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Vyzhga Y, Wittkowski H, Hentgen V, Georgin-Lavialle S, Theodoropoulou A, Fuehner S, Jesenak M, Frenkel J, Papadopoulou-Alataki E, Anton J, Olivieri AN, Brunner J, Sanchez J, Koné-Paut I, Fingerhutova S, Pillet P, Meinzer U, Khubchandani R, Jansson A, Haas JP, Berendes R, Kallinich T, Horneff G, Lilienthal E, Papa R, Foell D, Lainka E, Caorsi R, Gattorno M, Hofer M. Unravelling the clinical heterogeneity of undefined recurrent fever over time in the European registries on Autoinflammation. Pediatr Rheumatol Online J 2024; 22:55. [PMID: 38760816 PMCID: PMC11100049 DOI: 10.1186/s12969-024-00987-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Systemic autoinflammatory disorders (SAIDs) represent a growing spectrum of diseases characterized by dysregulation of the innate immune system. The most common pediatric autoinflammatory fever syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA), has well defined clinical diagnostic criteria, but there is a subset of patients who do not meet these criteria and are classified as undefined autoinflammatory diseases (uAID). This project, endorsed by PRES, supported by the EMERGE fellowship program, aimed to analyze the evolution of symptoms in recurrent fevers without molecular diagnosis in the context of undifferentiated AIDs, focusing on PFAPA and syndrome of undifferentiated recurrent fever (SURF), using data from European AID registries. METHODS Data of patients with PFAPA, SURF and uSAID were collected from 3 registries including detailed epidemiological, demographic and clinical data, results of the genetic testing and additional laboratory investigations with retrospective application of the modified Marshall and PRINTO/Eurofever classification criteria on the cohort of PFAPA patients and preliminary SURF criteria on uSAID/SURF patients. RESULTS Clinical presentation of PFAPA is variable and some patients did not fit the conventional PFAPA criteria and exhibit different symptoms. Some patients did not meet the criteria for either PFAPA or SURF, highlighting the heterogeneity within these groups. The study also explored potential overlaps between PFAPA and SURF/uAID, revealing that some patients exhibited symptoms characteristic of both conditions, emphasizing the need for more precise classification criteria. CONCLUSIONS Patients with recurrent fevers without molecular diagnoses represent a clinically heterogeneous group. Improved classification criteria are needed for both PFAPA and SURF/uAID to accurately identify and manage these patients, ultimately improving clinical outcomes.
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Affiliation(s)
- Y Vyzhga
- National Pirogov Memorial Medical University, Vinnytsya, Ukraine.
| | - H Wittkowski
- Department of Pediatric Rheumatology and Immunology, University Hospital Munster, Munster, Germany
| | - V Hentgen
- Department for Pediatrics, National Referral Centre of Auto-Inflammatory Diseases and Inflammatory Amyloidosis, - CEREMAIA, Versailles Hospital, Le Chesnay (Paris), France
| | - S Georgin-Lavialle
- CEREMAIA (French Reference Center for Auto-Inflammatory Diseases and Inflammatory Amyloidosis), Kremlin-Bicêtre, France
- Department of Internal Medicine, Sorbonne University, Tenon Hospital (APHP), Paris, France
| | - A Theodoropoulou
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - S Fuehner
- Department of Pediatric Rheumatology and Immunology, University Hospital Munster, Munster, Germany
| | - M Jesenak
- Department of Peadiatrics and Adolescent Medicine, Jesenius Faculty of Medicine in Martin, Comenius University, University Hospital Martin, Martin, Slovakia
| | - J Frenkel
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, Netherlands
| | - E Papadopoulou-Alataki
- Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Papageorgiou General Hospital, Fourth, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Jordi Anton
- Department of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona. Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - A Nunzia Olivieri
- Dipartimento Della Donna del Bambino E Di Chirurgia Generale E Specialistica, Università Degli Studi Della Campania L.Vanvitelli, Naples, Italy
| | - J Brunner
- Department of Pediatrics, Pediatric Rheumatology, Medical University Innsbruck, Innsbruck and Danube Private University Krems, Innsbruck, Austria
| | - J Sanchez
- Hospital Parc Taulí de Sabadell, Reumatologia Pediàtrica - Servei de Medicina Pediàtrica, Barcelona, Spain
| | - I Koné-Paut
- Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and Inflammatory Amyloidosis, CEREMAIA, CHU de Biĉetre, APHP, University of Paris Sud, Le Kremlin Biĉetre, France
| | - S Fingerhutova
- Department of Paediatrics and Inherited Metabolic Disorders, Centre for Paediatric Rheumatology and Autoinflammatory Diseases 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - P Pillet
- Pediatrics and Immunology, CHU Pellegrin, Bordeaux, France
| | - U Meinzer
- Department of General Paediatrics, Paediatric Infectious Disease and Internal Medicine, Assistance Publique-Hôpitaux de Paris, Robert Debré University Hospital, Université de Paris, Paris, France
| | - R Khubchandani
- Department of Pediatrics, Jaslok Hospital, Mumbai, India
| | - A Jansson
- Division of Pediatric Rheumatology and Immunology, Dr. Von Hauner Children's Hospital, University Hospital Munich, Munich, Germany
| | - J-P Haas
- German Center for Paediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - R Berendes
- Marien Children's Hospital, Landshut, Germany
| | - T Kallinich
- German Rheumatism Research Center, Leibniz Institute Berlin Charité Universitätsmedizin Berlin, Paediatric Pneumology, Immunology and Critical Care Medicine and SPZ (Center for Chronically Sick Children), Berlin, Germany
| | - G Horneff
- Department of Pediatrics, Asklepios Clinic Sankt Augustin GmbH, Sankt Augustin, Germany
| | - E Lilienthal
- Department of Pediatrics, Ruhr University of Bochum, Bochum, Germany
| | - R Papa
- Centre for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - D Foell
- Department of Pediatric Rheumatology and Immunology, University Hospital Munster, Munster, Germany
| | - E Lainka
- Department of Pediatric Rheumatology, University Children's Hospital Essen, Essen, Germany
| | - R Caorsi
- Centre for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Gattorno
- Centre for Autoinflammatory Diseases and Immunodeficiencies, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - M Hofer
- Department of Pediatrics, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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Rosina S, Rebollo-Gimenez AI, Tarantola L, Pistorio A, Vyzhga Y, El Miedany Y, Lotfy HM, Abu-Shady H, Eissa M, Osman NS, Hassan W, Mahgoub MY, Fouad NA, Mosa DM, Adel Y, Mohamed SEM, Radwan AR, Abu-Zaid MH, Tabra SAA, Shalaby RH, Nasef SI, Khubchandani R, Khan A, Maldar NP, Ozen S, Bayindir Y, Alsuweiti M, Alzyoud R, Almaaitah H, Vilaiyuk S, Lerkvaleekul B, Alexeeva E, Dvoryakovskaya T, Kriulin I, Bracaglia C, Pardeo M, De Benedetti F, Licciardi F, Montin D, Robasto F, Minoia F, Filocamo G, Rossano M, Simonini G, Marrani E, Abu-Rumeleih S, Kostik MM, Belozerov KE, Pal P, Bathia JN, Katsicas MM, Villarreal G, Marino A, Costi S, Sztajnbok F, Silva RM, Maggio MC, El-Ghoneimy DH, El Owaidy R, Civino A, Diomeda F, Al-Mayouf SM, Al-Sofyani F, Dāvidsone Z, Patrone E, Saad-Magalhães C, Consolaro A, Ravelli A. Defining criteria for disease activity states in systemic juvenile idiopathic arthritis based on the systemic Juvenile Arthritis Disease Activity Score. Arthritis Rheumatol 2024. [PMID: 38682570 DOI: 10.1002/art.42865] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 02/06/2024] [Accepted: 04/03/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE To develop and validate cutoff values in the systemic Juvenile Arthritis Disease Activity Score 10 (sJADAS10) that distinguish the states of inactive disease (ID), minimal disease activity (MiDA), moderate disease activity (MoDA), and high disease activity (HDA) in children with systemic juvenile idiopathic arthritis (sJIA), based on subjective disease state assessment by the treating pediatric rheumatologist. METHODS The cutoffs definition cohort was composed of 400 patients enrolled at 30 pediatric rheumatology centers in 11 countries. Using the subjective physician rating as an external criterion, 6 methods were applied to identify the cutoffs: mapping, calculation of percentiles of cumulative score distribution, Youden index, 90% specificity, maximum agreement, and ROC curve analysis. Sixty percent of the patients were assigned to the definition cohort and 40% to the validation cohort. Cutoff validation was conducted by assessing discriminative ability. RESULTS The sJADAS10 cutoffs that separated ID from MiDA, MiDA from MoDA, and MoDA from HDA were ≤ 2.9, ≤ 10, and > 20.6. The cutoffs discriminated strongly among different levels of pain, between patients with or without morning stiffness, and between patients whose parents judged their disease status as remission or persistent activity/flare or were satisfied or not satisfied with current illness outcome. CONCLUSION The sJADAS cutoffs revealed good metrologic properties in both definition and validation cohorts, and are therefore suitable for use in clinical trials and routine practice.
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Affiliation(s)
- Silvia Rosina
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Ana I Rebollo-Gimenez
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Letizia Tarantola
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Angela Pistorio
- Direzione Scientifica - Unità di Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Yulia Vyzhga
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Yasser El Miedany
- Canterbury Christ Church University, UK and Egyptian College of Pediatric Rheumatology, Egypt
| | - Hala M Lotfy
- Pediatric Rheumatology Department, Abu- el Reesh Hospital, Cairo University, Cairo, Egypt
| | - Hend Abu-Shady
- Pediatric Rheumatology Department, Abu- el Reesh Hospital, Cairo University, Cairo, Egypt
| | - Mervat Eissa
- Rheumatology, Kasr Elainy Cairo University, Cairo, Egypt
| | | | - Waleed Hassan
- Rheumatology, Rehabilitation and Physical Medicine, Benha University, Benha, Egypt
| | - Marwa Y Mahgoub
- Rheumatology, Rehabilitation and Physical Medicine, Benha University, Benha, Egypt
| | - Nermeen A Fouad
- Rheumatology and Rehabilitation, Fayoum University, Fayoum, Egypt
| | - Doaa M Mosa
- Rheumatology, Rehabilitation and Physical Medicine, Mansoura University, Mansoura, Egypt
| | - Yasmin Adel
- Rheumatology, Rehabilitation and Physical Medicine, Mansoura University, Mansoura, Egypt
| | | | - Ahmed R Radwan
- Rheumatology and Rehabilitation, Sohag University, Sohag, Egypt
| | | | - Samar A A Tabra
- Rheumatology and Rehabilitation Tanta University, Tanta, Egypt
| | - Radwa H Shalaby
- Rheumatology and Rehabilitation Tanta University, Tanta, Egypt
| | - Samah I Nasef
- Rheumatology & Rehabilitation, Faculty of Medicine Suez Canal University, Ismailia, Egypt
| | | | | | | | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Yagmur Bayindir
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Motasem Alsuweiti
- Pediatric Immunology and Rheumatology division, Queen Rania Children's Hospital, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Raed Alzyoud
- Pediatric Immunology and Rheumatology division, Queen Rania Children's Hospital, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Hiba Almaaitah
- Pediatric Immunology and Rheumatology division, Queen Rania Children's Hospital, King Hussein Medical Center, Royal Medical Services, Amman, Jordan
| | - Soamarat Vilaiyuk
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Butsabong Lerkvaleekul
- Division of Rheumatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Ekaterina Alexeeva
- National Medical Research Center of Children's Health, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Tatyana Dvoryakovskaya
- National Medical Research Center of Children's Health, Moscow, Russian Federation
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Ivan Kriulin
- National Medical Research Center of Children's Health, Moscow, Russian Federation
| | - Claudia Bracaglia
- Division of Rheumatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - Manuela Pardeo
- Division of Rheumatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Francesco Licciardi
- Città della Salute e della Scienza, Pediatria specialistica Universitaria, Immunoreumatologia, Torino, Italy
| | - Davide Montin
- Città della Salute e della Scienza, Pediatria specialistica Universitaria, Immunoreumatologia, Torino, Italy
| | - Francesca Robasto
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli studi di Torino, Torino, Italy
| | - Francesca Minoia
- SC Pediatria e Immunoreumatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Filocamo
- SC Pediatria e Immunoreumatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Martina Rossano
- SC Pediatria e Immunoreumatologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gabriele Simonini
- Rheumatology Unit, IRCCS Meyer Children's Hospital, Florence, Italy
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Edoardo Marrani
- Rheumatology Unit, IRCCS Meyer Children's Hospital, Florence, Italy
| | | | - Mikhail M Kostik
- Department of Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation
| | - Konstantin E Belozerov
- Department of Pediatrics, Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation
| | - Priyankar Pal
- Pediatric Rheumatology Institute of Child Health, Kolkata, India
| | - Jigna N Bathia
- Pediatric Rheumatology Institute of Child Health, Kolkata, India
| | - María M Katsicas
- Service of Rheumatology. Hospital de Pediatría Prof Dr JP Garrahan, Buenos Aires, Argentina
| | - Giselle Villarreal
- Service of Rheumatology. Hospital de Pediatría Prof Dr JP Garrahan, Buenos Aires, Argentina
| | - Achille Marino
- Unit of Pediatric Rheumatology, ASST G.Pini-CTO, Milan, Italy
| | - Stefania Costi
- Unit of Pediatric Rheumatology, ASST G.Pini-CTO, Milan, Italy
| | - Flavio Sztajnbok
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
- Division of Pediatric Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo M Silva
- Division of Pediatric Rheumatology, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria C Maggio
- Department PROMISE "G. D'Alessandro", University of Palermo, Italy
| | - Dalia H El-Ghoneimy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Rasha El Owaidy
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Adele Civino
- Pediatric Rheumatology and Immunology Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - Federico Diomeda
- Pediatric Rheumatology and Immunology Unit, "Vito Fazzi" Hospital, Lecce, Italy
| | - Sulaiman M Al-Mayouf
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fuad Al-Sofyani
- Pediatric Rheumatology, King Faisal Specialist Hospital and Research Center, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Zane Dāvidsone
- Department of Pediatrics, University Children Hospital, Riga, Latvia
| | - Elisa Patrone
- Servizio di Sperimentazioni Cliniche Pediatriche, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | | | - Alessandro Consolaro
- UOC Reumatologia e Malattie Autoinfiammatorie, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Angelo Ravelli
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Khubchandani R, Avčin T, Ravelli A. Towards telehealth delivery in pediatric rheumatology practice. Pediatr Rheumatol Online J 2023; 21:145. [PMID: 38105249 PMCID: PMC10726584 DOI: 10.1186/s12969-023-00892-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 09/06/2023] [Indexed: 12/19/2023] Open
Abstract
INTRODUCTION Much has been written and spoken about telemedicine since about two decades including an article in this journal at the start of the pandemic. It took a global catastrophe to enforce its usage across the world in various medical specialties. Telemedicine however remains unstructured, unregulated and lacks uniformity. DISCUSSION This article highlights the practical learnings and opinions of the authors who provided over two thousand video consults and asynchronous telemedicine services through the entire pandemic. It includes lessons learnt from emerging economies where pediatric rheumatologists are scarce. Pediatric rheumatology, which relies heavily on history, musculoskeletal and skin examination is aptly suited to exploit telemedicine in its synchronous and asynchronous forms. Pediatric tele rheumatology could temporarily address the shortage and uneven distribution of specialists in vast parts of the globe, besides serving as a method of triage and shared care with the primary physician. Reduction of direct and indirect costs and family/primary physician education are additional benefits. There also exist challenges for all stakeholders and it is important to address the latter. CONCLUSION The learnings of the pandemic suggest a vital role for telemedicine in the practice of pediatric rheumatology. This is a fertile area for research and consensus building by international and national pediatric societies and issue position statements like some adult bodies already have. The authors speculate a hybrid system of care in the not-so-distant future.
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Affiliation(s)
- Raju Khubchandani
- Section of Pediatric Rheumatology, SRCC Childrens Hospital, K Khadye Marg Mumbai, Mumbai, India.
| | - Tadej Avčin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Department of Pediatrics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Angelo Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
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Maldar NP, Khubchandani R, Khan A. Genetic Disorders in Pediatric Rheumatology Clinic: When to Suspect, and Why? Indian J Pediatr 2023:10.1007/s12098-023-04845-w. [PMID: 37736825 DOI: 10.1007/s12098-023-04845-w] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 08/14/2023] [Indexed: 09/23/2023]
Abstract
Just under a decade ago, most children with genetic disorders received a phenotypic diagnosis, often by atlas matching. With advances in genomics (decoding of human genome, easy availability of genetic testing, and reduction in cost of tests), genotypic diagnosis is now a reality. Genetic diseases can lead to non-inflammatory arthritis that can mimic juvenile idiopathic arthritis (JIA). A small but growing number (as newer genes are discovered) of genetic diseases are being diagnosed in children with a seemingly inflammatory musculoskeletal diseases or connective tissue diseases. A high index of suspicion by the pediatrician is most important for early diagnosis of these genetic disorders. In a busy outpatient clinic, it is the atypical presentation of a disease in a child that suggests a possibility of underlying genetic autoinflammatory or autoimmune disease. Correct diagnosis helps the physician, child, parent, and community.
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Affiliation(s)
- Naziya Perveen Maldar
- Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Worli, Mumbai, India
| | - Raju Khubchandani
- Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Worli, Mumbai, India.
| | - Archana Khan
- Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Worli, Mumbai, India
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Foeldvari I, Klotsche J, Kasapcopur O, Adrovic A, Terreri MT, Sakamoto AP, Stanevicha V, Anton J, Feldman BM, Sztajnbok F, Khubchandani R, Alexeeva E, Katsicas M, Sawhney S, Smith V, Appenzeller S, Avcin T, Kostik M, Lehman T, Marrani E, Schonenberg-Meinema D, Sifuentes-Giraldo WA, Vasquez-Canizares N, Janarthanan M, Moll M, Nemcova D, Patwardhan A, Santos MJ, Battagliotti C, Berntson L, Bica B, Brunner J, Cimaz R, Costa-Reis P, Eleftheriou D, Harel L, Horneff G, Johnson SR, Kaiser D, Kallinich T, Lazarevic D, Minden K, Nielsen S, Nuruzzaman F, Opsahl Hetlevik S, Uziel Y, Helmus N, Torok KS. Gender differences in juvenile systemic sclerosis patients: Results from the international juvenile scleroderma inception cohort. J Scleroderma Relat Disord 2023; 8:120-130. [PMID: 37287945 PMCID: PMC10242693 DOI: 10.1177/23971983221143244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/17/2022] [Indexed: 12/24/2022]
Abstract
Objective To compare organ involvement and disease severity between male and female patients with juvenile onset systemic sclerosis. Methods Demographics, organ involvement, laboratory evaluation, patient-reported outcomes and physician assessment variables were compared between male and female juvenile onset systemic sclerosis patients enrolled in the prospective international juvenile systemic sclerosis cohort at their baseline visit and after 12 months. Results One hundred and seventy-five juvenile onset systemic sclerosis patients were evaluated, 142 females and 33 males. Race, age of onset, disease duration, and disease subtypes (70% diffuse cutaneous) were similar between males and females. Active digital ulceration, very low body mass index, and tendon friction rubs were significantly more frequent in males. Physician global assessment of disease severity and digital ulcer activity was significantly higher in males. Composite pulmonary involvement was also more frequent in males, though not statistically significantly. After 12 months, they are the pattern of differences changed female patients had significantly more frequent pulmonary involvement. Conclusion In this cohort, juvenile onset systemic sclerosis had a more severe course in males at baseline and but the pattern changed after 12 months. Some differences from adult findings persisted, there is no increased signal of pulmonary arterial hypertension or heart failure in male pediatric patients. While monitoring protocols of organ involvement in juvenile onset systemic sclerosis need to be identical for males and females.
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Affiliation(s)
- Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | | | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | | | | | - Valda Stanevicha
- Riga Stradins University, Department of Pediatric, University Children Hospital, Riga, Latvia
| | - Jordi Anton
- Pediatric Rheumatology, Hospital Sant Joan de Déu, Esplugues (Barcelona), Universitat de Barcelona, Barcelona, Spain
| | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | | | - Ekaterina Alexeeva
- National Medical Research Center of Children’s Health, Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Maria Katsicas
- Hospital de Pediatria J P Garrahan, Buenos Aires, Argentina
| | | | - Vanessa Smith
- Department of Internal Medicine, Ghent University and Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Center (IRC), Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | | | - Tadej Avcin
- University Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Mikhail Kostik
- Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russia
| | | | | | - Dieneke Schonenberg-Meinema
- Emma Children’s Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | | | - Monika Moll
- Pediatric Rheumatology, University Tübingen, Tübingen, Germany
| | - Dana Nemcova
- Department of Pediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | | | | | | | - Lillemor Berntson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Blanca Bica
- Hospital Universitário Clementino Fraga Filho (HUCFF), Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jürgen Brunner
- Department of Pediatrics, Pediatric Rheumatology, Medical University Innsbruck, Innsbruck, Austria
| | - Rolando Cimaz
- ASST Pini—CTO—Presidio Gaetano Pini, Università degli Studi Milano, Milan, Italy
| | - Patricia Costa-Reis
- Pediatrics Department, Hospital de Santa Maria, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | | | - Liora Harel
- Schneider Children’s Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Petah-Tikva, Israel
| | - Gerd Horneff
- Department of General Paediatrics, Asklepios Klinik Sankt Augustin, Sankt Augustin, Germany
- Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Sindhu R Johnson
- Toronto Scleroderma Program, Toronto Western Hospital, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Daniela Kaiser
- Luzerner Kantonsspital, Kinderspital, Luzern, Switzerland
| | - Tilmann Kallinich
- Charité University Medicine and German Rheumatism Research Center Berlin, Berlin, Germany
| | - Dragana Lazarevic
- Department of Pediatric Rheumatology and Immunology, Clinical Center Niš, Faculty of Medicine, University of Niš, Niš, Serbia
| | - Kirsten Minden
- Charité University Medicine and German Rheumatism Research Center Berlin, Berlin, Germany
| | | | | | | | - Yosef Uziel
- Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nicola Helmus
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Schön Klinik Hamburg Eilbek, Hamburg, Germany
| | - Kathryn S Torok
- University of Pittsburgh, Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
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Foeldvari I, Klotsche J, Kasapcopur O, Adrovic A, Torok K, Terreri MT, Sakamoto AP, Feldman B, Anton J, Katsikas M, Stanevicha V, Sztajnbok FR, Appenzeller S, Avcin T, Kostik M, Marrani E, Sifuentes-Giraldo WA, Johnson S, Khubchandani R, Nemcova D, Santos MJ, Battagliotti C, Berntson L, Bica B, Brunner J, Cimaz R, Eleftheriou D, Harel L, Horneff G, Janarthanan M, Kallinich T, Minden K, Moll M, Nielsen S, Patwardhan A, Schonenberg D, Smith V, Helmus N. POS1302 PATIENT AND PHYSICIAN REPORTED OUTCOMES OF JUVENILE SYSTEMIC SCLEROSIS PATIENTS SIGNIFICANTLY IMPROVE OVER 12 MONTHS OBSERVATION PERIOD IN THE JUVENILE SYSTEMIC SCLERODERMA INCEPTION COHORT. www.juvenile-scleroderma.com. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundJuvenile systemic sclerosis (jSSc) is an orphan disease with a prevalence of 3 in 1 000 000 children (1). The Juvenile Systemic Scleroderma Inception cohort (jSScC) is the largest cohort of jSSc patients in the world. The jSScC collects longitudinal data prospectively in jSSc, allowing the evaluation of the development of organ involvement and patients and physician reported outcomes in jSSc over time.ObjectivesTo review the changes in the clinical characteristics and patient and physician reported outcomes over 12 months observation period from the time of inclusion into the cohort.MethodsThe jSScC cohort enrolls jSSc patients who developed the first non-Raynaud´s symptom before the age of 16 years and are under the age of 18 years at the time of inclusion (2, 3). We reviewed jSScC patient clinical data and patient and physician reported outcomes, who had 12 months follow up from the time of inclusion until 1st of December 2021.ResultsWe could extract data of 113 patients. The female/male ratio was 3.5:1. Median age of onset of Raynaud´s was 10.1 years and the median age of onset of non-Raynaud´s was 10.8 years. Eighty-eight percent of the patients were treated with disease modifying anti-rheumatic drugs (DMARDs) at time of inclusion in the cohort (T0) and 93% after 12 months (T12). Median disease duration was 2.5 years at T0. Antibody profile stayed unchanged. Only 3 clinical parameters changed and improved significantly, the median modified Rodnan skin score improved from 13 to 8 (p=0.002), the number of patients with swollen joints decreased from 17% to 8% (p=0.043) and number of patients with joints with pain on motion decreased from 20% to 12% (p=0.048). All other organ involvement did not show any statistically significant change from T0 to T12.All collected patient reported outcomes improved significantly from T0 to T12: the patient reported disease activity (VAS 0 – 100) from 40 to 20 (p=0.011), the patient reported disease damage (VAS 0 – 100) from 40 to 20 (p=0.001), patient reported ulceration activity (VAS 0 – 100) from 10 to 0 (p=0.02) and the CHAQ score from 0.3 to 0.1 (p=0.002). Two of the three physician reported outcomes improved significantly, the physician global disease activity (VAS 0 – 100) from 30 to 20 (p=0.011) and physician reported global disease damage (VAS 0 – 100) from 30 to 25 (p=0.028).ConclusionSkin and musculoskeletal clinical features improved over 12 months, with almost all patients on DMARDs, supporting likely response of these features to therapy. It was promising that internal organ involvement, like cardiac and lung, although potentially stable, did not significantly worsen or increase. The most striking observation in the positive direction is improvement across several patient and physician reported outcome measures over the 12 month time period in this large international cohort.References[1]Beukelman T, Xie F, Foeldvari I. Assessing the prevalence of juvenile systemic sclerosis in childhood using administrative claims data from the United States. Journal of Scleroderma and Related Disorders. 2018;3(2):189-90.[2]Foeldvari I, Klotsche J, Kasapcopur O, Adrovic A, Terreri MT, Sakamoto AP, et al. Differences sustained between diffuse and limited forms of juvenile systemic sclerosis in expanded international cohort. www.juvenile-scleroderma.com. Arthritis Care Res (Hoboken). 2021.[3]Foeldvari I, Klotsche J, Torok KS, Kasapcopur O, Adrovic A, Stanevica V, et al. CHARACTERISTICS OF THE FIRST 80 PATIENTS AT TIMEPOINT OF FIRST ASSESSMENT INCLUDED IN THE JUVENILE SYSTEMIC SCLEROSIS INCEPTION COHORT. WWW.JUVENILESCLERODERMA.COM. Journal of Scleroderma and Related Disorders. 2018;4(1-13).Disclosure of InterestsNone declared
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Foeldvari I, Klotsche J, Kasapcopur O, Adrovic A, Torok K, Terreri MT, Sakamoto AP, Feldman B, Sztajnbok FR, Stanevicha V, Anton J, Johnson S, Khubchandani R, Alexeeva E, Katsikas M, Sawhney S, Smith V, Appenzeller S, Avcin T, Kostik M, Lehman T, Malcova H, Marrani E, Pain C, Schonenberg D, Sifuentes-Giraldo WA, Vasquez-Canizares N, Costa Reis P, Janarthanan M, Moll M, Nemcova D, Patwardhan A, Santos MJ, Abu Al Saoud S, Battagliotti C, Berntson L, Bica B, Brunner J, Cimaz R, Eleftheriou D, Harel L, Horneff G, Kaiser D, Kallinich T, Lazarevic D, Minden K, Nielsen S, Nuruzzaman F, Opsahl Hetlevik S, Uziel Y, Helmus N. POS0172 DIFFUSE JUVENILE SYSTEMIC SCLEROSIS PATIENTS SHOW DISTINCT ORGAN INVOLVEMENT AND HAVE MORE SEVERE DISEASE IN THE LARGEST jSSc COHORT OF THE WORLD. RESULTS FROM THE THE JUVENILE SCLERODERMA INCEPTION COHORT. www.juvenile-scleroderma.com. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundJuvenile systemic sclerosis (jSSc) is an orphan disease with a prevalence of 3 in 1 000 000 children (1). In adult patients there are significant differences between the clinical presentation of diffuse and limited subtypes (2). We reviewed clinical differences in presentation of subtypes in patients in the juvenile systemic scleroderma inception cohort up to 2021.ObjectivesTo study the clinical presentation of jSSc patients with diffuse (djSSc) and limited (ljSSc) subtypes.MethodsWe reviewed the clinical baseline characteristics of the patients, who were recruited to the juvenile scleroderma inception cohort (jSScC) (3, 4) till 1st of December 2021. jSScC is a prospective cohort of jSSc patients, who developed the first non-Raynaud´s symptom before the age of 16 years and are under the age of 18 years at the time of inclusion.Results210 patients with jSSc were included in the cohort, 71% (n=162) had diffuse subtype. The median age at onset of Raynaud phenomenon was 10.4 years (7.3 – 12.9) and the median age at the first non-Raynaud symptom was 10.9 years (7.4 – 13.2). Median disease duration was 2.5 years (1 – 4.4) at the time of inclusion. The female/male ratio was significantly lower in the djSSc subtype (3.7:1 versus 5:1, p<0.001). Antibody profile was quite similar, with the exception of a significantly higher number of anticentromere positive patients in the ljSSc (12% versus 2%, p=0.013). Decreased FVC < 80% was found in approximately 30% and decreased DLCO < 80% was found in around 40% in both subtypes. Pulmonary hypertension assessed by ultrasound was identified in 5% in both groups. Patients with diffuse subtype had significantly higher modified Rodnan Skin Score (mRSS) (16 versus 4.5, p<0.001), sclerodactyly (84% versus 60%, p<0.001), history of digital ulceration (62% versus 31%, p<0.001), decreased Body Mass Index (BMI) < -2 z score (20% versus 4%, p=0.003) and decreased joint range of motion (64% versus 46%, p=0.019). Patients with ljSSc had significantly higher rate of cardiac involvement (13% versus 2%, p=0.001).Regarding patient related outcomes djSSc patients had more severe disease, looking at patient reported global disease activity (VAS 0 – 100) (40 versus 25, p=0.039), patient reported global disease damage (VAS 0 – 100) (40 versus 25, p=0.021) and patient reported assessment of ulceration activity (10 versus 0, p=0.044). Regarding physician related outcomes the physician reported global disease activity (VAS 0 – 100) (32 versus 20, p<0.001) and physician reported global disease damage (VAS 0 – 100) (30 versus 15, p=0.014) was significantly higher in djSSc.ConclusionIn this jSSc cohort, the largest in the world, djSSc patients have a significantly more severe disease than ljSSc patients. Interestingly, we found no differences regarding interstitial lung disease and pulmonary hypertension.References[1]Beukelman T, Xie F, Foeldvari I. Assessing the prevalence of juvenile systemic sclerosis in childhood using administrative claims data from the United States. Journal of Scleroderma and Related Disorders. 2018;3(2):189-90.[2]Dougherty DH, Kwakkenbos L, Carrier ME, Salazar G, Assassi S, Baron M, et al. The Scleroderma Patient-Centered Intervention Network Cohort: baseline clinical features and comparison with other large scleroderma cohorts. Rheumatology (Oxford). 2018;57(9):1623-31.[3]Foeldvari I, Klotsche J, Kasapcopur O, Adrovic A, Terreri MT, Sakamoto AP, et al. Differences sustained between diffuse and limited forms of juvenile systemic sclerosis in expanded international cohort. www.juvenile-scleroderma.com. Arthritis Care Res (Hoboken). 2021.[4]Foeldvari I, Klotsche J, Torok KS, Kasapcopur O, Adrovic A, Stanevica V, et al. CHARACTERISTICS OF THE FIRST 80 PATIENTS AT TIMEPOINT OF FIRST ASSESSMENT INCLUDED IN THE JUVENILE SYSTEMIC SCLEROSIS INCEPTION COHORT. WWW.JUVENILESCLERODERMA.COM. Journal of Scleroderma and Related Disorders. 2018;4(1-13).Disclosure of InterestsNone declared
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Foeldvari I, Torok K, Kasapcopur O, Adrovic A, Terreri MT, Sakamoto AP, Feldman B, Anton J, Sztajnbok FR, Stanevicha V, Appenzeller S, Avcin T, Johnson S, Khubchandani R, Kostik M, Marrani E, Sifuentes-Giraldo WA, Nemcova D, Santos MJ, Schonenberg D, Battagliotti C, Berntson L, Bica B, Brunner J, Cimaz R, Eleftheriou D, Harel L, Horneff G, Janarthanan M, Kallinich T, Lehman T, Moll M, Nuruzzaman F, Patwardhan A, Smith V, Helmus N. POS1299 JUVENILE SYSTEMIC SCLEROSIS TREATMENT PRACTICES IN AN INTERNATIONAL COHORT AND COMPARISON TO RECENT SHARE CONSENSUS GUIDELINES. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundJuvenile systemic scleroderma (jSSc) is an orphan disease with a prevalence of 3 in 1,000,000 children. Currently no medications are licensed for the treatment of jSSc. Due to its rarity, only recently have the first management and treatment guidelines been published, the jSSc SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) recommendations, reflecting consensus opinion upon pediatric rheumatologists (1).ObjectivesTo better understand treatment practices internationally for jSSc, both at baseline and over 24 months observation period and to compare if real world therapies are congruent with the recent SHARE recommendations.MethodsThe juvenile systemic sclerosis inceptions cohort (jSScC) is a multinational cohort that prospectively collects clinical data, including medications at baseline and subsequent visits. The jSScC enrollment criteria include age of onset of the first non-Raynaud symptom younger than 16 years and age younger than 18 years at cohort entrance. The frequency of medications (general category and specific medication) was calculated across the cohort at timepoint 0 (enrollment), 12 months and 24 months.ResultsWe extracted data from the jSScC of patients who were followed for 12 or 24 months. 109 patients were followed at time point 0 (T0) and 12 months (T12), and data was available for 77 of them up at 24 months (T24). The mean age of the patients was 13.2 years at the timepoint 0. 77% were female and 75% had diffuse subtype. Disease duration at baseline visit was 3.1 years. The medications the patients were on recorded by the physician were captured at T0, T12 and T24 listed in Table 1.Table 1.MEDICATIONSTime point 0N=109T12 monthsN=109T24 months N=77Any Medication92% (100)97% (106)97% (75)Vascular medications Endothelial receptor antagonist16% (17)24% (26)21% (16) PDE-5-Blocker5% (5)8% (9)9% (7)ImmunomodulatorsCorticosteroids52% (57)44% (48)44% (21)All csDMARDs:81% (88)93% (101)92% (71) csDMARDs monotherapy61% (67)66% (72)60% (46) csDMARDs combination therapy17% (18)15% (16)14% (11) Methotrexate51% (56)50% (55)39% (30) Mycophenolate Mofetil26% (28)44% (48)47% (36) Hydroxychloriquine11% (12)15% (16)21% (16) Cyclophosphamide12% (13)2% (2)1% (1) Azathioprine2% (2)2% (2)3% (2)All bDMARDs:5% (5)14% (15)18% (14) bDMARDs monotherapy2%(2)2%(2)1% (1) bDMARDs combined with csDMARDs3% (3)12% (13)17% (13) Tocilizumab2% (2)10% (11)14% (11) Rituximab2% (2)4% (4)4% (3) Adalimumab1% (1)0% (0)0% (0)Autologous Stem cell transplantation0% (0)1% (1)0% (0)csDMARDs: Conventional synthetic disease-modifying antirheumatic drugsb DMARDs: Biological disease-modifying antirheumatic drugsConclusionAt baseline half of the patients were on corticosteroids. This is more frequent than typical adult SSc practice but coincides with jSSc SHARE treatment recommendations (#1). After 12 months observation in the cohort over 90% of patients received a DMARD therapy. Methotrexate and mycophenolate mofetil were the most commonly prescribed DMARDs, which also reflects the SHARE treatment recommendations (#2, #3). At 12 months the use of glucocorticoid decreased and the use of bDMARDs increased. In general, biological DMARDs are typically considered in severe or refractory (SHARE recommendation #7), reflecting the lower percentage compared to csDMARDs. Autologous stem cell transplantation was observed in one patient at 12 months, reflecting an option in jSSc with progressive and refractory disease (SHARE recommendation #8). Endothelial receptor antagonists, such as bosentan, were used over time in approximately 20% of the patients, reflecting SHARE recommendation #6 for pulmonary hypertension and/or digital tip ulcers. This is the first evaluation looking at clinical medication practice pattern in jSSc, and its comparison to recently published consensus guidelines.References[1]Foeldvari I, Culpo R, Sperotto F et al. Consensus-based recommendations for the management of juvenile systemic sclerosis. Rheumatology (Oxford). 2021;60(4):1651-8.Disclosure of InterestsNone declared
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Foeldvari I, Klotsche J, Carreira P, Kasapcopur O, Torok K, Airò P, Iannone F, Allanore Y, Balbir-Gurman A, Schmeiser T, Sztajnbok FR, Terreri MT, Stanevicha V, Anton J, Feldman B, Khubchandani R, Alexeeva E, Johnson S, Katsikas M, Sawhney S, Smith V, Appenzeller S, Avcin T, Campochiaro C, De Vries-Bouwstra J, Kostik M, Lehman T, Marrani E, Schonenberg D, Sifuentes-Giraldo WA, Vasquez-Canizares N, Janarthanan M, Malcova H, Moll M, Nemcova D, Patwardhan A, Santos MJ, Seskute G, Truchetet ME, Battagliotti C, Berntson L, Bica B, Brunner J, Cimaz R, Costa Reis P, Eleftheriou D, Harel L, Horneff G, Kaiser D, Kallinich T, Lazarevic D, Minden K, Nielsen S, Nuruzzaman F, Opsahl Hetlevik S, Uziel Y, Veale D, Hoffmann-Vold AM, Gabrielli A, Distler O. AB1236 CLINICAL CHARACTERISTICS OF JUVENILE ONSET SYSTEMIC SCLEROSIS PATIENTS FROM THE JUVENILE SCLERODERMA INCEPTION COHORT COMPARED TO ADULT AGE JUVENILE-ONSET PATIENTS FROM EUSTAR. ARE THESE DIFFERENCES SUGGESTING RISK FOR MORTALITY? Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundJuvenile systemic sclerosis (jSSc) is an orphan autoimmune disease with a prevalence of 3 in 1 000 000 children. Information on long-term development of organ involvement and clinical characteristics of jSSc patients in adulthood are lacking. It was believed that patients in adult cohorts may represent a survival biased population.ObjectivesTo assess differences in clinical characteristics of jSSc-onset patients from the pediatric age group, with a mean disease duration of 3 years, compared to the adult age jSSc-onset group, with a mean disease duration of 18.5 years.MethodsWe extracted clinical data at time of inclusion into the cohorts from the Juvenile Scleroderma Inception Cohort (jSScC) and data from juvenile-onset adult SSc patients from the European Trials and Research Group (EUSTAR) cohort. We compared the clinical characteristics of the patients by descriptive statistics.ResultsWe extracted data of 187 jSSc patients from the jSScC and 236 patients from EUSTAR. The mean age at time of assessment was 13.4 years old in the jSScC and 32.4 years old in EUSTAR. The mean disease duration since first non-Raynaud was 3.0 years in jSScC and 18.5 years in the EUSTAR (Table 1).We found significant differences between the cohorts. There were more female patients in EUSTAR (87.7% versus 80.2%, p=0.04). More patients had diffuse subtype in jSScC (72.2% versus 40%, p<0.001). The modified Rodnan skin score (mRSS) was significantly higher in jSScC (14.2 versus 12.1, p=0.02). Active digital ulceration occurred more often in EUSTAR (26.6%, versus 17.8% p=0.01), but history of active ulceration was more frequent in jSScC (54.1% versus 43%, p<0.001). Mean DLCO was lower in jSScC (75.4 versus 86.3, p<0.001). Intestinal involvement was significantly more common in jSSc (33.2% versus 23.8%, p=0.04). Esophageal involvement was more common in EUSTAR (63.7% versus 33.7%, p<0.001). (Table 1).Table 1.Clinical characteristics of juvenile onset SSc patients at time point of the inclusion into the juvenile scleroderma inception (jSScC) cohort and in the adult EUSTAR- cohortjSScCEUSTAR CohortP valueNumber of patients1872360.04Age in years, mean (SD)13.4 (3.6)32.4 (15.4)Female patients, n (%)150 (80.2%)207 (87.7%)jSSC Subtype, n (%)diffuse135 (72.2%)87 (38.1%)<0.001limited52 (27.8%)121 (53.3%)Age at Raynaud onset in years, mean (SD)10.0 (3.9)13.7 (9.1)Age at non-Raynaud onset in years, mean (SD)10.3 (3.9)11.7 (3.7)Duration since first Raynaud symptoms in years, mean (SD)3.4 (2.7)20.6 (15.9)Duration since first non-Raynaud symptoms in years, mean (SD)3.0 (2.7)18.5 (15.6)Raynaud´s, n (%)170 (90.9%)222 (94.9%)ANA positive, n (%)166 (91.7%)210 (92.9%)0.99Anti-Scl 70 positive, n (%)62 (34.4%)73 (33.3%)0.68Modified Rodnan Skin Score, mean (SD)5%Data missingModified Rodnan Skin Score, mean (SD)14.2 (11.7)12.1 (14.5)0.02Digital ulceration, n (%)At the time of inclusion33 (17.8)21 (26.6%)0.01In the past history100 (54.1%)34 (43%)<0.001Telangiectasia62 (37.4%)42 (53.2%)0.04FVC, mean (SD)84.1 (18.6)84 (22.4)0.96DLCO, mean (SD)75.4 (19.2)86.3 (19.9)<0.001Arterial hypertension, n (%)10 (5.4%)20 (8.5%)0.26Renal crisis, n (%)03 (1.3%)0.26Esophageal involvement, n (%)63 (33.7%)149 (63.7%)<0.001Intestinal involvement, n (%)62 (33.2%)56 (23.8%)0.04Articular involvement, n (%)34 (18.3%)27 (11.6%)0.06Muscular involvement, n (%)31 (19.3%)46 (19.8%)0.45ConclusionPatients with jSSc-onset who are currently adult age (defined as >18 years of age) are less frequently male and from the diffuse subset, have lower mRSS, less digital ulcers and intestinal involvement. This might represent a combination of both survival bias and/or be explained by the longer observation time with less active disease (i.e. natural progression decreased mRSS over time). Further long-term observational studies with jSSc patients are required to address this issue.Disclosure of InterestsNone declared
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Taft J, Markson M, Legarda D, Patel R, Chan M, Malle L, Richardson A, Gruber C, Martín-Fernández M, Mancini GMS, van Laar JAM, van Pelt P, Buta S, Wokke BHA, Sabli IKD, Sancho-Shimizu V, Chavan PP, Schnappauf O, Khubchandani R, Cüceoğlu MK, Özen S, Kastner DL, Ting AT, Aksentijevich I, Hollink IHIM, Bogunovic D. Human TBK1 deficiency leads to autoinflammation driven by TNF-induced cell death. Cell 2021; 184:4447-4463.e20. [PMID: 34363755 DOI: 10.1016/j.cell.2021.07.026] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/11/2021] [Accepted: 07/20/2021] [Indexed: 12/30/2022]
Abstract
TANK binding kinase 1 (TBK1) regulates IFN-I, NF-κB, and TNF-induced RIPK1-dependent cell death (RCD). In mice, biallelic loss of TBK1 is embryonically lethal. We discovered four humans, ages 32, 26, 7, and 8 from three unrelated consanguineous families with homozygous loss-of-function mutations in TBK1. All four patients suffer from chronic and systemic autoinflammation, but not severe viral infections. We demonstrate that TBK1 loss results in hypomorphic but sufficient IFN-I induction via RIG-I/MDA5, while the system retains near intact IL-6 induction through NF-κB. Autoinflammation is driven by TNF-induced RCD as patient-derived fibroblasts experienced higher rates of necroptosis in vitro, and CC3 was elevated in peripheral blood ex vivo. Treatment with anti-TNF dampened the baseline circulating inflammatory profile and ameliorated the clinical condition in vivo. These findings highlight the plasticity of the IFN-I response and underscore a cardinal role for TBK1 in the regulation of RCD.
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Affiliation(s)
- Justin Taft
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Michael Markson
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Diana Legarda
- Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Roosheel Patel
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Mark Chan
- Department of Immunology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Louise Malle
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Ashley Richardson
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Conor Gruber
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Marta Martín-Fernández
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Grazia M S Mancini
- Department of Clinical Genetics, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Jan A M van Laar
- Department of Immunology, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Philomine van Pelt
- Department of Rheumatology, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Sofija Buta
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Beatrijs H A Wokke
- Department of Neurology, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Ira K D Sabli
- Department of Paediatric Infectious Diseases and Virology, Imperial College London, London, UK; Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
| | - Vanessa Sancho-Shimizu
- Department of Paediatric Infectious Diseases and Virology, Imperial College London, London, UK; Centre for Paediatrics and Child Health, Faculty of Medicine, Imperial College London, London, UK
| | - Pallavi Pimpale Chavan
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, MD, 20892, USA; Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India
| | - Oskar Schnappauf
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Raju Khubchandani
- Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India; Consultant Pediatrician, Jaslok and Breach Candy Hospitals, Mumbai, India
| | | | - Seza Özen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Daniel L Kastner
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Adrian T Ting
- Department of Immunology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, Bethesda, MD, 20892, USA
| | - Iris H I M Hollink
- Department of Clinical Genetics, Erasmus University Medical Center, 3015GD Rotterdam, the Netherlands
| | - Dusan Bogunovic
- Center for Inborn Errors of Immunity, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Precision Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA; Department of Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
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Toplak N, Chavan PP, Rosina S, Dallos T, Semo Oz R, Aguiar C, Khubchandani R, Ravelli A, Patwardhan A. POS0071 IS ANTI-NXP2 AUTOANTIBODY A RISK FACTOR FOR CALCINOSIS AND POOR OUTCOME IN JUVENILE DERMATOMYOSITIS PATIENTS? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:It has been published that the presence of NXP2 autoantibodies presents a risk for calcinosis in patients with JDM.Objectives:To investigate the incidence of calcinosis and response to the treatment in NXP2 positive JDM patients with calcinosis.Methods:The study design is a retrospective, multinational, multicenter study. Data on gender, race, age at disease onset and age at disease diagnosis, age at inclusion in the study, clinical presentation, muscle function tests, laboratory results, imaging, data on treatment and outcome of disease were collectedResults:we collected 26 patients (19 F, 7 M) with JDM and positive NXP2 antibodies. Fourteen patients were white, eight asian, three black and one Hispanic ethnicity. The mean age at disease presentation was 6.5 years (SD 3.7), the median diagnosis delay was 4 months (range 0.5- 27 months). Patients were divided in two groups (A and B) based on the presence of calcinosis.Eleven patients (42%) developed calcinosis (group A) in the course of the disease, 10 females and 1 male. Four patients already had calcinosis at presentation, 1 developed after 4 months, and 6 developed calcinosis later in disease course (median 2 years, range 0,8- 7,8). Four patients developed lipodystrophy in group A (1 in group B). In group A, 3 patients developed skin ulcerations (1 in group B), 2 patients had polyarthritis (1 in group B), 2 patients had gut involvement (1 in group B) and 1 patient had lung involvement (2 in group B).The mean age at disease presentation (5.2 / 7.5 y) and mean CK level (1548.6 / 1811.6 U/L) were lower in group A. The platelet count (306.5 / 258 109/L), and mean values of AST (111.4 / 103.8 U/L), ALT (72.2 / 50.8 U/L), LDH (1048.3 / 808 IU/L), and IgG (11.8 / 9.9 g/L) were higher in group A. However, the differences were not statistically significant. ANA antibodies were positive in 9/11 in group A and 12/15 in group B. One patient in group A was also positive for anti-MDA5 antibody. The data on muscle strength measurement (MMT/CMAS) were available only in a few patients.Treatments used for patients with calcinosis includes, methotrexate and glucocorticosteroids (GCS) (all patients), hydroxychloroquine (9), IVIG (7), cyclosporine (4), bisphosphonate (4), MMF (5), rituximab (4), cyclophosphamide (1), abatacept (1) and TNF alpha blocker (1).Disease outcome (by evaluation of the treating physician) was excellent in 4, good in 2, stable in 2 and poor in 3 patients. None of the patients from group B had a poor disease outcome. Patients with excellent disease outcomes from group A were treated with GCS and methotrexate (4), hydroxychloroquine (3), IVIG (1) and cyclosporine (1). Out of two patients who had good outcomes, one was additionally treated with MMF, bisphosphonates and rituximab and the second was treated with cyclophosphamide and rituximab. One patient with calcinosis at the presentation (age 4 years) was treated also with anti-TNF alpha therapy which not only stopped progression but partially dissolved the calcinosis. However, after 2 years of anti-TNF alpha therapy the calcinosis start to progress and the therapy was changed to MMF and rituximab, which stopped the progression of calcinosis.Conclusion:Our preliminary results showed that calcinosis occurred in 42% of NXP2 positive JDM patients. Children with calcinosis were treated with several combinations of drugs. In four cases, rituximab and in one case, for limited time of 2 years, anti-TNF alpha agent, were used successfully.References:[1]Chung MP, Richardson C, Kirakossian D, Orandi AB, Saketkoo LA, et al. Calcinosis biomarkers in adult and juvenile dermatomyositis. Autoimmun Rev 2020; 19(6):102533.Disclosure of Interests:Natasa Toplak: None declared, Pallavi Pimpale Chavan: None declared, Silvia Rosina: None declared, Tomas Dallos Consultant of: Abbvie, Novartis, Rotem Semo Oz: None declared, Cassyanne Aguiar: None declared, Raju Khubchandani: None declared, Angelo Ravelli: None declared, Anjali Patwardhan: None declared.
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Foeldvari I, Klotsche J, Kasapcopur O, Adrovic A, Torok K, Terreri MT, Sakamoto AP, Feldman B, Stanevicha V, Anton J, Sztajnbok FR, Khubchandani R, Alexeeva E, Katsikas M, Sawhney S, Smith V, Appenzeller S, Avcin T, Kostik M, Lehman T, Marrani E, Schonenberg D, Sifuentes-Giraldo WA, Vasquez-Canizares N, Janarthanan M, Moll M, Nemcova D, Patwardhan A, Santos MJ, Battagliotti C, Berntson L, Bica B, Brunner J, Cimaz R, Costa Reis P, Eleftheriou D, Harel L, Horneff G, Johnson S, Kaiser D, Kallinich T, Lazarevic D, Minden K, Nielsen S, Nuruzzaman F, Opsahl Hetlevik S, Uziel Y, Helmus N. POS0079 PATIENTS WITH JUVENILE SYSTEMIC SCLEROSIS HAVE A DISTINCT PATTERN OF ORGAN INVOLVEMENT.RESULTS FROM THE JUVENILE SYSTEMIC SCLEROSIS INCEPTION COHORT. WWW.JUVENILE-SCLERODERMA.COM. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Juvenile systemic sclerosis (jSSc) is a rare disease with a prevalence of around 3 in 1,000,000 children. To better capture the clinical manifestations of jSSc the juvenile systemic sclerosis inception cohort (jSScC) has been prospectively enrolling patients with predetermined clinical variables over the past 12 years. One of the goals is to study the demographic, clinical features, and physician and patient reported outcome differences between those with juvenile limited cutaneous (lc) compared to diffuse cutaneous (dc) disease subtypes, to determine if characteristics are similar or different between dc and lc jSSc.Objectives:Evaluation of the baseline clinical characteristics of jSSc patients in the jSScC. Compare clinical phenotype between diffuse (dcjSSc) and limited cutaneous (lcjSSc) subtypes.Methods:Demographic, physical examination, organ system evaluation, autoantibody profile, treatment, and patient and physician reported outcome variables were evaluated from the jSSc Inception cohort and summary statistics applied using chi-square test and Mann Whitney U-test comparing lcjSSc and dcjSSc subtypes.Results:At the time of data extraction, 175 jSSc patients were enrolled in the cohort, 81% were Caucasian and 81% female. Diffuse cutaneous jSSc subtype predominated (73%). Mean disease duration was 3.1 year (±2.7). Mean age at Raynaud´s was 10 years (+3.8) and mean age of first non-Raynaud´s was 10.2 years (±3.8). Significant differences were found between dcjSSc versus lcjSSc, regarding several clinical characteristics. Patients with diffuse cutaneous subtype had significantly higher modified Rodnan skin score (p=0.001), presence of sclerodactyly (p=0.02), presence of Gottron’s papules (p=0.003), presence of telangiectasia (p=0.001), history of digital tip ulceration (p=0.01), and frequency of elevated CK value (p=0.04). Cardiac involvement was significantly higher in limited cutaneous jSSc subtype (p=0.02). Diffuse cutaneous jSSc patients had significantly worse scores for Physician Global Assessment of disease activity (38 vs 25; p=0.002) and disease damage (34 vs 19; p=0.008).Table 1.Comparison of demographic data and significant differences between dcjSSc and lcjSSc at time of inclusionWhole CohortN=175Diffuse SubtypeN=128Limited SubtypeN=47P valueFemale to Male Ratio4.3:1 (142/33)4.1:1 (103/25)4.8:1 (39/8)0.829Cutaneous subtypeDiffuse subtype73% (128)1280Limited subtype27% (47)047Mean Disease duration (years)3.1 (± 2.7)3.3 (± 2.9)2.6 (± 2.2)0.135Mean age of onset of Raynaud´s (years)10.0 (± 3.8)17 non-Raynaud9.8 (± 3.6)10 non-Raynaud10.6 (± 4.3)7 non-Raynaud0.219Mean age of onset of non-Raynaud´s (years)10.2 (± 3.9)10.0 (± 3.7)10.9 (± 4.3)0.173Disease modifying drugs88% (154)89% (114)85% (40)0.446CutaneousMean modified Rodnan skin score14.3 (0-51)17.4 (0-51)6.1 (0-24)0.001Gottron Papules27% (46/171)33% (41/124)11% (5)0.003Sclerodactyly78% (126/162)82% (98/119)65% (28/43)0.020Laboratory valuesElevated CK25% (30/122)30% (26/88)12% (4/34)0.041VascularTelangiectasia36% (56/154)44% (49/111)16% (7/43)0.001History of ulceration53% (91/173)61% (77/127)30% (14/46)0.001CardiacCardiac Involvement6% (10)2% (3)15% (7)0.002Patient Related OutcomesPhysician global disease activity(0-100) min -max35(0-90) n=14138(0-90) n=10825(0-80) n=330.002Physician global disease damage(0-100) min -max31(0-85) n=14034(0-85) n=10819(0-60) n=320.008Conclusion:Results from this large international cohort of jSSc patients demonstrate significant differences between dcjSSc and lcjSSc patients. According to the general organ involvement and physician global scores, the dcjSSc patients had significantly more severe disease. These observations strengthen our previous findings of the unique organ pattern of pediatric patients.Supported by the “Joachim Herz Stiftung”Disclosure of Interests:None declared.
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Foeldvari I, Klotsche J, Kasapcopur O, Adrovic A, Torok K, Terreri MT, Sakamoto AP, Feldman B, Stanevicha V, Anton J, Sztajnbok FR, Khubchandani R, Alexeeva E, Katsikas M, Sawhney S, Smith V, Appenzeller S, Avcin T, Kostik M, Lehman T, Marrani E, Schonenberg D, Sifuentes-Giraldo WA, Vasquez-Canizares N, Janarthanan M, Moll M, Nemcova D, Patwardhan A, Santos MJ, Battagliotti C, Berntson L, Bica B, Brunner J, Cimaz R, Costa Reis P, Eleftheriou D, Harel L, Horneff G, Johnson S, Kaiser D, Kallinich T, Lazarevic D, Minden K, Nielsen S, Nuruzzaman F, Opsahl Hetlevik S, Uziel Y, Helmus N. POS1304 JUVENILE SYSTEMIC SCLEROSIS (JSSC) PATIENTS WITH OVERLAP CHARACTERISTICS DO NOT HAVE MILD DISEASE. RESULTS FROM THE JSSC INCEPTION COHORT. WWW.JUVENILESCLERODERMA.COM. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Juvenile systemic sclerosis (jSSc) is an orphan disease with a prevalence of around 3 in 1, 000,000 children. It is known that in pediatric jSSc cohorts, there are a significant number of patients with overlap features, such as arthritis and myositis. However, the disease burden between those with and without overlap features in jSSc has not been defined.Objectives:Compare the clinical phenotype between children with and without overlap features in the juvenile systemic scleroderma inception cohort (jSScC).Methods:A cross-sectional study was performed using baseline visit data. Demographic, organ system evaluation, autoantibody profile, treatment, and patient and physician reported outcome variables were extracted from jSScC. Comparison between patients with and without overlap features was performed using chi-square test and Mann Whitney U-test.Results:At the time of data extraction, 175 jSSc patients were enrolled in the cohort, 81% were Caucasian and 81% female. Mean disease duration was 3.1 year (±2.7). Mean age at Raynaud´s onset was 10 years (±3.8) and mean age of first non-Raynaud´s was 10.2 years (±3.8). Overlap features occurred 17% (n=30) of the cohort, 12.5% in the diffuse cutaneous (dc) jSSc and in 30% in the limited cutaneous (lc) jSSc. Significant differences in clinical characteristics were found between those patients with compared to without overlap characteristics. Patients with overlap features presented more frequently with Gottron papules (p=0.007), swollen joints (p=0.019), muscle weakness (p=0.003), and lung involvement documented by decreased DLCO < 80% (p=0.06) and/or abnormal high resolution computed tomography (p=0.049). Anti-PM/Scl autoantibodies were also more common in this group (p=0.001). Significantly more patients without overlap features had Raynaud´s (p=0.006). Physician Global Assessment of disease activity was significantly higher in patients with overlap features (41 vs 34; p=0.041). (Table 1.)Table 1.Demographic and clinical characteristics of jSSc patients with and without overlap features.Whole CohortN=175Patients without overlapN=145Patients with overlapN=30P valueFemale to Male Ratio 4.3:1(142/33)4:1(116/29)6.5:1(26/4)0.395Cutaneous subtypeDiffuse subtype (N)73% (128)11216Limited subtype (N)27% (47)3317Mean disease duration (years)3.1 (± 2.7)3.2 (± 2.8)3.1 (± 2.2)0.291Mean age of onset of Raynaud´s (years)10.0 (± 3.8)17 non-Raynaud10.0 (± 3.8)10 non-Raynaud10.0 (± 3.7)7 non-Raynaud0.931Mean age of onset of non-Raynaud´s (years)10.2 (± 3.8)10.2 (± 3.9)9.8 (± 3.7)Disease modifying drugs (N)88% (154) 89% (129)83% (25)0.388Raynaud´s phenomenon90% (158)93% (135)77% (23)0.006Anti-PMScl18% (12/68)9% (5/53)47% (7/15)0.001Gottron Papules (N)27% (46/171)23% (33/144)48% (13/27)0.007DLCO <80% (N)44% (39/88)39% (28/71)65% (11/17)0.06Abnormal findings in HRCT (N)44% (59/133)40% (43/107)62% (16/26)0.049Proportion of patients with swollen joints 18% (32) 14% (21) 37% (11)0.019Muscle Weakness (N) 21% (31/149)16% (20/123) 42% (11/26)0.003Physician global disease activity(0-100) min -max35 (0-90) n=14134 (0-90) n=11441 (0-80) n=270.041Conclusion:Results from this large international cohort of jSSc patients demonstrate significant differences between patients with and without overlap features. Patients with overlap have significantly more interstitial lung disease and more physician rated disease activity and should not be considered to have more “mild disease”.Supported by the “Joachim Herz Stiftung”Disclosure of Interests:None declared
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Pimpale Chavan P, Aksentijevich I, Daftary A, Panwala H, Khemani C, Khan A, Khubchandani R. Majeed Syndrome: Five Cases With Novel Mutations From Unrelated Families in India With a Review of Literature. J Rheumatol 2021; 48:1850-1855. [PMID: 33993107 DOI: 10.3899/jrheum.201663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Majeed syndrome (MJS) is an autosomal recessive, systemic autoinflammatory disease (SAID) caused by biallelic loss-of-function variants in the LPIN2 gene. It is characterized by early-onset chronic recurrent multifocal osteomyelitis (CRMO), dyserythropoietic anemia, and neutrophilic dermatosis. We analyzed a cohort of uncharacterized Indian patients for pathogenic variants in LPIN2 and other genes associated with SAIDs. METHODS We performed whole-exome sequencing (WES) for 1 patient and next-generation sequencing (NGS) targeted gene panel for SAIDs in 3 patients. One patient was a referral from neurology after clinical exome sequencing identified a novel variant in LPIN2. We reviewed the literature for all published studies of mutation-positive MJS patients and have summarized their clinical features and disease-causing variants. RESULTS We describe the largest series of patients with MJS outside of the Middle East. All 5 patients are homozygous for novel, possibly pathogenic variants in the LPIN2 gene. Two of these variants are missense substitutions, and 3 are predicted to alter transcript splicing and create a truncated protein. In addition to the classical features of CRMO and anemia, patients exhibited previously unreported features, including abdominal pain, recurrent diarrhea/ear discharge, and erythema nodosum. CONCLUSION Patients with MJS may present initially to different specialists, and thus it is important to create awareness in the medical community. In India, consanguinity is a common sociocultural factor in many ethnic communities and an abbreviated NGS gene panel for autoinflammatory diseases should include MJS. The unavailability of interleukin 1 inhibitors in some countries poses a treatment challenge.
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Affiliation(s)
- Pallavi Pimpale Chavan
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Ivona Aksentijevich
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Aditya Daftary
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Hiren Panwala
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Chetna Khemani
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Archana Khan
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
| | - Raju Khubchandani
- P. Pimpale Chavan, DNB Pediatrics, Fellowship in Pediatric Rheumatology, A. Khan, DCH DNB Pediatrics, R. Khubchandani, MD, Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India; I. Aksentijevich, MD, Genetics, Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA; A. Daftary, DABNM, DABR, Consultant Radiologist, H. Panwala, DNB Radiology, Fellowship in Pediatric Radiology, Consultant Pediatric Radiologist, NH SRCC Children's Hospital, Mumbai, India; C. Khemani, DCH DNB Pediatrics, Department of Pediatrics, North Goa District Hospital, Mapusa, Goa, India. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. R. Khubchandani, 31, Kailash Darshan, 8th floor, Opposite Ness Baug, Nana Chowk, 7, Kennedy Bridge, Gamdevi, Mumbai 400007, Maharashtra, India. . Accepted for publication April 29, 2021
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Khan A, Panwala H, Ramadoss D, Khubchandani R. Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Disease in a 11 Year Old with COVID-19 Infection. Indian J Pediatr 2021; 88:488-489. [PMID: 33471314 PMCID: PMC7815970 DOI: 10.1007/s12098-020-03656-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 12/31/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Archana Khan
- Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India.
| | - Hiren Panwala
- Department of Pediatric Radiology, NH SRCC Children's Hospital, Mumbai, India
| | - Divya Ramadoss
- Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India
| | - Raju Khubchandani
- Section of Pediatric Rheumatology, NH SRCC Children's Hospital, Mumbai, India
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Muhammed H, Jain A, Irfan M, Charles S, Dwivedi P, Chavan PP, Khubchandani R, Sharma A, Phatak S, Shukla AN, Shah R, Subramanian N, Pandya SC, Singh YP, Chengappa KG, Thabah M, Rajasekhar L, Shobha V, Negi VS, Dhir V, Sharma A, Misra R, Aggarwal A. Clinical features, severity and outcome of acute pancreatitis in systemic lupus erythematosus. Rheumatol Int 2021; 42:1363-1371. [PMID: 33723658 DOI: 10.1007/s00296-021-04834-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
Acute pancreatitis (AP) is a rare but life threatening manifestation of Systemic Lupus Erythematosus (SLE). The current study aims to study the clinical characteristics, severity, mortality, and outcome of SLE-related AP in Indian population. We retrospectively reviewed medical records of patients with SLE who had AP in the past. Data from 13 rheumatology centers across India were compiled. All patients satisfied SLICC criteria for SLE and ATLANTA criteria for AP. AP was classified in to mild, moderate and severe using revised Atlanta classification. Patients with known risk factors like gall stone and alcohol were excluded.Sixty-six patients (six, children) were studied. Majority of patients were females (82%). The median age of presentation was 24 (11-63) years and most patients (57.5%) presented within first year of diagnosis of lupus. AP occurred mostly in the setting of active lupus (89%). Active nephritis was seen in 39% while a fourth had CNS disease. Patients with severe AP had lower C3. Ascites and sepsis were most common local and systemic complications, respectively. Mortality was 17%. Hypocalcemia, presence of sepsis and shock predicted mortality. In the multivariate analysis, only presence of shock remained as independent predictor of death (OR 63.0, 95% CI: 5.2-760.3). Pancreatitis is an early manifestation of SLE and is associated with active disease. Significant mortality is seen particularly with severe pancreatitis.
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Affiliation(s)
- Hafis Muhammed
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Avinash Jain
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.,Currently SMS Medical College and Hospital, Jaipur, India
| | | | - Sheba Charles
- St John's National Academy of Medical College, Bengaluru, India
| | - Preksha Dwivedi
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | | | | | | | - Ripal Shah
- One-Centre for Rheumatology and Genetics, Vadodara, India
| | | | | | | | - K G Chengappa
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Molly Thabah
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | | | - Vineeta Shobha
- St John's National Academy of Medical College, Bengaluru, India
| | - V S Negi
- Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Varun Dhir
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Aman Sharma
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramnath Misra
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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17
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Sharma A, Naidu GSRSNK, Sharma V, Jha S, Dhooria A, Dhir V, Bhatia P, Sharma V, Bhattad S, KG C, Gupta V, Misra DP, Chavan PP, Malaviya S, Dudam R, Sharma B, Kumar S, Bhojwani R, Gupta P, Agarwal V, Sharma K, Singhal M, Rathi M, Nada R, Minz RW, Chaturvedi V, Aggarwal A, Handa R, Grossi A, Gattorno M, Huang Z, Wang J, Jois R, Negi VS, Khubchandani R, Jain S, Arostegui JI, Chambers EP, Hershfield MS, Aksentijevich I, Zhou Q, Lee PY. Deficiency of Adenosine Deaminase 2 in Adults and Children: Experience From India. Arthritis Rheumatol 2021; 73:276-285. [PMID: 32892503 PMCID: PMC7902299 DOI: 10.1002/art.41500] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/17/2020] [Accepted: 08/20/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Deficiency of adenosine deaminase 2 (DADA2) is a potentially fatal monogenic syndrome characterized by variable manifestations of systemic vasculitis, bone marrow failure, and immunodeficiency. Most cases are diagnosed by pediatric care providers, given the typical early age of disease onset. This study was undertaken to describe the clinical phenotypes and treatment response both in adults and in children with DADA2 in India. METHODS A retrospective analysis of pediatric and adult patients with DADA2 diagnosed at various rheumatology centers across India was conducted. Clinical characteristics, diagnostic findings, and treatment responses were analyzed in all subjects. RESULTS In total, 33 cases of DADA2 were confirmed in this cohort between April 2017 and March 2020. Unlike previous studies, nearly one-half of the confirmed cases presented during adulthood. All symptomatic patients exhibited features of vasculitis, whereas constitutional symptoms and anemia were more common in pediatric patients. Cutaneous and neurologic involvement were common, and 18 subjects had experienced at least one stroke. In addition, the clinical spectrum of DADA2 was expanded by recognition of novel features in these patients, including pancreatic infarction, focal myocarditis, and diffuse alveolar hemorrhage. Treatment with tumor necrosis factor inhibitors (TNFi) was initiated in 25 patients. All of the identified disease manifestations showed marked improvement after initiation of TNFi, and disease remission was achieved in 19 patients. Two cases were complicated by tuberculosis infection, and 2 deaths were reported. CONCLUSION This report presents the first case series of patients with DADA2 from India, diagnosed by adult and pediatric care providers. The findings raise awareness of this syndrome, particularly with regard to its presentation in adults.
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Affiliation(s)
- Aman Sharma
- Clinical Immunology and Rheumatology Services, Department
of Internal Medicine, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
| | - GSRSNK Naidu
- Clinical Immunology and Rheumatology Services, Department
of Internal Medicine, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
| | - Vikas Sharma
- Clinical Immunology and Rheumatology Services, Department
of Internal Medicine, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
| | - Saket Jha
- Clinical Immunology and Rheumatology, Om Hospital and
Research Center, Kathmandu, Nepal
| | - Aaadhar Dhooria
- Department of Rheumatology Santokba Durlabhji Memorial
Hospital, Jaipur, India
| | - Varun Dhir
- Clinical Immunology and Rheumatology Services, Department
of Internal Medicine, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
| | - Prateek Bhatia
- Department of Paediatrics, Postgraduate Institute of
Medical Education and Research, Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of
Medical Education and Research, Chandigarh, India
| | - Sagar Bhattad
- Department of Pediatrics ASTER CMI Hospitals, Bengaluru,
India
| | - Chengappa KG
- Department of Clinical Immunology, JIPMER, Puducherry,
India
| | - Vikas Gupta
- Department of Rheumatology, DMC, Ludhiana, India
| | - Durga Prasanna Misra
- Department of Clinical Immunology and Rheumatology, Sanjay
Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | | | | | | | | | | | - Rajesh Bhojwani
- Santokba Institute of Digestive Surgical Sciences,
Santokba Durlabhji Memorial Hospital, Jaipur, India
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of
Medical Education and Research, Chandigarh, India
| | - Vikas Agarwal
- Department of Clinical Immunology and Rheumatology, Sanjay
Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kusum Sharma
- Department of Medical Microbiology, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate
Institute of Medical Education and Research, Chandigarh, India
| | - Manish Rathi
- Department of Nephrology, Postgraduate Institute of
Medical Education and Research, Chandigarh, India
| | - Ritambhra Nada
- Department of Histopathology, Postgraduate Institute of
Medical Education and Research, Chandigarh, India
| | - Ranjana W Minz
- Department of Immunopathology, Postgraduate Institute of
Medical Education and Research, Chandigarh, India
| | - Ved Chaturvedi
- Department of Rheumatology and Clinical Immunology, Sir
Ganga Ram Hospital, New Delhi, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay
Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rohini Handa
- Department of Rheumatology, Indraprastha Apollo
Hospitals, New Delhi, India
| | - Alice Grossi
- IRCCS Istituto Giannina Gaslini, UOSD Genetics and
Genomics of Rare Diseases, Genoa, Italy
| | - Marco Gattorno
- Centro Malattie Autoinfiammatorie e Immunodeficienze,
IRCCS G. Gaslini, Genoa, Italy
| | - Zhengping Huang
- Department of Rheumatology and Immunology, Guangdong
Second Provincial General Hospital, Guangzhou, China
| | - Jun Wang
- Life Sciences Institute, Zhejiang University, Zhejiang,
China
| | | | - VS Negi
- Department of Clinical Immunology, JIPMER, Puducherry,
India
| | - Raju Khubchandani
- Department of Paediatric Rheumatology, SRCC
Children’s Hospital, Mumbai, India
| | - Sanjay Jain
- Clinical Immunology and Rheumatology Services, Department
of Internal Medicine, Postgraduate Institute of Medical Education and Research,
Chandigarh, India
| | - Juan I Arostegui
- Department of Immunology, Hospital Clinic, Barcelona,
Spain
- Institut d’Investigacions Biomèdiques
August Pi i Sunyer, Barcelona, Spain
| | - Eugene P. Chambers
- Department of Surgery, Vanderbilt University Medical
Center, Nashville, Tennessee, USA
- DADA2 Foundation, Nashville, Tennessee, USA
| | - Michael S. Hershfield
- Department of Medicine and Biochemistry, Duke University
School of Medicine, Durham, North Caroline, USA
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome
Research Institute, Bethesda, Maryland, USA
| | - Qing Zhou
- Life Sciences Institute, Zhejiang University, Zhejiang,
China
| | - Pui Y. Lee
- Division of Immunology, Boston Children’s
Hospital, Boston, Massachusetts, USA
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18
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Tibaldi J, Pistorio A, Aldera E, Puzone L, El Miedany Y, Pal P, Giri PP, De H, Khubchandani R, Chavan PP, Vilaiyuk S, Lerkvaleekul B, Yamsuwan J, Sabui TK, Datta P, Pardeo M, Bracaglia C, Sawhney S, Mittal S, Hassan WA, Elderiny GF, Abu-Zaid MH, Eissa M, Sztajnbok F, das Neves Sztajnbok FC, Russo R, Katsicas MM, Cimaz R, Marrani E, Alexeeva E, Dvoryakovskaya TM, Alsuweiti MO, Alzyoud RM, Kostik M, Chikova I, Minoia F, Filocamo G, Farag Y, Lotfy H, Nasef SI, Al-Mayouf SM, Maggio MC, Magalhaes CS, Gallizzi R, Conti G, Shimizu M, Civino A, Felici E, Giancane G, Ruperto N, Consolaro A, Ravelli A. Development and initial validation of a composite disease activity score for systemic juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 59:3505-3514. [PMID: 32829413 DOI: 10.1093/rheumatology/keaa240] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 12/31/2019] [Revised: 04/06/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To develop a composite disease activity score for systemic JIA (sJIA) and to provide preliminary evidence of its validity. METHODS The systemic Juvenile Arthritis Disease Activity Score (sJADAS) was constructed by adding to the four items of the original JADAS a fifth item that aimed to quantify the activity of systemic features. Validation analyses were conducted on patients with definite or probable/possible sJIA enrolled at first visit or at the time of a flare, who had active systemic manifestations, which should include fever. Patients were reassessed 2 weeks to 3 months after baseline. Three versions were examined, including ESR, CRP or no acute-phase reactant. RESULTS A total of 163 patients were included at 30 centres in 10 countries. The sJADAS was found to be feasible and to possess face and content validity, good construct validity, satisfactory internal consistency (Cronbach's alpha 0.64-0.65), fair ability to discriminate between patients with different disease activity states and between those whose parents were satisfied or not satisfied with illness outcome (P < 0.0001 for both), and strong responsiveness to change over time (standardized response mean 2.04-2.58). Overall, these properties were found to be better than those of the original JADAS and of DAS for RA and of Puchot score for adult-onset Still's disease. CONCLUSION The sJADAS showed good measurement properties and is therefore a valid instrument for the assessment of disease activity in children with sJIA. The performance of the new tool should be further examined in other patient cohorts that are evaluated prospectively.
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Affiliation(s)
- Jessica Tibaldi
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Angela Pistorio
- Dipartimento di Epidemiologia e Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elena Aldera
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Laura Puzone
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | | | - Priyankar Pal
- Pediatric Rheumatology Division, Institute of Child Health, Kolkata, India
| | | | - Hriday De
- Pediatric Rheumatology Division, Institute of Child Health, Kolkata, India
| | - Raju Khubchandani
- Section of Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India
| | | | - Soamarat Vilaiyuk
- Rheumatology Division, Pediatric Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Butsabong Lerkvaleekul
- Rheumatology Division, Pediatric Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jutamas Yamsuwan
- Rheumatology Division, Pediatric Department, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tapas K Sabui
- Pediatric Rheumatology Clinic, R G Kar Medical College, Kolkata, India
| | - Pragati Datta
- Pediatric Rheumatology Clinic, R G Kar Medical College, Kolkata, India
| | - Manuela Pardeo
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Claudia Bracaglia
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Sujata Sawhney
- Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | - Sumidha Mittal
- Division of Pediatric Rheumatology, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India
| | | | | | | | - Mervat Eissa
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Flavio Sztajnbok
- Pediatric Rheumatology Division, Adolescent Health Care Unit, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ricardo Russo
- Servicio de Inmunología y Reumatología, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - María Martha Katsicas
- Servicio de Inmunología y Reumatología, Hospital de Pediatría Garrahan, Buenos Aires, Argentina
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Edoardo Marrani
- Division of Rheumatology, University Hospital Meyer, Florence, Italy
| | - Ekaterina Alexeeva
- Rheumatology Division, National Medical Research Center of Children's Health, Moscow, Russian Federation.,Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Tatyana M Dvoryakovskaya
- Rheumatology Division, National Medical Research Center of Children's Health, Moscow, Russian Federation.,Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Motasem O Alsuweiti
- Department of Immunology, Rheumatology and Allergy, Queen Rania Children's Hospital, Amman, Jordan
| | - Ra'ed M Alzyoud
- Department of Immunology, Rheumatology and Allergy, Queen Rania Children's Hospital, Amman, Jordan
| | - Mikhail Kostik
- Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation
| | - Irina Chikova
- Saint-Petersburg State Pediatric Medical University, Saint-Petersburg, Russian Federation
| | - Francesca Minoia
- UOC Pediatria a Media Intensità di Cure, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Filocamo
- UOC Pediatria a Media Intensità di Cure, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Yomna Farag
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hala Lotfy
- Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Samah Ismail Nasef
- Rheumatology Department, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Sulaiman M Al-Mayouf
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maria Cristina Maggio
- Dipartimento Promise G. D'Alessandro, Università degli Studi di Palermo, Palermo, Italy
| | - Claudia Saad Magalhaes
- Pediatric Department, Hospital das Clínicas - Botucatu Medicine University, UNESP, Botucatu, Brazil
| | - Romina Gallizzi
- UOC Pediatria, Servizio di Immuno-Reumatologia Pediatrica, Azienda Ospedaliera Universitaria Gaetano Martino Messina, Messina, Italy
| | - Giovanni Conti
- UO Nefrologia e Reumatologia Pediatrica, Azienda Ospedaliera Universitaria Gaetano Martino, Messina, Italy
| | - Masaki Shimizu
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Adele Civino
- Pediatric Unit, Ospedale Vito Fazzi, Lecce, Italy
| | - Enrico Felici
- Pediatric Unit, AON SS Antonio e Biagio e Cesare Arrigo Children's Hospital, Alessandria, Italy
| | - Gabriella Giancane
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Nicolino Ruperto
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Alessandro Consolaro
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Angelo Ravelli
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy.,Sechenov First Moscow State Medical University, Moscow, Russian Federation
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19
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Toplak N, Pimpale Chavan P, Rosina S, Dallos T, Rotem Semo O, Aguiar CL, Khubchandani R, Ravelli A, Patwardhan A. Is Anti-NXP2 Autoantibody a Risk Factor for Calcinosis and Poor Outcome in Juvenile Dermatomyositis Patients? Case Series. Front Pediatr 2021; 9:810785. [PMID: 35280444 PMCID: PMC8904416 DOI: 10.3389/fped.2021.810785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 12/20/2021] [Indexed: 11/27/2022] Open
Abstract
Juvenile dermatomyositis (JDM) has a wide spectrum of clinical presentations. In the last decade, several myositis-specific antibodies have been identified in patients with JDM and connected with specific organ involvement or specific clinical picture. It has been published that the presence of anti-NXP2 autoantibodies presents a risk for calcinosis in patients with JDM. We aimed to investigate the prevalence of calcinosis and response to the treatment in JDM patients with anti-NXP2. In a retrospective, multinational, multicenter study, data on 26 JDM (19 F, 7 M) patients with positive anti-NXP2 were collected. The mean age at disease presentation was 6.5 years (SD 3.7), the median diagnosis delay was 4 months (range 0.5-27 months). Patients were divided into two groups (A and B) based on the presence of calcinosis, which occurred in 42% of anti-NXP2 positive JDM patients (group A). Four patients already had calcinosis at presentation, one developed calcinosis after 4 months, and 6 developed calcinosis later in the disease course (median 2 years, range 0.8-7.8). The differences in laboratory results were not statistically significant between the groups. The mean age at disease presentation (5.2/7.5 years) trended toward being younger in group A. Children with calcinosis were treated with several combinations of drugs. In four cases, rituximab and, in one case, anti-TNF alpha agents were used successfully. Disease outcome (by evaluation of the treating physician) was excellent in four, good in two, stable in two, and poor in three patients. None of the patients from group B had a poor disease outcome. In conclusion, JDM patients with anti-NXP2 are prone to develop calcinosis, especially if they present with the disease early, before 5 years of age. The development of calcinosis is associated with worse disease outcomes. The combination of several immunomodulatory drugs and biologic drugs can stop calcinosis progression; however, there are no evidence-based therapies for treating calcinosis in JDM patients.
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Affiliation(s)
- Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, Faculty of Medicine, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | | | - Silvia Rosina
- Pediatric Rheumatology, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Tomas Dallos
- Department of Paediatrics, Comenius University Medical School, National Institute of Children's Diseases, Bratislava, Slovakia
| | - Oz Rotem Semo
- Section of Pediatric Rheumatology, University of Chicago Medical Center, Chicago, IL, United States
| | - Cassyanne L Aguiar
- Pediatric Rheumatology, Eastern Virginia Medical School (EVMS), Children's Hospital of The King's Daughters, Norfolk, VA, United States
| | | | - Angelo Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Universita Degli Studi di Genova, Genoa, Italy
| | - Anjali Patwardhan
- Pediatric Rheumatology, University of Missouri, School of Medicine, Columbia, MO, United States
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20
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Bajaj S, Patil P, Khubchandani R. Enthesitis-related arthritis in a child with turner syndrome. Indian J Rheumatol 2021. [DOI: 10.4103/injr.injr_203_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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21
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Khubchandani R, Aksentijevich I. Deficiency of Adenosine Deaminase 2 (DADA2) - A New Autoinflammatory Disease with Multisystem Features. Indian Pediatr 2020; 57:1074-1075. [PMID: 32796151] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Raju Khubchandani
- Department of Pediatric Rheumatology, SRCC Children's Hospital, Mumbai, India.
| | - Ivona Aksentijevich
- Inflammatory Disease Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland, USA
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22
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Foeldvari I, Klotsche J, Hinrichs B, Helmus N, Kasapcopur O, Adrovic A, Sztajnbok F, Terreri MT, Anton J, Smith V, Katsicas M, Kostik M, Vasquez‐Canizares N, Avcin T, Feldman B, Janarthanan M, Santos MJ, Sawhney S, Schonenberg‐Meinema D, Sifuentes‐Giraldo W, Alexeeva E, Appenzeller S, Battagliotti C, Berntson L, Bica B, Costa Reis P, Eleftheriou D, Kallinich T, Lehman T, Marrani E, Minden K, Nielsen S, Nuruzzaman F, Patwardhan A, Khubchandani R, Stanevicha V, Uziel Y, Torok KS. Under detection of interstitial lung disease in juvenile systemic sclerosis (jSSc). Arthritis Care Res (Hoboken) 2020; 74:364-370. [PMID: 33141441 DOI: 10.1002/acr.24499] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/15/2020] [Accepted: 10/27/2020] [Indexed: 11/07/2022]
Affiliation(s)
- Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology Schön Klinik Hamburg Eilbek Hamburg Germany
| | | | - Bernd Hinrichs
- Children's pulmonology, Asklepios Klinik Nord – Heidberg Hamburg Germany
| | - Nicola Helmus
- Hamburg Centre for Pediatric and Adolescent Rheumatology Schön Klinik Hamburg Eilbek Hamburg Germany
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology Cerrahpasa Medical School Istanbul University ‐ Cerrahpasa Istanbul Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology Cerrahpasa Medical School Istanbul University ‐ Cerrahpasa Istanbul Turkey
| | | | | | - Jordi Anton
- Pediatric Rheumatology. Hospital Sant Joan de Déu Esplugues (Barcelona) Spain
| | - Vanessa Smith
- Department of Internal Medicine Ghent University Department of Rheumatology Ghent University Hospital Unit for Molecular Immunology and Inflammation VIB Inflammation Research Center (IRC) Ghent Belgium
| | | | - Mikhail Kostik
- Saint‐Petersburg State Pediatric Medical University and Almazov National Medical Research Centre St Petersburg Russian Federation
| | | | - Tadej Avcin
- University Children's Hospital University Medical Center Ljubljana Ljubljana Slovenia
| | - Brian Feldman
- SickKids The Hospital for Sick Children Toronto Canada
| | | | | | | | | | | | - Ekaterina Alexeeva
- National Medical Research Center of Children's Health Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation Moscow Russian Federation
| | - Simone Appenzeller
- School of Medical Science State University of Campinas (UNICAMP) Sao Paulo Brazil
| | | | - Lillemor Berntson
- Dept. of Women’s and Children’s Health Uppsala University Uppsala Sweden
| | - Blanca Bica
- Chefe do Serviço de Reumatologia do Hospital Universitário Clementino Fraga Filho (HUCFF Universidade Federal do Rio de Janeiro Rio de Janeiro Brazil
| | - Patrícia Costa Reis
- Hospital de Santa Maria Faculdade de Medicina Universidade de Lisboa Lisbon Portugal
| | | | - Tilmann Kallinich
- Division of Rheumatology and Clinical Immunology Charité University Medicine Berlin Germany
| | | | | | - Kirsten Minden
- German Rheumatism Research Center Berlin Germany
- Division of Rheumatology and Clinical Immunology Charité University Medicine Berlin Germany
| | | | | | | | | | - Valda Stanevicha
- Riga Stradins University Department of Pediatric University Children Hospital Riga Latvia
| | - Yosef Uziel
- Meir Medical Center Tel Aviv University Kfar Saba Israel
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Khubchandani R, Aksentijevich I. Deficiency of Adenosine Deaminase 2 (DADA2) — A New Autoinflammatory Disease with Multisystem Features. Indian Pediatr 2020. [DOI: 10.1007/s13312-020-2041-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lee PY, Kellner ES, Huang Y, Furutani E, Huang Z, Bainter W, Alosaimi MF, Stafstrom K, Platt CD, Stauber T, Raz S, Tirosh I, Weiss A, Jordan MB, Krupski C, Eleftheriou D, Brogan P, Sobh A, Baz Z, Lefranc G, Irani C, Kilic SS, El-Owaidy R, Lokeshwar MR, Pimpale P, Khubchandani R, Chambers EP, Chou J, Geha RS, Nigrovic PA, Zhou Q. Genotype and functional correlates of disease phenotype in deficiency of adenosine deaminase 2 (DADA2). J Allergy Clin Immunol 2020; 145:1664-1672.e10. [PMID: 31945408 DOI: 10.1016/j.jaci.2019.12.908] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [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: 10/30/2019] [Revised: 12/07/2019] [Accepted: 12/27/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Deficiency of adenosine deaminase 2 (DADA2) is a syndrome with pleiotropic manifestations including vasculitis and hematologic compromise. A systematic definition of the relationship between adenosine deaminase 2 (ADA2) mutations and clinical phenotype remains unavailable. OBJECTIVE We sought to test whether the impact of ADA2 mutations on enzyme function correlates with clinical presentation. METHODS Patients with DADA2 with severe hematologic manifestations were compared with vasculitis-predominant patients. Enzymatic activity was assessed using expression constructs reflecting all 53 missense, nonsense, insertion, and deletion genotypes from 152 patients across the DADA2 spectrum. RESULTS We identified patients with DADA2 presenting with pure red cell aplasia (n = 5) or bone marrow failure (BMF, n = 10) syndrome. Most patients did not exhibit features of vasculitis. Recurrent infection, hepatosplenomegaly, and gingivitis were common in patients with BMF, of whom half died from infection. Unlike patients with DADA2 with vasculitis, patients with pure red cell aplasia and BMF proved largely refractory to TNF inhibitors. ADA2 variants associated with vasculitis predominantly reflected missense mutations with at least 3% residual enzymatic activity. In contrast, pure red cell aplasia and BMF were associated with missense mutations with minimal residual enzyme activity, nonsense variants, and insertions/deletions resulting in complete loss of function. CONCLUSIONS Functional interrogation of ADA2 mutations reveals an association of subtotal function loss with vasculitis, typically responsive to TNF blockade, whereas more extensive loss is observed in hematologic disease, which may be refractory to treatment. These findings establish a genotype-phenotype spectrum in DADA2.
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Affiliation(s)
- Pui Y Lee
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
| | - Erinn S Kellner
- Division of Allergy/Immunology, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, Ohio
| | - Yuelong Huang
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Elissa Furutani
- Dana Farber and Boston Children's Cancer and Blood Disorders Center, Boston, Mass
| | - Zhengping Huang
- Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Wayne Bainter
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Mohammed F Alosaimi
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Kelsey Stafstrom
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Craig D Platt
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Tali Stauber
- Primary Immunodeficiency Clinic, Sheba Medical Center, Jeffrey Modell Foundation, Tel Hashomer, Israel
| | - Somech Raz
- Primary Immunodeficiency Clinic, Sheba Medical Center, Jeffrey Modell Foundation, Tel Hashomer, Israel
| | - Irit Tirosh
- Pediatric Rheumatology Service, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
| | - Aaron Weiss
- Department of Pediatrics, Maine Medical Center, Portland, Me
| | - Michael B Jordan
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio; Division of Immunobiology, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Christa Krupski
- Division of Bone Marrow Transplantation and Immune Deficiency, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Despina Eleftheriou
- University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Paul Brogan
- University College London, Great Ormond Street Institute of Child Health, London, United Kingdom
| | - Ali Sobh
- Department of Pediatrics, Mansoura University Children's Hospital, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Zeina Baz
- Department of Pediatrics, St George Hospital University Medical Center, Beirut, Lebanon
| | - Gerard Lefranc
- Institut de Génétique Humaine, UMR 9002 CNRS-Université de Montpellier, Montpellier, France
| | - Carla Irani
- Internal Medicine & Clinical Immunology Department, Hotel Dieu de France Hospital, Saint Joseph University, Beirut, Lebanon
| | - Sara S Kilic
- Department of Pediatric Immunology and Rheumatology, Uludag University Medical Faculty, Bursa, Turkey
| | - Rasha El-Owaidy
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - M R Lokeshwar
- Department of Pediatrics, Lilavati Hospital and Research Centre, Mumbai, India
| | | | | | - Eugene P Chambers
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tenn; DADA2 Foundation, Nashville, Tenn
| | - Janet Chou
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Raif S Geha
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass
| | - Peter A Nigrovic
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, Mass; Division of Rheumatology, Inflammation and Immunity, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Qing Zhou
- Life Sciences Institute, Zhejiang University, Zhejiang, China
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Holland MJ, Beresford MW, Feldman BM, Huggins J, Norambuena X, Silva CA, Susic G, Sztajnbok F, Uziel Y, Appenzeller S, Ardoin SP, Avcin T, Flores F, Goilav B, Khubchandani R, Klein-Gitelman M, Levy D, Ravelli A, Wenderfer SE, Ying J, Ruperto N, Brunner HI. Measuring Disease Damage and Its Severity in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2019; 70:1621-1629. [PMID: 29409150 DOI: 10.1002/acr.23531] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 01/30/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To describe the frequency and types of disease damage occurring with childhood-onset systemic lupus erythematosus (SLE) as measured by the 41-item Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), and to assess the SDI's ability to reflect damage severity. METHODS Information for the SDI was prospectively collected from 1,048 childhood-onset SLE patients. For a subset of 559 patients, physician-rated damage severity measured by visual analog scale (MD VAS damage) was also available. Frequency of SDI items and the association between SDI summary scores and MD VAS damage were estimated. Finally, an international consensus conference, using nominal group technique, considered the SDI's capture of childhood-onset SLE-associated damage and its severity. RESULTS After a mean disease duration of 3.8 years, 44.2% of patients (463 of 1,048) already had an SDI summary score >0 (maximum 14). The most common SDI items scored were proteinuria, scarring alopecia, and cognitive impairment. Although there was a moderately strong association between SDI summary scores and MD VAS damage (Spearman's r = 0.49, P < 0.0001) in patients with damage (SDI summary score >0), mixed-effects analysis showed that only 4 SDI items, each occurring in <2% of patients overall, were significantly associated with MD VAS damage. There was consensus among childhood-onset SLE experts that the SDI in its current form is inadequate for estimating the severity of childhood-onset SLE-associated damage. CONCLUSION Disease damage as measured by the SDI is common in childhood-onset SLE, even with relatively short disease durations. Given the shortcomings of the SDI, there is a need to develop new tools to estimate the impact of childhood-onset SLE-associated damage.
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Affiliation(s)
| | - Michael W Beresford
- Alder Hey Children's National Health Service Foundation Trust and University of Liverpool, Liverpool, UK
| | - Brian M Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Clovis A Silva
- Children's Institute, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Flavio Sztajnbok
- Hospital Universitario Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Yosef Uziel
- Meir Medical Centre, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Stacy P Ardoin
- Nationwide Children's Hospital, Ohio State University Wexner College of Medicine, Columbus
| | - Tadej Avcin
- Ljubljana University Medical Center, University of Ljubljana Medical Faculty, Ljubljana, Slovenia
| | | | - Beatrice Goilav
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, New York, New York
| | | | | | - Deborah Levy
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Angelo Ravelli
- Istituto Giannina Gaslini and Università degli Studi di Genova, Genoa, Italy
| | | | - Jun Ying
- University of Cincinnati College of Medicine, Cincinnati, Ohio
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Brunner HI, Holland MJ, Beresford MW, Ardoin SP, Appenzeller S, Silva CA, Flores F, Goilav B, Aydin POA, Wenderfer SE, Levy DM, Ravelli A, Khubchandani R, Avcin T, Klein-Gitelman MS, Ruperto N, Feldman BM, Ying J. American College of Rheumatology Provisional Criteria for Clinically Relevant Improvement in Children and Adolescents With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2019; 71:579-590. [PMID: 30680946 PMCID: PMC6483875 DOI: 10.1002/acr.23834] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a Childhood Lupus Improvement Index (CHILI) as a tool to measure response to therapy in childhood-onset systemic lupus erythematosus (cSLE), with a focus on clinically relevant improvement (CRIc SLE ). METHODS Pediatric nephrology and rheumatology subspecialists (n = 213) experienced in cSLE management were invited to define CRIc SLE and rate a total of 433 unique patient profiles for the presence/absence of CRIc SLE . Patient profiles included the following cSLE core response variables (CRVs): global assessment of patient well-being (patient-global), physician assessment of cSLE activity (MD-global), disease activity index score (here, we used the Systemic Lupus Erythematosus Disease Activity Index), urine protein-to-creatinine ratio, and Child Health Questionnaire physical summary score. Percentage and absolute changes in these cSLE-CRVs (baseline versus follow-up) were considered in order to develop candidate algorithms and validate their performance (sensitivity, specificity, area under the receiver operating characteristic curve [AUC]; range 0-1). RESULTS During an international consensus conference, unanimous agreement on a definition of CRIc SLE was achieved; cSLE experts (n = 13) concurred (100%) that the preferred CHILI algorithm considers absolute changes in the cSLE-CRVs. After transformation to a range of 0-100, a CHILI score of ≥54 had outstanding accuracy for identifying CRIc SLE (AUC 0.93, sensitivity 81.1%, and specificity 84.2%). CHILI scores also reflect minor, moderate, and major improvement for values exceeding 15, 68, and 92, respectively (all AUC ≥0.92, sensitivity ≥93.1%, and specificity ≥73.4%). CONCLUSION The CHILI is a new, seemingly highly accurate index for measuring CRI in cSLE over time. This index is useful to categorize the degree of response to therapy in children and adolescents with cSLE.
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Affiliation(s)
- Hermine I. Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael J. Holland
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael W. Beresford
- Department of Paediatric Rheumatology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Stacy P. Ardoin
- Department of Pediatrics and Internal Medicine, Ohio State University, Division of Rheumatology, Nationwide Children’s Hospital and Wexner Medical Center, Columbus, OH
| | - Simone Appenzeller
- Rheumatology Unit-School of Medical Science; University of Campinas, Campinas, Brazil
| | - Clovis A. Silva
- Children’s Institute, Hospital das Clinicas HCFMUSP; Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Francisco Flores
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Beatrice Goilav
- Department of Pediatrics, The Children’s Hospital at Montefiore, Division of Nephrology and Albert Einstein College of Medicine, Bronx, NY
| | - Pinar Ozge Avar Aydin
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Scott E. Wenderfer
- Department of Pediatrics, Baylor College of Medicine; Renal Section, Texas Children’s Hospital Houston, TX
| | - Deborah M. Levy
- Department of Pediatrics, University of Toronto and Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Angelo Ravelli
- Istituto G. Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | | | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Centre Ljubljana, Slovenia
| | - Marisa S. Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Division of Rheumatology, Ann and Robert Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Nicolino Ruperto
- Istituto G. Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Brian M. Feldman
- Department of Pediatrics, University of Toronto and Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Jun Ying
- Department of Environmental Health Sciences, University of Cincinnati, Cincinnati, OH
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Reddy P, Tiwari K, Kulkarni A, Parikh K, Khubchandani R. Van Wyk Grumbach Syndrome: A Rare Consequence of Hypothyroidism. Indian J Pediatr 2018; 85:1028-1030. [PMID: 29777468 DOI: 10.1007/s12098-018-2704-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/04/2018] [Indexed: 10/16/2022]
Abstract
Long standing hypothyroidism presenting as an ovarian mass has been well described in literature as the Van Wyk Grumbach syndrome (hypothyroidism, isosexual precocious puberty and ovarian mass). Here, authors report this entity in a 11 y 7 mo old girl child who was referred to a surgeon in view of intestinal obstruction along with a multiloculated ovarian cyst. On evaluation, she was found to have raised serum creatinine, short stature, delayed bone age and pituitary enlargement. She was diagnosed with autoimmune thyroiditis and was started on replacement therapy with thyroxine, after which the ovarian cysts regressed. This entity should be kept in mind in cases of ovarian cysts, especially those with isosexual precocity, to prevent unnecessary evaluation and surgical misadventures.
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Affiliation(s)
- Pavan Reddy
- Department of Pediatrics, Jaslok Hospital and Research Centre, Mumbai, India.
| | - Kritika Tiwari
- Department of Pediatrics, Jaslok Hospital and Research Centre, Mumbai, India
| | - Abhishek Kulkarni
- Department of Pediatrics, Jaslok Hospital and Research Centre, Mumbai, India
| | - Ketan Parikh
- Department of Pediatrics, Jaslok Hospital and Research Centre, Mumbai, India
| | - Raju Khubchandani
- Department of Pediatrics, Jaslok Hospital and Research Centre, Mumbai, India
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28
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Martini A, Ravelli A, Avcin T, Beresford MW, Burgos-Vargas R, Cuttica R, Ilowite NT, Khubchandani R, Laxer RM, Lovell DJ, Petty RE, Wallace CA, Wulffraat NM, Pistorio A, Ruperto N. Toward New Classification Criteria for Juvenile Idiopathic Arthritis: First Steps, Pediatric Rheumatology International Trials Organization International Consensus. J Rheumatol 2018; 46:190-197. [PMID: 30275259 DOI: 10.3899/jrheum.180168] [Citation(s) in RCA: 241] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To revise the current juvenile idiopathic arthritis (JIA) International League of Associations for Rheumatology (ILAR) classification criteria with an evidence-based approach, using clinical and routine laboratory measures available worldwide, to identify homogeneous clinical groups and to distinguish those forms of chronic arthritis typically seen only in children from the childhood counterpart of adult diseases. METHODS The overall project consists of 4 steps. This work represents Step 1, a Delphi Web-based consensus and Step 2, an international nominal group technique (NGT) consensus conference for the new provisional Pediatric Rheumatology International Trials Organization JIA classification criteria. A future large data collection of at least 1000 new-onset JIA patients (Step 3) followed by analysis and NGT consensus (Step 4) will provide data for the evidence-based validation of the JIA classification criteria. RESULTS In Step 1, three Delphi rounds of interactions were implemented to revise the 7 ILAR JIA categories. In Step 2, forty-seven questions with electronic voting were implemented to derive the new proposed criteria. Four disorders were proposed: (a) systemic JIA; (b) rheumatoid factor-positive JIA; (c) enthesitis/spondylitis-related JIA; and (d) early-onset antinuclear antibody-positive JIA. The other forms were gathered under the term "others." These will be analyzed during the prospective data collection using a list of descriptors to see whether the clustering of some of them could identify homogeneous entities. CONCLUSION An international consensus was reached to identify different proposed homogeneous chronic disorders that fall under the historical term JIA. These preliminary criteria will be formally validated with a dedicated project.
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Affiliation(s)
- Alberto Martini
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands. .,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO.
| | - Angelo Ravelli
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Tadej Avcin
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Michael W Beresford
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Ruben Burgos-Vargas
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Ruben Cuttica
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Norman T Ilowite
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Raju Khubchandani
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Ronald M Laxer
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Daniel J Lovell
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Ross E Petty
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Carol A Wallace
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Nico M Wulffraat
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Angela Pistorio
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
| | - Nicolino Ruperto
- From Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Istituto Giannina Gaslini, Direzione Scientifica; IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Pediatric Rheumatology International Trials Organization (PRINTO), and Università degli Studi di Genova; IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, Genoa, Italy; University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology, Ljubljana, Slovenia; Department of Paediatric Rheumatology, Alder Hey Children's National Health Service (NHS) Foundation Trust; Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Hospital General de Mexico, Departamento de Reumatología, Mexico City, Mexico; Hospital Pedro de Elizalde, Rheumatology Section, Buenos Aires, Argentina; Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics, New Hyde Park, New York; Cincinnati Children's Hospital Medical Center, Division of Rheumatology, Cincinnati, Ohio; Seattle Children's Hospital, Seattle, Washington, USA; Jaslok Hospital and Research Centre, Department of Paediatrics, Mumbai, India; The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto, Toronto, Ontario; British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada; Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology, Utrecht, the Netherlands.,A. Martini, MD, Professor, IRCCS Istituto Giannina Gaslini, Direzione Scientifica; A. Ravelli, MD, Professor, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia and Università degli Studi di Genova; T. Avcin, MD, PhD, University Children's Hospital, University Medical Center Ljubljana, Department of Allergology, Rheumatology and Clinical Immunology; M.W. Beresford, MBChB, PhD, Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, and Institute of Translational Medicine, University of Liverpool; R. Burgos-Vargas, MD, Hospital General de Mexico, Departamento de Reumatología; R. Cuttica, MD, Hospital Pedro de Elizalde, Rheumatology Section; N.T. Ilowite, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Pediatrics; R. Khubchandani, MD, Jaslok Hospital and Research Centre, Department of Paediatrics; R.M. Laxer, MD, The Hospital for Sick Children, Division of Rheumatology, Department of Paediatrics, University of Toronto; D.J. Lovell, MD, MPH, Cincinnati Children's Hospital Medical Center, Division of Rheumatology; R.E. Petty, MD, PhD, British Columbia Children's Hospital, Department of Pediatrics, University of British Columbia; C.A. Wallace, MD, Seattle Children's Hospital; N.M. Wulffraat, MD, PhD, Wilhelmina Children's Hospital, Department of Pediatric Immunology and Rheumatology; A. Pistorio, MD, PhD, IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica; N. Ruperto, MD, MPH, IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO
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Smith N, Jandial S, Wyllie R, English C, Davies B, Khubchandani R, Chan M, Munro J, Ferriani V, Magalhães CS, Russo R, Yan J, Scott C, Charuvanij S, Khawaja K, Vojinovic J, Rapley T, Foster H. 260 Globalisation of Paediatric Musculoskeletal Matters (PMM). Rheumatology (Oxford) 2018. [DOI: 10.1093/rheumatology/key075.484] [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)
- Nicola Smith
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UNITED KINGDOM
| | - Sharmila Jandial
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Upon Tyne, UNITED KINGDOM
| | - Ruth Wyllie
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Upon Tyne, UNITED KINGDOM
| | - Christine English
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne, UNITED KINGDOM
| | - Barbara Davies
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle Upon Tyne, UNITED KINGDOM
| | - Raju Khubchandani
- Department of Paediatrics, Jaslok Hospital and Research Center, Mumbai, INDIA
| | - Mercedes Chan
- Paediatric Rheumatology, University of Alberta, Edmonton, AB, CANADA
| | - Jane Munro
- Paediatric Rheumatology, Royal Children’s Hospital, Victoria, AUSTRALIA
| | - Virginia Ferriani
- Department of Paediatrics, Ribeirão Preto Medical School, University of São Paulo, Sao Paulo, BRAZIL
| | | | - Ricardo Russo
- Service of Immunology/Rheumatology, Hospital de Pediatría Garrahan, Garrahan, ARGENTINA
| | - Jacqueline Yan
- Paediatric Rheumatology, Starship Children’s Health, Auckland, NEW ZEALAND
| | - Chris Scott
- Department of Paediatrics, University of Cape Town, Cape Town, SOUTH AFRICA
| | - Sirirat Charuvanij
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, THAILAND
| | - Khulood Khawaja
- Department of Immunology/Rheumatology, Al-Mafraq Hospital, Abu Dhabi, UNITED ARAB EMIRATES
| | - Jelena Vojinovic
- Paediatric Rheumatology, Faculty of Medicine, University of Nis, Nis, SERBIA
| | - Tim Rapley
- Institute of Health and Society, Newcastle University, Newcastle Upon Tyne, UNITED KINGDOM
| | - Helen Foster
- Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UNITED KINGDOM
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Upon Tyne, UNITED KINGDOM
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Jiao F, Jindal AK, Pandiarajan V, Khubchandani R, Kamath N, Sabui T, Mondal R, Pal P, Singh S. The emergence of Kawasaki disease in India and China. Glob Cardiol Sci Pract 2017; 2017:e201721. [PMID: 29564342 PMCID: PMC5856971 DOI: 10.21542/gcsp.2017.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 06/16/2017] [Accepted: 09/19/2017] [Indexed: 12/18/2022] Open
Abstract
Kawasaki disease (KD) is recognized as a leading cause of acquired heart disease in children in developed countries. Although global in distribution, Japan records the highest incidence of KD in the world. Epidemiological reports from the two most populous countries in the world, namely China and India, indicate that KD is now being increasingly recognized. Whether this increased reporting is due to increased ascertainment, or is due to a true increase in incidence, remains a matter of conjecture. The diagnosis and management of KD in developing countries is a challenging proposition. In this review we highlight some of the difficulties faced by physicians in managing children with KD in resource-constrained settings.
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Affiliation(s)
- Fuyong Jiao
- Children’s Hospital, Shaanxi Provincial People’s Hospital of Xian, Jiaotong Univeristy, China
| | - Ankur Kumar Jindal
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India
| | - Vignesh Pandiarajan
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India
| | | | - Nutan Kamath
- Department of Pediatrics, Kasturba Medical College, Mangalore, India
| | - Tapas Sabui
- Department of Pediatrics, RG Kar Medical College, Kolkata, India
| | - Rakesh Mondal
- Institute of Post Graduate Medical Education and Research, Kolkata, India
| | | | - Surjit Singh
- Allergy Immunology Unit, Department of Pediatrics, Advanced Pediatrics Centre, PGIMER, Chandigarh, India
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Minoia F, Bovis F, Davì S, Insalaco A, Lehmberg K, Shenoi S, Weitzman S, Espada G, Gao YJ, Anton J, Kitoh T, Kasapcopur O, Sanner H, Merino R, Astigarraga I, Alessio M, Jeng M, Chasnyk V, Nichols KE, Huasong Z, Li C, Micalizzi C, Ruperto N, Martini A, Cron RQ, Ravelli A, Horne A, Aggarwal A, Akikusa J, Al-Mayouf S, Alessio M, Anton J, Apaz MT, Astigarraga I, Avcin T, Ayaz NA, Barone P, Bica B, Bolt I, Bovis F, Breda L, Chasnyk V, Cimaz R, Corona F, Cron RQ, Cuttica R, Davì S, Davidsone Z, De Cunto C, De Inocencio J, Demirkaya E, Eisenstein EM, Enciso S, Espada G, Fischbach M, Frosch M, Gallizzi R, Gamir ML, Gao YJ, Griffin T, Grom A, Hashad S, Hennon T, Henter JI, Horne A, Horneff G, Huasong Z, Huber A, Ilowite N, Insalaco A, Ioseliani M, Jeng M, Kapović AM, Kasapcopur O, Khubchandani R, Kitoh T, Koné-Paut I, de Oliveira SKF, Lattanzi B, Lehmberg K, Lepore L, Li C, Lipton JM, Magni-Manzoni S, Maritsi D, Martini A, McCurdy D, Merino R, Micalizzi C, Miettunen P, Minoia F, Mulaosmanovic V, Nichols KE, Nielsen S, Ozen S, Pal P, Prahalad S, Ravelli A, Rigante D, Rumba-Rozenfelde I, Ruperto N, Russo R, Magalhães CS, Sanner H, Sewairi WMS, Shenoi S, Artur Silva C, Stanevicha V, Sterba G, Stine KC, Susic G, Sztajnbok F, Takei S, Trauzeddel R, Tsitsami E, Unsal E, Uziel Y, Vougiouka O, Wallace CA, Weaver L, E. Weiss J, Weitzman S, Wouters C, Wulffraat N, Zletni M, Arico M, Egeler RM, Filipovich AH, Gadner H, Imashuku S, Janka G, Ladisch S, McClain KL, Webb D. Development and Initial Validation of the Macrophage Activation Syndrome/Primary Hemophagocytic Lymphohistiocytosis Score, a Diagnostic Tool that Differentiates Primary Hemophagocytic Lymphohistiocytosis from Macrophage Activation Syndrome. J Pediatr 2017; 189:72-78.e3. [PMID: 28807357 DOI: 10.1016/j.jpeds.2017.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 05/02/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To develop and validate a diagnostic score that assists in discriminating primary hemophagocytic lymphohistiocytosis (pHLH) from macrophage activation syndrome (MAS) related to systemic juvenile idiopathic arthritis. STUDY DESIGN The clinical, laboratory, and histopathologic features of 362 patients with MAS and 258 patients with pHLH were collected in a multinational collaborative study. Eighty percent of the population was assessed to develop the score and the remaining 20% constituted the validation sample. Variables that entered the best fitted model of logistic regression were assigned a score, based on their statistical weight. The MAS/HLH (MH) score was made up with the individual scores of selected variables. The cutoff in the MH score that discriminated pHLH from MAS best was calculated by means of receiver operating characteristic curve analysis. Score performance was examined in both developmental and validation samples. RESULTS Six variables composed the MH score: age at onset, neutrophil count, fibrinogen, splenomegaly, platelet count, and hemoglobin. The MH score ranged from 0 to 123, and its median value was 97 (1st-3rd quartile 75-123) and 12 (1st-3rd quartile 11-34) in pHLH and MAS, respectively. The probability of a diagnosis of pHLH ranged from <1% for a score of <11 to >99% for a score of ≥123. A cutoff value of ≥60 revealed the best performance in discriminating pHLH from MAS. CONCLUSION The MH score is a powerful tool that may aid practitioners to identify patients who are more likely to have pHLH and, thus, could be prioritized for functional and genetic testing.
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Affiliation(s)
| | | | | | | | | | - Susan Shenoi
- Seattle Children's Hospital and University of Washington, Seattle, WA
| | | | - Graciela Espada
- Ricardo Gutierrez Children's Hospital, Buenos Aires, Argentina
| | - Yi-Jin Gao
- Children's Hospital of Fudan University, Shanghai, China
| | - Jordi Anton
- Hospital Saint Joan de Déu, Barcelona, Spain
| | | | - Ozgur Kasapcopur
- Istanbul University, Cerrahpasa Medical School, Istanbul, Turkey
| | - Helga Sanner
- Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | | | - Itziar Astigarraga
- BioCruces Health Research Institute, Cruces University Hospital, University of the Basque Country, Barakaldo, Spain
| | | | | | - Vyacheslav Chasnyk
- Saint Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | | | | | - Caifeng Li
- Beijing Children's Hospital, Beijing, China
| | | | | | | | | | - Angelo Ravelli
- G. Gaslini Institute, Genoa, Italy; University of Genova, Genoa, Italy
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Smith N, Jandial S, Wyllie R, English C, Davies B, Khubchandani R, Chan M, Munro J, Ferriani V, Magalhães CS, Yan J, Scott C, Charuvanij S, Khawaja K, Vojinovic J, Rapley T, Foster H. 054. Globalisation of Paediatric Musculoskeletal Matters’ (PMM). Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lomakina O, Alekseeva E, Valieva S, Bzarova T, Nikishina I, Zholobova E, Rodionovskaya S, Kaleda M, Nakagishi Y, Shimizu M, Mizuta M, Yachie A, Sugita Y, Okamoto N, Shabana K, Murata T, Tamai H, Smith EM, Yin P, Jorgensen AL, Beresford MW, Smith EM, Eleuteri A, Goilav B, Lewandowski L, Phuti A, Wahezi D, Rubinstein T, Jones C, Newland P, Marks S, Corkhill R, Ekdawy D, Pilkington C, Tullus K, Putterman C, Scott C, Fisher AC, Beresford MW, Smith EM, Lewandowski L, Phuti A, Jorgensen A, Scott C, Beresford MW, Batu ED, Kosukcu C, Taskiran E, Akman S, Ozturk K, Sozeri B, Unsal E, Ekinci Z, Bilginer Y, Alikasifoglu M, Ozen S, Lythgoe H, Beresford MW, Brunner HI, Gulati G, Jones JT, Altaye M, Eaton J, Difrancesco M, Yeo JG, Leong J, Bathi LDT, Arkachaisri T, Albani S, Abdelrahman N, Beresford MW, Leone V, Groot N, Shaikhani D, Bultink IEM, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Wright RD, Smith EM, Beresford MW, Abdawani R, Al Shaqshi L, Al Zakwani I, Gormezano NW, Kern D, Pereira OL, Esteves GCC, Sallum AM, Aikawa NE, Pereira RM, Silva CA, Bonfa E, Beckmann J, Bartholomä N, Foeldvari I, Bohnsack J, Milojevic D, Rabinovich C, Kingsbury D, Marzan K, Quartier P, Minden K, Chalom E, Horneff G, Venhoff N, Kuester RM, Dare J, Heinrich M, Kupper H, Kalabic J, Martini A, Brunner HI, Consolaro A, Horneff G, Burgos-Vargas R, Henneke P, Constantin T, Foeldvari I, Vojinovic J, Dehoorne J, Panaviene V, Susic G, Stanevica V, Kobusinska K, Zuber Z, Mouy R, Salzer U, Rumba-Rozenfelde I, Dolezalova P, Job-Deslandre C, Wulffraat N, Pederson R, Bukowski J, Hinnershitz T, Vlahos B, Martini A, Ruperto N, Janda A, Keskitalo P, Kangas S, Vähäsalo P, Valencia RAC, Martino D, Munro J, Ponsonby AL, Chiaroni-Clarke R, Meyer B, Allen RC, Boteanu AL, Akikusa JD, Craig JM, Saffrey R, Ellis JA, Davì S, Minoia F, Horne A, Wulffraat N, Wouters C, Wallace C, Corral SG, Uziel Y, Sterba G, Schneider R, Russo R, Ramanan AV, Schmid JP, Ozen S, Nichols KE, Miettunen P, Lovell DJ, Giraldo AS, Lehmberg K, Kitoh T, Khubchandani R, Ilowite NT, Henter JI, Grom AA, De Benedetti F, Behrens EM, Avcin T, Aricò M, Gámir MG, Martini A, Ruperto N, Cron RQ, Ravelli A, Grevich S, Lee P, Ringold S, Leroux B, Leahey H, Yuasa M, Mendoza AZ, Foster J, Sokolove J, Lahey L, Robinson W, Newson J, Stevens A, Shoop SJW, Hyrich KL, Verstappen SMM, Thomson W, Adrovic A, McDonagh JE, Beukelman T, Kimura Y, Natter M, Ilowite N, Mieszkalski K, Burrell G, Best B, Bristow H, Carr S, Dedeoglu R, Dennos A, Kaufmann R, Schanberg L, Parissenti I, Insalaco A, Taddio A, Mauro A, Pardeo M, Ricci F, Simonini G, Sahin S, Cattalini M, Montesano P, Parissenti I, Ricci F, Bonafini B, Medeghini V, Lancini F, Cattalini M, Gerbaux M, Lê PQ, Barut K, Goffin L, Badot V, La C, Caspers L, Willermain F, Ferster A, Ceci M, Licciardi F, Turco M, Santarelli F, Koka A, Montin D, Toppino C, Maggio MC, Alizzi C, Papia B, Vergara B, Corpora U, Messina L, Corsello G, Tsinti M, Oztunc F, Dermentzoglou V, Tziavas P, Tsitsami E, Perica M, Vidović M, Lamot L, Harjaček M, Bukovac LT, Çakan M, Ayaz NA, Kasapcopur O, Keskindemirci G, Miettunen P, Lang M, Laing C, Benseler S, Gerschman T, Luca N, Schmeling H, Dropol A, Taiani J, Rodriguez-Lozano AL, Johnson N, Rusted B, Nalbanti P, Trachana M, Pratsidou P, Pardalos G, Tzimouli V, Taparkou A, Stavrakidou M, Papachristou F, Rivas-Larrauri F, Kanakoudi-Tsakalidou F, Bale P, Robinson E, Palman J, Pilkington C, Ralph E, Gilmour K, Heard C, Wedderburn LR, Carlomagno R, de la Puente SG, Barrense-Dias Y, Gregory A, Amira D, Paolo S, Sylviane H, Michaël H, Panko N, Shokry S, Rakovska L, Pino S, Alves AGF, Diaz-Maldonado A, Guarnizo P, Torreggiani S, Cressoni P, Garagiola U, Di Landro G, Farronato G, Corona F, Filocamo G, Shenoi S, Giacomin MFDA, Bell S, Bhatti P, Nelson L, Mueller BA, Simon TA, Baheti A, Ray N, Guo Z, Ruperto N, Brunner HI, Farhat J, Hazra A, Stock T, Wang R, Mebus C, Alvey C, Lamba M, Krishnaswami S, Conte U, Wang M, 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Simou S, Dossetter L, Wedderburn LR, Pilkington C, Campanilho-Marques R, Ozcakar ZB, Deakin C, Simou S, Wedderburn LR, Pilkington CA, Rosina S, Consolaro A, van Dijkhuizen P, Nistala K, Ruperto N, Pilkington C, Çakar N, Ravelli A, Soponkanaporn S, Simou S, Deakin CT, Wedderburn LR, Arıcı ZS, Tuğcu GD, Batu ED, Sönmez HE, Doğru-Ersöz D, Uncu N, Bilginer Y, Talim B, Kiper N, Özen S, Solyom A, Hügle B, Makay B, Magnusson B, Batu E, Mitchell J, Gür G, Kariminejad A, Hadipour F, Hadipour Z, Torcoletti M, Agostoni C, Di Rocco M, Tanpaiboon P, Superti-Furga A, Bonafé L, Arslan N, Özdel S, Guelbert N, Kostik M, Ehlert K, Grigelioniene G, Puri R, Ozen S, Schuchman E, Malagon C, Gomez P, Mosquera AC, Yalçınkaya F, Gonzalez T, Yepez R, Vargas C, Fernanda F, Lepri G, Ferrari A, Rigante D, Matucci-Cerinic M, Meini A, Moneta GM, Scott C, Caiello I, Marasco E, Nicolai R, Pardeo M, Bracaglia C, Insalaco A, Bracci-Laudiero L, De Benedetti F, Kopchak O, Kostik M, Brice N, Mushkin A, Maletin A, Makay B, 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M, Hentgen V, Woerner A, Schwarz T, Klotsche J, Niewerth M, Horneff G, Haas JP, Hospach A, Huppertz HI, Ganser G, Minden K, Jeyaratnam J, ter Haar N, Kasapcopur O, Rigante D, Dedeoglu F, Baris E, Vastert S, Wulffraat N, Frenkel J, Hausmann JS, Lomax KG, Shapiro A, Durrant KL, Brogan PA, Hofer M, Kuemmerle-Deschner JB, Lauwerys B, Speziale A, Leon K, Wei X, Laxer RM, Signa S, Rusmini M, Campione E, Chiesa S, Grossi A, Omenetti A, Caorsi R, Viglizzo G, Martini A, Ceccherini I, Gattorno M, Federici S, Frenkel J, Ozen S, Lachmann H, Finetti M, Martini A, Ruperto N, Gattorno M, Federici S, Vanoni F, Ozen S, Hofer M, Frenkel J, Lachmann H, Martini A, Ruperto N, Gattorno M, Gomes SM, Omoyinmi E, Arostegui JI, Gonzalez-Roca E, Eleftheriou D, Klein N, Brogan P, Volpi S, Santori E, Picco P, Pastorino C, Caorsi R, Rice G, Tesser A, Martini A, Crow Y, Candotti F, Gattorno M, Barut K, Sahin S, Adrovic A, Sinoplu AB, Yucel G, Pamuk G, Kasapcopur O, Damian LO, Lazea C, Sparchez M, Vele P, Muntean L, Albu A, Rednic S, Lazar C, Mendonça LO, Pontillo A, Kalil J, Castro FM, Barros MT, Pardeo M, Messia V, De Benedetti F, Insalaco A, Malighetti G, Gorio C, Ricci F, Parissenti I, Montesano P, Bonafini B, Medeghini V, Cattalini M, Giordano L, Zani G, Ferraro R, Vairo D, Giliani S, Cattalini M, Maggio MC, Luppino G, Corsello G, Fernandez MIG, Montesinos BL, Vidal AR, Gorospe JIA, Penades IC, Rafiq NK, Wynne K, Hussain K, Brogan PA, Ang E, Ng N, Kacar A, Gucenmez OA, Makay B, Unsal SE, Sahin Y, Barut K, Kutlu T, Cullu-Cokugras F, Sahin S, Adrovic A, Ayyildiz-Civan H, Kasapcopur O, Erkan T, Abdawani R, Al Zuhbi S, Abdalla E, Russo RA, Katsicas MM, Caorsi R, Minoia F, Viglizzo G, Grossi A, Chiesa S, Picco P, Ravelli A, Gattorno M, Bhattad S, Rawat A, Gupta A, Suri D, Pandiarajan V, Nada R, Tiewsoh K, Hawkins P, Rowczenio D, Singh S, Fingerhutova S, Franova J, Prochazkova L, Hlavackova E, Dolezalova P, Evrengül H, Yüksel S, Doğan M, Gürses D, Evrengül H, De Pauli S, Pastore S, Bianco AM, 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Ganeva M, Stefanov S, Telcharova A, Mihaylova D, Saraeva R, Tzveova R, Kaneva R, Tsakova A, Temelkova K, Picarelli MMC, Danzmann LC, Barbé-Tuana F, Grun LK, Jones MH, Frković M, Ištuk K, Birkić I, Sršen S, Jelušić M, Smith N, Jandial S, Easton A, Quarmby R, Khubchandani R, Chan M, Rapley T, Foster H, Srp R, Kobrova K, Franova J, Fingerhutova S, Nemcova D, Hoza J, Uher M, Saifridova M, Linkova L, Dolezalova P, Charuvanij S, Leelayuwattanakul I, Pacharapakornpong T, Vallipakorn SAO, Lerkvaleekul B, Vilaiyuk S, Muratore V, Giancane G, Lanni S, Alongi A, Alpigiani MG, Martini A, Ravelli A, Consolaro A, Alongi A, Bovis F, Minoia F, Davì S, Martini A, Ruperto N, Cron RQ, Ravelli A, Passarelli C, Pardeo M, Pisaneschi E, Novelli A, De Benedetti F, Bracaglia C, Bracaglia C, Marafon DP, Caiello I, de Graaf K, Guilhot F, Ferlin W, Davi’ S, Schulert G, Ravelli A, Grom AA, Nelson R, de Min C, De Benedetti F, Holzinger D, Kessel C, Fall N, Grom A, de Jager W, Vastert S, Strippoli R, Bracaglia C, Sundberg E, Horne A, Ehl S, Ammann S, Lehmberg K, De Benedetti F, Beutel K, Foell D, Minoia F, Horne A, Bovis F, Davì S, Pagani L, Espada G, Gao YJ, Insalaco A, Lehmberg K, Sanner H, Shenoi S, Weitzman S, Ruperto N, Martini A, Cron RQ, Ravelli A, Prencipe G, Caiello I, Pascarella A, Bracaglia C, Ferlin WG, Chatel L, Strippoli R, de Min C, De Benedetti F, Jacqmin P, De Graaf K, Ballabio M, Nelson R, Johnson Z, Ferlin W, Lapeyre G, de Benedetti F, Cristina DM, Wakiguchi H, Hasegawa S, Hirano R, Okazaki F, Nakamura T, Kaneyasu H, Ohga S, Yamazaki K, Nozawa T, Kanetaka T, Ito S, Yokota S, McLellan K, MacGregor I, Martin N, Davidson J, Kuemmerle-Deschner J, Hansmann S, Wulffraat N, Eikelberg A, Haug I, Schuller S, Benseler SM, Nazarova LS, Danilko KV, Malievsky VA, Viktorova TV, Mauro A, Omoyinmi E, Barnicoat A, Brogan P, Foley C, Killeen O, MacDermott E, Veale D, Foley C, Killeen O, MacDermott E, Veale D, Gomes SM, Omoyinmi E, Hurst J, Canham N, Eleftheriou D, Klein N, Lacassagne S, Brogan P, Wiener A, Hügle B, Denecke B, Costa-Filho I, Haas JP, Tenbrock K, Popp D, Boltjes A, Rühle F, Herresthal S, de Jager W, van Wijk F, Schultze J, Stoll M, Klotz L, Vogl T, Roth J, Quesada-Masachs E, de la Sierra DÁ, Prat MG, Sánchez AMM, Borrell RP, Barril SM, Gallo MM, Caballero CM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Giner T, Hackl L, Albrecht J, Würzner R, Brunner J, Pastore S, Minute M, Parentin F, Tesser A, Nocerino A, Taddio A, Tommasini A, Nørgaard M, Herlin T, Alberdi-Saugstrup M, Zak MS, Nielsen SM, Herlin T, Nordal E, Berntson L, Fasth A, Rygg M, Müller KG, Avramovič MZ, Dolžan V, Toplak N, Avčin T, Ruperto N, Lovell DJ, Wallace C, Toth M. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part two. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461533 DOI: 10.1186/s12969-017-0142-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Cabral DA, Canter DL, Muscal E, Nanda K, Wahezi DM, Spalding SJ, Twilt M, Benseler SM, Campillo S, Charuvanij S, Dancey P, Eberhard BA, Elder ME, Hersh A, Higgins GC, Huber AM, Khubchandani R, Kim S, Klein-Gitelman M, Kostik MM, Lawson EF, Lee T, Lubieniecka JM, McCurdy D, Moorthy LN, Morishita KA, Nielsen SM, O'Neil KM, Reiff A, Ristic G, Robinson AB, Sarmiento A, Shenoi S, Toth MB, Van Mater HA, Wagner-Weiner L, Weiss JE, White AJ, Yeung RSM. Comparing Presenting Clinical Features in 48 Children With Microscopic Polyangiitis to 183 Children Who Have Granulomatosis With Polyangiitis (Wegener's): An ARChiVe Cohort Study. Arthritis Rheumatol 2016; 68:2514-26. [DOI: 10.1002/art.39729] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 04/19/2016] [Indexed: 11/05/2022]
Affiliation(s)
- David A. Cabral
- British Columbia Children's Hospital, Vancouver; British Columbia Canada
| | | | | | | | | | | | - Marinka Twilt
- Alberta Children's Hospital and University of Calgary; Calgary Alberta Canada
| | - Susanne M. Benseler
- Alberta Children's Hospital and University of Calgary; Calgary Alberta Canada
| | - Sarah Campillo
- Montreal Children's Hospital and McGill University Health Centre; Montreal Quebec Canada
| | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre; St. John's Newfoundland Canada
| | | | | | | | | | - Adam M. Huber
- IWK Health Centre and Dalhousie University; Halifax Nova Scotia
| | | | - Susan Kim
- Children's Hospital of Boston; Boston Massachusetts
| | | | - Mikhail M. Kostik
- St. Petersburg State Pediatric Medical University; St. Petersburg Russia
| | | | - Tzielan Lee
- Stanford Children's Health and Stanford University School of Medicine; Stanford California
| | | | | | | | | | | | | | - Andreas Reiff
- Children's Hospital Los Angeles; Los Angeles California
| | - Goran Ristic
- Mother and Child Health Care Institute of Serbia; Belgrade Serbia
| | - Angela B. Robinson
- University Hospitals Case Medical Center and Rainbow Babies and Children's Hospital; Cleveland Ohio
| | - Angelyne Sarmiento
- British Columbia Children's Hospital, Vancouver; British Columbia Canada
| | | | | | - Heather A. Van Mater
- Duke Children's Hospital and Health Center and Duke University Medical Center; Durham North Carolina
| | | | - Jennifer E. Weiss
- Joseph M. Sanzari Children's Hospital and Hackensack University Medical Center; Hackensack New Jersey
| | - Andrew J. White
- St. Louis Children's Hospital and Washington University School of Medicine; St. Louis Missouri
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Ravelli A, Minoia F, Davì S, Horne A, Bovis F, Pistorio A, Aricò M, Avcin T, Behrens EM, De Benedetti F, Filipovic L, Grom AA, Henter JI, Ilowite NT, Jordan MB, Khubchandani R, Kitoh T, Lehmberg K, Lovell DJ, Miettunen P, Nichols KE, Ozen S, Pachlopnik Schmid J, Ramanan AV, Russo R, Schneider R, Sterba G, Uziel Y, Wallace C, Wouters C, Wulffraat N, Demirkaya E, Brunner HI, Martini A, Ruperto N, Cron RQ. 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Ann Rheum Dis 2016; 75:481-9. [PMID: 26865703 DOI: 10.1136/annrheumdis-2015-208982] [Citation(s) in RCA: 250] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
To develop criteria for the classification of macrophage activation syndrome (MAS) in patients with systemic juvenile idiopathic arthritis (JIA). A multistep process, based on a combination of expert consensus and analysis of real patient data, was conducted. A panel of 28 experts was first asked to classify 428 patient profiles as having or not having MAS, based on clinical and laboratory features at the time of disease onset. The 428 profiles comprised 161 patients with systemic JIA-associated MAS and 267 patients with a condition that could potentially be confused with MAS (active systemic JIA without evidence of MAS, or systemic infection). Next, the ability of candidate criteria to classify individual patients as having MAS or not having MAS was assessed by evaluating the agreement between the classification yielded using the criteria and the consensus classification of the experts. The final criteria were selected in a consensus conference. Experts achieved consensus on the classification of 391 of the 428 patient profiles (91.4%). A total of 982 candidate criteria were tested statistically. The 37 best-performing criteria and 8 criteria obtained from the literature were evaluated at the consensus conference. During the conference, 82% consensus among experts was reached on the final MAS classification criteria. In validation analyses, these criteria had a sensitivity of 0.73 and a specificity of 0.99. Agreement between the classification (MAS or not MAS) obtained using the criteria and the original diagnosis made by the treating physician was high (κ=0.76). We have developed a set of classification criteria for MAS complicating systemic JIA and provided preliminary evidence of its validity. Use of these criteria will potentially improve understanding of MAS in systemic JIA and enhance efforts to discover effective therapies, by ensuring appropriate patient enrollment in studies.
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Affiliation(s)
- Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - AnnaCarin Horne
- Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
| | | | | | | | - Tadej Avcin
- University Children's Hospital, Ljubljana, Slovenia
| | - Edward M Behrens
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Lisa Filipovic
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alexei A Grom
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jan-Inge Henter
- Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Norman T Ilowite
- Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York, USA
| | - Michael B Jordan
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | | | | | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Kim E Nichols
- St Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | | | | | - Ricardo Russo
- Hospital de Pediatria Juan P. Garrahan, Buenos Aires, Argentina
| | - Rayfel Schneider
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gary Sterba
- Mount Sinai Medical Center, Miami Beach, Florida, USA
| | | | - Carol Wallace
- Seattle Children's Hospital and University of Washington, Seattle, USA
| | | | - Nico Wulffraat
- Wilhelmina Children's Hospital and University Medical Center Utrecht, Uthrecht, The Netherlands
| | | | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alberto Martini
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
| | | | - Randy Q Cron
- University of Alabama at Birmingham, Birmingham, UK
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Mina R, Harris JG, Klein-Gitelman MS, Appenzeller S, Centeville M, Eskra D, Huggins JL, Johnson AL, Khubchandani R, Khandekar P, Lee J, Liu HM, Pendl JD, Silva CA, Silva MF, Zaal AI, DeWitt EM, Ardoin SP, Brunner HI. Initial Benchmarking of the Quality of Medical Care in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2016. [PMID: 26219749 DOI: 10.1002/acr.22666] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the quality of medical care in childhood-onset systemic lupus erythematosus (SLE) at tertiary pediatric rheumatology centers as measured by observance of SLE quality indicators (SLE-QIs). METHODS International consensus has been achieved for childhood-onset SLE-QIs capturing medical care provision in 9 domains: diagnostic testing, education of cardiovascular (CV) risk and lifestyles, lupus nephritis (LN), medication management, bone health, ophthalmologic surveillance, transition, pregnancy, and vaccination. Using medical record information, the level of performance of these childhood-onset SLE-QIs was assessed in childhood-onset SLE populations treated at 4 tertiary pediatric rheumatology centers in the US, 2 in Brazil, and 1 center in India. RESULTS A total of 483 childhood-onset SLE patients were assessed. Care for the 310 US patients differed markedly for childhood-onset SLE-QIs addressing LN, bone health, vaccinations, education on CV risk, and transition planning. Performance of safety blood testing for medications was high at all centers. Despite often similar performance on the childhood-onset SLE-QI, access to kidney biopsies was lower in Brazil than in the US. Irrespective of the country of practice, larger centers tended to meet the childhood-onset SLE-QIs more often than smaller centers. CONCLUSION The childhood-onset SLE-QIs, evidence-based minimum standards of medical care, are not consistently met in the US or some other countries outside the US. This has the potential to contribute to suboptimal childhood-onset SLE outcomes.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Julia G Harris
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | | | | | | | - Diane Eskra
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Anne L Johnson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Jiha Lee
- University of Cincinnati, Cincinnati, Ohio
| | - Hai Mei Liu
- Children's Hospital of Fudan University, Shanghai, China
| | - Joshua D Pendl
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Ahmad I Zaal
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Stacy P Ardoin
- Nationwide Children's Hospital and Ohio State University, Columbus, Ohio
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Ravelli A, Minoia F, Davì S, Horne A, Bovis F, Pistorio A, Aricò M, Avcin T, Behrens EM, De Benedetti F, Filipovic L, Grom AA, Henter JI, Ilowite NT, Jordan MB, Khubchandani R, Kitoh T, Lehmberg K, Lovell DJ, Miettunen P, Nichols KE, Ozen S, Pachlopnik Schmid J, Ramanan AV, Russo R, Schneider R, Sterba G, Uziel Y, Wallace C, Wouters C, Wulffraat N, Demirkaya E, Brunner HI, Martini A, Ruperto N, Cron RQ. 2016 Classification Criteria for Macrophage Activation Syndrome Complicating Systemic Juvenile Idiopathic Arthritis: A European League Against Rheumatism/American College of Rheumatology/Paediatric Rheumatology International Trials Organisation Collaborative Initiative. Arthritis Rheumatol 2016; 68:566-76. [PMID: 26314788 DOI: 10.1002/art.39332] [Citation(s) in RCA: 283] [Impact Index Per Article: 35.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 11/30/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To develop criteria for the classification of macrophage activation syndrome (MAS) in patients with systemic juvenile idiopathic arthritis (JIA). METHODS A multistep process, based on a combination of expert consensus and analysis of real patient data, was conducted. A panel of 28 experts was first asked to classify 428 patient profiles as having or not having MAS, based on clinical and laboratory features at the time of disease onset. The 428 profiles comprised 161 patients with systemic JIA-associated MAS and 267 patients with a condition that could potentially be confused with MAS (active systemic JIA without evidence of MAS, or systemic infection). Next, the ability of candidate criteria to classify individual patients as having MAS or not having MAS was assessed by evaluating the agreement between the classification yielded using the criteria and the consensus classification of the experts. The final criteria were selected in a consensus conference. RESULTS Experts achieved consensus on the classification of 391 of the 428 patient profiles (91.4%). A total of 982 candidate criteria were tested statistically. The 37 best-performing criteria and 8 criteria obtained from the literature were evaluated at the consensus conference. During the conference, 82% consensus among experts was reached on the final MAS classification criteria. In validation analyses, these criteria had a sensitivity of 0.73 and a specificity of 0.99. Agreement between the classification (MAS or not MAS) obtained using the criteria and the original diagnosis made by the treating physician was high (κ = 0.76). CONCLUSION We have developed a set of classification criteria for MAS complicating systemic JIA and provided preliminary evidence of its validity. Use of these criteria will potentially improve understanding of MAS in systemic JIA and enhance efforts to discover effective therapies, by ensuring appropriate patient enrollment in studies.
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Affiliation(s)
- Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - AnnaCarin Horne
- Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
| | | | | | | | - Tadej Avcin
- University Children's Hospital, Ljubljana, Slovenia
| | - Edward M Behrens
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Lisa Filipovic
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Alexei A Grom
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jan-Inge Henter
- Karolinska Institute and Karolinska University Hospital Solna, Stockholm, Sweden
| | - Norman T Ilowite
- Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York
| | | | | | | | | | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Kim E Nichols
- St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Seza Ozen
- Hacettepe University, Ankara, Turkey
| | | | | | - Ricardo Russo
- Hospital de Pediatria Juan P. Garrahan, Buenos Aires, Argentina
| | - Rayfel Schneider
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Gary Sterba
- Mount Sinai Medical Center, Miami Beach, Florida
| | | | - Carol Wallace
- Seattle Children's Hospital and University of Washington, Seattle
| | | | - Nico Wulffraat
- Wilhelmina Children's Hospital and University Medical Center Utrecht, Uthrecht, The Netherlands
| | | | | | - Alberto Martini
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
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Ravelli A, Minoia F, Davì S, Horne A, Bovis F, Pistorio A, Aricò M, Avcin T, Behrens EM, De Benedetti F, Filipovic A, Grom AA, Henter JI, Ilowite NT, Jordan MB, Khubchandani R, Kitoh T, Lehmberg K, Lovell DJ, Miettunen P, Nichols KE, Ozen S, Pachlopnik Schmid J, Ramanan AV, Russo R, Schneider R, Sterba G, Uziel Y, Wallace C, Wouters C, Wulffraat N, Demirkaya E, Brunner HI, Martini A, Ruperto N, Cron RQ. Expert consensus on dynamics of laboratory tests for diagnosis of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis. RMD Open 2016; 2:e000161. [PMID: 26848401 PMCID: PMC4731834 DOI: 10.1136/rmdopen-2015-000161] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 09/08/2015] [Accepted: 09/12/2015] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To identify which laboratory tests that change over time are most valuable for the timely diagnosis of macrophage activation syndrome (MAS) complicating systemic juvenile idiopathic arthritis (sJIA). METHODS A multistep process, based on a combination of expert consensus and analysis of real patient data, was conducted. A panel of experts was first asked to evaluate 115 profiles of patients with MAS, which included the values of laboratory tests at the pre-MAS visit and at MAS onset, and the change in values between the two time points. The experts were asked to choose the 5 laboratory tests in which change was most important for the diagnosis of MAS and to rank the 5 selected tests in order of importance. The relevance of change in laboratory parameters was further discussed and ranked by the same experts at a consensus conference. RESULTS Platelet count was the most frequently selected test, followed by ferritin level, aspartate aminotransferase (AST), white cell count, neutrophil count, and fibrinogen and erythrocyte sedimentation rate. Ferritin was most frequently assigned the highest score. At the end of the process, platelet count, ferritin level and AST were the laboratory tests in which the experts found change over time to be most important. CONCLUSIONS We identified the laboratory tests in which change over time is most valuable for the early diagnosis of MAS in sJIA. The dynamics of laboratory values during the course of MAS should be further scrutinised in a prospective study in order to establish the optimal cut-off values for their variation.
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Affiliation(s)
- Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy; Istituto Giannina Gaslini, Genoa, Italy
| | | | | | - AnnaCarin Horne
- Karolinska Institute , Karolinska University Hospital Solna , Stockholm , Sweden
| | | | | | | | - Tadej Avcin
- University Children's Hospital , Ljubljana , Slovenia
| | - Edward M Behrens
- The Children's Hospital of Philadelphia , Philadelphia, Pennsylvania , USA
| | | | | | - Alexei A Grom
- Albert Einstein College of Medicine and Children's Hospital at Montefiore , Bronx, New York , USA
| | - Jan-Inge Henter
- Karolinska Institute , Karolinska University Hospital Solna , Stockholm , Sweden
| | - Norman T Ilowite
- Albert Einstein College of Medicine and Children's Hospital at Montefiore , Bronx, New York , USA
| | - Michael B Jordan
- Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio , USA
| | | | | | | | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio , USA
| | | | - Kim E Nichols
- St Jude Children's Research Hospital , Memphis, Tennessee , USA
| | - Seza Ozen
- Hacettepe University , Ankara , Turkey
| | | | | | - Ricardo Russo
- Hospital de Pediatria Juan P Garrahan , Buenos Aires , Argentina
| | - Rayfel Schneider
- University of Toronto and Hospital for Sick Children , Toronto, Ontario , Canada
| | - Gary Sterba
- Mount Sinai Medical Center , Miami Beach, Florida , USA
| | | | - Carol Wallace
- Seattle Children's Hospital and University of Washington , Seattle, Washington , USA
| | | | - Nico Wulffraat
- Wilhelmina Children's Hospital and University Medical Center Utrecht , Utrecht , The Netherlands
| | | | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center , Cincinnati, Ohio , USA
| | - Alberto Martini
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy; Istituto Giannina Gaslini, Genoa, Italy
| | | | - Randy Q Cron
- University of Alabama at Birmingham , Birmingham, Alabama , USA
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Cattalini M, Khubchandani R, Cimaz R. When flexibility is not necessarily a virtue: a review of hypermobility syndromes and chronic or recurrent musculoskeletal pain in children. Pediatr Rheumatol Online J 2015; 13:40. [PMID: 26444669 PMCID: PMC4596461 DOI: 10.1186/s12969-015-0039-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/01/2015] [Indexed: 01/09/2023] Open
Abstract
Chronic or recurrent musculoskeletal pain is a common complaint in children. Among the most common causes for this problem are different conditions associated with hypermobility. Pediatricians and allied professionals should be well aware of the characteristics of the different syndromes associated with hypermobility and facilitate early recognition and appropriate management. In this review we provide information on Benign Joint Hypermobility Syndrome, Ehlers-Danlos Syndrome, Marfan Syndrome, Loeys-Dietz syndrome and Stickler syndrome, and discuss their characteristics and clinical management.
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Affiliation(s)
- Marco Cattalini
- Pediatric Clinic, University of Brescia and Spedali Civili di Brescia, Brescia, Italy.
| | - Raju Khubchandani
- Pediatric Rheumatology Clinic, Department of Paediatrics, Jaslok Hospital and Research Centre, Mumbai, India.
| | - Rolando Cimaz
- Anna Meyer Children's Hospital and University of Florence, Florence, Italy.
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Horne A, Minoia F, Davì S, Bovis F, Rosina S, Lehmberg K, Weitzman S, Insalaco A, Wouters C, Shenoi S, Espada G, Ozen S, Anton J, Khubchandani R, Russo R, Ruperto N, Martini A, Cron R, Ravelli A. SAT0486 Macrophage Activation Syndrome and Familial Hemophagocytic Lymphohistiocytosis: Is Their Clinical Phenotype Really Similar? Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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41
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Minoia F, Davì S, Horne A, Demirkaya E, Bovis F, Li C, Lehmberg K, Weitzman S, Insalaco A, Wouters C, Shenoi S, Espada G, Ozen S, Anton J, Khubchandani R, Russo R, Pal P, Kasapcopur O, Miettunen P, Maritsi D, Merino R, Shakoory B, Alessio M, Chasnyk V, Sanner H, Gao YJ, Huasong Z, Kitoh T, Avcin T, Fischbach M, Frosch M, Grom A, Huber A, Jelusic M, Sawhney S, Uziel Y, Ruperto N, Martini A, Cron RQ, Ravelli A. Clinical features, treatment, and outcome of macrophage activation syndrome complicating systemic juvenile idiopathic arthritis: a multinational, multicenter study of 362 patients. Arthritis Rheumatol 2015; 66:3160-9. [PMID: 25077692 DOI: 10.1002/art.38802] [Citation(s) in RCA: 261] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 07/24/2014] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe the clinical, laboratory, and histopathologic features, current treatment, and outcome of patients with macrophage activation syndrome (MAS) complicating systemic juvenile idiopathic arthritis (JIA). METHODS In this multinational, multicenter study, pediatric rheumatologists and hemato-oncologists entered patient data collected retrospectively into a web-based database. RESULTS A total of 362 patients, 22% of whom had MAS at the onset of systemic JIA, were included in the study by 95 investigators from 33 countries. The most frequent clinical manifestations were fever (96%), hepatomegaly (70%), and splenomegaly (58%). Central nervous system dysfunction and hemorrhages were recorded in 35% and 20% of the patients, respectively. Platelet count and liver transaminase, ferritin, lactate dehydrogenase, triglyceride, and d-dimer levels were the sole laboratory biomarkers showing a percentage change of >50% between the pre-MAS visit and MAS onset. Evidence of macrophage hemophagocytosis was found in 60% of the patients who underwent bone marrow aspiration. MAS occurred most frequently in the setting of active underlying disease, in the absence of a specific trigger. Nearly all patients were given corticosteroids, and 61% received cyclosporine. Biologic medications and etoposide were given to 15% and 12% of the patients, respectively. Approximately one-third of the patients required admission to the intensive care unit (ICU), and the mortality rate was 8%. CONCLUSION This study provides information on the clinical spectrum and current management of systemic JIA-associated MAS through the analysis of a very large patient sample. MAS remains a serious condition, as a sizeable proportion of patients required admission to the ICU or died.
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Rose CD, Pans S, Casteels I, Anton J, Bader-Meunier B, Brissaud P, Cimaz R, Espada G, Fernandez-Martin J, Hachulla E, Harjacek M, Khubchandani R, Mackensen F, Merino R, Naranjo A, Oliveira-Knupp S, Pajot C, Russo R, Thomee C, Vastert S, Wulffraat N, Arostegui JI, Foley KP, Bertin J, Wouters CH. Blau syndrome: cross-sectional data from a multicentre study of clinical, radiological and functional outcomes. Rheumatology (Oxford) 2014; 54:1008-16. [DOI: 10.1093/rheumatology/keu437] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Indexed: 11/12/2022] Open
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Palaniappan P, Lionel AP, Agarwal I, Mathai S, Mathew L, Agarwal S, Keni P, Khubchandani R, Kumar S. Cryosupernatant and Immunosuppression as Effective Alternative Therapies for TTP in Three Pediatric SLE Patients. Indian J Hematol Blood Transfus 2014; 30:232-6. [PMID: 25332586 DOI: 10.1007/s12288-014-0338-8] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 01/15/2014] [Indexed: 11/25/2022] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) very rarely present simultaneously and pose a diagnostic and therapeutic dilemma to the physician. Prompt diagnosis and management with plasma exchange and immunosuppression is life-saving. To describe the effectiveness of cryosupernatant and steroids in pediatric SLE with TTP. We describe three children aged 12-14 years with SLE who were diagnosed with TTP based on fever, CNS manifestations, ANA, anti-dsDNA, anti-sm positivity, hypocomplementemia, and microangiopathic anemia with thrombocytopenia. All three children were managed with cryosupernatant and steroids without plasmapheresis. All children improved with cryosupernatant and steroids. All attained remission within 10 days. They were doing well at last follow up without relapse or flare. Cryosupernatant and steroids may be an effective therapy for Thrombotic thrombocytopenic purpura with systemic lupus erythematosus.
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Affiliation(s)
| | | | - Indira Agarwal
- Department of Paediatrics, Christian Medical College, Vellore, 632004 India
| | - Sarah Mathai
- Department of Paediatrics, Christian Medical College, Vellore, 632004 India
| | - Leni Mathew
- Department of Paediatrics, Christian Medical College, Vellore, 632004 India
| | - Sanwar Agarwal
- Jaslok Hospital & Research Centre, 15 - Dr. Deshmukh Marg, Pedder Road, Mumbai, 400 026 India
| | - Purva Keni
- Jaslok Hospital & Research Centre, 15 - Dr. Deshmukh Marg, Pedder Road, Mumbai, 400 026 India
| | - Raju Khubchandani
- Jaslok Hospital & Research Centre, 15 - Dr. Deshmukh Marg, Pedder Road, Mumbai, 400 026 India
| | - Sathish Kumar
- Department of Paediatrics, Christian Medical College, Vellore, 632004 India
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Khubchandani R, Dhanrajani AD, Parikh DA. PReS-FINAL-2305: Erythema multiforme in a child with lupus - what's in a name? Pediatr Rheumatol Online J 2013. [PMCID: PMC4045823 DOI: 10.1186/1546-0096-11-s2-p295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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45
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Rose CD, Cimaz R, Thomee C, Khubchandani R, Espada G, Russo R, Harjacek M, Bader-Meunier B, Brissaud P, Wulffraat N, Vastert S, Merino R, Naranjo-Hernandez A, Oliveira-Knupp S, Mackensen F, Arostegui J, Anton J, Fernandez-Martin J, Wouters C. PW03-016 – Blau prospective cohort study: articular outcomes. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952171 DOI: 10.1186/1546-0096-11-s1-a242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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46
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Rose CD, Cimaz R, Thomee C, Khubchandani R, Espada G, Russo R, Harjacek M, Bader-Meunier B, Brissaud P, Wulffraat N, Vastert S, Merino R, Naranjo-Hernandez A, Knupp SO, Mackenson F, Arostegui J, Lopez JA, Fernandez-Martin J, Wouters C. OR3-002 – Blau Syndrome cohort study: ocular outcome. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953341 DOI: 10.1186/1546-0096-11-s1-a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Demirkaya E, Turker T, Ruperto N, Cuttica R, Brogan P, Quartier P, Anton J, Ayaz N, Garay S, Espada G, Khubchandani R, Zulian F, Bagga A, Belot A, Silva C, Al-Mayouf S, Estrella A, Oliveira S, Magalhães C, Martini A, Ozen S. THU0210 The comparison of childhood polyarteritis nodosa and cutaneous polyarteritis NODOSA. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2012-eular.2175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hasija R, Pistorio A, Ravelli A, Demirkaya E, Khubchandani R, Guseinova D, Malattia C, Canhao H, Harel L, Foell D, Wouters C, De Cunto C, Huemer C, Kimura Y, Mangge H, Minetti C, Nordal EB, Philippet P, Garozzo R, Martini A, Ruperto N. Therapeutic approaches in the treatment of juvenile dermatomyositis in patients with recent-onset disease and in those experiencing disease flare: an international multicenter PRINTO study. ACTA ACUST UNITED AC 2013; 63:3142-52. [PMID: 21647864 DOI: 10.1002/art.30475] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate response to therapy over a 24-month period in a large prospective international cohort of patients with juvenile dermatomyositis (DM). METHODS The study included 145 patients with recent-onset juvenile DM and 130 juvenile DM patients experiencing disease flare, all of whom were <18 years old. Disease activity parameters and therapeutic approaches in 4 geographic areas were analyzed at baseline and at 6, 12, and 24 months. Response was assessed according to the Pediatric Rheumatology International Trials Organization (PRINTO) juvenile DM response criteria, and data were reported "as observed" and in the intent-to-treat (ITT) population. RESULTS Patients with recent-onset juvenile DM at baseline had higher baseline disease activity and greater improvement over 24 months when compared to juvenile DM patients experiencing disease flare at baseline. Methotrexate (MTX) or high-dose corticosteroids were administered more frequently to patients with recent-onset juvenile DM, compared to juvenile DM patients experiencing disease flare, who were more likely to receive cyclosporine. Compared to patients from Western and Eastern Europe, a higher proportion of patients from South and Central America and North America received pulse steroids, and the average steroid dosage was higher in the North American and South and Central American patients. The use of MTX was similar in all 4 regions, while cyclosporin A was more frequently used in Western Europe. In the "as observed" analysis, 57.9% of the patients with recent-onset juvenile DM and 36.4% of the patients experiencing disease flare (P<0.001) reached at least a 70% response by PRINTO criteria at 6 months; these proportions had increased at month 24 to 78.4% and 51.2%, respectively (P<0.001). Corresponding results of the ITT analysis were much lower, with only one-third of the patients able to maintain the initial assigned therapy over 24 months. CONCLUSION Patients with recent-onset juvenile DM are more likely to achieve significant clinical improvement over 24 months, when compared to patients experiencing flares of juvenile DM. Internationally, various therapeutic approaches are used to treat this disease.
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Ruperto N, Ozen S, Pistorio A, Dolezalova P, Brogan P, Cabral DA, Cuttica R, Khubchandani R, Lovell DJ, O'Neil KM, Quartier P, Ravelli A, Iusan SM, Filocamo G, Magalhaes CS, Unsal E, Oliveira S, Bracaglia C, Bagga A, Stanevicha V, Manzoni SM, Pratsidou P, Lepore L, Espada G, Paut IK, Zulian F, Barone P, Bircan Z, Maldonado MDR, Russo R, Vilca I, Tullus K, Cimaz R, Horneff G, Anton J, Garay S, Nielsen S, Barbano G, Martini A. EULAR/PRINTO/PRES criteria for Henoch-Schonlein purpura, childhood polyarteritis nodosa, childhood Wegener granulomatosis and childhood Takayasu arteritis: Ankara 2008. Part I: Overall methodology and clinical characterisation. Ann Rheum Dis 2010; 69:790-7. [DOI: 10.1136/ard.2009.116624] [Citation(s) in RCA: 146] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Foell D, Wulffraat N, Wedderburn LR, Wittkowski H, Frosch M, Gerss J, Stanevicha V, Mihaylova D, Ferriani V, Tsakalidou FK, Foeldvari I, Cuttica R, Gonzalez B, Ravelli A, Khubchandani R, Oliveira S, Armbrust W, Garay S, Vojinovic J, Norambuena X, Gamir ML, García-Consuegra J, Lepore L, Susic G, Corona F, Dolezalova P, Pistorio A, Martini A, Ruperto N, Roth J. Methotrexate withdrawal at 6 vs 12 months in juvenile idiopathic arthritis in remission: a randomized clinical trial. JAMA 2010; 303:1266-73. [PMID: 20371785 DOI: 10.1001/jama.2010.375] [Citation(s) in RCA: 188] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Novel therapies have improved the remission rate in chronic inflammatory disorders including juvenile idiopathic arthritis (JIA). Therefore, strategies of tapering therapy and reliable parameters for detecting subclinical inflammation have now become challenging questions. OBJECTIVES To analyze whether longer methotrexate treatment during remission of JIA prevents flares after withdrawal of medication and whether specific biomarkers identify patients at risk for flares. DESIGN, SETTING, AND PATIENTS Prospective, open, multicenter, medication-withdrawal randomized clinical trial including 364 patients (median age, 11.0 years) with JIA recruited in 61 centers from 29 countries between February 2005 and June 2006. Patients were included at first confirmation of clinical remission while continuing medication. At the time of therapy withdrawal, levels of the phagocyte activation marker myeloid-related proteins 8 and 14 heterocomplex (MRP8/14) were determined. INTERVENTION Patients were randomly assigned to continue with methotrexate therapy for either 6 months (group 1 [n = 183]) or 12 months (group 2 [n = 181]) after induction of disease remission. MAIN OUTCOME MEASURES Primary outcome was relapse rate in the 2 treatment groups; secondary outcome was time to relapse. In a prespecified cohort analysis, the prognostic accuracy of MRP8/14 concentrations for the risk of flares was assessed. RESULTS Intention-to-treat analysis of the primary outcome revealed relapse within 24 months after the inclusion into the study in 98 of 183 patients (relapse rate, 56.7%) in group 1 and 94 of 181 (55.6%) in group 2. The odds ratio for group 1 vs group 2 was 1.02 (95% CI, 0.82-1.27; P = .86). The median relapse-free interval after inclusion was 21.0 months in group 1 and 23.0 months in group 2. The hazard ratio for group 1 vs group 2 was 1.07 (95% CI, 0.82-1.41; P = .61). Median follow-up duration after inclusion was 34.2 and 34.3 months in groups 1 and 2, respectively. Levels of MRP8/14 during remission were significantly higher in patients who subsequently developed flares (median, 715 [IQR, 320-1 110] ng/mL) compared with patients maintaining stable remission (400 [IQR, 220-800] ng/mL; P = .003). Low MRP8/14 levels indicated a low risk of flares within the next 3 months following the biomarker test (area under the receiver operating characteristic curve, 0.76; 95% CI, 0.62-0.90). CONCLUSIONS In patients with JIA in remission, a 12-month vs 6-month withdrawal of methotrexate did not reduce the relapse rate. Higher MRP8/14 concentrations were associated with risk of relapse after discontinuing methotrexate. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN18186313.
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Affiliation(s)
- Dirk Foell
- Department of Pediatrics, University of Muenster, Albert-Schweitzer-Strasse 33, D-48149 Muenster, Germany.
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