and maintain self-tolerance. Their trophic activities and regenerative properties make them potential immunosuppressants for treating autoimmune and autoinflammatory diseases. MSCs are drawn to sites of injury and inflammation where they can both reduce inflammation and contribute to tissue regeneration. An increased understanding of the role of MSCs in the development and progression of autoimmune disorders has revealed that MSCs are passive targets in the inflammatory process, becoming impaired by it and exhibiting loss of immunomodulatory activity. MSCs have been considered as potential novel cell therapies for severe autoimmune and autoinflammatory diseases, which at present have only disease modifying rather than curative treatment options. MSCs are emerging as potential therapies for severe autoimmune and autoinflammatory diseases. Clinical application of MSCs in rare cases of severe disease in which other existing treatment modalities have failed, have demonstrated potential use in treating multiple diseases, including rheumatoid arthritis, systemic lupus erythematosus, myocardial infarction, liver cirrhosis, spinal cord injury, multiple sclerosis, and COVID-19 pneumonia. This review explores the biological mechanisms behind the role of MSCs in autoimmune and autoinflammatory diseases. It also covers their immunomodulatory capabilities, potential therapeutic applications, and the challenges and risks associated with MSC therapy.
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Affiliation(s)
- Lina N. Zaripova
- Institute of Fundamental and Applied Medicine, National Scientific Medical Center, 42 Abylai Khan Avenue, Astana 010000, Kazakhstan;
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
| | - Angela Midgley
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Liverpool L14 5AB, UK; (A.M.); (M.W.B.); (C.P.)
| | - Stephen E. Christmas
- Department of Clinical Infection, Microbiology and Immunology, Institute of Infection and Global Health, Faculty of Health and Life Sciences, University of Liverpool, The Ronald Ross Building, 8 West Derby Street, Liverpool L69 7BE, UK;
| | - Michael W. Beresford
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Liverpool L14 5AB, UK; (A.M.); (M.W.B.); (C.P.)
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, East Prescott Road, Liverpool L14 5AB, UK
| | - Clare Pain
- Department of Women and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Institute in the Park, Alder Hey Children’s NHS Foundation Trust, Liverpool L14 5AB, UK; (A.M.); (M.W.B.); (C.P.)
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, East Prescott Road, Liverpool L14 5AB, UK
| | - Eileen M. Baildam
- Department of Paediatric Rheumatology, The Alexandra Hospital, Mill Lane, Cheadle SK8 2PX, UK;
| | - Rachel A. Oldershaw
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool L7 8TX, UK
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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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7
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Platt C, Longthorpe C, Sit J, Marks SD, Harmer M, Ciurtin C, Ramanan AV, Beresford MW. Pulmonary hypertension in juvenile-onset systemic lupus erythematosus: a case series. Clin Exp Rheumatol 2023; 41:1934-1939. [PMID: 37083167 DOI: 10.55563/clinexprheumatol/pye2t3] [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: 09/30/2022] [Accepted: 02/06/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVES Systemic lupus erythematosus (SLE) is a rare multisystem autoimmune disorder with a variable clinical phenotype. Pulmonary hypertension (PHTN) is a recognised (and not uncommonly asymptomatic) complication of the condition with an associated poor prognosis in adults. It is relatively rare in juvenile-onset SLE (JSLE). METHODS We present a retrospective descriptive case series of four female children aged 4 to 15 years at presentation of JSLE and aged 8 to 27 years at time of diagnosis of PHTN from the United Kingdom. All cases were identified through the UK JSLE Cohort Study. RESULTS Of 665 children with JSLE in the UK cohort study to date (data from 2006-2020), four (0.6%) were identified as having PHTN. 3/4 of the PHTN cases presented with cardiovascular symptoms and / or signs at presentation.3/4 were treated with Rituximab and had a good long-term outcome. Shared clinical features include high baseline disease activity scores. CONCLUSIONS JSLE has a high associated cardiovascular morbidity and mortality and early identification of treatable complications such as PHTN is vital. We suggest that children with high baseline disease activity scores and those presenting with cardiovascular symptoms and signs are most likely to have concurrent PHTN. Routine echocardiography is an effective screening tool and should be used as part of a standard diagnostic work-up.
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Affiliation(s)
- Caroline Platt
- Department of Paediatric Nephrology, Bristol Royal Hospital for Children, Bristol, UK.
| | - Catherine Longthorpe
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
| | - Jacqueline Sit
- Department of Paediatric Nephrology, Evelina London Children's Hospital, London, UK
| | - Stephen D Marks
- NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, and Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
| | - Matthew Harmer
- Department of Paediatric Nephrology, Southampton Children's Hospital, Southampton, UK
| | - Coziana Ciurtin
- Department of Paediatric Rheumatology, University College London, UK
| | | | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, and Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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8
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Hospach T, Belot A, Beresford MW, Dressler F, Kallinich T, Oommen P, Pain CE, Tenbrock K, Weller F, Roth J, Minden K, Hinze C, Sander O, Hedrich CM. On the climate emergency and the health of our patients: comment on the article by Dellaripa et al. Arthritis Rheumatol 2023; 75:1493-1494. [PMID: 36821404 DOI: 10.1002/art.42483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Toni Hospach
- Zentrum für Pädiatrische Rheumatologie am Klinikum Stuttgart (ZEPRAS), Stuttgart, Germany
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology Unit National Referee Centre for Rheumatic and Autoimmune and Systemic Diseases in Children (RAISE), Hospices Civils de Lyon, Lyon, France
| | - Michael W Beresford
- Department of Women's and Children's Health Institute of Life Course and Medical Sciences, University of Liverpool and Department of Rheumatology Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Frank Dressler
- Department of Paediatric Pneumology, Allergology and Neonatology, Children's Hospital, Medical School, Hanover, Germany
| | - Tilmann Kallinich
- German Rheumatism Research Centre Berlin Leibniz Institute and Department of Paediatric Pulmonology, Immunology, and Intensive Care Medicine Charité-Universitätsmedizin, Berlin, Germany
| | - Prassad Oommen
- Division of Pediatric Rheumatology Department of Pediatric Oncology, Hematology and Clinical Immunology, University Hospital, Medical Faculty Heinrich Heine University, Düsseldorf, Germany
| | - Clare E Pain
- Department of Women's and Children's Health Institute of Life Course and Medical Sciences, University of Liverpool and Department of Rheumatology Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Frank Weller
- Department of Pediatrics, Prof. Hess-Kinderklinik, Bremen, Germany
| | - Johannes Roth
- Division of Dermatology and Rheumatology, Department of Pediatrics and Professor of PediatricsUniversity of Ottawa, Ottawa, Canada
| | | | - Claas Hinze
- Pediatric Rheumatology, University Münster, Münster, Germany
| | - Oliver Sander
- Department of Rheumatology, University Düsseldorf, Düsseldorf, Germany
| | - Christian M Hedrich
- Department of Women's and Children's Health Institute of Life Course and Medical Sciences, University of Liverpool and Department of Rheumatology Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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9
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Preston J, Biglino G, Harbottle V, Dalrymple E, Stalford H, Beresford MW. Reporting involvement activities with children and young people in paediatric research: a framework analysis. Res Involv Engagem 2023; 9:61. [PMID: 37525218 PMCID: PMC10388467 DOI: 10.1186/s40900-023-00477-8] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND The active involvement of patients and the public in the design and delivery of health research has been increasingly encouraged, if not enforced. Knowledge of how this is realised in practice, especially where children and young people (CYP) are concerned, is limited, partly due to the low level of reporting of patient and public involvement (PPI) in general. The aim of this work was to assess how researchers funded by the National Institute for Health and Care Research (NIHR) report the involvement of CYP in the design and conduct of child health research to better understand the opportunities offered to CYP, and the realities of involvement in practice. METHODS A participation matrix, analysis framework and accompanying tools were adapted from existing frameworks, including a child-rights informed framework, the Guidance for Reporting Involvement of Patients and the Public Checklist Short Form (GRIPP2SF), and NIHR reporting expectations. Child-focused research reports were identified from the NIHR Journals Library, including any interventional or observational study involving CYP aged 0-< 24 years. In two co-design workshops with healthcare professionals and CYP, we tested and refined the participation matrix, analysis framework and accompanying tools. RESULTS Only thirty-two NIHR reports out of 169 (19%) were identified as relevant and included reporting of PPI with CYP. We identified significant variability in the way PPI with CYP was reported. Only 4/32 (12%) reports fully met NIHR (and GRIPP2SF) reporting criteria. Only 3/32 (9%) reports formally evaluated or self-reflected on PPI activities with CYP, whilst 15/32 (47%) provided minimal information about CYP involvement. The most common approach to involving CYP (23/32, 72%) was through the medium of existing groups or networks. CONCLUSION Despite the NIHR's commitment to increase the quality, transparency, and consistency of reporting PPI, the reporting of involvement with CYP remains sub-optimal. Neglecting to report key details of involvement methods and impacts deprives the research community of knowledge to advance the field of delivering 'meaningful' PPI with CYP. Practical guidance on how researchers can report the processes and outputs of CYP involvement more rigorously may help child health researchers to involve them more meaningfully. This research offers practical tools informed by CYP to aid the reporting process.
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Affiliation(s)
- Jennifer Preston
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.
| | | | - Victoria Harbottle
- Population Health Sciences Institute, University of Newcastle, Newcastle upon Tyne, UK
- Rehabilitation Department, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Emma Dalrymple
- Institute of Child Health, University College London, London, UK
| | - Helen Stalford
- School of Social Justice and Law, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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10
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Smith EMD, Aggarwal A, Ainsworth J, Al-Abadi E, Avcin T, Bortey L, Burnham J, Ciurtin C, Hedrich CM, Kamphuis S, Lambert L, Levy DM, Lewandowski L, Maxwell N, Morand E, Ozen S, Pain CE, Ravelli A, Saad Magalhaes C, Pilkington C, Schonenberg-Meinema D, Scott C, Tullus K, Beresford MW. PReS-endorsed international childhood lupus T2T task force definition of childhood lupus low disease activity state (cLLDAS). Clin Immunol 2023; 250:109296. [PMID: 36934849 PMCID: PMC10500564 DOI: 10.1016/j.clim.2023.109296] [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: 01/10/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To achieve a consensus-based definition of Low Disease Activity (LDA) for use in cSLE trials. METHODS The International cSLE T2T Task Force, comprising of paediatric rheumatologists/nephrologists, and adult rheumatologists undertook a series of Delphi surveys/consensus meetings to discuss, refine, and vote upon cSLE LDA criteria. RESULTS The Task Force agreed that LDA should be based upon the adult-SLE Lupus Low Disease Activity State definition (LLDAS), with modifications to make it applicable to cSLE (cLLDAS). They agreed upon five cLLDAS criteria: (1) SLE Disease Activity Index (SLEDAI)-2 K ≤4, with no activity in major organ systems; (2) no new features of lupus disease activity compared with the last assessment; (3) Physician Global Assessment score of ≤1 (0-3 scale); (4) prednisolone dose of ≤0.15 mg/kg/day, 7.5 mg/day/maximum; while on (5) stable antimalarials, immunosuppressives, and biologics. CONCLUSIONS A cSLE-appropriate definition of cLLDAS has been generated, maintaining alignment with the adult-SLE definition to promote life-course research.
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Affiliation(s)
- E M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - A Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - J Ainsworth
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Al-Abadi
- Department of Paediatric Rheumatology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - T Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Slovenia
| | - L Bortey
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J Burnham
- Department of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - C Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - S Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - L Lambert
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - D M Levy
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - L Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - N Maxwell
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Morand
- Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - S Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - C E Pain
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - C Saad Magalhaes
- Department of Pediatric Rheumatology, Botucatu Medical School, Sao Paulo State University, Sao Paulo, Brazil
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious diseases, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - C Scott
- Clinical Research Centre, Department of Pediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - K Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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11
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Hedrich CM, Beresford MW, Dedeoglu F, Hahn G, Hofmann SR, Jansson AF, Laxer RM, Miettunen P, Morbach H, Pain CE, Ramanan AV, Roberts E, Schnabel A, Theos A, Whitty L, Zhao Y, Ferguson PJ, Girschick HJ. Gathering expert consensus to inform a proposed trial in chronic nonbacterial osteomyelitis (CNO). Clin Immunol 2023; 251:109344. [PMID: 37098355 DOI: 10.1016/j.clim.2023.109344] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/23/2022] [Accepted: 04/07/2023] [Indexed: 04/27/2023]
Abstract
Chronic nonbacterial osteomyelitis (CNO) is an autoinflammatory bone disease that primarily affects children and adolescents. CNO is associated with pain, bone swelling, deformity, and fractures. Its pathophysiology is characterized by increased inflammasome assembly and imbalanced expression of cytokines. Treatment is currently based on personal experience, case series and resulting expert recommendations. Randomized controlled trials (RCTs) have not been initiated because of the rarity of CNO, expired patent protection of some medications, and the absence of agreed outcome measures. An international group of fourteen CNO experts and two patient/parent representatives was assembled to generate consensus to inform and conduct future RCTs. The exercise delivered consensus inclusion and exclusion criteria, patent protected (excludes TNF inhibitors) treatments of immediate interest (biological DMARDs targeting IL-1 and IL-17), primary (improvement of pain; physician global assessment) and secondary endpoints (improved MRI; improved PedCNO score which includes physician and patient global scores) for future RCTs in CNO.
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Affiliation(s)
- C M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK.
| | - M W Beresford
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - F Dedeoglu
- Boston Children's Hospital & Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - G Hahn
- Department of Radiology, University Medical Center Carl Gustav Carus, TU Dresden, Germany
| | - S R Hofmann
- Department of Paediatrics, University Medical Center Carl Gustav Carus, TU Dresden, Germany
| | - A F Jansson
- Department of Pediatrics, Dr von Hauner Children's Hospital, Ludwig Maximilian University, Munich, Germany
| | - R M Laxer
- The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - P Miettunen
- University of Calgary, Calgary, Alberta, Canada
| | - H Morbach
- Pediatric Immunology, University Childrens' Hospital Würzburg, Würzburg, Germany
| | - C E Pain
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - A V Ramanan
- Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol and Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - E Roberts
- CNO/CRMO Patient Partner, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - A Schnabel
- Department of Paediatrics, University Medical Center Carl Gustav Carus, TU Dresden, Germany
| | - A Theos
- CNO/CRMO Patient/parent Partner, Department of Human Science, Georgetown University, Washington, DC, USA
| | - L Whitty
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Y Zhao
- Seattle Children's Hospital, University of Washington, Seattle, United States of America
| | - P J Ferguson
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - H J Girschick
- Vivantes Children's Hospital in Friedrichshain, Berlin, Germany
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12
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Charras A, Haldenby S, Smith EMD, Egbivwie N, Olohan L, Kenny JG, Schwarz K, Roberts C, Al-Abadi E, Armon K, Bailey K, Ciurtin C, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, McErlane F, Modgil G, Pilkington C, Ramanan AV, Rangaraj S, Riley P, Sridhar A, Beresford MW, Hedrich CM. Panel sequencing links rare, likely damaging gene variants with distinct clinical phenotypes and outcomes in juvenile-onset SLE. Rheumatology (Oxford) 2023; 62:SI210-SI225. [PMID: 35532072 PMCID: PMC9949710 DOI: 10.1093/rheumatology/keac275] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/22/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Juvenile-onset systemic lupus erythematosus (jSLE) affects 15-20% of lupus patients. Clinical heterogeneity between racial groups, age groups and individual patients suggests variable pathophysiology. This study aimed to identify highly penetrant damaging mutations in genes associated with SLE/SLE-like disease in a large national cohort (UK JSLE Cohort Study) and compare demographic, clinical and laboratory features in patient sub-cohorts with 'genetic' SLE vs remaining SLE patients. METHODS Based on a sequencing panel designed in 2018, target enrichment and next-generation sequencing were performed in 348 patients to identify damaging gene variants. Findings were integrated with demographic, clinical and treatment related datasets. RESULTS Damaging gene variants were identified in ∼3.5% of jSLE patients. When compared with the remaining cohort, 'genetic' SLE affected younger children and more Black African/Caribbean patients. 'Genetic' SLE patients exhibited less organ involvement and damage, and neuropsychiatric involvement developed over time. Less aggressive first line treatment was chosen in 'genetic' SLE patients, but more second and third line agents were used. 'Genetic' SLE associated with anti-dsDNA antibody positivity at diagnosis and reduced ANA, anti-LA and anti-Sm antibody positivity at last visit. CONCLUSION Approximately 3.5% of jSLE patients present damaging gene variants associated with younger age at onset, and distinct clinical features. As less commonly observed after treatment induction, in 'genetic' SLE, autoantibody positivity may be the result of tissue damage and explain reduced immune complex-mediated renal and haematological involvement. Routine sequencing could allow for patient stratification, risk assessment and target-directed treatment, thereby increasing efficacy and reducing toxicity.
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Affiliation(s)
- Amandine Charras
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
| | - Sam Haldenby
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
| | - Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Naomi Egbivwie
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Lisa Olohan
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
| | - John G Kenny
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
- Teagasc Food Research Centre, Moorepark, Cork, Ireland
| | - Klaus Schwarz
- Institut for Transfusion Medicine, University Ulm, Ulm
- Institute for Clinical Transfusion Medicine and Immunogenetics Ulm, German Red Cross Blood Service Baden-Württemberg—Hessen, Ulm, Germany
| | - Carla Roberts
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s Hospital, Birmingham
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds
| | - Flora McErlane
- Paediatric Rheumatology, Great North Children’s Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Gita Modgil
- Department of Paediatrics, Musgrove Park Hospital, Taunton
| | | | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham
| | - Phil Riley
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester
| | - Arani Sridhar
- Department of Paediatrics, Leicester Royal Infirmary, Leicester, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences
- Centre for Genomic Research, Institute of Infection, Veterinary & Ecological Sciences, University of Liverpool
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13
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Wright RD, Marro J, Northey SJ, Corkhill R, Beresford MW, Oni L. Urinary complement proteins are increased in children with IgA vasculitis (Henoch-Schönlein purpura) nephritis. Pediatr Nephrol 2022; 38:1491-1498. [PMID: 36227437 PMCID: PMC10060309 DOI: 10.1007/s00467-022-05747-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 09/08/2022] [Accepted: 09/08/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Children with immunoglobulin A vasculitis (IgAV Henoch-Schönlein purpura) frequently encounter nephritis (IgAV-N) with 1-2% risk of kidney failure. The pathophysiology of IgAV-N is not fully understood with speculation that complement may contribute. The aim of this study was to identify whether urinary complement proteins are increased in children with IgAV-N. METHODS A cross-sectional prospective cohort of children with IgAV were recruited together with controls including healthy children and children with systemic lupus erythematosus (SLE). Patients were subdivided according to the presence of nephritis. Urinary C3, C4, C5, and C5a were measured by enzyme-linked immunosorbent assay (ELISA) and corrected for urinary creatinine. RESULTS The study included 103 children; 47 with IgAV (37 IgAV without nephritis, IgAVwoN; 10 IgAV-N), 30 SLE and 26 healthy children. Urinary complement C3, C4, and C5 were all statistically significantly increased in all children with IgAV compared to SLE patients (all p < 0.05). In patients with IgAV-N, urinary complement C3, C4, C5, C5a were all statistically significantly increased compared to IgAVwoN (C3 14.65 μg/mmol [2.26-20.21] vs. 2.26 μg/mmol [0.15-3.14], p = 0.007; C4 6.52 μg/mmol [1.30-9.72] vs. 1.37 μg/mmol [0.38-2.43], p = 0.04; C5 1.36 μg/mmol [0.65-2.85] vs. 0.38 μg/mmol [0.03-0.72], p = 0.005; C5a 101.9 ng/mmol [15.36-230.0] vs. 18.33 ng/mmol [4.27-33.30], p = 0.01). Using logistic regression, the urinary complement components produced an outstanding ability to discriminate between patients with and without nephritis in IgAV (AUC 0.92, p < 0.001). CONCLUSIONS Children with IgAV-N have evidence of increased complement proteins present in their urine that may indicate a pathological role and may allow treatment stratification. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Rachael D Wright
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
| | - Julien Marro
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
| | - Sarah J Northey
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
| | - Rachel Corkhill
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Member of Liverpool Health Partners, Liverpool, UK
| | - Louise Oni
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK.
- Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, Member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK.
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14
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Kearsley-Fleet L, Jain S, Baildam E, Beresford MW, Douglas S, Foster HE, Southwood TR, Hyrich KL. P66 Adalimumab originator versus biosimilar in children and young people with JIA. Rheumatol Adv Pract 2022. [PMCID: PMC9515880 DOI: 10.1093/rap/rkac067.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Background
Biosimilar therapies are considered to have comparable efficacy to their originators and prescribing is encouraged in the UK for significant cost-savings to the NHS. However, real-world evidence comparing originators and biosimilars is limited, particularly in children and young people. The objective of this analysis was to compare the effectiveness of the anti-TNF adalimumab originator and a biosimilar in the treatment of JIA in children and young people, by comparing change in disease activity after six months.
Description/Method
This analysis included children and young people with JIA from the Biologics for Children with Rheumatic Diseases (BCRD) study. Data are collected at the point of starting biologic therapy, and after 6 months, including patient demographics, biologic therapy, and disease activity. Patients were included if they were starting adalimumab (originator or biosimilar) as their first biologic. Patients with follow-up data at 6 months were assessed for outcomes at 6 months. Change in Juvenile Arthritis Disease Activity Score (JADAS-71) from baseline to 6 months was calculated and compared between therapies using linear regression. Multivariable logistical regression was used to compare remission (JADAS-71 ≤1) at 6 months between therapies. Both regression models were adjusted for baseline characteristics at the start of biologic therapy: age, gender, disease duration, ILAR category, history of uveitis, number of comorbidities (0/1/2+), and JADAS-71. Multiple imputation was used to account for missing data.
Discussion/Results
A total of 457 patients were registered starting adalimumab as their first biologic: 413 on originator, 44 on biosimilar (Table). Of these, 63% were female, median age at start of therapy was 11 years old (IQR 6, 14), and median disease duration was 2 years (IQR 1, 5). The majority of patients had RF-negative polyarticular JIA (29%), persistent oligoarticular (20%) or extended oligoarticular JIA (18%). There were 47% of patients who had a history of uveitits when starting biologic therapy, and 68% reported at least one comorbidity. Baseline characters were similar between both therapies. There were 429 patients with follow-up data after six months of treatment: 393 on originator and 36 on biosimliar. The median JADAS-71 improved by -4.4 (IQR -9.9, -0.2) with no difference seen between the originator and the biosimilar patients (adjusted b-coefficient: -0.4; 95% CI -2.6, 1.8; p = 734). There were 36% of patients in remission, with no difference between the two therapies (odds ratio 1.2; 95% CI 0.5, 2.9; p = 0.543).
Key learning points/Conclusion
There was no significant difference in disease activity response between children and young people with JIA treated with adalimumab originator versus biosimilar. These results support that the adalimumab biosimilar is similar in effectiveness to the originator in treating JIA, although more research is needed regarding safety and tolerability.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, The University of Manchester , Manchester, United Kingdom
| | - Sarthak Jain
- Centre for Epidemiology Versus Arthritis, The University of Manchester , Manchester, United Kingdom
| | - Eileen Baildam
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust , Liverpool, United Kingdom
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust , Liverpool, United Kingdom
- Institute of Life Course and Medical Specialities, University of Liverpool , Liverpool, United Kingdom
| | - Sharon Douglas
- Scottish Network for Arthritis in Children (SNAC) , Edinburgh, United Kingdom
| | - Helen E Foster
- Population and Health Institute, Newcastle University , Newcastle, United Kingdom
| | | | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester , Manchester, United Kingdom
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre , Manchester, United Kingdom
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15
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Kearsley-Fleet L, Baildam E, Beresford MW, Douglas S, Foster HE, Southwood TR, Hyrich KL, Ciurtin C. Successful stopping of biologic therapy for remission in children and young people with juvenile idiopathic arthritis. Rheumatology (Oxford) 2022; 62:1926-1935. [PMID: 36104094 PMCID: PMC10152290 DOI: 10.1093/rheumatology/keac463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/07/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Clinicians concerned about long-term safety of biologics in JIA may consider tapering or stopping treatment once remission is achieved despite uncertainty in maintaining drug-free remission. This analysis aims to (i) calculate how many patients with JIA stop biologics for remission, (ii) calculate how many later re-start therapy and after how long, and (iii) identify factors associated with re-starting biologics. METHODS Patients starting biologics between 1 January 2010 and 7 September 2021 in the UK JIA Biologics Register were included. Patients stopping biologics for physician-reported remission, those re-starting biologics and factors associated with re-starting, were identified. Multiple imputation accounted for missing data. RESULTS Of 1451 patients with median follow-up of 2.7 years (IQR 1.4, 4.0), 269 (19%) stopped biologics for remission after a median of 2.2 years (IQR 1.7, 3.0). Of those with follow-up data (N = 220), 118 (54%) later re-started therapy after a median of 4.7 months, with 84% re-starting the same biologic. Patients on any-line tocilizumab (prior to stopping) were less likely to re-start biologics (vs etanercept; odds ratio [OR] 0.3; 95% CI: 0.2, 0.7), while those with a longer disease duration prior to biologics (OR 1.1 per year increase; 95% CI: 1.0, 1.2) or prior uveitis were more likely to re-start biologics (OR 2.5; 95% CI: 1.3, 4.9). CONCLUSIONS This analysis identified factors associated with successful cessation of biologics for remission in JIA as absence of uveitis, prior treatment with tocilizumab and starting biologics earlier in the disease course. Further research is needed to guide clinical recommendations.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Eileen Baildam
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust.,Institute of Life Course and Medical Specialities, University of Liverpool, Liverpool
| | - Sharon Douglas
- Scottish Network for Arthritis in Children (SNAC), Edinburgh
| | - Helen E Foster
- Population and Health Institute, Newcastle University, Newcastle upon Tyne
| | | | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, London, UK
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16
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Smith EMD, Egbivwie N, Jorgensen AL, Ciurtin C, Al-Abadi E, Armon K, Bailey K, Brennan M, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, Malik G, McLaren Z, Pilkington C, Ramanan AV, Rangaraj S, Ratcliffe A, Riley P, Sen E, Sridhar A, Wilkinson N, Wood F, Beresford MW, Hedrich CM. Real world treatment of juvenile-onset systemic lupus erythematosus: Data from the UK JSLE cohort study. Clin Immunol 2022; 239:109028. [PMID: 35513304 DOI: 10.1016/j.clim.2022.109028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 04/28/2022] [Accepted: 04/28/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND In the absence of clinical trials evidence, Juvenile-onset Systemic Lupus Erythematosus (JSLE) treatment plans vary. AIM To explore 'real world' treatment utilising longitudinal UK JSLE Cohort Study data. METHODS Data collected between 07/2009-05/2020 was used to explore the choice/sequence of immunomodulating drugs from diagnosis. Multivariate logistic regression determined how organ-domain involvement (pBILAG-2004) impacted treatment choice. RESULT 349 patients met inclusion criteria, median follow-up 4-years (IQR:2,6). Mycophenolate mofetil (MMF) was most commonly used for the majority of organ-domains, and significantly associated with renal involvement (OR:1.99, 95% CI:1.65-2.41, pc < 0.01). Analyses assessing the sequence of immunomodulators focused on 197/349 patients (meeting relevant inclusion/exclusion criteria). 10/197 (5%) solely recieved hydroxychloroquine/prednisolone, 62/197 (31%) received a single-immunomodulator, 69/197 (36%) received two, and 36/197 patients (28%) received ≥three immunomodulators. The most common first and second line immunomodulator was MMF. Rituximab was the most common third-line immunomodulator. CONCLUSIONS Most UK JSLE patients required ≥two immunomodulators, with MMF used most commonly.
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Affiliation(s)
- Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK.
| | - Naomi Egbivwie
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
| | | | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London, UK
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mary Brennan
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds, UK
| | - Gulshan Malik
- Paediatric Rheumatology, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Zoe McLaren
- Liverpool University Hospitals NHS Foundation Trusts, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham, UK
| | - Annie Ratcliffe
- Department of Paediatrics, Taunton & Somerset NHS Foundation Trust - Musgrove Park Hospital, Taunton, UK
| | - Phil Riley
- Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ethan Sen
- Paediatric Rheumatology, Great North Children's Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Arani Sridhar
- Leicester Children's Hospital, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Nick Wilkinson
- Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Fiona Wood
- Department of Paediatrics, University Hospitals of Morecambe Bay NHS Foundation Trust, Royal Lancaster Infirmary, Lancaster, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
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17
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Carlsson E, Quist A, Davies JC, Midgley A, Smith EMD, Bruce IN, Beresford MW, Hedrich CM. Longitudinal analysis of urinary proteins in lupus nephritis - A pilot study. Clin Immunol 2022; 236:108948. [PMID: 35123058 DOI: 10.1016/j.clim.2022.108948] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 01/20/2023]
Abstract
Approximately 30% of adult-onset systemic lupus erythematosus (SLE) patients develop lupus nephritis (LN). The gold standard for LN detection involves renal biopsies, invasive procedures not suitable for routine disease monitoring. A urinary biomarker panel comprised of lipocalin-like prostaglandin D synthase (LPGDS), transferrin, alpha-1-acid glycoprotein (AGP-1), ceruloplasmin, monocyte chemoattractant protein 1 (MCP-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) has shown promise to predict LN and response to rituximab at baseline. Whether these proteins predict LN during longitudinal sampling, however, remained unknown. Here, we quantified aforementioned urinary proteins at baseline (N = 25), six and twelve months (N = 17 each) after rituximab treatment. Urine MCP-1 (at six and twelve months) and AGP-1 (at twelve months) levels varied between patients with active vs mildly active/inactive LN. Findings support the use of urinary proteins to detect active LN in ongoing disease monitoring in adult-onset SLE patients, but need to be validated in larger cohorts.
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Affiliation(s)
- Emil Carlsson
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Alexandra Quist
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Jennifer C Davies
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Angela Midgley
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Eve M D Smith
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool Health Partners, Liverpool, UK
| | - Ian N Bruce
- Versus Arthritis Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool Health Partners, Liverpool, UK
| | - Christian M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool Health Partners, Liverpool, UK.
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18
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Gallagher KL, Patel P, Beresford MW, Smith EMD. What Have We Learnt About the Treatment of Juvenile-Onset Systemic Lupus Erythematous Since Development of the SHARE Recommendations 2012? Front Pediatr 2022; 10:884634. [PMID: 35498799 PMCID: PMC9047745 DOI: 10.3389/fped.2022.884634] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/21/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction Juvenile-onset systemic lupus erythematous (JSLE) is a rare multisystem autoimmune disorder. In 2012, the Single Hub and Access point for pediatric Rheumatology in Europe (SHARE) initiative developed recommendations for the diagnosis/management of JSLE, lupus nephritis (LN) and childhood-onset anti-phospholipid syndrome (APS). These recommendations were based upon available evidence informing international expert consensus meetings. Objective To review new evidence published since 2012 relating to the management of JSLE, LN and APS in children, since the original literature searches informing the SHARE recommendations were performed. Method MEDLINE, EMBASE and CINAHL were systematically searched for relevant literature (2012-2021) using the following criteria: (1) English language studies; (2) original research studies regarding management of JSLE, LN, APS in children; (3) adult studies with 3 or more patients <18-years old, or where the lower limit of age range ≤16-years and the mean/median age is ≤30-years; (4) randomized controlled trials (RCTs), cohort studies, case control studies, observational studies, case-series with >3 patients. Three reviewers independently screened all titles/abstracts against predefined inclusion/exclusion criteria. All relevant manuscripts were reviewed independently by at least two reviewers. Data extraction, assessment of the level of evidence/methodological quality of the manuscripts was undertaken in-line with the original SHARE processes. Specific PUBMED literature searches were also performed to identify new evidence relating to each existing SHARE treatment recommendation. Results Six publications met the inclusion/exclusion criteria for JSLE: three RCTs, one feasibility trial, one case series. For LN, 16 publications met the inclusion/exclusion criteria: eight randomized trials, three open label prospective clinical trials, five observational/cohort studies. For APS, no publications met the inclusion criteria. The study with the highest evidence was an RCT comparing belimumab vs. placebo, including 93 JSLE patients. Whilst the primary-endpoint was not met, a significantly higher proportion of belimumab-treated patients met the PRINTO/ACR cSLE response to therapy criteria. New evidence specifically addressing each SHARE recommendation remains limited. Conclusion Since the original SHARE literature searches, undertaken >10-years ago, the main advance in JSLE treatment evidence relates to belimumab. Additional studies are urgently needed to test new/existing agents, and assess their long-term safety profile in JSLE, to facilitate evidence-based practice.
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Affiliation(s)
- Kathy L Gallagher
- Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Pallavi Patel
- Department of Public Health, Liverpool City Council, Liverpool, United Kingdom
| | - Michael W Beresford
- Institute of Life Course and Medical Science, University of Liverpool, Liverpool, United Kingdom.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Eve Mary Dorothy Smith
- Institute of Life Course and Medical Science, University of Liverpool, Liverpool, United Kingdom.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
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19
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Smith EMD, Tharmaratnam K, Al-Abadi E, Armon K, Bailey K, Brennan M, Ciurtin C, Gardner-Medwin J, Haslam KE, Hawley D, Leahy A, Leone V, Malik G, McLaren Z, Pilkington C, Ramanan AV, Rangaraj S, Ratcliffe A, Riley P, Sen E, Sridhar A, Wilkinson N, Hedrich CM, Jorgensen A, Beresford MW. Attainment of Low Disease Activity and Remission Targets reduces the risk of severe flare and new damage in Childhood Lupus. Rheumatology (Oxford) 2021; 61:3378-3389. [PMID: 34894234 PMCID: PMC9348762 DOI: 10.1093/rheumatology/keab915] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/03/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives To assess the achievability and effect of attaining low disease activity (LDA) or remission in childhood-onset SLE (cSLE). Methods Attainment of three adult-SLE derived definitions of LDA (LLDAS, LA, Toronto-LDA), and four definitions of remission (clinical-SLEDAI-defined remission on/off treatment, pBILAG-defined remission on/off treatment) was assessed in UK JSLE Cohort Study patients longitudinally. Prentice–Williams–Petersen gap recurrent event models assessed the impact of LDA/remission attainment on severe flare/new damage. Results LLDAS, LA and Toronto-LDA targets were reached in 67%, 73% and 32% of patients, after a median of 18, 15 or 17 months, respectively. Cumulatively, LLDAS, LA and Toronto-LDA was attained for a median of 23%, 31% and 19% of total follow-up-time, respectively. Remission on-treatment was more common (61% cSLEDAI-defined, 42% pBILAG-defined) than remission off-treatment (31% cSLEDAI-defined, 21% pBILAG-defined). Attainment of all target states, and disease duration (>1 year), significantly reduced the hazard of severe flare (P < 0.001). As cumulative time in each target increased, hazard of severe flare progressively reduced. LLDAS attainment reduced the hazard of severe flare more than LA or Toronto-LDA (P < 0.001). Attainment of LLDAS and all remission definitions led to a statistically comparable reduction in the hazards of severe flare (P > 0.05). Attainment of all targets reduced the hazards of new damage (P < 0.05). Conclusions This is the first study demonstrating that adult-SLE-derived definitions of LDA/remission are achievable in cSLE, significantly reducing risk of severe flare/new damage. Of the LDA definitions, LLDAS performed best, leading to a statistically comparable reduction in the hazards of severe flare to attainment of clinical remission.
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Affiliation(s)
- Eve M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Kukatharmini Tharmaratnam
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Mary Brennan
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London, UK
| | | | - Kirsty E Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - Daniel Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds, UK
| | - Gulshan Malik
- Paediatric Rheumatology, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Zoe McLaren
- Rheumatology Department, Aintree University Hospital, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham, UK
| | - Annie Ratcliffe
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
| | - Philip Riley
- Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Ethan Sen
- Paediatric Rheumatology, Great North Children's Hospital & Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Arani Sridhar
- Leicester Children's Hospital, University Hospitals of Leicester NHS trust, Leicester, UK
| | - Nick Wilkinson
- Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Andrea Jorgensen
- Department of Health Data Science, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
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20
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Smith EMD, Gorst SL, Al-Abadi E, Hawley DP, Leone V, Pilkington C, Ramanan AV, Rangaraj S, Sridhar A, Beresford MW, Young B. 'It is good to have a target in mind': qualitative views of patients and parents informing a treat to target clinical trial in juvenile-onset systemic lupus erythematosus. Rheumatology (Oxford) 2021; 60:5630-5641. [PMID: 33629109 PMCID: PMC8645274 DOI: 10.1093/rheumatology/keab173] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 10/01/2020] [Revised: 02/05/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE We sought to explore patient and parental views on treatment targets, outcome measures and study designs being considered for a future JSLE treat-to-target (T2T) study. METHODS We conducted topic-guided, semistructured interviews with JSLE patients and parents and analysed the audio recorded interviews using thematic approaches. RESULTS Patients and parents differed regarding symptoms they felt would be tolerable, representing 'low disease activity'. Patients often classed symptoms that they had previously experienced, were 'invisible' or had minimal disruption on their life as signs of low disease activity. Parents were more accepting of visible signs but were concerned about potential organ involvement and symptom severity. Overall, patients and parents preferred that children were entirely asymptomatic, with no ongoing treatment side effects. They regarded fatigue as particularly challenging, requiring proper monitoring using a fatigue patient-reported outcome measure. Most families felt that reducing corticosteroids would also be a good treatment target. Overall, families liked the concept of T2T, commenting that it could help to improve disease control, help structure treatment and improve communication with clinicians and treatment compliance. They were concerned that T2T might increase the frequency of hospital visits, thus impacting upon schooling, parental employment and finances. Families made suggestions on how to modify the future trial design to mitigate such effects. CONCLUSION This study provides guidance from patients and parents on T2T targets and study designs. Complementary quantitative studies assessing the achievability and impact of different targets (e.g. lupus low disease activity state or remission) are now warranted to inform an international consensus process to develop treatment targets.
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Affiliation(s)
- Eve M D Smith
- Institute of Life Course and Medical Science, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust
| | - Sarah L Gorst
- Department of Health Data Science, University of Liverpool, Liverpool
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s Hospital, Birmingham
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s NHS Foundation Trust, Sheffield
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds General Infirmary, Leeds
| | | | - Athimalaipet V Ramanan
- Bristol Royal Hospital for Children & Translational Health Sciences, University of Bristol, Bristol
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham
| | - Arani Sridhar
- Leicester Children’s Hospital, University Hospitals of Leicester NHS Trust, Leicester
| | - Michael W Beresford
- Institute of Life Course and Medical Science, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, UK
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21
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Smith EMD, Rasul S, Ciurtin C, Al-Abadi E, Armon K, Bailey K, Brennan M, Gardner-Medwin J, Haslam K, Hawley D, Lane S, Leahy A, Leone V, Malik G, Mewar D, Moots R, Pilkington C, Ramanan AV, Rangaraj S, Ratcliffe A, Riley P, Sen E, Sridhar A, Wilkinson N, Beresford MW, McCann LJ, Hedrich CM. Limited sensitivity and specificity of the ACR/EULAR-2019 classification criteria for SLE in JSLE?-observations from the UK JSLE Cohort Study. Rheumatology (Oxford) 2021; 60:5271-5281. [PMID: 33690793 PMCID: PMC8566265 DOI: 10.1093/rheumatology/keab210] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This study aimed to test the performance of the new ACR and EULAR criteria, that include ANA positivity as entry criterion, in JSLE. METHODS Performance of the ACR/EULAR-2019 criteria were compared with Systemic Lupus International Collaborating Clinics (SLICC-2012), using data from children and young people (CYP) in the UK JSLE Cohort Study (n = 482), with the ACR-1997 criteria used as reference standard. An unselected cohort of CYP positive for ANA (n = 129) was used to calculate positive/negative predictive values of the criteria. RESULTS At both first and last visits, the number of patients fulfilling the different classification criteria varied significantly (P < 0.001). The sensitivity of the SLICC-2012 criteria was higher when compared with that of the ACR/EULAR-2019 criteria at first and last visits (98% vs 94% for first visit, and 98% vs 96% for last visit; P < 0.001), when all available CYP were considered. The ACR/EULAR-2019 criteria were more specific when compared with the SLICC-2012 criteria (77% vs 67% for first visit, and 81% vs 71% for last visit; P < 0.001). Significant differences between the classification criteria were mainly caused by the variation in ANA positivity across ages. In the unselected cohort of ANA-positive CYP, the ACR/EULAR-2019 criteria produced the highest false-positive classification (6/129, 5%). CONCLUSION In CYP, the ACR/EULAR-2019 criteria are not superior to those of the SLICC-2012 or ACR-1997 criteria. If classification criteria are designed to include CYP and adult populations, paediatric rheumatologists should be included in the consensus and evaluation process, as seemingly minor changes can significantly affect outcomes.
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Affiliation(s)
- Eve M D Smith
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Sajida Rasul
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester
| | - Coziana Ciurtin
- Department of Rheumatology, Centre for Adolescent Rheumatology, University College London, London
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s Hospital, Birmingham
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - Mary Brennan
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford
| | - Daniel P Hawley
- Department of Paediatric Rheumatology, Sheffield Children’s Hospital, Sheffield
| | - Steven Lane
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds
| | - Gulshan Malik
- Paediatric Rheumatology, Royal Aberdeen Children’s Hospital, Aberdeen
| | - Devesh Mewar
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool
| | - Robert Moots
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk
| | | | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham
| | | | - Phil Riley
- Department of Paediatric Rheumatology, Royal Manchester Children’s Hospital, Manchester
| | - Ethan Sen
- Paediatric Rheumatology, Great North Children’s Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne
| | - Arani Sridhar
- Leicester Children’s Hospital, University Hospitals of Leicester NHS trust, Leicester
| | - Nick Wilkinson
- Department of Paediatric Rheumatology, Guy’s & St Thomas’s NHS Foundation Trust, Evelina Children’s Hospital, London, UK
| | - Michael W Beresford
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Liza J McCann
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
| | - Christian M Hedrich
- Department of Women’s & Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool
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22
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Pain CE, Beresford MW, Fortune F, Lai ETC, Murphy R, Taylor-Robinson D, Brogan PA, Moots RJ. Behçet's syndrome in children and young people in the United Kingdom and the Republic of Ireland: a prospective epidemiological study. Rheumatology (Oxford) 2021; 60:4728-4736. [PMID: 33527995 DOI: 10.1093/rheumatology/keab084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 01/02/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To define the incidence and prevalence of Behçet's syndrome (BS) in children and young people (CYP) up to the age of 16 years in the United Kingdom (UK) and Republic of Ireland (ROI). METHODS A prospective epidemiological study was undertaken with the support of the British Paediatric Surveillance Unit (BPSU) and the British Society of Paediatric Dermatologists (BSPD). Consultants reported anonymised cases of BS seen. A follow-up study at one year examined progression of disease and treatment. RESULTS Over a two-year period, 56 cases met the International Criteria for Behçet's Disease. For children under 16 years of age, the two-year period prevalence estimate was 4.2 per million (95% CI: 3.2, 5.4) and the incidence was 0.96 per million person years (95% CI: 0.66, 1.41). Mucocutaneous disease was the most common phenotype (56/100%), with ocular (10/56; 17.9%), neurological (2/56; 3.6%) and vascular involvement (3/56; 5.4%) being less common. Median age at onset was 6.34 years and at diagnosis was 11.72 years. There were slightly more female than male children reported (32/56; 55.6%). The majority of cases (85.7%) were white Caucasian. Apart from genital ulcers, which were more common in females, there were no significant differences in frequency of manifestations between male or females, nor between ethnicities. Over 83% of cases had three or more non-primary care healthcare professionals involved in their care. CONCLUSION BS is extremely rare in CYP in the UK and ROI and most have mucocutaneous disease. Healthcare needs are complex, and coordinated care is key.
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Affiliation(s)
- Clare E Pain
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool
| | - Farida Fortune
- Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Eric T C Lai
- Department of Public Health and Policy, University of Liverpool, Liverpool
| | - Ruth Murphy
- Department of Dermatology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | | | - Paul A Brogan
- Department of Paediatric Rheumatology, Great Ormond St Hospital NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London
| | - Robert J Moots
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust.,Faculty of Health, Social Care and Medicine, Edge Hill University, Liverpool, UK
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23
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Giani T, Smith EMD, Al-Abadi E, Armon K, Bailey K, Ciurtin C, Davidson J, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, McErlane F, Mewar D, Modgil G, Moots R, Pilkington C, Pregnolato F, Ramanan AV, Rangaraj S, Riley P, Sridhar A, Wilkinson N, Cimaz R, Beresford MW, Hedrich CM. Neuropsychiatric involvement in juvenile-onset systemic lupus erythematosus: Data from the UK Juvenile-onset systemic lupus erythematosus cohort study. Lupus 2021; 30:1955-1965. [PMID: 34601989 PMCID: PMC8649437 DOI: 10.1177/09612033211045050] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 08/19/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Juvenile-onset systemic lupus erythematosus (JSLE) is a rare autoimmune/inflammatory disease with significant morbidity and mortality. Neuropsychiatric (NP) involvement is a severe complication, encompassing a heterogeneous range of neurological and psychiatric manifestations. METHODS Demographic, clinical, and laboratory features of NP-SLE were assessed in participants of the UK JSLE Cohort Study, and compared to patients in the same cohort without NP manifestations. RESULTS A total of 428 JSLE patients were included in this study, 25% of which exhibited NP features, half of them at first visit. Most common neurological symptoms among NP-JSLE patients included headaches (78.5%), mood disorders (48.6%), cognitive impairment (42%), anxiety (23.3%), seizures (19.6%), movement disorders (17.7%), and cerebrovascular disease (14.9%). Peripheral nervous system involvement was recorded in 7% of NP-SLE patients. NP-JSLE patients more frequently exhibited thrombocytopenia (<100 × 109/L) (p = 0.04), higher C-reactive protein levels (p = 0.01), higher global pBILAG score at first visit (p < 0.001), and higher SLICC damage index score at first (p = 0.02) and last (p < 0.001) visit when compared to JSLE patients without NP involvement. CONCLUSIONS A significant proportion of JSLE patients experience NP involvement (25%). Juvenile-onset NP-SLE most commonly affects the CNS and is associated with increased overall disease activity and damage.
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Affiliation(s)
- Teresa Giani
- Rheumatology Unit, AOU Meyer, Florence, Italy
- Department of Medical
Biotechnology, University of Siena, Siena, Italy
| | - Eve MD Smith
- Department of Women’s &
Children’s Health, Institute of Life Course and Medical
Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric
Rheumatology, Alder Hey Children’s NHS Foundation
Trust Hospital, Liverpool, UK
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children’s
Hospital, Birmingham, UK
| | - Kate Armon
- Department of Paediatric
Rheumatology, Cambridge University
Hospitals, Cambridge, UK
| | - Kathryn Bailey
- Department of Paediatric
Rheumatology, Oxford University Hospitals NHS
Foundation Trust, Oxford, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College
London, London, UK
| | - Joyce Davidson
- Department of Paediatric
Rheumatology, Royal Hospital for Sick
Children, Edinburgh, UK
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal
Infirmary, Bradford, UK
| | - Dan P Hawley
- Department of Paediatric
Rheumatology, Sheffield Children’s
Hospital, Sheffield, UK
| | - Alice Leahy
- Department of Paediatric
Rheumatology, Southampton General
Hospital, Southampton, UK
| | - Valentina Leone
- Department of Paediatric
Rheumatology, Leeds Children Hospital, Leeds, UK
| | - Flora McErlane
- Paediatric Rheumatology, Great
North Children’s Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine,
Newcastle University, Newcastle Upon Tyne, UK
| | - Devesh Mewar
- Department of Rheumatology, Royal Liverpool University
Hospital, Liverpool, UK
| | - Gita Modgil
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
| | - Robert Moots
- Department of Rheumatology, University Hospital
Aintree, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric
Rheumatology, Great Ormond Street
Hospital, London, UK
| | | | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS
Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Satyapal Rangaraj
- Department of Paediatric
Rheumatology, Nottingham University
Hospitals, Nottingham, UK
| | - Phil Riley
- Department of Paediatric
Rheumatology, Royal Manchester Children’s
Hospital, Manchester, UK
| | - Arani Sridhar
- Department of Paediatrics, Leicester Royal
Infirmary, Leicester, UK
| | - Nick Wilkinson
- Guy’s & St Thomas’s NHS
Foundation Trust, Evelina Children’s
Hospital, London, UK
| | - Rolando Cimaz
- ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences
and Community Health, Research Center for Adult and
Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
| | - Michael W Beresford
- Department of Women’s &
Children’s Health, Institute of Life Course and Medical
Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric
Rheumatology, Alder Hey Children’s NHS Foundation
Trust Hospital, Liverpool, UK
| | - Christian M Hedrich
- Department of Women’s &
Children’s Health, Institute of Life Course and Medical
Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric
Rheumatology, Alder Hey Children’s NHS Foundation
Trust Hospital, Liverpool, UK
| | - on behalf of the UK JSLE Cohort Study
- Rheumatology Unit, AOU Meyer, Florence, Italy
- Department of Medical
Biotechnology, University of Siena, Siena, Italy
- Department of Women’s &
Children’s Health, Institute of Life Course and Medical
Sciences, University of Liverpool, Liverpool, UK
- Department of Paediatric
Rheumatology, Alder Hey Children’s NHS Foundation
Trust Hospital, Liverpool, UK
- Department of Rheumatology, Birmingham Children’s
Hospital, Birmingham, UK
- Department of Paediatric
Rheumatology, Cambridge University
Hospitals, Cambridge, UK
- Department of Paediatric
Rheumatology, Oxford University Hospitals NHS
Foundation Trust, Oxford, UK
- Centre for Adolescent Rheumatology, University College
London, London, UK
- Department of Paediatric
Rheumatology, Royal Hospital for Sick
Children, Edinburgh, UK
- Department of Child Health, University of Glasgow, Glasgow, UK
- Department of Paediatrics, Bradford Royal
Infirmary, Bradford, UK
- Department of Paediatric
Rheumatology, Sheffield Children’s
Hospital, Sheffield, UK
- Department of Paediatric
Rheumatology, Southampton General
Hospital, Southampton, UK
- Department of Paediatric
Rheumatology, Leeds Children Hospital, Leeds, UK
- Paediatric Rheumatology, Great
North Children’s Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine,
Newcastle University, Newcastle Upon Tyne, UK
- Department of Rheumatology, Royal Liverpool University
Hospital, Liverpool, UK
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
- Department of Rheumatology, University Hospital
Aintree, Liverpool, UK
- Department of Paediatric
Rheumatology, Great Ormond Street
Hospital, London, UK
- Immunorheumatology Research
Laboratory, Auxologico Institute, Milan, Italy
- University Hospitals Bristol NHS
Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
- Department of Paediatric
Rheumatology, Nottingham University
Hospitals, Nottingham, UK
- Department of Paediatric
Rheumatology, Royal Manchester Children’s
Hospital, Manchester, UK
- Department of Paediatrics, Leicester Royal
Infirmary, Leicester, UK
- Guy’s & St Thomas’s NHS
Foundation Trust, Evelina Children’s
Hospital, London, UK
- ASST Gaetano Pini-CTO, Milan, Italy
- Department of Clinical Sciences
and Community Health, Research Center for Adult and
Pediatric Rheumatic Diseases, University of Milan, Milan, Italy
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24
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Desai Y, Jaki T, Beresford MW, Burnett T, Eleftheriou D, Jacobe H, Leone V, Li S, Mozgunov P, Ramanan AV, Torok KS, Anderson ME, Anton J, Avcin T, Felton J, Foeldvari I, Laguda B, McErlane F, Shaw L, Zulian F, Pain CE. Prior elicitation of the efficacy and tolerability of Methotrexate and Mycophenolate Mofetil in Juvenile Localised Scleroderma. AMRC Open Res 2021; 3:20. [PMID: 38708070 PMCID: PMC11064983 DOI: 10.12688/amrcopenres.13008.1] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 05/07/2024]
Abstract
Background Evidence is lacking for safe and effective treatments for juvenile localised scleroderma (JLS). Methotrexate (MTX) is commonly used first line and mycophenolate mofetil (MMF) second line, despite a limited evidence base. A head to head trial of these two medications would provide data on relative efficacy and tolerability. However, a frequentist approach is difficult to deliver in JLS, because of the numbers needed to sufficiently power a trial. A Bayesian approach could be considered. Methods An international consensus meeting was convened including an elicitation exercise where opinion was sought on the relative efficacy and tolerability of MTX compared to MMF to produce prior distributions for a future Bayesian trial. Secondary aims were to achieve consensus agreement on critical aspects of a future trial. Results An international group of 12 clinical experts participated. Opinion suggested superior efficacy and tolerability of MMF compared to MTX; where most likely value of efficacy of MMF was 0.70 (95% confidence interval (CI) 0.34-0.90) and of MTX was 0.68 (95% CI 0.41-0.8). The most likely value of tolerability of MMF was 0.77 (95% CI 0.3-0.94) and of MTX was 0.62 (95% CI 0.32-0.84). The wider CI for MMF highlights that experts were less sure about relative efficacy and tolerability of MMF compared to MTX. Despite using a Bayesian approach, power calculations still produced a total sample size of 240 participants, reflecting the uncertainty amongst experts about the performance of MMF. Conclusions Key factors have been defined regarding the design of a future Bayesian approach clinical trial including elicitation of prior opinion of the efficacy and tolerability of MTX and MMF in JLS. Combining further efficacy data on MTX and MMF with prior opinion could potentially reduce the pre-trial uncertainty so that, when combined with smaller trial sample sizes a compelling evidence base is available.
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Affiliation(s)
- Yasin Desai
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Thomas Jaki
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, L12 2AP, UK
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Thomas Burnett
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health, London, WC1N 1EH, UK
- Department of Paediatric Rheumatology, Great Ormond St Hospital NHS Foundation Trust, London, WC1N 3JH, UK
| | - Heidi Jacobe
- UT Southwestern Medical Center, Dallas, Texas, TX 75390, USA
| | - Valentina Leone
- Paediatric Rheumatology Department, Leeds Children Hospital (Leeds Teaching Hospitals) and University of Leeds, Leeds, LS1 3EX, UK
| | - Suzanne Li
- Department of Pediatrics, Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center & Hackensack Meridian School of Medicine, Hackensack, New Jersey, NJ 07601, USA
| | - Pavel Mozgunov
- MPS Research Unit, Department of Mathematics and Statistics, Lancaster University, Lancaster, LA1 4YF, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Translational Health Sciences, Bristol, BS1 3NU, UK
| | - Kathryn S Torok
- Division of Rheumatology, Department of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - Marina E Anderson
- Department of Rheumatology, Liverpool University Hospitals NHS Foundation Trust, Liverpool, L9 7AL, UK
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4YF, UK
| | - Jordi Anton
- Pediatric Rheumatology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Barcelona, 08007, UK
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre, Ljubljana, 1000 Ljubljana, Slovenia
| | - Jessie Felton
- Department of Dermatology, Brighton and Sussex University Hospitals & Royal Alexandra Children’s Hospital, Brighton, BN2 1DH, UK
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescence Rheumatology, Hamburg, 22081 Hamburg, Germany
| | - Bisola Laguda
- Department of Paediatric Dermatology, Chelsea and Westminster Hospital, London, SW10 9NH, UK
| | - Flora McErlane
- Department of Paediatric Rheumatology, Great North Children's Hospital, Newcastle, NE1 4LP, UK
| | - Lindsay Shaw
- Department of Paediatric Rheumatology, Great Ormond St Hospital NHS Foundation Trust, London, WC1N 3JH, UK
- University Hospitals Bristol NHS Foundation Trust & Translational Health Sciences, Bristol, BS1 3NU, UK
| | - Francesco Zulian
- Department of Woman's and Child's Health, University of Padova, Padua, 35122 Padua, Italy
| | - Clare E Pain
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, L12 2AP, UK
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25
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Brogan PA, Arch B, Hickey H, Anton J, Iglesias E, Baildam E, Mahmood K, Cleary G, Moraitis E, Papadopoulou C, Beresford MW, Riley P, Demir S, Ozen S, Culeddu G, Hughes DA, Dolezalova P, Hampson LV, Whitehead J, Jayne D, Ruperto N, Tudur-Smith C, Eleftheriou D. Mycophenolate Mofetil Versus Cyclophosphamide for Remission Induction in Childhood Polyarteritis Nodosa: An Open-Label, Randomized, Bayesian Noninferiority Trial. Arthritis Rheumatol 2021; 73:1673-1682. [PMID: 33760371 DOI: 10.1002/art.41730] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 07/09/2020] [Accepted: 03/11/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Cyclophosphamide (CYC) is used in clinical practice off-label for the induction of remission in childhood polyarteritis nodosa (PAN). Mycophenolate mofetil (MMF) might offer a less toxic alternative. This study was undertaken to explore the relative effectiveness of CYC and MMF treatment in a randomized controlled trial (RCT). METHODS This was an international, open-label, Bayesian RCT to investigate the relative effectiveness of CYC and MMF for remission induction in childhood PAN. Eleven patients with newly diagnosed childhood PAN were randomized (1:1) to receive MMF or intravenous CYC; all patients received the same glucocorticoid regimen. The primary end point was remission within 6 months while compliant with glucocorticoid taper. Bayesian distributions for remission rates were established a priori for MMF and CYC by experienced clinicians and updated to posterior distributions on trial completion. RESULTS Baseline disease activity and features were similar between the 2 treatment groups. The primary end point was met in 4 of 6 patients (67%) in the MMF group and 4 of 5 patients (80%) in the CYC group. Time to remission was shorter in the MMF group compared to the CYC group (median 7.1 weeks versus 17.6 weeks). No relapses occurred in either group within 18 months. Two serious infections were found to be likely linked to MMF treatment. Physical and psychosocial quality-of-life scores were superior in the MMF group compared to the CYC group at 6 months and 18 months. Combining the prior expert opinion with results from the present study provided posterior estimates of remission of 71% for MMF (90% credibility interval [90% CrI] 51, 83) and 75% for CYC (90% CrI 57, 86). CONCLUSION The present results, taken together with prior opinion, indicate that rates of remission induction in childhood PAN are similar with MMF treatment and CYC treatment, and MMF treatment might be associated with better health-related quality of life than CYC treatment.
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Affiliation(s)
- Paul A Brogan
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | | | | | - Eileen Baildam
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Kamran Mahmood
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Gavin Cleary
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Elena Moraitis
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | | | | | - Phil Riley
- Royal Manchester Children's Hospital, Manchester, UK
| | | | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | | | | | - Pavla Dolezalova
- General University Hospital in Prague and Charles University, Prague, Czech Republic
| | | | | | | | - Nicola Ruperto
- Instituto Giannina Gaslini, IRCCS, UOSID Centro Trial, Genoa, Italy
| | | | - Despina Eleftheriou
- University College London Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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26
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Smith E, Beresford MW, McCann L, Hedrich CM. Comment on: Limited sensitivity and specificity of the ACR/EULAR-2019 classification criteria for SLE in JSLE?" Reply. Rheumatology (Oxford) 2021; 61:e27-e28. [PMID: 34459913 DOI: 10.1093/rheumatology/keab667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Eve Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
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27
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Zaripova LN, Midgley A, Christmas SE, Beresford MW, Baildam EM, Oldershaw RA. Juvenile idiopathic arthritis: from aetiopathogenesis to therapeutic approaches. Pediatr Rheumatol Online J 2021; 19:135. [PMID: 34425842 PMCID: PMC8383464 DOI: 10.1186/s12969-021-00629-8] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [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: 06/02/2021] [Accepted: 07/25/2021] [Indexed: 12/11/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common paediatric rheumatological disorder and is classified by subtype according to International League of Associations for Rheumatology criteria. Depending on the number of joints affected, presence of extra-articular manifestations, systemic symptoms, serology and genetic factors, JIA is divided into oligoarticular, polyarticular, systemic, psoriatic, enthesitis-related and undifferentiated arthritis. This review provides an overview of advances in understanding of JIA pathogenesis focusing on aetiology, histopathology, immunological changes associated with disease activity, and best treatment options. Greater understanding of JIA as a collective of complex inflammatory diseases is discussed within the context of therapeutic interventions, including traditional non-biologic and up-to-date biologic disease-modifying anti-rheumatic drugs. Whilst the advent of advanced therapeutics has improved clinical outcomes, a considerable number of patients remain unresponsive to treatment, emphasising the need for further understanding of disease progression and remission to support stratification of patients to treatment pathways.
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Affiliation(s)
- Lina N Zaripova
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
| | - Angela Midgley
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, University Department, Liverpool Women's Hospital, First Floor, Crown Street, Liverpool, L8 7SS, UK
| | - Stephen E Christmas
- Department of Clinical Infection, Microbiology and Immunology, Faculty of Health and Life Sciences, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, The Ronald Ross Building, 8 West Derby Street, Liverpool, L69 7BE, UK
| | - Michael W Beresford
- Department of Women and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, University Department, Liverpool Women's Hospital, First Floor, Crown Street, Liverpool, L8 7SS, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, East Prescott Road, Liverpool, L14 5AB, UK
| | - Eileen M Baildam
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, East Prescott Road, Liverpool, L14 5AB, UK
| | - Rachel A Oldershaw
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK.
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Davies JC, Carlsson E, Midgley A, Smith EMD, Bruce IN, Beresford MW, Hedrich CM. A panel of urinary proteins predicts active lupus nephritis and response to rituximab treatment. Rheumatology (Oxford) 2021; 60:3747-3759. [PMID: 33313921 DOI: 10.1093/rheumatology/keaa851] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/05/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES ∼30% of patients with SLE develop LN. Presence and/or severity of LN are currently assessed by renal biopsy, but biomarkers in serum or urine samples may provide an avenue for non-invasive routine testing. We aimed to validate a urinary protein panel for its ability to predict active renal involvement in SLE. METHODS A total of 197 SLE patients and 48 healthy controls were recruited, and urine samples collected. Seventy-five of the SLE patients had active LN and 104 had no or inactive renal disease. Concentrations of lipocalin-like prostaglandin D synthase (LPGDS), transferrin, alpha-1-acid glycoprotein (AGP-1), ceruloplasmin, monocyte chemoattractant protein 1 (MCP-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were quantified by MILLIPLEX® Assays using the MAGPIX Luminex platform. Binary logistic regression was conducted to examine whether proteins levels associate with active renal involvement and/or response to rituximab treatment. RESULTS Urine levels of transferrin (P <0.005), AGP-1 (P <0.0001), MCP-1 (P <0.001) and sVCAM-1 (P <0.005) were significantly higher in SLE patients when compared with healthy controls. Furthermore, levels of transferrin, AGP-1, ceruloplasmin, MCP-1 and sVCAM-1 (all P <0.0001) were higher in SLE patients with active LN when compared with patients without active LN. A combination of five urine proteins, namely LPGDS, transferrin, ceruloplasmin, MCP-1 and sVCAM-1 was a good predictor of active LN (AUC 0.898). A combined model of LPGDS, transferrin, AGP-1, ceruloplasmin, MCP-1 and sVCAM-1 predicted response to rituximab treatment at 12 months (AUC 0.818). CONCLUSIONS Findings support the use of a urinary protein panel to identify active LN and potentially predict response to treatment with rituximab in adult SLE patients. Prospective studies are required to confirm findings.
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Affiliation(s)
- Jennifer C Davies
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Emil Carlsson
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Angela Midgley
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Eve M D Smith
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool Health Partners, Liverpool, UK
| | - Ian N Bruce
- Versus Arthritis Epidemiology Unit, Faculty of Biology Medicine and Health, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK.,NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool Health Partners, Liverpool, UK
| | - Christian M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool Health Partners, Liverpool, UK
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Carlsson E, Beresford MW, Ramanan AV, Dick AD, Hedrich CM. Juvenile Idiopathic Arthritis Associated Uveitis. Children (Basel) 2021; 8:children8080646. [PMID: 34438537 PMCID: PMC8393258 DOI: 10.3390/children8080646] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/20/2021] [Accepted: 07/23/2021] [Indexed: 01/31/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common childhood rheumatic disease. The development of associated uveitis represents a significant risk for serious complications, including permanent loss of vision. Initiation of early treatment is important for controlling JIA-uveitis, but the disease can appear asymptomatically, making frequent screening procedures necessary for patients at risk. As our understanding of pathogenic drivers is currently incomplete, it is difficult to assess which JIA patients are at risk of developing uveitis. Identification of specific risk factors for JIA-associated uveitis is an important field of research, and in this review, we highlight the genomic, transcriptomic, and proteomic factors identified as potential uveitis risk factors in JIA, and discuss therapeutic strategies.
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Affiliation(s)
- Emil Carlsson
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, UK;
- Correspondence: (E.C.); (C.M.H.); Tel.: +44-151-228-4811 (ext. 2690) (E.C.); +44-151-252-5849 (C.M.H.)
| | - Michael W. Beresford
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, UK;
- Department of Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
- National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
| | - Athimalaipet V. Ramanan
- Bristol Royal Hospital for Children & Translational Health Sciences, University of Bristol, Bristol BS2 8DZ, UK;
| | - Andrew D. Dick
- Translational Health Sciences, University of Bristol, Bristol BS2 8DZ, UK;
- UCL Institute of Ophthalmology, London EC1V 9EL, UK
- NIHR Biomedical Research Centre, Moorfields Eye Hospital, London EC1V 2PD, UK
| | - Christian M. Hedrich
- Department of Women’s and Children’s Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, UK;
- Department of Rheumatology, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
- National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Children’s NHS Foundation Trust Hospital, Liverpool L14 5AB, UK
- Correspondence: (E.C.); (C.M.H.); Tel.: +44-151-228-4811 (ext. 2690) (E.C.); +44-151-252-5849 (C.M.H.)
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Carlsson E, Midgley A, Perkins S, Caamano-Gutierrez E, Gritzfeld JF, Beresford MW, Hedrich CM. Serum protein signatures differentiate paediatric autoimmune/inflammatory disorders. Clin Immunol 2021; 229:108790. [PMID: 34197952 DOI: 10.1016/j.clim.2021.108790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/25/2021] [Accepted: 06/25/2021] [Indexed: 01/04/2023]
Abstract
Because of their rarity, limited awareness among non-specialists, and significant overlaps in their clinical presentation, childhood autoimmune/inflammatory conditions represent a diagnostic and therapeutic challenge. Juvenile idiopathic arthritis (JIA), with its 7 sub-forms, is the most common paediatric "rheumatic" disease. Juvenile-onset systemic lupus erythematosus (jSLE) is a severe autoimmune/inflammatory disease that can affect any organ system and shares clinical features with JIA. To overcome issues around diagnostic approaches in the context of clinical overlap, we aimed at the definition of disease sub-form specific cytokine and chemokine profiles. Serum samples from patients with JIA (n = 77) and jSLE (n = 48), as well as healthy controls (n = 30), were collected. Samples were analysed using the Meso Scale Discovery (MSD) U-PLEX Biomarker Group 1 (hu) panel. Distinct serum protein signatures associate with JIA vs jSLE disease groups. Proteins with high discriminatory ability include IL-23, MIP-1β, MCP-1, M-CSF and MDC. Furthermore, serum IL-18, MIF, MIP-5 and YKL-40 discriminate between systemic JIA and other JIA subtypes. Thus, simultaneous quantification of serum proteins in a panel format may provide an avenue for the diagnosis and monitoring of childhood autoimmune/inflammatory conditions.
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Affiliation(s)
- Emil Carlsson
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, United Kingdom
| | - Angela Midgley
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, United Kingdom
| | - Simon Perkins
- Computation Biology Facility, Technology Directorate, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, United Kingdom; Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, United Kingdom
| | - Eva Caamano-Gutierrez
- Computation Biology Facility, Technology Directorate, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, United Kingdom; Department of Biochemistry and Systems Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, United Kingdom
| | - Jenna F Gritzfeld
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, United Kingdom
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, United Kingdom; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, United Kingdom; National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, United Kingdom
| | - Christian M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L14 5AB, United Kingdom; Department of Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, United Kingdom; National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, United Kingdom.
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Massias JS, Smith EM, Al-Abadi E, Armon K, Bailey K, Ciurtin C, Davidson J, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, McErlane F, Mewar D, Modgil G, Moots R, Pilkington C, Ramanan AV, Rangaraj S, Riley P, Sridhar A, Wilkinson N, Beresford MW, Hedrich CM. Clinical and laboratory phenotypes in juvenile-onset Systemic Lupus Erythematosus across ethnicities in the UK. Lupus 2021; 30:597-607. [PMID: 33413005 PMCID: PMC7967896 DOI: 10.1177/0961203320984251] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Systemic lupus erythematosus (SLE) is a systemic autoimmune/inflammatory disease. Patients diagnosed with juvenile-onset SLE (jSLE), when compared to individuals with adult-onset SLE, develop more severe organ involvement, increased disease activity and greater tissue and organ damage. In adult-onset SLE, clinical characteristics, pathomechanisms, disease progression and outcomes do not only vary between individuals and age groups, but also ethnicities. However, in children and young people, the influence of ethnicity on disease onset, phenotype and outcome has not been investigated in detail. In this study, we investigated clinical and laboratory characteristics in pediatric SLE patients from different ethnic backgrounds (White Caucasian, Asian, Black African/Caribbean) accessing data from a national cohort of jSLE patients (the UK JSLE Cohort Study). Among jSLE patients in the UK, ethnicity affects both the disease’s clinical course and outcomes. At diagnosis, Black African/Caribbean jSLE patients show more “classical” laboratory and clinical features when compared to White Caucasian or Asian patients. Black African/Caribbean jSLE patients exhibit more renal involvement and more frequently receive cyclophosphamide and rituximab. Studies targeting ethnicity-specific contributors to disease expression and phenotypes are necessary to improve our pathophysiological understanding, diagnosis and treatment of jSLE.
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Affiliation(s)
| | - Eve Md Smith
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Eslam Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - Kate Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - Kathryn Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology, University College London, London, UK
| | - Joyce Davidson
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - Kirsty Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - Dan P Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - Alice Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - Valentina Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds, UK
| | - Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Devesh Mewar
- Department of Rheumatology, Royal Liverpool University Hospital, Liverpool, UK
| | - Gita Modgil
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
| | - Robert Moots
- Department of Rheumatology, University Hospital Aintree, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Satyapal Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals, Nottingham, UK
| | - Phil Riley
- Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - Arani Sridhar
- Department of Paediatrics, Leicester Royal Infirmary, Leicester, UK
| | - Nick Wilkinson
- Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - Michael W Beresford
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK
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Smith EMD, Ainsworth S, Beresford MW, Buys V, Costello W, Egert Y, Foster HE, Lamot L, Prakken BJ, Scott C, Stones SR. Establishing an international awareness day for paediatric rheumatic diseases: reflections from the inaugural World Young Rheumatic Diseases (WORD) Day 2019. Pediatr Rheumatol Online J 2020; 18:71. [PMID: 32917217 PMCID: PMC7488434 DOI: 10.1186/s12969-020-00465-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/03/2020] [Indexed: 11/10/2022] Open
Abstract
There is a lack of awareness of paediatric rheumatic diseases (PRDs), among the public, and certain groups of healthcare professionals (HCPs), including general practitioners. To help improve international awareness and understanding of PRDs, World yOung Rheumatic Diseases (WORD) Day was established on 18 March 2019. Its aim was to raise awareness of PRDs and the importance of timely referral plus early diagnosis and access to appropriate treatment and support. A steering committee was established, and an external agency provided digital support. A social media campaign was launched in December 2018 to promote it, and analytics were used to measure its impact. Face-to-face and virtual events took place globally on or around WORD Day 2019, with 34 countries reporting events. Examples included lectures, social gatherings and media appearances. A total of 2585 and 660 individuals followed the official Facebook and Twitter accounts respectively, up until WORD Day. The official #WORDDay2019 hashtag was seen by 533,955 unique accounts on 18 March 2019 alone, with 3.3 million impressions. WORD Day 2019 was the first international campaign focused solely on PRDs. It demonstrated that despite awareness events being often resource-light, they can be implemented across a range of diverse settings. WORD Day has now become an annual global awareness event, facilitated by a growing network of patient, parent and professional community supporters.
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Affiliation(s)
- Eve M. D. Smith
- grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool Health Partners UK, Liverpool, UK ,Paediatric Rheumatology European Society, Geneva, Switzerland ,grid.10025.360000 0004 1936 8470Department of Women and Children’s Health, Institute of Translational Medicine, Liverpool, UK
| | - Sammy Ainsworth
- European Network for Children with Arthritis, Geneva, Switzerland ,NIHR Alder Hey Clinical Research Facility, Liverpool Health Partners UK, Liverpool, UK
| | - Michael W. Beresford
- grid.417858.70000 0004 0421 1374Alder Hey Children’s NHS Foundation Trust, Liverpool Health Partners UK, Liverpool, UK ,Paediatric Rheumatology European Society, Geneva, Switzerland ,grid.10025.360000 0004 1936 8470Department of Women and Children’s Health, Institute of Translational Medicine, Liverpool, UK ,NIHR Alder Hey Clinical Research Facility, Liverpool Health Partners UK, Liverpool, UK
| | - Veerle Buys
- European Network for Children with Arthritis, Geneva, Switzerland ,Ouders van ReumaKinderen en –Adolescenten, De Haan, Belgium ,Certified patient expert, ReumaNet, Zaventem, Belgium
| | - Wendy Costello
- European Network for Children with Arthritis, Geneva, Switzerland ,Irish Children’s Advisory Network (iCAN), Tipperary, Ireland
| | - Yona Egert
- European Network for Children with Arthritis, Geneva, Switzerland ,Inbar, Ramat Gan, Israel
| | - Helen E. Foster
- grid.459561.a0000 0004 4904 7256Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK ,Paediatric Global Musculoskeletal Task Force, Newcastle, UK ,grid.472342.40000 0004 0367 3753Newcastle University Medicine Malaysia, Iskandar Puteri, Johor Malaysia
| | - Lovro Lamot
- Paediatric Rheumatology European Society, Geneva, Switzerland ,grid.412488.30000 0000 9336 4196Sestre Milosrdnice University Hospital Center, Zagreb, Croatia ,grid.4808.40000 0001 0657 4636School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Berent J. Prakken
- Paediatric Rheumatology European Society, Geneva, Switzerland ,grid.7692.a0000000090126352Department of Pediatric Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Christiaan Scott
- Paediatric Global Musculoskeletal Task Force, Newcastle, UK ,grid.7836.a0000 0004 1937 1151Paediatric Rheumatology, University of Cape Town/Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Simon R. Stones
- European Network for Children with Arthritis, Geneva, Switzerland ,grid.9909.90000 0004 1936 8403School of Healthcare, University of Leeds, Leeds, UK ,Collaboro Consulting, Bolton, UK
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Ramanan AV, Dick AD, Jones AP, Hughes DA, McKay A, Rosala-Hallas A, Williamson PR, Hardwick B, Hickey H, Rainford N, Hickey G, Kolamunnage-Dona R, Culeddu G, Plumpton C, Wood E, Compeyrot-Lacassagne S, Woo P, Edelsten C, Beresford MW. Adalimumab in combination with methotrexate for refractory uveitis associated with juvenile idiopathic arthritis: a RCT. Health Technol Assess 2020; 23:1-140. [PMID: 31033434 DOI: 10.3310/hta23150] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) are at risk of uveitis. The role of adalimumab (Humira®; AbbVie Inc., Ludwigshafen, Germany) in the management of uveitis in children needs to be determined. OBJECTIVE To compare the efficacy, safety and cost-effectiveness of adalimumab in combination with methotrexate (MTX) versus placebo with MTX alone, with regard to controlling disease activity in refractory uveitis associated with JIA. DESIGN This was a randomised (applying a ratio of 2 : 1 in favour of adalimumab), double-blind, placebo-controlled, multicentre parallel-group trial with an integrated economic evaluation. A central web-based system used computer-generated tables to allocate treatments. A cost-utility analysis based on visual acuity was conducted and a 10-year extrapolation by Markov modelling was also carried out. SETTING The setting was tertiary care centres throughout the UK. PARTICIPANTS Patients aged 2-18 years inclusive, with persistently active JIA-associated uveitis (despite optimised MTX treatment for at least 12 weeks). INTERVENTIONS All participants received a stable dose of MTX and either adalimumab (20 mg/0.8 ml for patients weighing < 30 kg or 40 mg/0.8 ml for patients weighing ≥ 30 kg by subcutaneous injection every 2 weeks based on body weight) or a placebo (0.8 ml as appropriate according to body weight by subcutaneous injection every 2 weeks) for up to 18 months. A follow-up appointment was arranged at 6 months. MAIN OUTCOME MEASURES Primary outcome - time to treatment failure [multicomponent score as defined by set criteria based on the Standardisation of Uveitis Nomenclature (SUN) criteria]. Economic outcome - incremental cost per quality-adjusted life-year (QALY) gained from the perspective of the NHS in England and Personal Social Services providers. Full details of secondary outcomes are provided in the study protocol. RESULTS A total of 90 participants were randomised (adalimumab, n = 60; placebo, n = 30). There were 14 (23%) treatment failures in the adalimumab group and 17 (57%) in the placebo group. The analysis of the data from the double-blind phase of the trial showed that the hazard risk (HR) of treatment failure was significantly reduced, by 75%, for participants in the adalimumab group (HR 0.25, 95% confidence interval 0.12 to 0.51; p < 0.0001 from log-rank test). The cost-effectiveness of adalimumab plus MTX was £129,025 per QALY gained. Adalimumab-treated participants had a much higher incidence of adverse and serious adverse events. CONCLUSIONS Adalimumab in combination with MTX is safe and effective in the management of JIA-associated uveitis. However, the likelihood of cost-effectiveness is < 1% at the £30,000-per-QALY threshold. FUTURE WORK A clinical trial is required to define the most effective time to stop therapy. Prognostic biomarkers of early and complete response should also be identified. TRIAL REGISTRATION Current Controlled Trials ISRCTN10065623 and European Clinical Trials Database number 2010-021141-41. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 15. See the NIHR Journals Library website for further project information. This trial was also funded by Arthritis Research UK (grant reference number 19612). Two strengths of adalimumab (20 mg/0.8 ml and 40 mg/0.8 ml) and a matching placebo were manufactured by AbbVie Inc. (the Marketing Authorisation holder) and supplied in bulk to the contracted distributor (Sharp Clinical Services, Crickhowell, UK) for distribution to trial centres.
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Affiliation(s)
- Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew D Dick
- Bristol Eye Hospital, Bristol, UK.,School of Clinical Sciences, University of Bristol, Bristol, UK.,University College London Institute of Ophthalmology and National Institute for Health Research (NIHR) Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Ashley P Jones
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Andrew McKay
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Anna Rosala-Hallas
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Paula R Williamson
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ben Hardwick
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Helen Hickey
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Naomi Rainford
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Graeme Hickey
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ruwanthi Kolamunnage-Dona
- Department of Biostatistics, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Giovanna Culeddu
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Catrin Plumpton
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Eifiona Wood
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | | | | | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Davies R, De Cock D, Kearsley-Fleet L, Southwood T, Baildam E, Beresford MW, Foster HE, Thomson W, Ramanan AV, Hyrich KL. The risk of uveitis in patients with JIA receiving etanercept: the challenges of analysing real-world data. Rheumatology (Oxford) 2020; 59:1391-1397. [PMID: 31605484 PMCID: PMC7244776 DOI: 10.1093/rheumatology/kez449] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 08/22/2019] [Indexed: 02/02/2023] Open
Abstract
Objectives To describe and compare the occurrence of newly diagnosed uveitis in children with JIA receiving MTX, etanercept, adalimumab and infliximab. Methods This on-drug analysis included patients within UK JIA registries (British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study and Biologics for Children with Rheumatic Diseases) with non-systemic disease, registered at MTX or biologic start with no history of uveitis. Follow-up began from date of first treatment, continuing until first uveitis, discontinuation of registered drug, most recent follow-up up or death, whichever came first. Hazard ratios comparing risk of uveitis between drugs were calculated using propensity-adjusted Cox regression. Results A total of 2294 patients were included (943 MTX, 304 adalimumab/infliximab, 1047 etanercept). There were 44 reported cases of uveitis (27 MTX, 16 etanercept, 1 adalimumab). Unadjusted hazard ratio showed a reduced risk of uveitis in biologic cohorts compared with MTX. After adjusting for propensity deciles, there was no significant difference in the risk of uveitis between patients receiving etanercept or MTX [hazard ratio 0.5 (0.2–1.1)]. Fully adjusted comparisons were not possible for adalimumab/infliximab as there were too few events. Conclusions In this first paper to compare the rate of new onset uveitis across the three main anti-TNF therapies used in JIA, a new diagnosis of uveitis is less common among patients starting biologics compared with MTX, although this did not reach statistical significance. The suggested protective effect of etanercept is likely explained by confounding, whereby patients in the MTX cohort are younger and earlier in disease, and therefore at greater risk of developing uveitis compared with etanercept patients.
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Affiliation(s)
- Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Diederik De Cock
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Lianne Kearsley-Fleet
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester
| | - Taunton Southwood
- Institute of Child Health, University of Birmingham & Birmingham Children's Hospital, Birmingham
| | - Eileen Baildam
- Clinical Academic Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool
| | - Michael W Beresford
- Clinical Academic Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool.,University of Liverpool and Alder Hey Children's NHS Foundation Trust, Members of Liverpool Health Partners, Liverpool
| | - Helen E Foster
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne.,Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne
| | - Wendy Thomson
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Faculty of Biologic, Medicine and Health, The University of Manchester, Manchester.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Athimalaipet V Ramanan
- Bristol Medical School, University of Bristol, Bristol.,Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester Academic Health Science Centre, Manchester.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
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Jones AP, Clayton D, Nkhoma G, Sherratt FC, Peak M, Stones SR, Roper L, Young B, McErlane F, Moitt T, Ramanan AV, Foster HE, Williamson PR, Deepak S, Beresford MW, Baildam EM. Different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis: the SIRJIA mixed-methods feasibility study. Health Technol Assess 2020; 24:1-152. [PMID: 32758350 PMCID: PMC7443738 DOI: 10.3310/hta24360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the UK, juvenile idiopathic arthritis is the most common inflammatory disorder in childhood, affecting 10 : 100,000 children and young people aged < 16 years each year, with a population prevalence of around 1 : 1000. Corticosteroids are commonly used to treat juvenile idiopathic arthritis; however, there is currently a lack of consensus as to which corticosteroid induction regimen should be used with various disease subtypes and severities of juvenile idiopathic arthritis. OBJECTIVE The main study objective was to determine the feasibility of conducting a randomised controlled trial to compare the different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis. DESIGN This was a mixed-methods study. Work packages included a literature review; qualitative interviews with children and young people with juvenile idiopathic arthritis and their families; a questionnaire survey and screening log to establish current UK practice; a consensus meeting with health-care professionals, children and young people with juvenile idiopathic arthritis, and their families to establish the primary outcome; a feasibility study to pilot data capture and to collect data for future sample size calculations; and a final consensus meeting to establish the final protocol. SETTING The setting was rheumatology clinics across the UK. PARTICIPANTS Children, young people and their families who attended clinics and health-care professionals took part in this mixed-methods study. INTERVENTIONS This study observed methods of prescribing corticosteroids across the UK. MAIN OUTCOME MEASURES The main study outcomes were the acceptability of a future trial for children, young people, their families and health-care professionals, and the feasibility of delivering such a trial. RESULTS Qualitative interviews identified differences in the views of children, young people and their families on a randomised controlled trial and potential barriers to recruitment. A total of 297 participants were screened from 13 centres in just less than 6 months. In practice, all routes of corticosteroid administration were used, and in all subtypes of juvenile idiopathic arthritis. Intra-articular corticosteroid injection was the most common treatment. The questionnaire surveys showed the varying clinical practice across the UK, but established intra-articular corticosteroids as the treatment control for a future trial. The primary outcome of choice for children, young people, their families and health-care professionals was the Juvenile Arthritis Disease Activity Score, 71-joint count. However, results from the feasibility study showed that, owing to missing blood test data, the clinical Juvenile Arthritis Disease Activity Score should be used. The Juvenile Arthritis Disease Activity Score, 71-joint count, and the clinical Juvenile Arthritis Disease Activity Score are composite disease activity scoring systems for juvenile arthritis. Two final trial protocols were established for a future randomised controlled trial. LIMITATIONS Fewer clinics were included in this feasibility study than originally planned, limiting the ability to draw strong conclusions about these units to take part in future research. CONCLUSIONS A definitive randomised controlled trial is likely to be feasible based on the findings from this study; however, important recommendations should be taken into account when planning such a trial. FUTURE WORK This mixed-methods study has laid down the foundations to develop the evidence base in this area and conducting a randomised control trial to compare different corticosteroid induction regimens in children and young people with juvenile idiopathic arthritis is likely to be feasible. STUDY REGISTRATION Current Controlled Trials ISRCTN16649996. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 36. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ashley P Jones
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | - Dannii Clayton
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | - Gloria Nkhoma
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | | | - Matthew Peak
- Alder Hey Children's NHS Foundation Trust, a member of the Liverpool Health Partners, Liverpool, UK
| | | | - Louise Roper
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Bridget Young
- School of Psychology, University of Liverpool, Liverpool, UK
| | - Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Tracy Moitt
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | - Athimalaipet V Ramanan
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Helen E Foster
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | - Paula R Williamson
- Liverpool Clinical Trials Centre, University of Liverpool, a member of the Liverpool Health Partners, Liverpool, UK
| | - Samundeeswari Deepak
- Paediatric Rheumatology, Nottingham Children's Hospital, Queen's Medical Centre, Nottingham, UK
| | - Michael W Beresford
- Faculty of Health and Life Science, University of Liverpool and Alder Hey Children's NHS Foundation Trust, members of Liverpool Health Partners, Liverpool, UK
| | - Eileen M Baildam
- Alder Hey Children's NHS Foundation Trust, a member of the Liverpool Health Partners, Liverpool, UK
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Davies JC, Midgley A, Carlsson E, Donohue S, Bruce IN, Beresford MW, Hedrich CM. Urine and serum S100A8/A9 and S100A12 associate with active lupus nephritis and may predict response to rituximab treatment. RMD Open 2020; 6:e001257. [PMID: 32723832 PMCID: PMC7722276 DOI: 10.1136/rmdopen-2020-001257] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [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: 04/01/2020] [Revised: 05/27/2020] [Accepted: 06/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Approximately 30% of patients with the systemic autoimmune/inflammatory disorder systemic lupus erythematosus (SLE) develop lupus nephritis (LN) that affects treatment and prognosis. Easily accessible biomarkers do not exist to reliably predict renal disease. The Maximizing SLE Therapeutic Potential by Application of Novel and Systemic Approaches and the Engineering Consortium aims to identify indicators of treatment responses in SLE. This study tested the applicability of calcium-binding S100 proteins in serum and urine as biomarkers for disease activity and response to treatment with rituximab (RTX) in LN. METHODS S100A8/A9 and S100A12 proteins were quantified in the serum and urine of 243 patients with SLE from the British Isles Lupus Assessment Group Biologics Register (BILAG-BR) study and 48 controls matched for age using Meso Scale Discovery's technology to determine whether they perform as biomarkers for active LN and/or may be used to predict response to treatment with RTX. Renal disease activity and response to treatment was based on BILAG-BR scores and changes in response to treatment. RESULTS Serum S100A12 (p<0.001), and serum and urine S100A8/A9 (p<0.001) levels are elevated in patients with SLE. While serum and urine S100 levels do not correlate with global disease activity (SLE Disease Activity Index), levels in urine and urine/serum ratios are elevated in patients with active LN. S100 proteins perform better as biomarkers for active LN involvement in patients with SLE who tested positive for anti-double-stranded DNA antibodies. Binary logistic regression and area under the curve analyses suggest the combination of serum S100A8/A9 and S100A12 can predict response to RTX treatment in LN after 6 months. CONCLUSIONS Findings from this study show promise for clinical application of S100 proteins to predict active renal disease in SLE and response to treatment with RTX.
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Affiliation(s)
- Jennifer C Davies
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Angela Midgley
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Emil Carlsson
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sean Donohue
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Ian N Bruce
- Arc Epidemiology Unit, University of Manchester, Manchester, UK
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Christian M Hedrich
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Wright RD, Bannerman F, Beresford MW, Oni L. A systematic review of the role of eculizumab in systemic lupus erythematosus-associated thrombotic microangiopathy. BMC Nephrol 2020; 21:245. [PMID: 32605540 PMCID: PMC7329551 DOI: 10.1186/s12882-020-01888-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 06/08/2020] [Indexed: 12/19/2022] Open
Abstract
Background Lupus nephritis (LN) is a severe consequence of systemic lupus erythematosus (SLE) that affects approximately 40% of patients. Pathogenic immune complexes that are characteristic of LN deposit in the kidney and activate immune mediated pathways including the complement system. Complete remission rates in LN are approximately 44% highlighting the need for new treatment strategies in these patients. Eculizumab is a fully humanised IgG2/IgG4 monoclonal antibody directed at C5 and thus prevents the formation of the terminal complement complex. Eculizumab is successfully used in atypical haemolytic uraemic syndrome (aHUS) and paroxysomal nocturnal haemoglobinuria (PNH) but it is not standardly used in LN. The aim of this project was to determine whether there is any role for eculizumab as adjunctive therapy in LN. Methods Using a predefined search strategy on Ovid MEDLINE and EMBASE the literature was reviewed systematically to identify studies in which eculizumab had been used to treat patients with SLE. All patients were included that were treated with complement inhibitors. Favourable outcome in this study was defined as resolution of symptoms that led to treatment, discharge from hospital or recovery of renal function. Patients were excluded if there was no outcome data or if complement inhibition was unrelated to their SLE. Results From 192 abstracts screened, 14 articles were identified, involving 30 patients. All SLE patients administered eculizumab were treated for thrombotic microangiopathy (TMA) secondary to LN diagnosed either histologically (66%) or as part of a diagnosis of aHUS (73%). 93% of patients had a favourable outcome in response to eculizumab treatment, of which 46% had a favourable outcome and successfully stopped treatment without relapse in symptoms during a median follow up of 7 months. Three patients (10%) reported adverse outcomes related to eculizumab therapy. Conclusions Scientific evidence supports the involvement of complement in the pathogenesis of LN however the role of complement inhibition in clinical practice is limited to those with TMA features. This systematic review showed that in cases of LN complicated with TMA, eculizumab seems to be a very efficacious therapy. Further evidence is required to determine whether patients with refractory LN may benefit from adjunctive complement inhibition.
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Affiliation(s)
- Rachael D Wright
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK.
| | - Fariba Bannerman
- Library and Knowledge Service, Alder Hey Children's NHS Foundation Trust, member of Liverpool Health Partners, Liverpool, UK
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, member of Liverpool Health Partners, Liverpool, UK
| | - Louise Oni
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, member of Liverpool Health Partners, Eaton Road, Liverpool, L12 2AP, UK.,Department of Paediatric Nephrology, Alder Hey Children's NHS Foundation Trust, member of Liverpool Health Partners, Liverpool, UK
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38
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de Graeff N, Groot N, Brogan P, Ozen S, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, Marks SD, McCann L, Pilkington C, Ravelli A, van Royen A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European consensus-based recommendations for the diagnosis and treatment of rare paediatric vasculitides – the SHARE initiative. Rheumatology (Oxford) 2020; 59:919. [DOI: 10.1093/rheumatology/keaa057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nienke de Graeff
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Noortje Groot
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Paul Brogan
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Seza Ozen
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Tadej Avcin
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | | | - Pavla Dolezalova
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Brian M Feldman
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Pekka Lahdenne
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Stephen D Marks
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Liza McCann
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Angelo Ravelli
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Annet van Royen
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Yosef Uziel
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Bas Vastert
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Nico Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
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Massias JS, Smith EMD, Al-Abadi E, Armon K, Bailey K, Ciurtin C, Davidson J, Gardner-Medwin J, Haslam K, Hawley DP, Leahy A, Leone V, McErlane F, Mewar D, Modgil G, Moots R, Pilkington C, Ramanan AV, Rangaraj S, Riley P, Sridhar A, Wilkinson N, Beresford MW, Hedrich CM. Clinical and laboratory characteristics in juvenile-onset systemic lupus erythematosus across age groups. Lupus 2020; 29:474-481. [PMID: 32233733 PMCID: PMC7528537 DOI: 10.1177/0961203320909156] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Systemic lupus erythematous (SLE) is a systemic autoimmune/inflammatory condition. Approximately 15–20% of patients develop symptoms before their 18th birthday and are diagnosed with juvenile-onset SLE (JSLE). Gender distribution, clinical presentation, disease courses and outcomes vary significantly between JSLE patients and individuals with adult-onset SLE. This study aimed to identify age-specific clinical and/or serological patterns in JSLE patients enrolled to the UK JSLE Cohort Study. Methods Patient records were accessed and grouped based on age at disease-onset: pre-pubertal (≤7 years), peri-pubertal (8–13 years) and adolescent (14–18 years). The presence of American College of Rheumatology (ACR) classification criteria, laboratory results, disease activity [British Isles Lupus Assessment Group (BILAG) and Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2 K) scores] and damage [Systemic Lupus International Collaborating Clinics (SLICC) damage index] were evaluated at diagnosis and last follow up. Results A total of 418 JSLE patients were included in this study: 43 (10.3%) with pre-pubertal disease onset; 240 (57.4%) with peri-pubertal onset and 135 (32.3%) were diagnosed during adolescence. At diagnosis, adolescent JSLE patients presented with a higher number of ACR criteria when compared with pre-pubertal and peri-pubertal patients [pBILAG2004 scores: 9(4–20] vs. 7(3–13] vs. 7(3–14], respectively, p = 0.015] with increased activity in the following BILAG domains: mucocutaneous (p = 0.025), musculoskeletal (p = 0.029), renal (p = 0.027) and cardiorespiratory (p = 0.001). Furthermore, adolescent JSLE patients were more frequently ANA-positive (p = 0.034) and exhibited higher anti-dsDNA titres (p = 0.001). Pre-pubertal individuals less frequently presented with leukopenia (p = 0.002), thrombocytopenia (p = 0.004) or low complement (p = 0.002) when compared with other age groups. No differences were identified in disease activity (pBILAG2004 score), damage (SLICC damage index) and the number of ACR criteria fulfilled at last follow up. Conclusions Disease presentations and laboratory findings vary significantly between age groups within a national cohort of JSLE patients. Patients diagnosed during adolescence exhibit greater disease activity and “classic” autoantibody, immune cell and complement patterns when compared with younger patients. This supports the hypothesis that pathomechanisms may vary between patient age groups.
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Affiliation(s)
- J S Massias
- School of Medicine, University of Liverpool, UK
| | - E M D Smith
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - E Al-Abadi
- Department of Rheumatology, Birmingham Children's Hospital, Birmingham, UK
| | - K Armon
- Department of Paediatric Rheumatology, Cambridge University Hospitals, Cambridge, UK
| | - K Bailey
- Department of Paediatric Rheumatology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J Davidson
- Department of Paediatric Rheumatology, Royal Hospital for Sick Children, Edinburgh, UK
| | | | - K Haslam
- Department of Paediatrics, Bradford Royal Infirmary, Bradford, UK
| | - D P Hawley
- Department of Paediatric Rheumatology, Sheffield Children's Hospital, Sheffield, UK
| | - A Leahy
- Department of Paediatric Rheumatology, Southampton General Hospital, Southampton, UK
| | - V Leone
- Department of Paediatric Rheumatology, Leeds Children Hospital, Leeds, UK
| | - F McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Royal Victoria Infirmary, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - D Mewar
- Department of Rheumatology, Royal Liverpool University Hospital, Liverpool, UK
| | - G Modgil
- Department of Paediatrics, Musgrove Park Hospital, Taunton, UK
| | - R Moots
- Department of Rheumatology, University Hospital Aintree, Liverpool, UK
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - A V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - S Rangaraj
- Department of Paediatric Rheumatology, Nottingham University Hospitals Nottingham, UK
| | - P Riley
- Department of Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
| | - A Sridhar
- Department of Paediatrics, Leicester Royal Infirmary, Leicester, UK
| | - N Wilkinson
- Guy's & St Thomas's NHS Foundation Trust, Evelina Children's Hospital, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, UK.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK
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40
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Kearsley-Fleet L, Heaf E, Davies R, Baildam E, Beresford MW, Foster HE, Southwood TR, Thomson W, Hyrich KL. Frequency of biologic switching and the outcomes of switching in children and young people with juvenile idiopathic arthritis: a national cohort study. Lancet Rheumatol 2020; 2:e217-e226. [PMID: 32280951 PMCID: PMC7134528 DOI: 10.1016/s2665-9913(20)30025-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Information is scarce about biological disease-modifying antirheumatic drug (DMARD) switching patterns in children and young people (aged ≤16 years) with juvenile idiopathic arthritis in an era of many biologic therapies. The best choice of biologic to use if the first biological DMARD is not beneficial also remains unclear. We aimed to quantify and characterise biologic switching patterns in children and young people with juvenile idiopathic arthritis, and to compare the effectiveness of using a second tumour necrosis factor inhibitor (TNFi) versus non-TNF is following failure of a first TNFi biologic in routine clinical practice. METHODS Our study population comprised patients with juvenile idiopathic arthritis who were enrolled in two parallel UK cohort studies (the British Society for Paediatric and Adolescent Rheumatology Etanercept Cohort Study [BSPAR-ETN] and the Biologics for Children with Rheumatic Diseases [BCRD] study) between Jan 1, 2004, and April 11, 2019. Data on disease characteristics and DMARD therapy were collected at the time of initiation of a first biologic, at 6 months, at 1 year, and annually thereafter. Biologic switching patterns were described in all patients who started their first biologic from Jan 1, 2010, onwards. Among patients who started treatment with their first biologic from Jan 1, 2004, onwards, had polyarticular course juvenile idiopathic arthritis (extended oligoarthritis or polyarthritis [positive or negative for rheumatoid factor]), and who had started a second biologic, we assessed changes in outcome variables at 6 months compared with baseline and compared the proportion of patients who achieved an American College of Rheumatology Pediatric (ACR Pedi) 90 response and minimal disease activity at 6 months on the basis of the class of the second biologic (a second TNFi vs non-TNFi biologic). Changes in outcome variables at 6 months were compared using linear regression or logistic regression, adjusted for propensity quintiles to account for confounding by indication. We used multiple imputation to account for missing data. FINDINGS Between Jan 1, 2004, and April 11, 2019, 2361 patients were enrolled on initiation of biologic therapy. From Jan 1, 2010, onwards, 1152 patients started their first biologic, most of whom started treatment with TNFis (1050 [91%]). The median follow-up was 2·2 years (IQR 1·1-3·8). During this time, 270 (23%) of 1152 patients started a second biologic, 61 (5%) started a third biologic, and 11 (1%) started a fourth biologic. Among 240 patients with polyarticular-course juvenile idiopathic arthritis, 194 (81%) started a second TNFi and 46 (19%) started a non-TNFi after an initial TNFi had failed. Choice of second treatment (second TNFi vs non-TNFi biologic) did not affect the proportion of patients who achieved an ACR Pedi 90 response (adjusted odds ratio [OR] 2·5, 95% CI 0·8-7·9; p=0·11) or minimal disease activity (adjusted OR 1·6, 95% CI 0·6-3·8; p=0·33). INTERPRETATION For many children and young people with juvenile idiopathic arthritis, treatment with a first or second biologic is not beneficial. We found no evidence that switching to a second non-TNFi biologic was more beneficial than a second TNFi. FUNDING Versus Arthritis and The British Society for Rheumatology.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Eleanor Heaf
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Rebecca Davies
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Eileen Baildam
- Clinical Academic Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Michael W Beresford
- Clinical Academic Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK,Institute of Translational Medicine (Child Health), University of Liverpool, Liverpool, UK
| | - Helen E Foster
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK,Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Taunton R Southwood
- Institute of Child Health, University of Birmingham and Birmingham Children's Hospital, Birmingham, UK
| | - Wendy Thomson
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK,Correspondence to: Prof Kimme L Hyrich, Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PT, UK
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Donohue SJ, Midgley A, Davies JC, Wright RD, Bruce I, Beresford MW, Hedrich CM. Differential analysis of serum and urine S100 proteins in juvenile-onset systemic lupus erythematosus (jSLE). Clin Immunol 2020; 214:108375. [PMID: 32135275 DOI: 10.1016/j.clim.2020.108375] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/28/2020] [Accepted: 02/28/2020] [Indexed: 12/21/2022]
Abstract
Up to 80% of juvenile-onset systemic lupus erythematosus (jSLE) patients develop lupus nephritis (LN) that affects treatment and prognosis. Easily accessible biomarkers do not exist to reliably diagnose LN, leaving kidney biopsies as the gold-standard. Calcium-binding S100 proteins are expressed by innate immune cells and epithelia and may act as biomarkers in systemic inflammatory conditions. We quantified S100 proteins in the serum and urine of jSLE patients, matched healthy and inflammatory (IgA vasculitis) controls. Serum S100A8/A9, and serum and urine S100A12 are increased in jSLE patients when compared to controls. Furthermore, serum S100A8/A9, and serum and urine S100A12 are increased in jSLE patients with active as compared to patients with inactive/no LN. No differences in S100A4 levels were seen between groups. This study demonstrates potential promise for S100A8/A9 and S100A12 as biomarkers for jSLE and active LN. Findings require to be confirmed and tested prospectively in independent and larger multi-ethnic cohorts.
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Affiliation(s)
- S J Donohue
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - A Midgley
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - J C Davies
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - R D Wright
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - I Bruce
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK; National Institute for Health Research (NIHR) Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust Hospital, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, UK; National Institute for Health Research (NIHR) Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust Hospital, UK.
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Dolezalova P, Anton J, Avcin T, Beresford MW, Brogan PA, Constantin T, Egert Y, Foeldvari I, Foster HE, Hentgen V, Kone-Paut I, Kuemmerle-Deschner JB, Lahdenne P, Magnusson B, Martini A, McCann L, Minden K, Ozen S, Schoemaker C, Quartier P, Ravelli A, Rumba-Rozenfelde I, Ruperto N, Vastert S, Wouters C, Zulian F, Wulffraat NM. The European network for care of children with paediatric rheumatic diseases: care across borders. Rheumatology (Oxford) 2020; 58:1188-1195. [PMID: 30668879 DOI: 10.1093/rheumatology/key439] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 11/25/2018] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To provide an overview of the paediatric rheumatology (PR) services in Europe, describe current delivery of care and training, set standards for care, identify unmet needs and inform future specialist service provision. METHODS An online survey was developed and presented to national coordinating centres of the Paediatric Rheumatology International Trials Organisation (PRINTO) (country survey) and to individual PR centres (centre and disease surveys) as a part of the European Union (EU) Single Hub and Access point for paediatric Rheumatology in Europe project. The survey contained components covering the organization of PR care, composition of teams, education, health care and research facilities and assessment of needs. RESULTS Response rates were 29/35 (83%) for country surveys and 164/288 (57%) for centre surveys. Across the EU, approximately one paediatric rheumatologist is available per million population. In all EU member states there is good access to specialist care and medications, although biologic drug availability is worse in Eastern European countries. PR education is widely available for physicians but is insufficient for allied health professionals. The ability to participate in clinical trials is generally high. Important gaps were identified, including lack of standardized clinical guidelines/recommendations and insufficient adolescent transition management planning. CONCLUSION This study provides a comprehensive description of current specialist PR service provision across Europe and did not reveal any major differences between EU member states. Rarity, chronicity and complexity of diseases are major challenges to PR care. Future work should facilitate the development, dissemination and implementation of standards of care, treatment and service recommendations to further improve patient-centred health care across Europe.
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Affiliation(s)
- Pavla Dolezalova
- Department of Paediatrics and Adolescent Medicine, General University Hospital, and 1st Faculty of Medicine, Charles University in Prague, Praha 2, Czech Republic
| | - Jordi Anton
- Department of Pediatric Rheumatology, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University of Ljubljana and Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Michael W Beresford
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Paul A Brogan
- Infection, Immunity and Inflammation, University College London Great Ormond St Institute of Child Health, London, UK
| | - Tamas Constantin
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | - Yona Egert
- European Network Childhood Arthritis Patient Organisation, Jerusalem, Israel
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Hamburg, Germany
| | - Helen E Foster
- Newcastle University, and Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Veronique Hentgen
- Reference Center for Autoinflammatory Diseases, Versailles Hospital- CEREMAIA, Le Chesnay, Paris, France
| | - Isabelle Kone-Paut
- Pediatric Rheumatology and CEREMAIA, Le Kremlin-Bicêtre University Hospital, APHP, Paris-Sud University, Paris, France
| | - Jasmine B Kuemmerle-Deschner
- Division of Rheumatology, Department of Pediatrics, University Hospital Tuebingen, and Autoinflammation Reference Center Tuebingen, Tuebingen, Germany
| | - Pekka Lahdenne
- Pediatric Rheumatology, Helsinki Children's Hospital, Helsinki University Central Hospital, Finland
| | - Bo Magnusson
- Pediatric Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Alberto Martini
- Direzione Scientifica, Istituto Giannina Gaslini, Genoa, Italy
| | - Liza McCann
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Kirsten Minden
- Department of Rheumatology and Clinical Immunology, German Rheumatism Research Centre Berlin, Charite University Medicine Berlin, Berlin, Germany
| | - Seza Ozen
- Department for Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Casper Schoemaker
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pierre Quartier
- French Reference Centre RAISE, Paris-Descartes University, IMAGINE Institute, Necker Hospital, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia and University of Genoa, Instituto Giannina Gaslini, Genoa, Italy
| | | | - Nicola Ruperto
- Clinica Pediatrica e Reumatologia, PRINTO Coordinating Centre, Instituto Giannina Gaslini, Genoa, Italy
| | - Sebastian Vastert
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, Utrecht, Netherlands
| | - Carine Wouters
- Department of Pediatrics, Division of Pediatric Rheumatology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Francesco Zulian
- Department of Woman and Child Health, University of Padova, Padova, Italy
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, University Medical Center Utrecht, Utrecht, Netherlands
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Ramanan AV, Dick AD, Guly C, McKay A, Jones AP, Hardwick B, Lee RWJ, Smyth M, Jaki T, Beresford MW. Tocilizumab in patients with anti-TNF refractory juvenile idiopathic arthritis-associated uveitis (APTITUDE): a multicentre, single-arm, phase 2 trial. Lancet Rheumatol 2020; 2:e135-e141. [PMID: 32280950 PMCID: PMC7134526 DOI: 10.1016/s2665-9913(20)30008-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Uveitis associated with juvenile idiopathic arthritis is a cause of major ocular morbidity. A substantial proportion of children are refractory to systemic methotrexate and TNF inhibitors. Our aim was to study the safety and efficacy of tocilizumab in children with juvenile idiopathic arthritis-associated uveitis refractory to both methotrexate and TNF inhibitors. METHODS This multicentre, single-arm, phase 2 trial was done following a Simon's two-stage design at seven tertiary hospital sites in the UK. Patients aged 2-18 years with active juvenile idiopathic arthritis-associated uveitis were eligible. All patients had been on a stable dose of methotrexate for at least 12 weeks and had not responded to treatment with a TNF inhibitor. Patients weighing 30 kg or more were treated with 162 mg subcutaneous tocilizumab every 2 weeks for 24 weeks, and participants weighing less than 30 kg were treated with 162 mg every 3 weeks for 24 weeks. The primary outcome was treatment response defined as a two-step decrease, or decrease to zero, from baseline in the level of inflammation (anterior chamber cells) at week 12, per the standardisation of uveitis nomenclature criteria. A phase 3 trial would be justified if more than seven patients responded to treatment. An interim analysis was planned to assess whether the trial would be stopped for futility, with futility defined as two or fewer treatment responses among ten participants. Adverse events were collected up to 30 calendar days after treatment cessation. The primary analysis was done in the intention-to-treat population and the safety analysis was done in all patients who started the treatment. This trial is registered with the International Standard Randomised Controlled Trial Number registry (ISRCTN95363507) and EU Clinical Trials Register (EudraCT 2015-001323-23). FINDINGS 22 participants were enrolled to the trial between Dec 3, 2015, and March 9, 2018, and 21 participants received treatment. One participant was found to be ineligible immediately after enrolment and was therefore withdrawn. Seven of 21 (median unbiased estimate of proportion 34% [95% CI 25-57]) responded to treatment (p=0·11). Safety results were consistent with the known safety profile of tocilizumab. INTERPRETATION The primary endpoint was not met, and thus the results do not support a phase 3 trial of tocilizumab in patients with juvenile idiopathic arthritis-associated uveitis. Importantly, data on the use of tocilizumab in clinical practice is now captured in national registries. Despite this trial not meeting the threshold required to justify a larger phase 3 trial, several patients responded to treatment; as such, tocilzumab might still be a therapeutic option in some children with uveitis refractory to anti-TNF drugs, given the absence of other treatment options. FUNDING Versus Arthritis and the National Institute for Health Research Clinical Research Network: Children.
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Affiliation(s)
- Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust and Bristol Medical School, University of Bristol, Bristol, UK,Correspondence to: Prof A V Ramanan, University Hospitals Bristol NHS Foundation Trust and Bristol Medical School, University of Bristol, Bristol BS2 8BJ, UK
| | - Andrew D Dick
- Bristol Eye Hospital, Bristol, UK,School of Clinical Sciences, University of Bristol, Bristol, UK,UCL Institute of Ophthalmology and National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital, London, UK,University College London Institute of Ophthalmology, London, UK
| | | | - Andrew McKay
- Liverpool Clinical Trials Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Ashley P Jones
- Liverpool Clinical Trials Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Ben Hardwick
- Liverpool Clinical Trials Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Richard W J Lee
- Bristol Eye Hospital, Bristol, UK,School of Clinical Sciences, University of Bristol, Bristol, UK,UCL Institute of Ophthalmology and National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital, London, UK,University College London Institute of Ophthalmology, London, UK
| | - Matthew Smyth
- Liverpool Clinical Trials Centre, Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Thomas Jaki
- Mathematics and Statistics, Lancaster University, Lancaster, UK
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Belot A, Rice GI, Omarjee SO, Rouchon Q, Smith EMD, Moreews M, Tusseau M, Frachette C, Bournhonesque R, Thielens N, Gaboriaud C, Rouvet I, Chopin E, Hoshino A, Latour S, Ranchin B, Cimaz R, Romagnani P, Malcus C, Fabien N, Sarda MN, Kassai B, Lega JC, Decramer S, Abou-Jaoude P, Bruce IN, Simonet T, Bardel C, Rollat-Farnier PA, Viel S, Reumaux H, O'Sullivan J, Walzer T, Mathieu AL, Marenne G, Ludwig T, Genin E, Ellingford J, Bader-Meunier B, Briggs TA, Beresford MW, Crow YJ. Contribution of rare and predicted pathogenic gene variants to childhood-onset lupus: a large, genetic panel analysis of British and French cohorts. Lancet Rheumatol 2020; 2:e99-e109. [PMID: 38263665 DOI: 10.1016/s2665-9913(19)30142-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/09/2019] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is a rare immunological disorder and genetic factors are considered important in its causation. Monogenic lupus has been associated with around 30 genotypes in humans and 60 in mice, while genome-wide association studies have identified more than 90 risk loci. We aimed to analyse the contribution of rare and predicted pathogenic gene variants in a population of unselected cases of childhood-onset SLE. METHODS For this genetic panel analysis we designed a next-generation sequencing panel comprising 147 genes, including all known lupus-causing genes in humans, and potentially lupus-causing genes identified through GWAS and animal models. We screened 117 probands fulfilling American College of Rheumatology (ACR) criteria for SLE, ascertained through British and French cohorts of childhood-onset SLE, and compared these data with those of 791 ethnically matched controls from the 1000 Genomes Project and 574 controls from the FREX Consortium. FINDINGS After filtering, mendelian genotypes were confirmed in eight probands, involving variants in C1QA, C1QC, C2, DNASE1L3, and IKZF1. Seven additional patients carried heterozygous variants in complement or type I interferon-associated autosomal recessive genes, with decreased concentrations of the encoded proteins C3 and C9 recorded in two patients. Rare variants that were predicted to be damaging were significantly enriched in the childhood-onset SLE cohort compared with controls; 25% of SLE probands versus 5% of controls were identified to harbour at least one rare, predicted damaging variant (p=2·98 × 10-11). Inborn errors of immunity were estimated to account for 7% of cases of childhood-onset SLE, with defects in innate immunity representing the main monogenic contribution. INTERPRETATION An accumulation of rare variants that are predicted to be damaging in SLE-associated genes might contribute to disease expression and clinical heterogeneity. FUNDING European Research Council.
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Affiliation(s)
- Alexandre Belot
- Paediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, France; CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France.
| | - Gillian I Rice
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Sulliman Ommar Omarjee
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Quentin Rouchon
- Data Mining and Modelling for Biomedicine, VIB Center for Inflammation Research, Ghent, Belgium; Department of Applied Mathematics, Computer Science and Statistics, Ghent University, Ghent, Belgium
| | - Eve M D Smith
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Marion Moreews
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Maud Tusseau
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Cécile Frachette
- Paediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, France; CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Raphael Bournhonesque
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Nicole Thielens
- University of Grenoble Alpes, CNRS, CEA, IBS, F-38000 Grenoble, France
| | | | - Isabelle Rouvet
- Centre de biotechnologie cellulaire et Biothèque, Groupe Hospitalier Est, Hospices Civils de Lyon, 69677 Bron, France
| | - Emilie Chopin
- Centre de biotechnologie cellulaire et Biothèque, Groupe Hospitalier Est, Hospices Civils de Lyon, 69677 Bron, France
| | - Akihiro Hoshino
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, INSERM UMR 1163, Paris, France
| | - Sylvain Latour
- Laboratory of Lymphocyte Activation and Susceptibility to EBV infection, INSERM UMR 1163, Paris, France; University Paris Descartes Sorbonne Paris Cité, Imagine Institute, Paris, France
| | - Bruno Ranchin
- Paediatric Nephrology, Rheumatology, Dermatology Unit, Femme Mere Enfant Hospital, Hospices Civils de Lyon, France
| | - Rolando Cimaz
- Rheumatology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
| | - Paula Romagnani
- Nephrology Unit, Anna Meyer Children Hospital and University of Florence, University of Florence, Florence, Italy
| | - Christophe Malcus
- Service d'Immunologie, Hôpital Edouard Herriot, Hospices Civils de Lyon, 69437 Lyon, France
| | - Nicole Fabien
- Service d'immunologie, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | - Marie-Nathalie Sarda
- Service d'immunologie, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | - Behrouz Kassai
- EPICIME-CIC 1407 de Lyon, Inserm, Service de Pharmacotoxicologie, Hospices Civils de Lyon & Université Lyon 1, 69677, Bron, France
| | - Jean-Christophe Lega
- Internal Medicine Unit, CHLS, Hospices Civils de Lyon, Pierre Benite, Université de Lyon 1, Lyon, France
| | - Stéphane Decramer
- Department of Pediatric Nephrology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France; Centre De Référence des Maladies Rénales Rares du Sud Ouest & Inserm U1048, France
| | - Pauline Abou-Jaoude
- Department of Paediatric Nephrology, St George Hospital, University Medical Center, Beirut, Lebanon
| | - Ian N Bruce
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, School of Biological Sciences, University of Manchester, Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Thomas Simonet
- Department of Biostatistics-bioinformatics, Hospices Civils de Lyon, 69677, Bron, France
| | - Claire Bardel
- Department of Biostatistics-bioinformatics, Hospices Civils de Lyon, 69677, Bron, France; CNRS UMR5558, Biometry and evolutionary biology lab, Lyon University, Lyon 1 University, F-69622 Villeurbanne, France
| | - Pierre Antoine Rollat-Farnier
- CNRS UMR5558, Biometry and evolutionary biology lab, Lyon University, Lyon 1 University, F-69622 Villeurbanne, France
| | - Sebastien Viel
- Service d'immunologie, Hospices Civils de Lyon, CHLS, 69495 Pierre-Bénite, France
| | | | - James O'Sullivan
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Thierry Walzer
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Anne-Laure Mathieu
- CIRI, Centre International de Recherche en Infectiologie/ International Center for Infectiology Research, Inserm, U1111, Ecole Normale Supérieure de Lyon, Université Lyon 1, CNRS, UMR5308, Lyon, France
| | - Gaelle Marenne
- Inserm, Univ Brest, EFS, UMR 1078, GGB, F-29200 Brest, France
| | - Thomas Ludwig
- Inserm, Univ Brest, EFS, UMR 1078, GGB, F-29200 Brest, France; CHU Brest, Brest, France
| | | | - Jamie Ellingford
- Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Brigitte Bader-Meunier
- Paediatric Rheumatology and Immunology Unit, Necker Hospital, Imagine Institution, Paris, France
| | - Tracy A Briggs
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Manchester Centre for Genomic Medicine, Manchester Academic Health Sciences Centre, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Michael W Beresford
- Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Department of Women and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Yanick J Crow
- Laboratory of Neurogenetics and Neuroinflammation, Institut Imagine, Paris, France; Paris Descartes University, Sorbonne-Paris-Cité, Institut Imagine, Paris, France; Centre for Genomic and Experimental Medicine, MRC Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
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de Graeff N, Groot N, Ozen S, Eleftheriou D, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, McCann L, Pilkington C, Ravelli A, van Royen-Kerkhof A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Brogan P, Beresford MW. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease - the SHARE initiative. Rheumatology (Oxford) 2020; 58:672-682. [PMID: 30535127 DOI: 10.1093/rheumatology/key344] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The European Single Hub and Access point for paediatric Rheumatology in Europe initiative aimed to optimize care for children with rheumatic diseases. Kawasaki disease (KD) is the most common cause of acquired heart disease in children and an important cause of long-term cardiac disease into adulthood. Prompt diagnosis and treatment of KD is difficult due to the heterogeneity of the disease but is crucial for improving outcome. To date, there are no European internationally agreed, evidence-based guidelines concerning the diagnosis and treatment of KD in children. Accordingly, treatment regimens differ widely. The aim of this study is to provide consensus-based, European-wide evidence-informed recommendations for diagnosis and treatment of children with KD. METHODS Recommendations were developed using the EULAR's standard operating procedures. An extensive systematic literature search was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of international experts via online surveys and subsequently discussed in three consensus meetings, using nominal group technique. Recommendations were accepted when ⩾80% agreed. RESULTS In total, 17 recommendations for diagnosis and 14 for treatment of KD in children were accepted. Diagnostic recommendations included laboratory and imaging workup for complete as well as incomplete KD. Treatment recommendations included the importance of early treatment in both complete and incomplete KD, use of intravenous immunoglobulin, aspirin, corticosteroids for high-risk cases, and other treatment options for those with resistant disease. CONCLUSION The Single Hub and Access point for paediatric Rheumatology in Europe initiative provides international evidence-based recommendations for diagnosing and treating KD in children, facilitating improvement and uniformity of care.
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Affiliation(s)
- Nienke de Graeff
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Noortje Groot
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Seza Ozen
- Department of Paediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Despina Eleftheriou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Tadej Avcin
- Department of Paediatric Rheumatology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Brigitte Bader-Meunier
- Department of Paediatric Rheumatology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pavla Dolezalova
- First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Brian M Feldman
- Department of Paediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Bicêtre Hospital, APHP, University of Paris SUD, Paris, France
| | - Pekka Lahdenne
- Department of Paediatric Rheumatology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Angelo Ravelli
- Department of Paediatric Rheumatology, Gaslini Children's Hospital, Genoa, Italy
| | - Annet van Royen-Kerkhof
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Yosef Uziel
- Meir Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bas Vastert
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Nico Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paul Brogan
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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de Graeff N, Groot N, Brogan P, Ozen S, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, Marks SD, McCann L, Pilkington C, Ravelli A, van Royen A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European consensus-based recommendations for the diagnosis and treatment of rare paediatric vasculitides - the SHARE initiative. Rheumatology (Oxford) 2020; 58:656-671. [PMID: 30535249 DOI: 10.1093/rheumatology/key322] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The European initiative Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) aimed to optimize care for children with rheumatic diseases. Systemic vasculitides are very rare in children. Consequently, despite recent advances, paediatric-specific information is sparse. The lack of evidence-based recommendations is an important, unmet need. This study aimed to provide recommendations for diagnosing and treating children with rare forms of childhood systemic vasculitis. METHODS Recommendations were developed by a consensus process in accordance with the European League Against Rheumatism standard operating procedures. A systematic literature review informed the recommendations, which were devised and evaluated by a panel of experts via an online survey, and two consensus meetings using nominal group technique. Recommendations were accepted when ⩾ 80% of experts agreed. RESULTS Ninety-three relevant articles were found, and 78 recommendations were accepted in the two consensus meetings. General, cross-cutting recommendations and disease-specific statements regarding the diagnosis and treatment of childhood-onset PAN, granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, and Takayasu arteritis are provided. CONCLUSION These Single Hub and Access point for paediatric Rheumatology in Europe recommendations were formulated through an evidence-based consensus process to support uniform, high-quality standard of care for children with rare forms of paediatric systemic vasculitis.
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Affiliation(s)
- Nienke de Graeff
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Noortje Groot
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht.,Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands.,Department of Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool
| | - Paul Brogan
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, London, UK
| | - Seza Ozen
- Department of Paediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Tadej Avcin
- Department of Paediatric Rheumatology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Brigitte Bader-Meunier
- Department of Paediatric Rheumatology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pavla Dolezalova
- 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Brian M Feldman
- Department of Paediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Bicêtre University Hospital, APHP, University of Paris Sud, Paris, France
| | - Pekka Lahdenne
- Department of Paediatric Rheumatology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Stephen D Marks
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, London, UK
| | - Angelo Ravelli
- Department of Paediatric Rheumatology, Gaslini Children's Hospital, Genoa, Italy
| | - Annet van Royen
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Yosef Uziel
- Meir Medical Center, Kfar Saba, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Bas Vastert
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Nico Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Kearsley-Fleet L, Sampath S, McCann LJ, Baildam E, Beresford MW, Davies R, De Cock D, Foster HE, Southwood TR, Thomson W, Hyrich KL. Use and effectiveness of rituximab in children and young people with juvenile idiopathic arthritis in a cohort study in the United Kingdom. Rheumatology (Oxford) 2019; 58:331-335. [PMID: 30358861 PMCID: PMC6343463 DOI: 10.1093/rheumatology/key306] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/11/2022] Open
Abstract
Objectives Rituximab (RTX) may be a treatment option for children and young people with JIA, although it is not licensed for this indication. The aim of this study was to describe RTX use and outcomes among children with JIA. Methods This analysis included all JIA patients within the UK Biologics for Children with Rheumatic Diseases study starting RTX. Disease activity was assessed at RTX start and at follow-up. The total number of courses each patient received was assessed. Serious infections and infusion reactions occurring following RTX were reported. Results Forty-one JIA patients starting RTX were included, the majority with polyarthritis: polyarthritis RF negative [n = 14 (35%)], polyarthritis RF positive [n = 13 (33%)] and extended oligoarthritis [n = 9 (23%)]. Most were female (80%) with a median age of 15 years [interquartile range (IQR) 12–16] and a median disease duration of 9 years (IQR 5–11). The median improvement in the clinical Juvenile Arthritis Disease Activity Score (cJADAS; three-variable 71-joint JADAS) from RTX start was 9 units (n = 7; IQR −14–2). More than half reported more than one course of RTX. The median time between each course was 219 days (IQR 198–315). During follow-up, 17 (41%) patients reported switching to another biologic, including tocilizumab (n = 8), abatacept (n = 6) and TNF inhibitor (n = 3). Three patients (7%) reported a serious infection on RTX (rate of first serious infection 6.2/100 person-years). Four patients (10%) reported an infusion reaction. Conclusions This real-world cohort of children with JIA, the majority with polyarticular or extended oligoarticular JIA, showed RTX may be an effective treatment option for children who do not respond to TNF inhibitor, with a low rate of serious infections on treatment.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Sunil Sampath
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Liza J McCann
- Clinical Academic Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, UK
| | - Eileen Baildam
- Clinical Academic Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, UK
| | - Michael W Beresford
- Clinical Academic Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, UK.,Institute of Translational Medicine (Child Health), University of Liverpool, Liverpool, UK
| | - Rebecca Davies
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Diederik De Cock
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Helen E Foster
- Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.,Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UK
| | - Taunton R Southwood
- Institute of Child Health, University of Birmingham and Birmingham Children's Hospital, Birmingham, UK
| | - Wendy Thomson
- Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Faculty of Biologic, Medicine and Health, University of Manchester, Manchester, UK.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kimme L Hyrich
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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48
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Wright RD, Dimou P, Northey SJ, Beresford MW. Mesangial cells are key contributors to the fibrotic damage seen in the lupus nephritis glomerulus. J Inflamm (Lond) 2019; 16:22. [PMID: 31807119 PMCID: PMC6857320 DOI: 10.1186/s12950-019-0227-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022]
Abstract
Background Lupus nephritis (LN) affects up to 80% of juvenile-onset systemic lupus erythematosus patients. Mesangial cells (MCs) comprise a third of the glomerular cells and are key contributors to fibrotic changes within the kidney. This project aims to identify the roles of MCs in an in vitro model of LN. Methods Conditionally immortalised MCs were treated with pro-inflammatory cytokines or with patient sera in an in vitro model of LN and assessed for their roles in inflammation and fibrosis. Results MCs were shown to produce pro-inflammatory cytokines in response to a model of the inflammatory environment in LN. Further the cells expressed increased levels of mRNA for extracellular matrix (ECM) proteins (COL1A1, COL1A2, COL4A1 and LAMB1), matrix metalloproteinase enzymes (MMP9) and tissue inhibitors of matrix metalloproteinases (TIMP1). Treatment of MCs with serum from patients with active LN was able to induce a similar, albeit milder phenotype. Treatment of MCs with cytokines or patient sera was able to induce secretion of TGF-β1, a known inducer of fibrotic changes. Inhibition of TGF-β1 actions through SB-431542 (an activin A receptor type II-like kinase (ALK5) inhibitor) was able to reduce these responses suggesting that the release of TGF-β1 plays a role in these changes. Conclusions MCs contribute to the inflammatory environment in LN by producing cytokines involved in leukocyte recruitment, activation and maturation. Further the cells remodel the ECM via protein deposition and enzymatic degradation. This occurs through the actions of TGF-β1 on its receptor, ALK5. This may represent a potential therapeutic target for treatment of LN-associated fibrosis.
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Affiliation(s)
- Rachael D Wright
- 1Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK.,2Department of Women and Children's Health, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP UK
| | - Paraskevi Dimou
- 1Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK
| | - Sarah J Northey
- 1Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK
| | - Michael W Beresford
- 1Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, member of Liverpool Health Partners, Liverpool, UK.,3Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, member of Liverpool Health Partners, Liverpool, UK
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49
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Horton S, Jones AP, Guly CM, Hardwick B, Beresford MW, Lee RW, Dick AD, Ramanan AV. Adalimumab in Juvenile Idiopathic Arthritis-Associated Uveitis: 5-Year Follow-up of the Bristol Participants of the SYCAMORE Trial. Am J Ophthalmol 2019; 207:170-174. [PMID: 31201796 DOI: 10.1016/j.ajo.2019.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 01/06/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE To determine longer-term outcomes of participants enrolled from a single center in the SYCAMORE trial, a randomized placebo-controlled trial of adalimumab vs placebo in children with juvenile idiopathic arthritis-associated uveitis (JIA-U) uncontrolled on methotrexate. DESIGN Retrospective interventional case series. METHODS Medical records of all 28 SYCAMORE participants recruited at the Bristol Eye Hospital were reviewed at approximately 3-monthly intervals up to 5 years from the trial randomization date. Uveitis activity, treatment course, visual outcomes, ocular complications, and adverse events were recorded. Data are presented using summary statistics. RESULTS Following withdrawal of the investigational medicinal product (IMP), 25 of the 28 participants were started on adalimumab for active JIA-U. Of the 12 participants in the active treatment arm of the SYCAMORE study, 11 (92%) were restarted on adalimumab after withdrawal of the IMP for active JIA-U (median time to flare 188 days [range 42-413 days). Two participants stopped adalimumab for uncontrolled JIA-U. One participant had a reduction in vision to 0.3 owing to cataract. Mean visual acuity for the remaining 27 participants was -0.04 (right eye) and -0.05 (left eye). CONCLUSIONS Drug-induced remission of JIA-U did not persist when adalimumab was withdrawn after 1-2 years of treatment. Adalimumab was well tolerated and visual acuity outcomes were excellent.
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Affiliation(s)
- Sarah Horton
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Ashley P Jones
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Catherine M Guly
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Ben Hardwick
- Clinical Trials Research Centre, Department of Biostatistics, University of Liverpool, Liverpool, United Kingdom
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
| | - Richard W Lee
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; University of Bristol, Bristol, United Kingdom
| | - Andrew D Dick
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom; University of Bristol, Bristol, United Kingdom; National Institute of Health Research and Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
| | - Athimalaipet V Ramanan
- University of Bristol, Bristol, United Kingdom; Department of Paediatric Rheumatology, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom.
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50
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Hofmann SR, Mäbert K, Kapplusch F, Russ S, Northey S, Beresford MW, Tsokos GC, Hedrich CM. cAMP Response Element Modulator α Induces Dual Specificity Protein Phosphatase 4 to Promote Effector T Cells in Juvenile-Onset Lupus. J Immunol 2019; 203:2807-2816. [PMID: 31653682 DOI: 10.4049/jimmunol.1900760] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/19/2019] [Indexed: 12/19/2022]
Abstract
Effector CD4+ T cells with increased IL-17A and reduced IL-2 production contribute to tissue inflammation and organ damage in systemic lupus erythematosus (SLE). Increased expression of the transcription factor cAMP response element modulator (CREM) α promotes altered cytokine expression in SLE. The aim of this study was to investigate CREMα-mediated events favoring effector CD4+ T cells in health and disease. Using CRISPR/Cas9 genome editing and lentiviral transduction, we generated CREMα-deficient and CREMα-overexpressing Jurkat T cells. Gene expression and regulatory events were assessed using luciferase reporter assays and chromatin immunoprecipitation. Interaction between CREMα and p300 was investigated using proximity ligation assays, coimmunoprecipitation, and knockdown of p300. Gene expression profiles of modified cells were compared with CD4+ T cells from patients with juvenile-onset SLE. We show that CREMα induces dual specificity protein phosphatase (DUSP) 4 in effector CD4+ T cells through corecruitment of p300. The transcriptional coactivator p300 mediates histone acetylation at DUSP4, prompting increased gene expression. Using DUSP4 transfection models and genetically modified CREM-deficient and CREMα-overexpressing T cells, we demonstrate the molecular underpinnings by which DUSP4 induces IL-17A while limiting IL-2 expression. We demonstrate that CD4+ T cells from patients with juvenile-onset SLE share phenotypical features with CREMα-overexpressing CD4+ T cells, including increased DUSP4 expression and imbalanced IL-17A and IL-2 production. Taken together, we describe CREMα-mediated mechanisms that involve the transcriptional upregulation of DUSP4, leading to imbalanced cytokine production by effector T cells. Our findings identify the CREMα/DUSP4 axis as a promising candidate in the search for biomarkers and therapeutic targets in SLE.
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Affiliation(s)
- Sigrun R Hofmann
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, D01307 Dresden, Germany
| | - Katrin Mäbert
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, D01307 Dresden, Germany
| | - Franz Kapplusch
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool L14 5AB, United Kingdom
| | - Susanne Russ
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, D01307 Dresden, Germany
| | - Sarah Northey
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool L14 5AB, United Kingdom
| | - Michael W Beresford
- Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool L14 5AB, United Kingdom.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, United Kingdom.,National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, United Kingdom; and
| | - George C Tsokos
- Division of Rheumatology and Clinical Immunology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215
| | - Christian M Hedrich
- Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, TU Dresden, D01307 Dresden, Germany; .,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool L14 5AB, United Kingdom.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, United Kingdom.,National Institute for Health Research Alder Hey Clinical Research Facility, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool L14 5AB, United Kingdom; and
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