1
|
Huang Y, Sompii-Montgomery L, Patti J, Pickering A, Yasin S, Do T, Baker E, Gao D, Abdul-Aziz R, Behrens EM, Canna S, Clark M, Co DO, Collins KP, Eberhard B, Friedman M, Graham TB, Hahn T, Hersh AO, Hobday P, Holland MJ, Huggins J, Lu PY, Mannion ML, Manos CK, Neely J, Onel K, Orandi AB, Ramirez A, Reinhardt A, Riskalla M, Santiago L, Stoll ML, Ting T, Grom AA, Towe C, Schulert GS. Disease Course, Treatments, and Outcomes of Children With Systemic Juvenile Idiopathic Arthritis-Associated Lung Disease. Arthritis Care Res (Hoboken) 2024; 76:328-339. [PMID: 37691306 PMCID: PMC11156420 DOI: 10.1002/acr.25234] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/17/2023] [Accepted: 09/07/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE Systemic juvenile idiopathic arthritis-associated lung disease (SJIA-LD) is a life-threatening disease complication. Key questions remain regarding clinical course and optimal treatment approaches. The objectives of the study were to detail management strategies after SJIA-LD detection, characterize overall disease courses, and measure long-term outcomes. METHODS This was a prospective cohort study. Clinical data were abstracted from the electronic medical record, including current clinical status and changes since diagnosis. Serum biomarkers were determined and correlated with presence of LD. RESULTS We enrolled 41 patients with SJIA-LD, 85% with at least one episode of macrophage activation syndrome and 41% with adverse reactions to a biologic. Although 93% of patients were alive at last follow-up (median 2.9 years), 37% progressed to requiring chronic oxygen or other ventilator support, and 65% of patients had abnormal overnight oximetry studies, which changed over time. Eighty-four percent of patients carried the HLA-DRB1*15 haplotype, significantly more than patients without LD. Patients with SJIA-LD also showed markedly elevated serum interleukin-18 (IL-18), variable C-X-C motif chemokine ligand 9 (CXCL9), and significantly elevated matrix metalloproteinase 7. Treatment strategies showed variable use of anti-IL-1/6 biologics and addition of other immunomodulatory treatments and lung-directed therapies. We found a broad range of current clinical status independent of time from diagnosis or continued biologic treatment. Multidomain measures of change showed imaging features were the least likely to improve with time. CONCLUSION Patients with SJIA-LD had highly varied courses, with lower mortality than previously reported but frequent hypoxia and requirement for respiratory support. Treatment strategies were highly varied, highlighting an urgent need for focused clinical trials.
Collapse
Affiliation(s)
- Yannan Huang
- Yannan Huang, MD, Laura Sompii-Montgomery, MD, Jessica Patti, BSN, Thuy Do, BS, Elizabeth Baker, Denny Gao, MS: Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Laura Sompii-Montgomery
- Yannan Huang, MD, Laura Sompii-Montgomery, MD, Jessica Patti, BSN, Thuy Do, BS, Elizabeth Baker, Denny Gao, MS: Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jessica Patti
- Yannan Huang, MD, Laura Sompii-Montgomery, MD, Jessica Patti, BSN, Thuy Do, BS, Elizabeth Baker, Denny Gao, MS: Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Alex Pickering
- Alex Pickering, PhD: Harvard Medical School, Boston, Massachusetts
| | - Shima Yasin
- Shima Yasin, MD, MSc: University of Iowa Carver College of Medicine, Iowa City
| | - Thuy Do
- Yannan Huang, MD, Laura Sompii-Montgomery, MD, Jessica Patti, BSN, Thuy Do, BS, Elizabeth Baker, Denny Gao, MS: Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Elizabeth Baker
- Yannan Huang, MD, Laura Sompii-Montgomery, MD, Jessica Patti, BSN, Thuy Do, BS, Elizabeth Baker, Denny Gao, MS: Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Denny Gao
- Yannan Huang, MD, Laura Sompii-Montgomery, MD, Jessica Patti, BSN, Thuy Do, BS, Elizabeth Baker, Denny Gao, MS: Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rabheh Abdul-Aziz
- Rabheh Abdul-Aziz, MD, MS: University at Buffalo, Oishei Children’s Hospital, Buffalo, New York
| | - Edward M. Behrens
- Edward M. Behrens, MD, Scott Canna, MD: The Children’s Hospital of Philadelphia and Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Scott Canna
- Edward M. Behrens, MD, Scott Canna, MD: The Children’s Hospital of Philadelphia and Perelman School of Medicine at The University of Pennsylvania, Philadelphia
| | - Matthew Clark
- Matthew Clark, MD: Prisma Health Children’s Hospital Upstate and University of South Carolina School of Medicine-Greenville, Greenville
| | - Dominic O. Co
- Dominic O. Co, MD, PhD: University of Wisconsin-Madison, Madison
| | - Kathleen P. Collins
- Kathleen P. Collins, MD: University of Tennessee Health Science Center College of Medicine, Memphis
| | - Barbara Eberhard
- Barbara Eberhard, MD: Cohen Children’s Northwell Health, New Hyde Park, New York
| | - Monica Friedman
- Monica Friedman, DO: Orlando Health Arnold Palmer Hospital for Children, Orlando, Florida
| | - Thomas B. Graham
- Thomas B. Graham, MD, MS: Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee
| | - Timothy Hahn
- Timothy Hahn, MD: Penn State Health Children’s Hospital, Hershey, Pennsylvania
| | - Aimee O. Hersh
- Aimee O. Hersh, MD: University of Utah School of Medicine, Salt Lake City
| | - Patricia Hobday
- Patricia Hobday, MD, Mona Riskalla, MD: University of Minnesota, Minneapolis
| | - Michael J. Holland
- Michael J. Holland, MD, MS: Children’s Mercy Kansas City, Kansas City, Missouri
| | - Jennifer Huggins
- Jennifer Huggins, MD, Tracy Ting, MD, MSc, Alexei A. Grom, MD, Christopher Towe, MD, Grant S. Schulert, MD, PhD: Cincinnati Children’s Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
| | - Pai-Yue Lu
- Pai-Yue Lu, MD, MSc: University of Kentucky, Lexington
| | - Melissa L. Mannion
- Melissa L. Mannion, MD, Matthew L. Stoll, MD, PhD: University of Alabama at Birmingham, Birmingham
| | - Cynthia K. Manos
- Cynthia K. Manos MD: Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Jessica Neely
- Jessica Neely, MD: University of California, San Francisco
| | - Karen Onel
- Karen Onel, MD: Hospital for Special Surgery and Weill Cornell Medical Center, New York City, New York
| | | | - Andrea Ramirez
- Andrea Ramirez, MD: Baylor College of Medicine, Houston, Texas
| | - Adam Reinhardt
- Adam Reinhardt, MD: Boys Town National Research Hospital, Boys Town, Nebraska
| | - Mona Riskalla
- Patricia Hobday, MD, Mona Riskalla, MD: University of Minnesota, Minneapolis
| | - Laisa Santiago
- Laisa Santiago, MD: Johns Hopkins All Children’s Hospital, St. Petersburg, Florida
| | - Matthew L. Stoll
- Melissa L. Mannion, MD, Matthew L. Stoll, MD, PhD: University of Alabama at Birmingham, Birmingham
| | - Tracy Ting
- Jennifer Huggins, MD, Tracy Ting, MD, MSc, Alexei A. Grom, MD, Christopher Towe, MD, Grant S. Schulert, MD, PhD: Cincinnati Children’s Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
| | - Alexei A. Grom
- Jennifer Huggins, MD, Tracy Ting, MD, MSc, Alexei A. Grom, MD, Christopher Towe, MD, Grant S. Schulert, MD, PhD: Cincinnati Children’s Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
| | - Christopher Towe
- Jennifer Huggins, MD, Tracy Ting, MD, MSc, Alexei A. Grom, MD, Christopher Towe, MD, Grant S. Schulert, MD, PhD: Cincinnati Children’s Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
| | - Grant S. Schulert
- Jennifer Huggins, MD, Tracy Ting, MD, MSc, Alexei A. Grom, MD, Christopher Towe, MD, Grant S. Schulert, MD, PhD: Cincinnati Children’s Hospital Medical Center and University Cincinnati College of Medicine, Cincinnati, Ohio
| |
Collapse
|
2
|
Chen S, Zhang C, Chen D, Dong L, Chang T, Tang ZH. Advances in attractive therapeutic approach for macrophage activation syndrome in COVID-19. Front Immunol 2023; 14:1200289. [PMID: 37483597 PMCID: PMC10358730 DOI: 10.3389/fimmu.2023.1200289] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/12/2023] [Indexed: 07/25/2023] Open
Abstract
Nowadays, people have relaxed their vigilance against COVID-19 due to its declining infection numbers and attenuated virulence. However, COVID-19 still needs to be concern due to its emerging variants, the relaxation of restrictions as well as breakthrough infections. During the period of the COVID-19 infection, the imbalanced and hyper-responsive immune system plays a critical role in its pathogenesis. Macrophage Activation Syndrome (MAS) is a fatal complication of immune system disease, which is caused by the excessive activation and proliferation of macrophages and cytotoxic T cells (CTL). COVID-19-related hyperinflammation shares common clinical features with the above MAS symptoms, such as hypercytokinemia, hyperferritinemia, and coagulopathy. In MAS, immune exhaustion or defective anti-viral responses leads to the inadequate cytolytic capacity of CTL which contributes to prolonged interaction between CTL, APCs and macrophages. It is possible that the same process also occurred in COVID-19 patients, and further led to a cytokine storm confined to the lungs. It is associated with the poor prognosis of severe patients such as multiple organ failure and even death. The main difference of cytokine storm is that in COVID-19 pneumonia is mainly the specific damage of the lung, while in MAS is easy to develop into a systemic. The attractive therapeutic approach to prevent MAS in COVID-19 mainly includes antiviral, antibiotics, convalescent plasma (CP) therapy and hemadsorption, extensive immunosuppressive agents, and cytokine-targeted therapies. Here, we discuss the role of the therapeutic approaches mentioned above in the two diseases. And we found that the treatment effect of the same therapeutic approach is different.
Collapse
Affiliation(s)
- Shunyao Chen
- Department of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cong Zhang
- Department of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Deng Chen
- Department of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Dong
- Department of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Teding Chang
- Department of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhao-Hui Tang
- Department of Trauma Surgery, Emergency Surgery & Surgical Critical, Tongji Trauma Center, Wuhan, China
- Department of Emergency and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
6
|
Ambler WG, Nanda K, Onel KB, Shenoi S. Refractory systemic onset juvenile idiopathic arthritis: current challenges and future perspectives. Ann Med 2022; 54:1839-1850. [PMID: 35786149 PMCID: PMC9258439 DOI: 10.1080/07853890.2022.2095431] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Systemic juvenile idiopathic arthritis (SJIA) is a rare disease with distinct features not seen in other categories of juvenile idiopathic arthritis. In recent years, advances in the understanding of disease immunopathogenesis have led to improved targeted therapies with significant improvement in patient outcomes. Despite these advances, there remain subsets of SJIA with refractory disease and severe disease-associated complications. This review highlights existing options for treatment of refractory SJIA and explores potential future therapeutics for refractory disease.Key Points:Despite targeted Interleukin IL-1 and IL-6 inhibitors a subset of SJIA remains refractory to therapy. About 1 in 7 SJIA patients will be refractory to targeted IL-1 or IL-6 therapy.There is no current agreed upon definition for refractory SJIA and we propose in this review that refractory SJIA is presence of active systemic or arthritic features despite treatment with anti-IL-1 or anti-IL-6 therapy or disease requiring glucocorticoids for control beyond 6 months.SJIA disease associated complications include presence of associated macrophage activation syndrome (MAS), interstitial lung disease (ILD) or amyloidosis and management of each differs.Refractory SJIA treatment options currently include additional conventional synthetic disease modifying anti-rheumatic drugs (csDMARDS), biologic (bDMARDS), combination biologic therapy, targeted synthetic (tsDMARDS) or other immunomodulatory therapies.
Collapse
Affiliation(s)
- William G Ambler
- Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Kabita Nanda
- Department of Pediatrics, Division of Rheumatology, University of Washington School of Medicine & Seattle Children's Hospital, Seattle, WA, USA
| | - Karen Brandt Onel
- Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, NY, USA.,Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Susan Shenoi
- Department of Pediatrics, Division of Rheumatology, University of Washington School of Medicine & Seattle Children's Hospital, Seattle, WA, USA
| |
Collapse
|
8
|
Erkens R, Esteban Y, Towe C, Schulert G, Vastert S. Pathogenesis and Treatment of Refractory Disease Courses in Systemic Juvenile Idiopathic Arthritis: Refractory Arthritis, Recurrent Macrophage Activation Syndrome and Chronic Lung Disease. Rheum Dis Clin North Am 2021; 47:585-606. [PMID: 34635293 DOI: 10.1016/j.rdc.2021.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Systemic juvenile idiopathic arthritis is a distinct and heterogeneous disease presently classified under the umbrella of juvenile idiopathic arthritis, with some patients following a monophasic remitting course, whereas others have persistent disease with chronic organ- and life-threatening complications. Although biologic therapies have revolutionized treatment, recent follow-up studies report significant numbers of children with persistently active disease on long term follow-up. This review focuses on refractory disease courses, specifically refractory arthritis, systemic juvenile idiopathic arthritis with recurrent, or longstanding signs of macrophage activation syndrome, and systemic juvenile idiopathic arthritis associated with suspected, probable, or definite lung disease.
Collapse
Affiliation(s)
- Remco Erkens
- Division of Pediatric Rheumatology & Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands; Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, the Netherlands
| | - Ysabella Esteban
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Christopher Towe
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Grant Schulert
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Sebastiaan Vastert
- Division of Pediatric Rheumatology & Immunology, Wilhelmina Children's Hospital, University Medical Center Utrecht, the Netherlands; Center for Translational Immunology, University Medical Center Utrecht, University of Utrecht, the Netherlands.
| |
Collapse
|