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Woo P, Petty RE. Eric Bywaters and Barbara Ansell: Founders of Modern Pediatric Rheumatology. Rheum Dis Clin North Am 2024; 50:93-101. [PMID: 37973291 DOI: 10.1016/j.rdc.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Eric Bywaters and Barbara Ansell were, without doubt, two of the giants in the field of Rheumatology. With their keen clinical observations and their visionary development of a dedicated multidisciplinary program focusing on diagnosis, treatment, and research, they are remembered as the founders of the modern specialty of Pediatric Rheumatology.
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Affiliation(s)
- Patricia Woo
- Rheumatology, University College Hospital, London, UK
| | - Ross E Petty
- Division of Rheumatology, British Columbia's Children's Hospital, 4480 Oak Street, Vancouver British Columbia, Canada.
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2
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Nguyen K, Barsalou J, Basodan D, Batthish M, Benseler SM, Berard RA, Blanchette N, Boire G, Bolaria R, Bruns A, Cabral DA, Cameron B, Campillo S, Cellucci T, Chan M, Chédeville G, Chetaille AL, Chhabra A, Couture J, Dancey P, De Bruycker JJ, Demirkaya E, Dhalla M, Duffy CM, Feldman BM, Feldman DE, Gerschman T, Haddad E, Heale L, Herrington J, Houghton K, Huber AM, Human A, Johnson N, Jurencak R, Lang B, Larché M, Laxer RM, LeBlanc CM, Lee JJY, Levy DM, Lim L, Lim LSH, Luca N, McGrath T, McMillan T, Miettunen PM, Morishita KA, Ng HY, Oen K, Park J, Petty RE, Proulx-Gauthier JP, Ramsey S, Roth J, Rosenberg AM, Rozenblyum E, Rumsey DG, Schmeling H, Schneider R, Scuccimarri R, Shiff NJ, Silverman E, Soon G, Spiegel L, Stringer E, Tam H, Tse SM, Tucker L, Turvey S, Twilt M, Duffy KW, Yeung RSM, Guzman J. A decade of progress in juvenile idiopathic athritis treatments and outcomes in Canada: results from ReACCh-Out and the CAPRI registry. Rheumatology (Oxford) 2023:kead560. [PMID: 37851400 DOI: 10.1093/rheumatology/kead560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To assess changes in juvenile idiopathic arthritis (JIA) treatments and outcomes in Canada, comparing a 2005-2010 and a 2017-2021 inception cohorts. METHODS Patients enrolled within three months of diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) and the Canadian Alliance of Pediatric Rheumatology Investigators Registry (CAPRI) cohorts were included. Cumulative incidences of drug starts and outcome attainment within 70 weeks of diagnosis were compared with Kaplan Meier survival analysis and multivariable Cox regression. RESULTS The 2005-2010 and 2017-2021 cohorts included 1128 and 721 patients, respectively. JIA category distribution and baseline clinical juvenile idiopathic arthritis disease activity (cJADAS10) scores at enrolment were comparable. By 70 weeks, 6% of patients (95% CI 5, 7) in the 2005-2010 and 26% (23, 30) in the 2017-2021 cohort had started a biologic DMARD (bDMARD), and 43% (40, 47) and 60% (56, 64) had started a conventional DMARD (cDMARD), respectively. Outcome attainment was 64% (61, 67) and 83% (80, 86) for Inactive disease (Wallace criteria), 69% (66, 72) and 84% (81, 87) for minimally active disease (cJADAS10 criteria), 57% (54, 61) and 63% (59, 68) for pain control (<1/10), and 52% (47, 56) and 54% (48, 60) for a good health-related quality of life. CONCLUSION Although baseline disease characteristics were comparable in the 2005-2010 and 2017-2021 cohorts, cDMARD and bDMARD use increased with a concurrent increase in minimally active and inactive disease. Improvements in parent and patient reported outcomes were smaller than improvements in disease activity.
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Affiliation(s)
- Kelly Nguyen
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Roxana Bolaria
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David A Cabral
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Mercedes Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Paul Dancey
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | | | | | | | | | | | - Tommy Gerschman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie Haddad
- Université de Montréal, Montréal, Quebec, Canada
| | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | | | - Kristin Houghton
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam M Huber
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Human
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Bianca Lang
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Lillian Lim
- University of Alberta, Edmonton, Alberta, Canada
| | - Lily S H Lim
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nadia Luca
- University of Ottawa, Ottawa, Ontario, Canada
| | - Tara McGrath
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | - Hon Yan Ng
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Ross E Petty
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Dax G Rumsey
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | - Gordon Soon
- Health Sciences North, Sudbury, Ontario, Canada
- North York General Hospital, North York, Toronto, Ontario, Canada
| | | | | | - Herman Tam
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori Tucker
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Turvey
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Jaime Guzman
- University of British Columbia, Vancouver, British Columbia, Canada
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3
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Guzman J, Petty RE. A Moving Target: Lessons from
Long‐Term
Studies in Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2022; 74:716-718. [DOI: 10.1002/acr.24858] [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] [Received: 12/29/2021] [Revised: 11/22/2021] [Accepted: 01/06/2022] [Indexed: 11/08/2022]
Affiliation(s)
- Jaime Guzman
- British Columbia Children’s Hospital and the University of British Columbia Vancouver British Columbia Canada
| | - Ross E. Petty
- British Columbia Children’s Hospital and the University of British Columbia Vancouver British Columbia Canada
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4
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Heale LD, Houghton KM, Rezaei E, Baxter-Jones ADG, Tupper SM, Muhajarine N, Benseler SM, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Ellsworth J, Guzman J, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Spiegel L, Stringer E, Tse SML, Tucker LB, Turvey SE, Yeung RSM, Rosenberg AM. Clinical and psychosocial stress factors are associated with decline in physical activity over time in children with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2021; 19:97. [PMID: 34187498 PMCID: PMC8243495 DOI: 10.1186/s12969-021-00584-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/19/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Physical activity (PA) patterns in children with juvenile idiopathic arthritis (JIA) over time are not well described. The aim of this study was to describe associations of physical activity (PA) with disease activity, function, pain, and psychosocial stress in the 2 years following diagnosis in an inception cohort of children with juvenile idiopathic arthritis (JIA). METHODS In 82 children with newly diagnosed JIA, PA levels, prospectively determined at enrollment, 12 and 24 months using the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A) raw scores, were evaluated in relation to disease activity as reflected by arthritis activity (Juvenile Arthritis Disease Activity Score (JADAS-71)), function, pain, and psychosocial stresses using a linear mixed model approach. Results in the JIA cohort were compared to normative Pediatric Bone Mineral Accrual Study data derived from healthy children using z-scores. RESULTS At enrollment, PA z-score levels of study participants were lower than those in the normative population (median z-score - 0.356; p = 0.005). At enrollment, PA raw scores were negatively associated with the psychosocial domain of the Juvenile Arthritis Quality of Life Questionnaire (r = - 0.251; p = 0.023). There was a significant decline in PAQ-C/A raw scores from baseline (median and IQR: 2.6, 1.4-3.1) to 24 months (median and IQR: 2.1, 1.4-2.7; p = 0.003). The linear mixed-effect model showed that PAQ-C/A raw scores in children with JIA decreased as age, disease duration, and ESR increased. The PAQ-C/A raw scores of the participants was also negatively influenced by an increase in disease activity as measured by the JADAS-71 (p < 0.001). CONCLUSION Canadian children with newly diagnosed JIA have lower PA levels than healthy children. The decline in PA levels over time was associated with disease activity and higher disease-specific psychosocial stress.
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Affiliation(s)
- Liane D. Heale
- grid.422356.40000 0004 0634 5667McMaster Children’s Hospital and McMaster University, Hamilton, Canada
| | - Kristin M. Houghton
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Elham Rezaei
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | | | - Susan M. Tupper
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Nazeem Muhajarine
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Susanne M. Benseler
- grid.413571.50000 0001 0684 7358Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Gilles Boire
- grid.86715.3d0000 0000 9064 6198Centre Intégré Universitaire de Santé et de Services Sociaux de l’Estrie– Centre Hospitalier Universitaire de Santé (CIUSSS de l’Estrie-CHUS) and University of Sherbrooke, Sherbrooke, Canada
| | - David A. Cabral
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Sarah Campillo
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Gaëlle Chédeville
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Anne-Laure Chetaille
- grid.411081.d0000 0000 9471 1794le Centre Hospitalier Universitaire de Quebec, Quebec, Canada
| | - Paul Dancey
- grid.477424.60000 0004 0640 6407Janeway Children’s Health and Rehabilitation Centre and Memorial University, St. John’s, Canada
| | - Ciaran Duffy
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Karen Watanabe Duffy
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Janet Ellsworth
- grid.416656.60000 0004 0633 3703Stollery Children’s Hospital and University of Alberta, Edmonton, Canada
| | - Jaime Guzman
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Adam M. Huber
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Roman Jurencak
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Bianca Lang
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Ronald M. Laxer
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kimberly Morishita
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Kiem G. Oen
- grid.413983.4The Children’s Hospital of Winnipeg and University of Manitoba, Winnipeg, Canada
| | - Ross E. Petty
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Suzanne E. Ramsey
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Johannes Roth
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Rayfel Schneider
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Rosie Scuccimarri
- grid.416084.f0000 0001 0350 814XMontreal Children’s Hospital and McGill University, Montreal, Canada
| | - Lynn Spiegel
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Elizabeth Stringer
- grid.414870.e0000 0001 0351 6983IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Shirley M. L. Tse
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Lori B. Tucker
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Stuart E. Turvey
- grid.414137.40000 0001 0684 7788British Columbia Children’s Hospital and University of British Columbia, 4480 Oak Street, Room K4-120, Vancouver, BC V6H 3V4 Canada
| | - Rae S. M. Yeung
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Alan M. Rosenberg
- grid.25152.310000 0001 2154 235XJim Pattison Children’s Hospital and University of Saskatchewan, Saskatoon, Canada
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5
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Finch SL, Rosenberg AM, Kusalik AJ, Maleki F, Rezaei E, Baxter-Jones A, Benseler S, Boire G, Cabral D, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Stringer E, Tse SML, Tucker LB, Turvey SE, Szafron M, Whiting S, Yeung RS, Vatanparast H. Higher concentrations of vitamin D in Canadian children with juvenile idiopathic arthritis compared to healthy controls are associated with more frequent use of vitamin D supplements and season of birth. Nutr Res 2021; 92:139-149. [PMID: 34311227 DOI: 10.1016/j.nutres.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 05/05/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
A number of studies have demonstrated that patients with autoimmune disease have lower levels of vitamin D prompting speculation that vitamin D might suppress inflammation and immune responses in children with juvenile idiopathic arthritis (JIA). The objective of this study was to compare vitamin D levels in children with JIA at disease onset with healthy children. We hypothesized that children and adolescents with JIA have lower vitamin D levels than healthy children and adolescents. Data from a Canadian cohort of children with new-onset JIA (n= 164, data collection 2007-2012) were compared to Canadian Health Measures Survey (CHMS) data (n=4027, data collection 2007-2011). We compared 25-hydroxy vitamin D (25(OH)D) concentrations with measures of inflammation, vitamin D supplement use, milk intake, and season of birth. Mean 25(OH)D level was significantly higher in patients with JIA (79 ± 3.1 nmol/L) than in healthy controls (68 ± 1.8 nmol/L P <.05). Patients with JIA more often used vitamin D containing supplements (50% vs. 7%; P <.05). The prevalence of 25(OH)D deficiency (<30 nmol/L) was 6% for both groups. Children with JIA with 25(OH)D deficiency or insufficiency (<50 nmol/L) had higher C-reactive protein levels. Children with JIA were more often born in the fall and winter compared to healthy children. In contrast to earlier studies, we found vitamin D levels in Canadian children with JIA were higher compared to healthy children and associated with more frequent use of vitamin D supplements. Among children with JIA, low vitamin D levels were associated with indicators of greater inflammation.
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Affiliation(s)
- Sarah L Finch
- University of Saskatchewan, Saskatoon, Canada; University of Prince Edward Island, Charlottetown, Canada
| | | | | | | | | | | | - Susanne Benseler
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - David Cabral
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | | | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre, St. John's, Canada
| | - Ciaran Duffy
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | | | - Jaime Guzman
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Kristin Houghton
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | | | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Ron M Laxer
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Kimberly Morishita
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Kiem G Oen
- University of Manitoba, Winnipeg, Canada
| | - Ross E Petty
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | - Johannes Roth
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Rayfel Schneider
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | | | | | - Shirley M L Tse
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
| | - Lori B Tucker
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | - Stuart E Turvey
- BC Children's Hospital and The University of British Columbia, Vancouver, Canada
| | | | | | - Rae Sm Yeung
- The University of Toronto and The Hospital for Sick Children, Toronto, Canada
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6
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Chhabra A, Robinson C, Houghton K, Cabral DA, Morishita K, Tucker LB, Petty RE, Larché M, Batthish M, Guzman J. Long-term outcomes and disease course of children with juvenile idiopathic arthritis in the ReACCh-Out cohort: a two-centre experience. Rheumatology (Oxford) 2021; 59:3727-3730. [PMID: 32402087 DOI: 10.1093/rheumatology/keaa118] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/20/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess long-term outcomes of children with JIA diagnosed in the biologic era. METHODS Chart review of patients prospectively enrolled in the Research in Arthritis in Canadian Children Emphasizing Outcomes inception cohort at two Canadian centres. Inactive disease and remission were defined according to Wallace criteria. RESULTS We included 247 of 254 (97%) eligible patients diagnosed 2005-10. At the last follow-up visit at a median age of 16.9 years, 47% were in remission off medications, 25% in remission on medications and 27% had active disease; 51% were on at least one anti-rheumatic medication (22% on biologics). Patients with systemic JIA had the highest frequency of remission off medications (70%) and patients with RF-positive polyarthritis had the lowest (18%) (P <0.05 by Fisher's exact test). Among 99 patients with oligoarthritis at enrolment, 14 (14%) had an oligoarthritis extended course. Forty-five patients (18%) had at least one erosion or joint space narrowing in X-rays or MRI, and two (0.8%) required joint replacement. CONCLUSION Relative to historical cohorts, this study suggests a reduction in JIA permanent damage, a more favourable prognosis for systemic JIA and a lower progression to oligoarthritis extended category. However, in an era of biologic therapy, one in four patients with JIA still enter adulthood with active disease and one in two still on treatment.
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Affiliation(s)
- Amieleena Chhabra
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - Cal Robinson
- McMaster University, Hamilton, Ontario, Canada.,McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Kristin Houghton
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - David A Cabral
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - Kimberly Morishita
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - Lori B Tucker
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | - Ross E Petty
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
| | | | - Michelle Batthish
- McMaster University, Hamilton, Ontario, Canada.,McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia.,British Columbia Children's Hospital, Vancouver, British Columbia
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7
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Rezaei E, Hogan D, Trost B, Kusalik AJ, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Watanabe Duffy K, Gordon J, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Morishita K, Oen KG, Petty RE, Ramsey SE, Scuccimarri R, Spiegel L, Stringer E, Taylor-Gjevre RM, Tse SML, Tucker LB, Turvey SE, Tupper S, Yeung RSM, Benseler S, Ellsworth J, Guillet C, Karananayake C, Muhajarine N, Roth J, Schneider R, Rosenberg AM. Clinical and associated inflammatory biomarker features predictive of short-term outcomes in non-systemic juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 59:2402-2411. [PMID: 31919503 DOI: 10.1093/rheumatology/kez615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/04/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To identify early predictors of disease activity at 18 months in JIA using clinical and biomarker profiling. METHODS Clinical and biomarker data were collected at JIA diagnosis in a prospective longitudinal inception cohort of 82 children with non-systemic JIA, and their ability to predict an active joint count of 0, a physician global assessment of disease activity of ≤1 cm, and inactive disease by Wallace 2004 criteria 18 months later was assessed. Correlation-based feature selection and ReliefF were used to shortlist predictors and random forest models were trained to predict outcomes. RESULTS From the original 112 features, 13 effectively predicted 18-month outcomes. They included age, number of active/effused joints, wrist, ankle and/or knee involvement, ESR, ANA positivity and plasma levels of five inflammatory biomarkers (IL-10, IL-17, IL-12p70, soluble low-density lipoprotein receptor-related protein 1 and vitamin D), at enrolment. The clinical plus biomarker panel predicted active joint count = 0, physician global assessment ≤ 1, and inactive disease after 18 months with 0.79, 0.80 and 0.83 accuracy and 0.84, 0.83, 0.88 area under the curve, respectively. Using clinical features alone resulted in 0.75, 0.72 and 0.80 accuracy, and area under the curve values of 0.81, 0.78 and 0.83, respectively. CONCLUSION A panel of five plasma biomarkers combined with clinical features at the time of diagnosis more accurately predicted short-term disease activity in JIA than clinical characteristics alone. If validated in external cohorts, such a panel may guide more rationally conceived, biologically based, personalized treatment strategies in early JIA.
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Affiliation(s)
- Elham Rezaei
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
| | - Daniel Hogan
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Brett Trost
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Anthony J Kusalik
- Department of Computer Sciences, University of Saskatchewan, Saskatoon, SKCanada
| | - Gilles Boire
- Département de Médecine, Université de Sherbrooke, Sherbrooke, QCCanada
| | - David A Cabral
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Sarah Campillo
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Gaëlle Chédeville
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Anne-Laure Chetaille
- Département de Médecine le, Centre Hospitalier Universitaire de Quebec, Quebec, QCCanada
| | - Paul Dancey
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St John's, NLCanada
| | - Ciaran Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Karen Watanabe Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - John Gordon
- Department of Medicine, University of Saskatchewan, Saskatoon, SKCanada
| | - Jaime Guzman
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Kristin Houghton
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Adam M Huber
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Roman Jurencak
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Bianca Lang
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Kimberly Morishita
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Kiem G Oen
- Department of Pediatrics, University of Manitoba, Winnipeg, MBCanada
| | - Ross E Petty
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Suzanne E Ramsey
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | - Rosie Scuccimarri
- Department of Pediatrics, McGill University Health Center, Montreal, QCCanada
| | - Lynn Spiegel
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Elizabeth Stringer
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, NSCanada
| | | | - Shirley M L Tse
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Lori B Tucker
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Stuart E Turvey
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver, BCCanada
| | - Susan Tupper
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
| | - Rae S M Yeung
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Susanne Benseler
- Department of Pediatrics, University of Calgary, Calgary, ABCanada
| | - Janet Ellsworth
- Department of Pediatrics, University of Alberta, Edmonton, ABCanada
| | - Chantal Guillet
- Department of Pediatrics, Hôpital Fleurimont (CHUS), Quebec, QCCanada
| | | | - Nazeem Muhajarine
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Johannes Roth
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ONCanada
| | - Rayfel Schneider
- Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, ONCanada
| | - Alan M Rosenberg
- Department of PediatricsUniversity of Saskatchewan, Saskatoon, SK, Canada
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8
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Affiliation(s)
- Ross E Petty
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada.
| | - Qi Zheng
- Department of Rheumatology Immunology and Allergy, Children's Hospital, Zhejiang University School of Medicine, 57# Zhu Gan Road Zhejiang Province, Hangzhou, 310000, China
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9
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Rezaei E, Newkirk MM, Li Z, Gordon JR, Oen KG, Benseler SM, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Houghton K, Huber AM, Jurencak R, Lang B, Morishita KA, Petty RE, Ramsey SE, Roth J, Schneider R, Scuccimarri R, Spiegel L, Stringer E, Tse SML, Tucker LB, Turvey SE, Yeung RSM, Rosenberg AM. Soluble Low-density Lipoprotein Receptor-related Protein 1 in Juvenile Idiopathic Arthritis. J Rheumatol 2020; 48:760-766. [PMID: 33060303 DOI: 10.3899/jrheum.200391] [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] [Accepted: 10/02/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aimed to expand knowledge about soluble low-density lipoprotein receptor-related protein 1 (sLRP1) in juvenile idiopathic arthritis (JIA) by determining associations of sLRP1 levels in nonsystemic JIA patients with clinical and inflammatory biomarker indicators of disease activity. METHODS Plasma sLRP1 and 44 inflammation-related biomarkers were measured at enrollment and 6 months later in a cohort of 96 newly diagnosed Canadian patients with nonsystemic JIA. Relationships between sLRP1 levels and indicators of disease activity and biomarker levels were analyzed at both visits. RESULTS At enrollment, sLRP1 levels correlated negatively with age and active joint counts. Children showed significantly higher levels of sLRP1 than adolescents (mean ranks: 55.4 and 41.9, respectively; P = 0.02). Participants with 4 or fewer active joints, compared to those with 5 or more active joints, had significantly higher sLRP1 levels (mean ranks: 56.2 and 40.7, respectively; P = 0.006). At enrollment, considering the entire cohort, sLRP1 correlated negatively with the number of active joints (r = -0.235, P = 0.017). In the entire cohort, sLRP1 levels at enrollment and 6 months later correlated with 13 and 6 pro- and antiinflammatory biomarkers, respectively. In JIA categories, sLRP1 correlations with inflammatory markers were significant in rheumatoid factor-negative polyarticular JIA, oligoarticular JIA, enthesitis-related arthritis, and psoriatic arthritis at enrollment. Higher sLRP1 levels at enrollment increased the likelihood of absence of active joints 6 months later. CONCLUSION Plasma sLRP1 levels correlate with clinical and biomarker indicators of short-term improvement in JIA disease activity, supporting sLRP1 as an upstream biomarker of potential utility for assessing JIA disease activity and outcome prediction.
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Affiliation(s)
- Elham Rezaei
- E. Rezaei, MD, PhD, A.M. Rosenberg, MD, Departments of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Marianna M Newkirk
- M.M. Newkirk, PhD, Department of Medicine, McGill University Health Center, Montreal, Quebec
| | - Zhenhong Li
- Z. Li, MSc, RC-CHUM, University of Montreal, Montreal, Quebec
| | - John R Gordon
- J.R. Gordon, PhD, Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Kiem G Oen
- K.G. Oen, MD, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba
| | - Susanne M Benseler
- S.M. Benseler, MD, PhD, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta
| | - Gilles Boire
- G. Boire, MD, Département de Médecine, Université de Sherbrooke, Sherbrooke, Quebec
| | - David A Cabral
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Sarah Campillo
- S. Campillo, MD, G. Chédeville, MD, R. Scuccimarri, MD, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Gaëlle Chédeville
- S. Campillo, MD, G. Chédeville, MD, R. Scuccimarri, MD, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Anne-Laure Chetaille
- A.L. Chetaille, MD, Département de Médecine le Centre Hospitalier Universitaire de Quebec, Quebec City, Quebec
| | - Paul Dancey
- P. Dancey, MD, Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland
| | - Ciaran Duffy
- C. Duffy, MD, R. Jurencak, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Karen Watanabe Duffy
- K. Watanabe Duffy, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Kristin Houghton
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Adam M Huber
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Roman Jurencak
- C. Duffy, MD, R. Jurencak, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Bianca Lang
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Kimberly A Morishita
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Ross E Petty
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Suzanne E Ramsey
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Johannes Roth
- J. Roth, MD, Department of Pediatrics, Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario
| | - Rayfel Schneider
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rosie Scuccimarri
- S. Campillo, MD, G. Chédeville, MD, R. Scuccimarri, MD, Department of Pediatrics, McGill University Health Center, Montreal, Quebec
| | - Lynn Spiegel
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elizabeth Stringer
- A.M. Huber, MD, B. Lang, MD, S.E. Ramsey, MD, E. Stringer, MD, Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia
| | - Shirley M L Tse
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lori B Tucker
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Stuart E Turvey
- D.A. Cabral, MD, K. Houghton, MD, K.A. Morishita, MD, R.E. Petty, MD, PhD, L.B. Tucker, MD, S.E. Turvey, MD, Department of Pediatrics, British Columbia Children's Hospital, Vancouver, British Columbia
| | - Rae S M Yeung
- R. Schneider, MD, L. Spiegel, MD, S.M. Tse, MD, R.S. Yeung, MD, PhD, Department of Paediatrics, University of Toronto and the Hospital for Sick Children, Toronto, Ontario, Canada
| | - Alan M Rosenberg
- E. Rezaei, MD, PhD, A.M. Rosenberg, MD, Departments of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan;
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10
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Rezaei E, Hogan D, Trost B, Kusalik AJ, Boire G, Cabral DA, Campillo S, Chédeville G, Chetaille AL, Dancey P, Duffy C, Duffy KW, Eng SWM, Gordon J, Guzman J, Houghton K, Huber AM, Jurencak R, Lang B, Laxer RM, Morishita K, Oen KG, Petty RE, Ramsey SE, Scherer SW, Scuccimarri R, Spiegel L, Stringer E, Taylor-Gjevre RM, Tse SML, Tucker LB, Turvey SE, Tupper S, Wintle RF, Yeung RSM, Rosenberg AM. Associations of clinical and inflammatory biomarker clusters with juvenile idiopathic arthritis categories. Rheumatology (Oxford) 2020; 59:1066-1075. [PMID: 32321162 DOI: 10.1093/rheumatology/kez382] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 07/30/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify discrete clusters comprising clinical features and inflammatory biomarkers in children with JIA and to determine cluster alignment with JIA categories. METHODS A Canadian prospective inception cohort comprising 150 children with JIA was evaluated at baseline (visit 1) and after six months (visit 2). Data included clinical manifestations and inflammation-related biomarkers. Probabilistic principal component analysis identified sets of composite variables, or principal components, from 191 original variables. To discern new clinical-biomarker clusters (clusters), Gaussian mixture models were fit to the data. Newly-defined clusters and JIA categories were compared. Agreement between the two was assessed using Kruskal-Wallis analyses and contingency plots. RESULTS Three principal components recovered 35% (three clusters) and 40% (five clusters) of the variance in patient profiles in visits 1 and 2, respectively. None of the clusters aligned precisely with any of the seven JIA categories but rather spanned multiple categories. Results demonstrated that the newly defined clinical-biomarker lustres are more homogeneous than JIA categories. CONCLUSION Applying unsupervised data mining to clinical and inflammatory biomarker data discerns discrete clusters that intersect multiple JIA categories. Results suggest that certain groups of patients within different JIA categories are more aligned pathobiologically than their separate clinical categorizations suggest. Applying data mining analyses to complex datasets can generate insights into JIA pathogenesis and could contribute to biologically based refinements in JIA classification.
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Affiliation(s)
- Elham Rezaei
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | - Daniel Hogan
- Department of Computer Sciences, University of Saskatchewan
| | - Brett Trost
- Department of Computer Sciences, University of Saskatchewan
| | | | - Gilles Boire
- Département de Médecine, Université de Sherbrooke, Sherbrooke
| | - David A Cabral
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Sarah Campillo
- Department of Pediatrics, McGill University Health Center, Montreal
| | | | | | - Paul Dancey
- Department of Pediatrics, Janeway Children's Health and Rehabilitation Centre, St. John's
| | - Ciaran Duffy
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa
| | | | - Simon W M Eng
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - John Gordon
- Department of Medicine, University of Saskatchewan
| | - Jaime Guzman
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Kristin Houghton
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Adam M Huber
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | - Roman Jurencak
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa
| | - Bianca Lang
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | - Ronald M Laxer
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Kimberly Morishita
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Kiem G Oen
- Department of Pediatrics, University of Manitoba, Winnipeg
| | - Ross E Petty
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Suzanne E Ramsey
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | | | | | - Lynn Spiegel
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Elizabeth Stringer
- Department of Pediatrics, IWK Health Centre and Dalhousie University, Halifax
| | | | - Shirley M L Tse
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Lori B Tucker
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Stuart E Turvey
- Department of Pediatrics, British Columbia Children's Hospital, Vancouver
| | - Susan Tupper
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
| | | | - Rae S M Yeung
- Department of Pediatrics, University of Toronto and the Hospital for Sick Children, Toronto
| | - Alan M Rosenberg
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Canada
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11
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Tucker LB, Lamot L, Niemietz I, Chung BK, Cabral DA, Houghton K, Petty RE, Morishita KA, Rice GI, Turvey SE, Gibson WT, Brown KL. Complexity in unclassified auto-inflammatory disease: a case report illustrating the potential for disease arising from the allelic burden of multiple variants. Pediatr Rheumatol Online J 2019; 17:70. [PMID: 31660995 PMCID: PMC6819641 DOI: 10.1186/s12969-019-0374-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/14/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Despite recent advances in the diagnosis and understanding of many autoinflammatory diseases, there are still a great number of patients with phenotypes that do not fit any clinically- and/or genetically-defined disorders. CASE PRESENTATION We describe a fourteen-year-old boy who presented at two and a half years of age with recurrent febrile episodes. Over the course of the disease, the episodes increased in frequency and severity, with new signs and symptoms continuing to appear. Most importantly, these included skin changes, splenomegaly and transaminitis. Only partial control of the disease was achieved with anti-IL-1 therapy. Extensive investigation showed generalized inflammation without immune deficiency, with increased levels of serum amyloid A and several pro-inflammatory cytokines including interferon-γ, as well as an increased type I interferon score. Exome sequence analysis identified P369S and R408Q variants in the MEFV innate immunity regulator, pyrin (MEFV) gene and T260 M and T320 M variants in the NLR family pyrin domain containing 12 (NLRP12) gene. CONCLUSION Patients with unclassified and/or unexplained autoinflammatory syndromes present diagnostic and therapeutic challenges and collectively form a substantial part of every cohort of patients with autoinflammatory diseases. Therefore, it is important to acquire their full genomic profile through whole exome and/or genome sequencing and present their cases to a broader audience, to facilitate characterization of similar patients. A critical mass of well-characterized cases will lead to improved diagnosis and informed treatment.
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Affiliation(s)
- Lori B. Tucker
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, The University of British Columbia Faculty of Medicine, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 0684 7788grid.414137.4The Division of Rheumatology at British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Lovro Lamot
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, The University of British Columbia Faculty of Medicine, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 0684 7788grid.414137.4The Division of Rheumatology at British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Iwona Niemietz
- 0000 0001 2288 9830grid.17091.3eDepartment of Microbiology and Immunology, The University of British Columbia Faculty of Science, Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,0000 0001 0684 7788grid.414137.4BC Children’s Hospital Research Institute, Rm A4-145, 950 West 28th Ave, Vancouver, BC V5Z 4H4 Canada
| | - Brian K. Chung
- 0000 0001 0684 7788grid.414137.4BC Children’s Hospital Research Institute, Rm A4-145, 950 West 28th Ave, Vancouver, BC V5Z 4H4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Medical Genetics, The University of British Columbia Faculty of Medicine, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada ,0000 0004 0389 8485grid.55325.34Present Address: Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Surgery, Inflammatory Medicine and Transplantation, Oslo University Hospital Rikshospitalet, Postboks 4950, Nydalen, N-0424 Oslo, Norway
| | - David A. Cabral
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, The University of British Columbia Faculty of Medicine, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 0684 7788grid.414137.4The Division of Rheumatology at British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Kristin Houghton
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, The University of British Columbia Faculty of Medicine, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 0684 7788grid.414137.4The Division of Rheumatology at British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Ross E. Petty
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, The University of British Columbia Faculty of Medicine, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 0684 7788grid.414137.4The Division of Rheumatology at British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Kimberly A. Morishita
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, The University of British Columbia Faculty of Medicine, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 0684 7788grid.414137.4The Division of Rheumatology at British Columbia Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada
| | - Gillian I. Rice
- 0000000121662407grid.5379.8Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Oxford Rd, Manchester, M13 9PL UK
| | - Stuart E. Turvey
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, The University of British Columbia Faculty of Medicine, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 0684 7788grid.414137.4BC Children’s Hospital Research Institute, Rm A4-145, 950 West 28th Ave, Vancouver, BC V5Z 4H4 Canada
| | - William T. Gibson
- 0000 0001 0684 7788grid.414137.4BC Children’s Hospital Research Institute, Rm A4-145, 950 West 28th Ave, Vancouver, BC V5Z 4H4 Canada ,0000 0001 2288 9830grid.17091.3eDepartment of Medical Genetics, The University of British Columbia Faculty of Medicine, 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Kelly L. Brown
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics, The University of British Columbia Faculty of Medicine, BC Children’s Hospital, 4480 Oak Street, Vancouver, BC V6H 3V4 Canada ,0000 0001 0684 7788grid.414137.4BC Children’s Hospital Research Institute, Rm A4-145, 950 West 28th Ave, Vancouver, BC V5Z 4H4 Canada
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12
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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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Cellucci T, Guzman J, Petty RE, Batthish M, Benseler SM, Ellsworth JE, Houghton KM, LeBLANC CMA, Huber AM, Luca N, Schmeling H, Shiff NJ, Soon GS, Tse SML. Management of Juvenile Idiopathic Arthritis 2015: A Position Statement from the Pediatric Committee of the Canadian Rheumatology Association. J Rheumatol 2018; 43:1773-1776. [PMID: 27698103 DOI: 10.3899/jrheum.160074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tania Cellucci
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ross E Petty
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada;
| | - Michelle Batthish
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Susanne M Benseler
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Janet E Ellsworth
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kristin M Houghton
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Adam M Huber
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nadia Luca
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Heinrike Schmeling
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Natalie J Shiff
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gordon S Soon
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Shirley M L Tse
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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14
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Guzman J, Kerr T, Ward LM, Ma J, Oen K, Rosenberg AM, Feldman BM, Boire G, Houghton K, Dancey P, Scuccimarri R, Bruns A, Huber AM, Watanabe Duffy K, Shiff NJ, Berard RA, Levy DM, Stringer E, Morishita K, Johnson N, Cabral DA, Larché M, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey SE, Roth J, Campillo S, Benseler S, Chédeville G, Schneider R, Tse SML, Bolaria R, Gross K, Feldman D, Cameron B, Jurencak R, Dorval J, LeBlanc C, St. Cyr C, Gibbon M, Yeung RSM, Duffy CM, Tucker LB. Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Pediatr Rheumatol Online J 2017; 15:68. [PMID: 28830457 PMCID: PMC5567720 DOI: 10.1186/s12969-017-0196-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND With modern treatments, the effect of juvenile idiopathic arthritis (JIA) on growth may be less than previously reported. Our objective was to describe height, weight and body mass index (BMI) development in a contemporary JIA inception cohort. METHODS Canadian children newly-diagnosed with JIA 2005-2010 had weight and height measurements every 6 months for 2 years, then yearly up to 5 years. These measurements were used to calculate mean age- and sex-standardized Z-scores, and estimate prevalence and cumulative incidence of growth impairments, and the impact of disease activity and corticosteroids on growth. RESULTS One thousand one hundred forty seven children were followed for median 35.5 months. Mean Z-scores, and the point prevalence of short stature (height < 2.5th percentile, 2.5% to 3.4%) and obesity (BMI > 95th percentile, 15.8% to 16.4%) remained unchanged in the whole cohort. Thirty-three children (2.9%) developed new-onset short stature, while 27 (2.4%) developed tall stature (>97.5th percentile). Children with systemic arthritis (n = 77) had an estimated 3-year cumulative incidence of 9.3% (95%CI: 4.3-19.7) for new-onset short stature and 34.4% (23-49.4) for obesity. Most children (81.7%) received no systemic corticosteroids, but 1 mg/Kg/day prednisone-equivalent maintained for 6 months corresponded to a drop of 0.64 height Z-scores (0.56-0.82) and an increase of 0.74 BMI Z-scores (0.56-0.92). An increase of 1 in the 10-cm physician global assessment of disease activity maintained for 6 months corresponded to a drop of 0.01 height Z-scores (0-0.02). CONCLUSIONS Most children in this modern JIA cohort grew and gained weight as children in the general population. About 1 in 10 children who had systemic arthritis, uncontrolled disease and/or prolonged corticosteroid use, had increased risk of growth impairment.
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Affiliation(s)
- Jaime Guzman
- From British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada. .,Division of Pediatric Rheumatology, BC Children's Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC, V6H 3N1, Canada.
| | - Tristan Kerr
- 0000 0001 0684 7788grid.414137.4Division of Pediatric Rheumatology, BC Children’s Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC V6H 3N1 Canada
| | - Leanne M. Ward
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Jinhui Ma
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Kiem Oen
- 0000 0004 1936 9609grid.21613.37Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Alan M. Rosenberg
- 0000 0004 0462 8356grid.412271.3Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Brian M. Feldman
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Gilles Boire
- 0000 0001 0081 2808grid.411172.0Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Kristin Houghton
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Paul Dancey
- grid.477424.6Janeway Children’s Health and Rehabilitation Centre and Memorial University, Saint John, ’s Canada
| | - Rosie Scuccimarri
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Alessandra Bruns
- 0000 0001 0081 2808grid.411172.0Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Karen Watanabe Duffy
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Natalie J. Shiff
- 0000 0004 1936 8091grid.15276.37Shands Children’s Hospital and University of Florida, Gainesville, USA
| | - Roberta A. Berard
- 0000 0000 9132 1600grid.412745.1London Health Sciences Centre and Western University, London, Canada
| | - Deborah M. Levy
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | - Kimberly Morishita
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Nicole Johnson
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - David A. Cabral
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Maggie Larché
- 0000 0004 1936 8227grid.25073.33McMaster University, Hamilton, Canada
| | - Ross E. Petty
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Ronald M. Laxer
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Earl Silverman
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paivi Miettunen
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | | | - Elie Haddad
- 0000 0001 2292 3357grid.14848.31Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada
| | - Lynn Spiegel
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stuart E. Turvey
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Heinrike Schmeling
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Janet Ellsworth
- 0000 0004 0633 3703grid.416656.6Stollery Children’s Hospital and University of Alberta, Edmonton, Canada
| | | | - Johannes Roth
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Sarah Campillo
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Susanne Benseler
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Gaëlle Chédeville
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Rayfel Schneider
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Shirley M. L. Tse
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roxana Bolaria
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics University of British Columbia, Vancouver, Canada
| | - Katherine Gross
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics University of British Columbia, Vancouver, Canada
| | - Debbie Feldman
- 0000 0001 2292 3357grid.14848.31Université de Montréal, Montréal, Canada
| | - Bonnie Cameron
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roman Jurencak
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Jean Dorval
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Canada
| | - Claire LeBlanc
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Claire St. Cyr
- 0000 0001 2292 3357grid.14848.31Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada
| | - Michele Gibbon
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Rae S. M. Yeung
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ciarán M. Duffy
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Lori B. Tucker
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
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Chan MO, Petty RE, Guzman J. A Family History of Psoriasis in a First-degree Relative in Children with JIA: to Include or Exclude? J Rheumatol 2016; 43:944-7. [PMID: 26980584 DOI: 10.3899/jrheum.150555] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the consequences of disregarding first-degree relatives with psoriasis (FRP) as a classification criterion in juvenile idiopathic arthritis (JIA). METHODS Criteria were examined in children from a prospective cohort with unclassified and psoriatic JIA. RESULTS FRP was the most common reason children were unclassified (57/85, 67%); all 57 children could be classified if FRP were disregarded as an exclusion criterion. FRP was a necessary inclusion criterion to classify 11/77 (14.3%) children with psoriatic JIA. CONCLUSION Eliminating FRP as an exclusion criterion, but keeping it as an inclusion criterion in psoriatic JIA simplifies classification, though it is unclear whether the resulting classification would be better.
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16
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Guzman J, Oen K, Huber AM, Watanabe Duffy K, Boire G, Shiff N, Berard RA, Levy DM, Stringer E, Scuccimarri R, Morishita K, Johnson N, Cabral DA, Rosenberg AM, Larché M, Dancey P, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Houghton K, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey SE, Bruns A, Roth J, Campillo S, Benseler S, Chédeville G, Schneider R, Tse SML, Bolaria R, Gross K, Feldman B, Feldman D, Cameron B, Jurencak R, Dorval J, LeBlanc C, St Cyr C, Gibbon M, Yeung RSM, Duffy CM, Tucker LB. The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Ann Rheum Dis 2015; 75:1092-8. [PMID: 25985972 DOI: 10.1136/annrheumdis-2014-207164] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [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: 12/16/2014] [Accepted: 05/01/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe probabilities and characteristics of disease flares in children with juvenile idiopathic arthritis (JIA) and to identify clinical features associated with an increased risk of flare. METHODS We studied children in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) prospective inception cohort. A flare was defined as a recurrence of disease manifestations after attaining inactive disease and was called significant if it required intensification of treatment. Probability of first flare was calculated with Kaplan-Meier methods, and associated features were identified using Cox regression. RESULTS 1146 children were followed up a median of 24 months after attaining inactive disease. We observed 627 first flares (54.7% of patients) with median active joint count of 1, physician global assessment (PGA) of 12 mm and duration of 27 weeks. Within a year after attaining inactive disease, the probability of flare was 42.5% (95% CI 39% to 46%) for any flare and 26.6% (24% to 30%) for a significant flare. Within a year after stopping treatment, it was 31.7% (28% to 36%) and 25.0% (21% to 29%), respectively. A maximum PGA >30 mm, maximum active joint count >4, rheumatoid factor (RF)-positive polyarthritis, antinuclear antibodies (ANA) and receiving disease-modifying antirheumatic drugs (DMARDs) or biological agents before attaining inactive disease were associated with increased risk of flare. Systemic JIA was associated with the lowest risk of flare. CONCLUSIONS In this real-practice JIA cohort, flares were frequent, usually involved a few swollen joints for an average of 6 months and 60% led to treatment intensification. Children with a severe disease course had an increased risk of flare.
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Affiliation(s)
- Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Natalie Shiff
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Roberta A Berard
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Stringer
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Johnson
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - David A Cabral
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Maggie Larché
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland, Canada
| | - Ross E Petty
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald M Laxer
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Earl Silverman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Paivi Miettunen
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Anne-Laure Chetaille
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Elie Haddad
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Stuart E Turvey
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Ellsworth
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne E Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alessandra Bruns
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Johannes Roth
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Campillo
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Susanne Benseler
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Rayfel Schneider
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Shirley M L Tse
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roxana Bolaria
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Gross
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Bonnie Cameron
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roman Jurencak
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Jean Dorval
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Claire LeBlanc
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Claire St Cyr
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Michele Gibbon
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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17
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Guzman J, Gómez-Ramírez O, Jurencak R, Shiff NJ, Berard RA, Duffy CM, Oen K, Petty RE, Benseler SM, Brant R, Tucker LB. What matters most for patients, parents, and clinicians in the course of juvenile idiopathic arthritis? A qualitative study. J Rheumatol 2014; 41:2260-9. [PMID: 25225279 DOI: 10.3899/jrheum.131536] [Citation(s) in RCA: 26] [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] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To assess which clinical features are most important for patients, parents, and clinicians in the course of juvenile idiopathic arthritis (JIA). METHODS Forty-nine people participated in 6 audience-specific focus group discussions and 112 reciprocal interviews in 3 Canadian cities. Participants included youth with JIA, experienced English- and French-speaking parents, novice parents (<6 mos since diagnosis), pediatric rheumatologists, and allied health professionals. Participants discussed the importance of 34 JIA clinical features extracted from medical literature. Transcripts and interview reports underwent qualitative analysis to establish relative priorities for each group. RESULTS Most study participants considered medication requirements, medication side effects, pain, participant-defined quality of life, and active joints as high priority clinical features of JIA. Active joint count was the only American College of Rheumatology core variable accorded high or medium priority by all groups. Rheumatologists and allied health professionals considered physician global assessment as high priority, but it had very low priority for patients and parents. The parent global assessment was considered high priority by clinicians, medium to high by parents, and low by patients. Child Health Assessment Questionnaire scores were considered low priority by patients and parents, and moderate or high by clinicians. The number of joints with limited motion was given low to very low priority by all groups. Parents gave high priority to arthritis flares. CONCLUSION If our findings are confirmed, medication requirements, medication side effects, pain, participant-defined quality of life, and active joint counts should figure prominently in describing the course of JIA.
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Affiliation(s)
- Jaime Guzman
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary.
| | - Oralia Gómez-Ramírez
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
| | - Roman Jurencak
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
| | - Natalie J Shiff
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
| | - Roberta A Berard
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
| | - Ciaran M Duffy
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
| | - Kiem Oen
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
| | - Ross E Petty
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
| | - Susanne M Benseler
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
| | - Rollin Brant
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
| | - Lori B Tucker
- From the British Columbia Children's Hospital; University of British Columbia, Vancouver; Children's Hospital of Eastern Ontario; University of Ottawa, Ottawa, Ontario; University of Saskatchewan, Saskatoon; Children's Hospital, London Health Sciences Centre; Western University, London, Ontario; Children's Hospital of Winnipeg; University of Manitoba, Winnipeg; Alberta Children's Hospital; University of Calgary, Calgary, Alberta, Canada.J. Guzman, MD, MSc; O. Gómez-Ramírez, MA, PhD Candidate; R.E. Petty, MD; R. Brant, PhD; L.B. Tucker, MD, British Columbia Children's Hospital, University of British Columbia; R. Jurencak, MD; C.M. Duffy, MB, BCh, MSc, Children's Hospital of Eastern Ontario, University of Ottawa; N.J. Shiff, MD, MHSc, University of Saskatchewan, Saskatoon; R.A. Berard, MD, MSc, Children's Hospital, London Health Sciences Centre, Western University; K. Oen, MD, Children's Hospital of Winnipeg, University of Manitoba; S.M. Benseler, MD, Alberta Children's Hospital, University of Calgary
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18
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Guzman J, Oen K, Tucker LB, Huber AM, Shiff N, Boire G, Scuccimarri R, Berard R, Tse SML, Morishita K, Stringer E, Johnson N, Levy DM, Duffy KW, Cabral DA, Rosenberg AM, Larché M, Dancey P, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Houghton K, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey S, Bruns A, Campillo S, Benseler S, Chédeville G, Schneider R, Yeung R, Duffy CM. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis 2014; 74:1854-60. [PMID: 24842571 DOI: 10.1136/annrheumdis-2014-205372] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [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: 02/07/2014] [Accepted: 05/03/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe clinical outcomes of juvenile idiopathic arthritis (JIA) in a prospective inception cohort of children managed with contemporary treatments. METHODS Children newly diagnosed with JIA at 16 Canadian paediatric rheumatology centres from 2005 to 2010 were included. Kaplan-Meier survival curves for each JIA category were used to estimate probability of ever attaining an active joint count of 0, inactive disease (no active joints, no extraarticular manifestations and a physician global assessment of disease activity <10 mm), disease remission (inactive disease >12 months after discontinuing treatment) and of receiving specific treatments. RESULTS In a cohort of 1104 children, the probabilities of attaining an active joint count of 0 exceeded 78% within 2 years in all JIA categories. The probability of attaining inactive disease exceeded 70% within 2 years in all categories, except for RF-positive polyarthritis (48%). The probability of discontinuing treatment at least once was 67% within 5 years. The probability of attaining remission within 5 years was 46-57% across JIA categories except for polyarthritis (0% RF-positive, 14% RF-negative). Initial treatment included joint injections and non-steroidal anti-inflammatory drugs for oligoarthritis, disease-modifying antirheumatic drugs (DMARDs) for polyarthritis and systemic corticosteroids for systemic JIA. CONCLUSIONS Most children with JIA managed with contemporary treatments attain inactive disease within 2 years of diagnosis and many are able to discontinue treatment. The probability of attaining remission within 5 years of diagnosis is about 50%, except for children with polyarthritis.
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Affiliation(s)
- Jaime Guzman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Kiem Oen
- Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Natalie Shiff
- Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Roberta Berard
- London Health Sciences Centre and Western University, London, Canada
| | - Shirley M L Tse
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | | | - Nicole Johnson
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | - David A Cabral
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Canada
| | - Ross E Petty
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Ronald M Laxer
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Earl Silverman
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paivi Miettunen
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | | | - Elie Haddad
- CHU Ste. Justine and Université de Montréal, Montréal, Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stuart E Turvey
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Heinrike Schmeling
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Janet Ellsworth
- The Stollery Children's Hospital and University of Alberta, Edmonton, Canada
| | - Suzanne Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Alessandra Bruns
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Sarah Campillo
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Susanne Benseler
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Rayfel Schneider
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Rae Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
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Chan MO, Petty RE, Oen K, Duffy CM, Tucker LB, Yeung RSM, Guzman J. A67: Factors That Contribute to Classification of Children as Having Undifferentiated Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mercedes O. Chan
- BC Children's Hospital and University of British Columbia; Vancouver BC
| | | | - Kiem Oen
- Children's Hospital of Winnipeg and University of Manitoba; Winnipeg MB
| | - Ciarán M. Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa; Ottawa ON
| | - Lori B. Tucker
- BC Children's Hospital and University of British Columbia; Vancouver BC
| | - Rae SM Yeung
- The Hospital for Sick Children and University of Toronto; Toronto ON
| | - Jaime Guzman
- BC Children's Hospital and University of British Columbia; Vancouver BC
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Gomez-Ramirez O, Gibbon M, Berard RA, Jurencak R, Green J, Benseler S, Duffy CM, Tucker LB, Petty RE, Shiff N, Oen K, Brant R, Guzman J. A96: The Roller Coaster of Juvenile Idiopathic Arthritis: A Qualitative Examination of Parents' Emotional Responses to the Disease and Its Management. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Michele Gibbon
- Children's Hospital of Eastern Ontario and University of Ottawa; Ottawa ON
| | | | | | | | | | - Ciarán M. Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa; Ottawa ON
| | - Lori B. Tucker
- BC Children's Hospital and University of British Columbia; Vancouver BC
| | | | | | - Kiem Oen
- Children's Hospital of Winnipeg and University of Manitoba; Winnipeg MB
| | | | - Jaime Guzman
- BC Children's Hospital and University of British Columbia; Vancouver BC
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Althagafi HO, Morishita K, Petty RE. Severe vocal cord dysfunction: an unusual complication of juvenile dermatomyositis. J Rheumatol 2013; 40:744-5. [PMID: 23637383 DOI: 10.3899/jrheum.121338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Petty RE. Paediatric rheumatology: What has changed in last 10 years? Indian Journal of Rheumatology 2012. [DOI: 10.1016/s0973-3698(12)60021-1] [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: 10/28/2022] Open
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Abstract
A short form for assessing individual differences in need for cognition is described.
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Affiliation(s)
- J T Cacioppo
- Dept. of Psychology, University of Iowa, Iowa City 52242, USA
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Oen K, Duffy CM, Tse SML, Ramsey S, Ellsworth J, Chédeville G, Chetaille AL, Saint-Cyr C, Cabral DA, Spiegel LR, Schneider R, Lang B, Huber AM, Dancey P, Silverman E, Rosenberg AM, Cameron B, Johnson N, Dorval J, Scuccimarri R, Campillo S, Petty RE, Duffy KNW, Boire G, Haddad E, Houghton K, Laxer R, Turvey SE, Miettunen P, Gross K, Guzman J, Benseler S, Feldman BM, Espinosa V, Yeung RSM, Tucker L. Early outcomes and improvement of patients with juvenile idiopathic arthritis enrolled in a Canadian multicenter inception cohort. Arthritis Care Res (Hoboken) 2010; 62:527-36. [DOI: 10.1002/acr.20044] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Oen K, Tucker L, Huber AM, Miettunen P, Scuccimarri R, Campillo S, Cabral DA, Feldman BM, Tse S, Chédeville G, Spiegel L, Schneider R, Lang B, Ellsworth J, Ramsey S, Dancey P, Silverman E, Chetaille AL, Cameron B, Johnson N, Dorval J, Petty RE, Duffy KW, Boire G, Haddad E, Houghton K, Saint-Cyr C, Turvey SE, Benseler S, Cheang M, Yeung RSM, Duffy CM. Predictors of early inactive disease in a juvenile idiopathic arthritis cohort: Results of a Canadian multicenter, prospective inception cohort study. ACTA ACUST UNITED AC 2009; 61:1077-86. [DOI: 10.1002/art.24539] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Shiff NJ, Abdwani R, Cabral DA, Houghton KM, Malleson PN, Petty RE, Espinosa VM, Tucker LB. Access to pediatric rheumatology subspecialty care in British Columbia, Canada. J Rheumatol 2009; 36:410-5. [PMID: 19132779 DOI: 10.3899/jrheum.080514] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Early recognition and treatment of pediatric rheumatic diseases is associated with improved outcome. We documented access to pediatric rheumatology subspecialty care for children in British Columbia (BC), Canada, referred to the pediatric rheumatology clinic at BC Children's Hospital, Vancouver. METHODS An audit of new patients attending the outpatient clinic from May 2006 to February 2007 was conducted. Parents completed a questionnaire through a guided interview at the initial clinic assessment. Referral dates were obtained from the referral letters. Patients were classified as having rheumatic disease, nonrheumatic disease, or a pain syndrome based on final diagnosis by a pediatric rheumatologist. RESULTS Data were collected from 124 of 203 eligible new patients. Before pediatric rheumatology assessment, a median of 3 healthcare providers were seen (range 1-11) for a median of 5 visits (range 1-39). Overall, the median time interval from symptom onset to pediatric rheumatology assessment was 268 days (range 13-4989), and the median time interval from symptom onset to referral to pediatric rheumatology was 179 days (range 3-4970). Among patients ultimately diagnosed with rheumatic diseases (n = 53), there was a median of 119 days (range 3-4970) from symptom onset to referral, and 169 days (range 31-4989) from onset to pediatric rheumatology assessment. CONCLUSION Children and adolescents with rheumatic complaints see multiple care providers for multiple visits before referral to pediatric rheumatology, and there is often a long interval between symptom onset and this referral.
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Affiliation(s)
- Natalie J Shiff
- Division of Rheumatology, BC Children's Hospital, Room K4-120, 4480 Oak Street, Vancouver, BC V6H 3V4.
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Ruperto N, Lovell DJ, Cuttica R, Wilkinson N, Woo P, Espada G, Wouters C, Silverman ED, Balogh Z, Henrickson M, Apaz MT, Baildam E, Fasth A, Gerloni V, Lahdenne P, Prieur AM, Ravelli A, Saurenmann RK, Gamir ML, Wulffraat N, Marodi L, Petty RE, Joos R, Zulian F, McCurdy D, Myones BL, Nagy K, Reuman P, Szer I, Travers S, Beutler A, Keenan G, Clark J, Visvanathan S, Fasanmade A, Raychaudhuri A, Mendelsohn A, Martini A, Giannini EH. A randomized, placebo-controlled trial of infliximab plus methotrexate for the treatment of polyarticular-course juvenile rheumatoid arthritis. ACTA ACUST UNITED AC 2007; 56:3096-106. [PMID: 17763439 DOI: 10.1002/art.22838] [Citation(s) in RCA: 259] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of infliximab in the treatment of juvenile rheumatoid arthritis (JRA). METHODS This was an international, multicenter, randomized, placebo-controlled, double-blind study. One hundred twenty-two children with persistent polyarticular JRA despite prior methotrexate (MTX) therapy were randomized to receive infliximab or placebo for 14 weeks, after which all children received infliximab through week 44. Patients received MTX plus infliximab 3 mg/kg through week 44, or MTX plus placebo for 14 weeks followed by MTX plus infliximab 6 mg/kg through week 44. RESULTS Although a higher proportion of patients in the 3 mg/kg infliximab group than in the placebo group had achieved responses according to the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30) criteria for improvement at week 14 (63.8% and 49.2%, respectively), the between-group difference in this primary efficacy end point was not statistically significant (P = 0.12). By week 16, after the crossover from placebo to infliximab 6 mg/kg when all patients were receiving infliximab, an ACR Pedi 30 response was achieved in 73.2% of all patients. By week 52, ACR Pedi 50 and ACR Pedi 70 responses had been reached in 69.6% and 51.8%, respectively, of patients. Infliximab was generally well tolerated, but the safety profile of infliximab 3 mg/kg appeared less favorable than that of infliximab 6 mg/kg, with more frequent occurrences of serious adverse events, infusion reactions, antibodies to infliximab, and newly induced antinuclear antibodies and antibodies to double-stranded DNA observed with the 3 mg/kg dose. CONCLUSION While infliximab at 3 mg/kg and 6 mg/kg showed durable efficacy at 1 year, achievement of the primary efficacy end point at 3 months did not differ significantly between infliximab-treated and placebo-treated patients. Safety data indicated that the 6-mg/kg dose may provide a more favorable risk/benefit profile. These results warrant further investigation in children with JRA.
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Houghton KM, Page J, Cabral DA, Petty RE, Tucker LB. Systemic lupus erythematosus in the pediatric North American Native population of British Columbia. J Rheumatol 2006; 33:161-3. [PMID: 16395763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To compare the estimated prevalence and the phenotype of pediatric systemic lupus erythematosus (SLE) in a North American Native population with other ethnic groups. METHODS We performed a retrospective chart review of all patients with SLE currently followed at the single tertiary care pediatric rheumatology clinic in our province. Data collected included demographic characteristics, family history, classification criteria for SLE, laboratory tests at diagnosis, SLE Disease Activity Index (SLEDAI) at presentation, and Systemic Lupus International Collaborating Clinics (SLICC) damage index at 6 months. RESULTS The prevalence of SLE in our pediatric Native population is 8.8 per 100,000 (n = 6) compared to 3.3 per 100,000 in the non-NAI population (n = 34) (p = 0.037, Fisher's exact test; OR 2.6, 95% CI 1.1-6.3). Family history of rheumatic disease is more common in our Native children (5/6, 83%) compared to non-Native children (5/34, 15%) (p = 0.002 Fisher's exact test; OR 29, 95% CI 2.8-303.3). The sample size is too small for reliable interpretation of disease phenotype, autoantibodies, disease activity, and disease damage measures. CONCLUSION There is an increased prevalence of SLE and familial autoimmunity among Native children in our population. Public health measures to screen children at risk may detect early disease and may reduce disease morbidity.
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Affiliation(s)
- Kristin M Houghton
- Division of Rheumatology, Department of Pediatrics, University of British Columbia and British Columbia's Children's Hospital, Vancouver, British Columbia, Canada.
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Ozen S, Ruperto N, Dillon MJ, Bagga A, Barron K, Davin JC, Kawasaki T, Lindsley C, Petty RE, Prieur AM, Ravelli A, Woo P. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis 2005; 65:936-41. [PMID: 16322081 PMCID: PMC1798210 DOI: 10.1136/ard.2005.046300] [Citation(s) in RCA: 572] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There has been a lack of appropriate classification criteria for vasculitis in children. OBJECTIVE To develop a widely accepted general classification for the vasculitides observed in children and specific and realistic classification criteria for common childhood vasculitides (Henoch-Schönlein purpura (HSP), Kawasaki disease (KD), childhood polyarteritis nodosa (PAN), Wegener's granulomatosis (WG), and Takayasu arteritis (TA)). METHODS The project was divided into two phases: (1) the Delphi technique was used to gather opinions from a wide spectrum of paediatric rheumatologists and nephrologists; (2) a consensus conference using nominal group technique was held. Ten international experts, all paediatricians, met for the consensus conference. Agreement of at least 80% of the participants was defined as consensus. RESULTS Consensus was reached to base the general working classification for childhood vasculitides on vessel size. The small vessel disease was further subcategorised into "granulomatous" and "non-granulomatous." Final criteria were developed to classify a child as HSP, KD, childhood PAN, WG, or TA, with changes introduced based on paediatric experience. Mandatory criteria were suggested for all diseases except WG. CONCLUSIONS It is hoped that the suggested criteria will be widely accepted around the world because of the reliable techniques used and the international and multispecialist composition of the expert group involved.
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Affiliation(s)
- S Ozen
- Department of Paediatrics, Hacettepe University Faculty of Medicine, 06100 Ankara, Turkey, and Paediatric Nephrology, Institute of Child Health and Great Ormond Street Hospital for Sick Children, London, UK.
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Houghton KM, Cabral DA, Petty RE, Tucker LB. Primary Sjögren's syndrome in dizygotic adolescent twins: one case with lymphocytic interstitial pneumonia. J Rheumatol 2005; 32:1603-6. [PMID: 16078341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Primary Sjögren's syndrome (pSS) is uncommonly recognized in childhood, and familial cases are rare. Pulmonary involvement in pediatric pSS is infrequently reported. In adults, asymptomatic pulmonary involvement is increasingly recognized, manifest by pulmonary function test abnormalities and changes on high resolution computerized tomographic scan. We describe a case of pSS in a 14-year-old Vietnamese-Canadian girl who presented with pulmonary symptoms, radiologic changes, and biopsy confirmation of lymphocytic interstitial pneumonia. Her dizygotic twin sister has primary SS without extraglandular manifestations. To our knowledge this is the first report of pediatric pSS with lymphocytic interstitial pneumonia and multiple pulmonary nodules on chest radiograph. We review the literature on pulmonary involvement and familial cases of pSS in childhood.
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Affiliation(s)
- Kristin M Houghton
- Division of Rheumatology, British Columbia's Children's Hospital and University of British Columbia, Vancouver, Canada.
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Oen K, Malleson PN, Cabral DA, Rosenberg AM, Petty RE, Nickerson P, Reed M. Cytokine genotypes correlate with pain and radiologically defined joint damage in patients with juvenile rheumatoid arthritis. Rheumatology (Oxford) 2005; 44:1115-21. [PMID: 15901906 DOI: 10.1093/rheumatology/keh689] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES Single nucleotide polymorphisms (SNPs) in cytokine genes have been associated with risk of a number of autoimmune diseases. Moreover, some SNPs are associated with variations in rates of in vitro gene expression, and it is therefore possible that these functional polymorphisms may differentially affect inflammatory processes and disease outcome. This project's objective was to determine whether cytokine genotypes correlate with disease outcomes in patients with juvenile rheumatoid arthritis (JRA). METHODS Genotypes of SNPs of pro-inflammatory cytokines, tumour necrosis factor-alpha -308G -->A, interleukin-6 (IL-6) -174G -->C and interferon-gamma +874G -->A, and anti-inflammatory, immunosuppressive cytokines, interleukin-10 -1082G -->A, -819C -->T and -592A -->C and transforming growth factor-beta1 (TGF-beta1) codon 10T -->C and codon 25G -->C, were determined for patients with JRA who previously participated in a long-term outcome study. Cytokine genotypes and clinical variables showing significant correlations with clinical outcomes at the alpha = 0.100 level in univariate analyses were entered in multivariate tests. RESULTS In multivariate tests, the IL-6 genotype -174G/G was positively correlated with pain [regression coefficient B = 0.899, 95% confidence intervals (CI) 0.185, 1.612, P = 0.014]. The homozygous TGF-beta1 codon 25G/G genotype showed a protective effect against joint space narrowing on radiographs taken within 2 yr of disease onset, but confidence intervals were wide [odds ratio (OR) 0.176, 95% CI 0.037, 0.837 P = 0.029]. CONCLUSIONS The correlation of IL-6 genotype with pain and the possible association of the TGF-beta1 codon 25 genotype with short-term radiographic damage (G/C with greater risk and G/G with decreased risk) suggests that both these polymorphisms may be useful early prognostic indicators. Further studies of the relation between cytokine genotypes and outcomes in patients with all forms of juvenile idiopathic arthritis (JIA) are warranted.
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Affiliation(s)
- K Oen
- Department of Paediatrics, University of Manitoba, Winnipeg, Canada.
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Alsufyani KA, Ortiz-Alvarez O, Cabral DA, Tucker LB, Petty RE, Nadel H, Malleson PN. Bone mineral density in children and adolescents with systemic lupus erythematosus, juvenile dermatomyositis, and systemic vasculitis: relationship to disease duration, cumulative corticosteroid dose, calcium intake, and exercise. J Rheumatol 2005; 32:729-33. [PMID: 15801032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To describe the frequency of abnormal bone mineralization in a population of children with juvenile systemic lupus erythematosus (JSLE), juvenile dermatomyositis (JDM), and systemic vasculitis; and to investigate the relationship of bone mineral density (BMD) to cumulative corticosteroid dose, disease duration, Tanner stage, calcium intake, and exercise in these patients. METHODS A retrospective chart review of children attending the pediatric rheumatology clinic at British Columbia's Children's Hospital was conducted to obtain demographic data (sex, ethnicity, disease duration, cumulative corticosteroid dose, and mean daily corticosteroid dose). All patients had at least one BMD measurement by dual energy x-ray absorptiometry (DEXA) at lumbar spine, hip, and total body. BMD was expressed as g/cm2 and Z scores; an abnormal Z score was defined as </= -1.5. Daily calcium intake was calculated. Physical activity was scored using a validated 7 day physical activities questionnaire. RESULTS A total of 36 patients were studied. Twenty-five patients had SLE, 7 had JDM, and 4 had systemic vasculitis. Fourteen subjects were Caucasian, 13 Asian, 6 East Indian, and 3 Canadian First Nations. An abnormal Z score at one or more sites was found in 10/25 (40%) with JSLE, and in 3/11 (27%) JDM/vasculitis patients. The mean Z scores (+/- SD) for lumbar spine were -1.02 (+/- 1.2), for hip -0.88 (+/- 1.3), and for total body -0.77 (+/- 1.5). Compared to children with normal bone densities, those with lower bone density tended to be younger (13.5 +/- 2.2 vs 15.5 +/- 1.7 yrs), received higher corticosteroid dosages at the time of the study (0.78 +/- 0.6 vs 0.35 +/- 0.2 mg/kg), and were more often prepubertal (OR for total body scores 5, 95% CI 0.7-46). CONCLUSION Decreased bone density is common in children with SLE and other systemic rheumatic diseases. Age, corticosteroid dose, and pubertal stage all appear to have some influence on bone mass in these children.
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Affiliation(s)
- Khayriah A Alsufyani
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Ortiz-Alvarez O, Morishita K, Avery G, Green J, Petty RE, Tucker LB, Malleson PN, Cabral DA. Guidelines for blood test monitoring of methotrexate toxicity in juvenile idiopathic arthritis. J Rheumatol 2004; 31:2501-6. [PMID: 15570658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To assess the utility of the American College of Rheumatology guidelines for monitoring methotrexate (MTX)-related toxicity in a cohort of children with juvenile idiopathic arthritis (JIA). METHODS Eighty-nine patients with JIA treated with MTX were monitored prospectively: aspartate aminotransferase (AST), alanine aminotransferase (ALT), complete blood count (CBC), and differential blood count were measured prior to starting MTX, and then monthly. Significantly abnormal blood tests (SABT) were prospectively defined as (1) significantly elevated liver enzymes (SELE) greater than twice the upper limit of normal; (2) granulocyte count < 1.5 109/l; (3) lymphocyte count < 0.9 109/l; or (4) hemoglobin decreased by > 2 g/l from previous level. Clinical interventions, current and cumulative MTX dose, duration of treatment, comorbidity, and concurrent medications at the time of the first SABT identification were recorded. Independent t tests and chi-squared tests were used for comparisons, and the probability of developing a SABT was calculated by Kaplan-Meier survival analysis. RESULTS Forty percent of patients had a SABT: 26% had hematological abnormalities and 14% had SELE. Ninety-five percent of patients with SABT had symptoms consistent with a viral infection when the SABT was drawn and MTX dose was withheld until results had normalized on repeat testing. SABT persisting beyond one month occurred in only 2 patients, and their abnormalities resolved by 6 months with no specific identified cause; they resumed MTX at a later time without recurrence of SABT. There were no differences between patients with and without SABT with respect to current or cumulative MTX dose, duration of treatment, and concurrent medications at the time of the SABT. The probability of developing a SABT was estimated to be 11% at 3 months, compared to 10% probability of having an abnormal blood test by chance alone. CONCLUSION Routine blood tests every 4 to 8 weeks in children with JIA are unnecessarily frequent.
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Affiliation(s)
- Oliva Ortiz-Alvarez
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Alsufyani K, Ortiz-Alvarez O, Cabral DA, Tucker LB, Petty RE, Malleson PN. Relative ineffectiveness of triamcinolone acetonide in the treatment of juvenile idiopathic arthritis. Arthritis Rheum 2004; 50:3737-8. [PMID: 15529350 DOI: 10.1002/art.20629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Miettunen PM, Ortiz-Alvarez O, Petty RE, Cimaz R, Malleson PN, Cabral DA, Ensworth S, Tucker LB. Gender and ethnic origin have no effect on longterm outcome of childhood-onset systemic lupus erythematosus. J Rheumatol 2004; 31:1650-4. [PMID: 15290748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To investigate the associations of gender and ethnic origin with longterm outcome in childhood-onset systemic lupus erythematosus (SLE). METHODS The study cohort consisted of 51 patients (13 males and 38 females) with childhood-onset SLE followed for > or = 5 years at the British Columbia Children's Hospital in Vancouver. Fifteen patients were Caucasian, 14 Chinese, 9 East Indian, and 13 patients were of other ethnic backgrounds: none was African-American or Hispanic. Outcome measures assessed retrospectively included Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index score (SDI), SLE-related death, need for dialysis or renal transplantation, and use of intensive immunosuppressive therapy. A SDI > or = 2 was assigned as poor outcome. RESULTS The median age at diagnosis was 10.8 years and the median duration of followup was 7.2 years. Five-year survival was 100%; 10-year survival was 85.7% (12/14 patients). The median SDI score at last followup was 2.0 (range 0-9); 2.0 for male, 1.5 for female; 2.0 for Caucasian and 2.03 for non-Caucasian patients. Twenty-six out of 51 patients (51%) had poor outcome (SDI score > 2). Three female patients required dialysis: 2 had subsequent renal transplants. Thirty patients received intensive immunosuppressive therapy. The SDI scores, mortality, and need for intensive immunosuppressive therapy were not influenced by either gender or ethnic origin. CONCLUSION The median SDI score was high for this cohort with childhood-onset SLE. In contrast to other published data, no association of male gender and/or non-Caucasian ethnicity with poor outcome was found in our study cohort.
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Affiliation(s)
- Paivi M Miettunen
- Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, AB, Canada
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Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004. [PMID: 14760812 DOI: 10.1021/ic50115a029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Ross E Petty
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Malleson PN, Oen K, Cabral DA, Petty RE, Rosenberg AM, Cheang M. Predictors of pain in children with established juvenile rheumatoid arthritis. Arthritis Care Res (Hoboken) 2004; 51:222-7. [PMID: 15077263 DOI: 10.1002/art.20238] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine demographic and disease-related variables that affect pain in a large cohort of patients with juvenile rheumatoid arthritis (JRA). METHODS Selection criteria were an onset of JRA >/=5 years prior to study and age >/=8 years at the time of the study. Pain was measured by a self-administered 10-cm visual analog scale. Possible explanatory variables studied included age at study, sex, race, onset subtype, active disease duration, active joint count, and physician's global assessment (PGA). RESULTS In a multiple regression model, active disease duration, PGA, and age at study were independent predictors explaining 22% of the variation in pain scores. Stratified analyses showed an effect of age in the 8-15-year group, but not in older patients. CONCLUSION Disease-related factors explain only a small proportion of the variation in pain scores. Age has an effect on pain scores only in younger patients. The role of other factors, including psychosocial factors, needs further study.
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Affiliation(s)
- Peter N Malleson
- University of British Columbia, Vancouver, British Columbia, Canada
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Petty RE, Southwood TR, Manners P, Baum J, Glass DN, Goldenberg J, He X, Maldonado-Cocco J, Orozco-Alcala J, Prieur AM, Suarez-Almazor ME, Woo P. International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001. J Rheumatol 2004; 31:390-2. [PMID: 14760812] [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: 04/28/2023]
Affiliation(s)
- Ross E Petty
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Alsufyani K, Ortiz-Alvarez O, Cabral DA, Tucker LB, Petty RE, Malleson PN. The role of subcutaneous administration of methotrexate in children with juvenile idiopathic arthritis who have failed oral methotrexate. J Rheumatol 2004; 31:179-82. [PMID: 14705239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
OBJECTIVE To describe the outcome of patients with juvenile idiopathic arthritis (JIA) treated with subcutaneous (Sc) methotrexate (MTX) after failing oral MTX (either because of inefficacy or toxicity) in a clinic population. METHODS The study cohort was identified from our clinical database, and consisted of 61 children with JIA treated with MTX between 1988-2001. All patients fulfilled International League Against Rheumatism (ILAR) criteria for JIA and had disease duration of >/= 6 months and 3 or more active joints before institution of MTX. All patients had a core set of outcome variables assessed at baseline and at 3 months after achieving both maximum oral and SC MTX. Outcome variables included physician global assessment of disease activity, number of active joints, number of joints with limited range of motion, duration of early morning stiffness, and erythrocyte sedimentation rate (ESR). Improvement was defined as at least 30% improvement from baseline in 3 of 5 variables in the core set, with no more than one of the remaining variables worsening by more than 30%. RESULTS A total of 61 patients, 43 females and 18 males with JIA were studied. The disease subtypes were systemic 8, polyarticular 25 (12 rheumatoid factor positive), oligoarticular 14, enthesitis related arthritis 5, and unclassified 4. Thirty-one patients were switched to SC MTX, 13 of whom had not improved, and 18 who had improved, but had nausea (11) or insufficient clinical improvement (7). After 3 months of SC MTX treatment, 76% of patients were classified as improved and 23% as not improved. Toxicity on SC MTX was less than on oral MTX. CONCLUSION Our results suggest that for patients failing oral MTX either because of inefficacy or toxicity, the use of SC MTX has a high likelihood of success with more than 70% of patients achieving clinically significant improvement, without clinically significant toxicity.
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Affiliation(s)
- Khayriah Alsufyani
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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Abstract
Complex regional pain syndrome, characterized by pain, autonomic dysfunction, and decreased range of motion, developed after hepatitis B vaccination in four grade-6 children since the introduction of the vaccination program in British Columbia in 1992. The reaction may result from injection trauma or may be secondary to a vaccine constituent.
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Affiliation(s)
- Wasil A Jastaniah
- Department of Pediatrics, University of British Columbia and British Columbia's Children's Hospital, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.
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Petty RE. Exclusivity versus the hierarchy, or fear and loathing of the undefined. J Rheumatol 2003; 30:1663-4. [PMID: 12913916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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Sandor GGS, Hishitani T, Petty RE, Potts MT, Desouza A, Desouza E, Potts JE. A novel Doppler echocardiographic method of measuring the biophysical properties of the aorta in pediatric patients. J Am Soc Echocardiogr 2003; 16:745-50. [PMID: 12835661 DOI: 10.1016/s0894-7317(03)00407-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.3] [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: 11/29/2022]
Abstract
BACKGROUND This study was performed to: (1) assess the feasibility of measuring pulse wave velocity (PWV) from aortic (AO) Doppler flow and deriving AO input and characteristic impedances and the arterial pressure strain elastic modulus; and (2) compare these indices in pediatric patients with arterial disease to control (C) patients. METHODS There were 14 healthy children in the C group, 9 with inflammatory connective tissue diseases (ICTD), and 6 with Marfan syndrome (M). Using standard echocardiographic equipment, the AO annulus, AO root diameter in systole (AO(S)) and diastole (AO(D)), and AO length (L) were measured. The time taken for the Doppler signal to travel from the ascending to descending aorta was measured. AO peak flow was calculated from AO annulus cross-sectional area x peak aortic velocity (AoV); PWV = L/time taken for the Doppler signal to travel from the ascending to descending aorta; input impedance = (systolic - diastolic blood pressure)/(AO cross-sectional area x AoV); characteristic impedance = (PWV x rho)/Ao cross-sectional area (where rho = 1.06); and pressure strain elastic modulus = (systolic - diastolic blood pressure)/[(AO(S) - AO(D))/AO(D)]; beta index = ln (systolic/diastolic blood pressure)/[(AO(S) - AO(D))/AO(D)]. RESULTS Results for PWV were ICTD = M > C (533, 496, 362 cm/s; P <.02); for input impedance were ICTD > M = C (245, 120, 116; P <.03); for characteristic impedance were ICTD < M = C (249, 107, 142; P <.05); for pressure strain elastic modulus were M > ICTD = C (262, 447, 187; P <.003); and for beta index were M > ICTD > C (2.91, 2.51, 2.13; P <.0006). CONCLUSIONS This novel, relatively simple method of assessing the biophysical properties of the aorta shows abnormal function in patients with M and ICTD. This technique may be helpful in the long-term follow up of patients with arterial disease.
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Affiliation(s)
- George G S Sandor
- Department of Pediatrics, British Columbia's Children's Hospital, Vancouver, Canada
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Abstract
PURPOSE We describe important characteristics of the chronic arthritides of childhood associated with anterior uveitis. DESIGN Literature review and commentary based on the investigators' experiences. METHOD A review of pertinent publications provides a background of current understanding of those forms of childhood arthritis that are of interest to ophthalmologists caring for children. Recommendations regarding screening for asymptomatic anterior uveitis in this patient group are reviewed, and current advances in therapy are noted. A new classification of childhood arthritis is compared with existing classifications. RESULTS Uveitis complicates several forms of juvenile idiopathic arthritis (oligoarthritis, rheumatoid factor-negative polyarthritis, psoriatic arthritis, and enthesitis-related arthritis). Uveitis is a complication in up to 30% of children with chronic arthritis, particularly in those with oligoarticular disease. CONCLUSIONS Visual prognosis is guarded for children with chronic arthritis and uveitis. Surveillance and early therapy are important factors for ensuring a good outcome.
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Affiliation(s)
- Ross E Petty
- Department of Pediatrics (Division of Rheumatology), University of British Columbia, Vancouver, Canada.
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Oen K, Reed M, Malleson PN, Cabral DA, Petty RE, Rosenberg AM, Cheang M. Radiologic outcome and its relationship to functional disability in juvenile rheumatoid arthritis. J Rheumatol 2003; 30:832-40. [PMID: 12672208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To determine the radiologic outcome in juvenile rheumatoid arthritis (JRA) and the relationship of radiologically detected joint damage to functional disability using multivariate analyses. METHODS Selection criteria included a diagnosis of JRA made by 1977 American College of Rheumatology criteria, onset of arthritis > or = 5 years prior to study, current age > or = 8 years, a minimum grade 3 reading ability, and the availability of radiographs. Disability was measured by the Childhood Health Assessment Questionnaire (CHAQ) and Steinbrocker classifications. Radiographs taken within 2 years after onset (early) and the most recent radiographs (late) were examined by a single pediatric radiologist blinded to patients' identities, diagnoses, and outcomes. Multiple regression analyses were performed. RESULTS On late radiographs the frequencies of joint space narrowing were 38, 14, 43, and 79%, respectively, among patients with systemic, pauciarticular, rheumatoid factor (RF) negative polyarticular, and RF positive polyarticular onset; erosions occurred in 63, 25, 39, and 75%, respectively. Early erosions were most frequent in patients with RF+ polyarticular onset, while both joint space narrowing and erosions occurred early in systemic onset. Radiologic signs of joint damage were most frequent at hips and wrists, while knees and ankles were relatively spared. Based on patients who had radiographs performed within one year of clinical study, 17.7% of the variation in CHAQ score was explained by joint space narrowing, 32.4% by pain, and 5% by a severe rating on physician's global estimate of disease activity. The odds of a Steinbrocker class > I were increased by joint space narrowing, pain, systemic onset, and active joint count. CONCLUSION Differences in the frequencies and patterns of joint damage occur both among JRA onset subtypes and among individual joints. Radiographic damage, especially joint space narrowing, correlates with functional disability. However, pain is the major contributor to variation in CHAQ scores.
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Affiliation(s)
- Kiem Oen
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
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Oen K, Malleson PN, Cabral DA, Rosenberg AM, Petty RE, Reed M, Schroeder ML, Cheang M. Early predictors of longterm outcome in patients with juvenile rheumatoid arthritis: subset-specific correlations. J Rheumatol 2003; 30:585-93. [PMID: 12610821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To determine early predictors of longterm outcome in juvenile rheumatoid arthritis (JRA) in a multicenter cohort. METHODS Patients were selected if they were > or = 8 years of age; the onset of arthritis occurred > or = 5 years before study; and a diagnosis of JRA was made at a participating center. Outcome variables were scores on self-administered Childhood Health Assessment Questionnaires (CHAQ) and active disease duration. Possible explanatory variables assessed included characteristics present at onset, HLA alleles, in particular the rheumatoid arthritis associated shared epitope (RASE), and radiographic indicators of joint damage within 2 years of onset. Data for 393 patients were available. Multivariate analyses were performed for the total group and for each onset subtype. RESULTS Male sex correlated with worse disability in systemic onset JRA but less disability in RF negative, and a shorter active disease duration in RF positive polyarticular onset JRA. Positive antinuclear antibody correlated with a longer active disease duration in patients with pauciarticular onset JRA. Younger age at onset predicted longer active disease duration in pauciarticular and RF negative polyarticular, and a shorter active disease duration in systemic onset JRA. Residence on a reserve, rather than native North American race, correlated with worse disability. The RASE correlated with less disability in systemic JRA; but no correlation with outcome was evident for patients with rheumatoid factor positive polyarticular JRA. CONCLUSION Variables predictive of longterm outcome in JRA are specific for each onset subtype. The most important early predictors were age at onset and sex of the patient. Place of residence may have a greater effect on disability than race. RASE may associate with a more favorable outcome in systemic onset disease.
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Affiliation(s)
- Kiem Oen
- Departments of Paediatrics, Radiology, and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Al-Matar MJ, Petty RE, Tucker LB, Malleson PN, Schroeder ML, Cabral DA. The early pattern of joint involvement predicts disease progression in children with oligoarticular (pauciarticular) juvenile rheumatoid arthritis. Arthritis Rheum 2002; 46:2708-15. [PMID: 12384930 DOI: 10.1002/art.10544] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To evaluate features during the first 6 months of disease that may be associated with a poor outcome as measured principally by extension to a polyarticular disease course in patients with oligoarticular-onset juvenile rheumatoid arthritis (oligo-JRA). METHODS This study was a retrospective review of patients who fulfilled the American College of Rheumatology criteria for oligo-JRA, were followed up for at least 5 years, and did not have juvenile psoriatic arthritis, spondylarthropathy-like disease, or rheumatoid factor positivity. Data from the first 6 months of disease were collected. Continuous variables were dichotomized and then screened by univariate analysis for association with poor outcome at the last followup visit, as measured by extension of involvement (>4 accumulated involved joints) and by "clinically meaningful" extension (> or =10 accumulated joints). Variables significantly associated with this latter outcome, with the addition of disease duration as a confounding independent variable, were included in a multiple logistic regression analysis. The same variables were then examined in separate multiple logistic regression models to look at other measures of outcome, including use of disease-modifying antirheumatic drugs (DMARDs) at any time, erosive disease on radiographs, any remission of disease ever occurring, physician's global assessment of disease activity at the last visit, and disability as measured by the Childhood Health Assessment Questionnaire (C-HAQ)/HAQ. RESULTS Of the 205 patients (160 of whom were female) studied for a median of 10.8 years (range 5-26.6 years), 39.5% developed extension to >4 joints and 17.6% developed arthritis in > or =10 joints. Using the logistic regression model, symmetric disease was predictive of all measures of poor outcome: extension to > or =10 joints (odds ratio [OR] 19.2), the need to use DMARDs (OR 11.5), radiographic demonstration of erosive disease (OR 4.73), inflammatory activity at last followup visit (OR 3.23), no remission of disease (OR 4.73), and disability as measured by a C-HAQ score >0.12 (OR 2.95). Ankle and/or wrist disease was predictive of extension (OR 6.61) and erosions (OR 3.59). Wrist disease alone was predictive of the need to use DMARDs (OR 5.87) and of inflammatory disease activity at the last followup visit (OR 4.01). An elevated erythrocyte sedimentation rate (ESR) was predictive of extension (OR 3.76), the need to use DMARDs (OR 6.47), and no remission of disease (OR 2.30). Disease duration was a confounding variable for extension (OR 1.18) and erosive disease (OR 1.19). CONCLUSION The early presence of ankle and/or wrist disease, symmetric joint involvement, and an elevated ESR in a child with oligo-JRA indicates the likelihood of disease progression.
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Oen K, Malleson PN, Cabral DA, Rosenberg AM, Petty RE, Cheang M. Disease course and outcome of juvenile rheumatoid arthritis in a multicenter cohort. J Rheumatol 2002; 29:1989-99. [PMID: 12233897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
OBJECTIVE To determine the disease course and outcome in a multicenter cohort of patients with juvenile rheumatoid arthritis (JRA). METHODS All patients with JRA seen at 3 pediatric rheumatology centers were identified from databases and/or clinic records. Inclusion criteria were a diagnosis of JRA (1977 American College of Rheumatology criteria), a followup period of at least 5 years since onset, and a minimum age of 8 years. Patients were examined and completed a Childhood Health Assessment Questionnaire (CHAQ). Kaplan-Meier curves were constructed to estimate rates of remission, relapse, and arthroplasty. Remission was defined as absence of active arthritis while off treatment for at least 2 years. Outcome measures were active disease duration, CHAQ scores, pain determined by visual analog scales, physician's global assessments, and Steinbrocker functional classifications. Years of education and employment status were ascertained. RESULTS We studied 392 patients of 652 (60%) who met the selection criteria. The probabilities of remission at 10 years after onset were 37, 47, 23, and 6% for patients with systemic, pauciarticular, RF- polyarticular, and RF+ polyarticular JRA, respectively. The probability of relapse varied from 30 to 100% at 15 years. The probability of arthroplasty varied from 13 to 57% after 15 years of active disease. We found 2.5% of patients assessed were in Steinbrocker Classes III or IV and 6% were in the highest CHAQ score (> 1.5) group. Compared with national statistics, fewer female patients received post-secondary education and unemployment rates for patients 20 to 24 years of age were higher. CONCLUSION Our results indicate that JRA is a disease that often extends into adulthood. Compared to previous decades, functional outcome has improved; however, the estimated rate of arthroplasty remains very high. Patients with JRA may have difficulty entering the workforce.
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Affiliation(s)
- Kiem Oen
- Department of Paediatrics, University of Manitoba, Winnipeg, Canada
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Petty RE. Frequency of uncommon diseases: is juvenile idiopathic arthritis underrecognized? J Rheumatol 2002; 29:1356-7. [PMID: 12136888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
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Huemer C, Malleson PN, Cabral DA, Huemer M, Falger J, Zidek T, Petty RE. Patterns of joint involvement at onset differentiate oligoarticular juvenile psoriatic arthritis from pauciarticular juvenile rheumatoid arthritis. J Rheumatol 2002; 29:1531-5. [PMID: 12136915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
OBJECTIVE To compare the patterns of joint involvement of patients with oligoarticular onset juvenile psoriatic arthritis (Oligo-JPsA) and pauciarticular onset juvenile rheumatoid arthritis (Pauci-JRA) in order to estimate the predictive performance of specific patterns for the diagnosis of Oligo-JPsA. METHODS Twenty-three children who fulfilled the diagnostic criteria for JPsA (Vancouver criteria) and who had fewer than 5 joints involved in the first 6 months of disease (Oligo-JPsA), and 64 children with Pauci-JRA (ACR criteria) were enrolled. Patients were also classified with respect to the ILAR criteria for juvenile idiopathic arthritis (JIA). Patient characteristics and clinical features at onset and during followup were determined. Patterns of joint involvement at onset of disease and their ability to differentiate between Oligo-JPsA and Pauci-JRA/Oligo-JIA were evaluated. RESULTS Small joint disease (defined as involvement of any of the metatarsophalangeal or proximal or distal interphalangeal joints of the foot, or metacarpophalangeal or proximal or distal interphalangeal joints of the hand) was significantly more frequent in Oligo-JPsA than in Pauci-JRA at disease onset. The odds of patients with Oligo-JPsA having small joint disease or wrist disease within 6 months of disease onset were much higher than those with Pauci-JRA or Oligo-JIA (p < 0.05 or 0.001). CONCLUSION Small joint disease and wrist disease are suggestive of Oligo-JPsA. The use of a criterion consisting of small joint disease and/or wrist disease and/or dactylitis instead of dactylitis alone may increase the ability to differentiate Oligo-JPsA from Pauci-JRA or Oligo-JIA.
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