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Avery CN, Russell ND, Steely CJ, Hersh AO, Bohnsack JF, Prahalad S, Jorde LB. Shared genomic segments analysis identifies MHC class I and class III molecules as genetic risk factors for juvenile idiopathic arthritis. HGG ADVANCES 2024; 5:100277. [PMID: 38369753 PMCID: PMC10918567 DOI: 10.1016/j.xhgg.2024.100277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/13/2024] [Accepted: 02/13/2024] [Indexed: 02/20/2024] Open
Abstract
Juvenile idiopathic arthritis (JIA) is a complex rheumatic disease encompassing several clinically defined subtypes of varying severity. The etiology of JIA remains largely unknown, but genome-wide association studies (GWASs) have identified up to 22 genes associated with JIA susceptibility, including a well-established association with HLA-DRB1. Continued investigation of heritable risk factors has been hindered by disease heterogeneity and low disease prevalence. In this study, we utilized shared genomic segments (SGS) analysis on whole-genome sequencing of 40 cases from 12 multi-generational pedigrees significantly enriched for JIA. Subsets of cases are connected by a common ancestor in large extended pedigrees, increasing the power to identify disease-associated loci. SGS analysis identifies genomic segments shared among disease cases that are likely identical by descent and anchored by a disease locus. This approach revealed statistically significant signals for major histocompatibility complex (MHC) class I and class III alleles, particularly HLA-A∗02:01, which was observed at a high frequency among cases. Furthermore, we identified an additional risk locus at 12q23.2-23.3, containing genes primarily expressed by naive B cells, natural killer cells, and monocytes. The recognition of additional risk beyond HLA-DRB1 provides a new perspective on immune cell dynamics in JIA. These findings contribute to our understanding of JIA and may guide future research and therapeutic strategies.
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Affiliation(s)
- Cecile N Avery
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA.
| | - Nicole D Russell
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Cody J Steely
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA
| | - Aimee O Hersh
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84112, USA
| | - John F Bohnsack
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84112, USA
| | - Sampath Prahalad
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30307, USA
| | - Lynn B Jorde
- Department of Human Genetics, University of Utah, Salt Lake City, UT 84112, USA.
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Antón J, Moreno Ruzafa E, Lopez Corbeto M, Bou R, Sánchez Manubens J, Carriquí Arenas S, Calzada Hernández J, Bittermann V, Estepa Guillén C, Mosquera Angarita J, Rodríguez Díez L, Iglesias E, Marti Masanet M, Lopez Montesinos B, González Fernández MI, de Lossada A, Peral C, Valderrama M, Llevat N, Montoro Álvarez M, Calvo Penadés I. Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:141-149. [PMID: 38145114 PMCID: PMC10742379 DOI: 10.36469/001c.85088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/07/2023] [Indexed: 12/26/2023]
Abstract
Background: Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. Objective: To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. Methods: Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). Results: Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). Conclusion: JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.
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Affiliation(s)
- Jordi Antón
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Mireia Lopez Corbeto
- Pediatric Rheumatology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rosa Bou
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | - Judith Sánchez Manubens
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
- Servei de Pediatria, Hospital Parc Taulí Sabadell
| | | | | | - Violetta Bittermann
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | | | | | | | - Estíbaliz Iglesias
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | - Miguel Marti Masanet
- Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Berta Lopez Montesinos
- Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Zang H, Kim HJ, Huang B, Szczesniak R. Bayesian causal inference for observational studies with missingness in covariates and outcomes. Biometrics 2023; 79:3624-3636. [PMID: 37553770 PMCID: PMC10840608 DOI: 10.1111/biom.13918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 07/13/2023] [Indexed: 08/10/2023]
Abstract
Missing data are a pervasive issue in observational studies using electronic health records or patient registries. It presents unique challenges for statistical inference, especially causal inference. Inappropriately handling missing data in causal inference could potentially bias causal estimation. Besides missing data problems, observational health data structures typically have mixed-type variables - continuous and categorical covariates - whose joint distribution is often too complex to be modeled by simple parametric models. The existence of missing values in covariates and outcomes makes the causal inference even more challenging, while most standard causal inference approaches assume fully observed data or start their works after imputing missing values in a separate preprocessing stage. To address these problems, we introduce a Bayesian nonparametric causal model to estimate causal effects with missing data. The proposed approach can simultaneously impute missing values, account for multiple outcomes, and estimate causal effects under the potential outcomes framework. We provide three simulation studies to show the performance of our proposed method under complicated data settings whose features are similar to our case studies. For example, Simulation Study 3 assumes the case where missing values exist in both outcomes and covariates. Two case studies were conducted applying our method to evaluate the comparative effectiveness of treatments for chronic disease management in juvenile idiopathic arthritis and cystic fibrosis.
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Affiliation(s)
- Huaiyu Zang
- Heart Institute, Cincinnati Children’s Hospital Medical Center, OH, U.S.A
| | - Hang J. Kim
- Division of Statistics and Data Science, University of Cincinnati, OH, U.S.A
| | - Bin Huang
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, OH, U.S.A
- Department of Pediatrics, University of Cincinnati, OH, U.S.A
| | - Rhonda Szczesniak
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, OH, U.S.A
- Department of Pediatrics, University of Cincinnati, OH, U.S.A
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4
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Kelty E, Quintrell E, Preen DB, Manners P, Nossent J. The effect of TNF treatment uptake on incident hospital admission in Western Australia. Pediatr Rheumatol Online J 2023; 21:29. [PMID: 36973788 PMCID: PMC10045824 DOI: 10.1186/s12969-023-00810-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
OBJECTIVE Treatment strategies for juvenile idiopathic arthritis (JIA) have shifted significantly over the last 20 years. We examined the effect of the introduction of government-subsidised TNF inhibitor (TNFi) treatment on incident hospitalisation for JIA. METHODS Western Australian (WA) hospital data were used to identify patients < 16 years hospitalised with JIA between 1990 and 2012. Changes in the number of patients with an incident hospitalisation, overall admissions and admissions for joint aspiration were examined using join-point regression TNFi dispensing data from 2002-2012 was used to describe defined daily doses (DDD)/1000 population/day. RESULTS We included 786 patients (59.2% girls, median age 8 years) with a first-time admission with JIA. The annual incident admission rate was 7.9 per 100,000 person-years (95%CI: 7.3, 8.4) which did not change significantly between 1990 and 2012 (annual percentage change (APC): 1.3, 95%CI: -0.3, 2.8). Annual hospital-based prevalence of JIA reached 0.72/1000 in 2012. DDD for TNFi usage rose steadily from 2003 indicating TNFi usage by 1/2700 children in 2012, while overall admission rates (APC 3.7; 95%CI: 2.3, 5.1) and admission rates for joint injections (APC 4.9%; 95%CI: 3.8, 6.0) also increased significantly in that period. CONCLUSION Incident inpatient admission rates for JIA were stable over a 22-year period. The uptake of TNFi was not associated with lower admission rates for JIA, due mainly to an increase in admissions for joint injection. These results indicate a notable but unexpected change in hospital-based management of JIA since the introduction of TNFi therapy in WA, where hospital-based prevalence of JIA is slightly higher than in North America.
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Affiliation(s)
- Erin Kelty
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy (M503), PerthCrawley, WA, 6009, Australia.
| | - Ebony Quintrell
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy (M503), PerthCrawley, WA, 6009, Australia
- Telethon Kids Institute, Perth, Australia
| | - David B Preen
- School of Population and Global Health, The University of Western Australia, 35 Stirling Hwy (M503), PerthCrawley, WA, 6009, Australia
| | - Prue Manners
- Rheumatology Section, Division Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Johannes Nossent
- Rheumatology Section, Division Medicine, Medical School, The University of Western Australia, Perth, Australia
- Department of Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia
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English J, Patrick S, Stewart LD. The potential role of molecular mimicry by the anaerobic microbiome in the aetiology of autoimmune disease. Anaerobe 2023; 80:102721. [PMID: 36940867 DOI: 10.1016/j.anaerobe.2023.102721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/28/2023] [Accepted: 03/13/2023] [Indexed: 03/23/2023]
Abstract
Autoimmune diseases are thought to develop as a consequence of various environmental and genetic factors, each of which contributes to dysfunctional immune responses and/or a breakdown in immunological tolerance towards native structures. Molecular mimicry by microbial components is among the environmental factors thought to promote a breakdown in immune tolerance, particularly through the presence of cross-reactive epitopes shared with the human host. While resident members of the microbiome are essential promoters of human health through immunomodulation, defence against pathogenic colonisation and conversion of dietary fibre into nutritional resources for host tissues, there may be an underappreciated role of these microbes in the aetiology and/or progression of autoimmune disease. An increasing number of molecular mimics are being identified amongst the anaerobic microbiota which structurally resemble endogenous components and, in some cases, for example the human ubiquitin mimic of Bacteroides fragilis and DNA methyltransferase of Roseburia intestinalis, have been associated with promoting antibody profiles characteristic of autoimmune diseases. The persistent exposure of molecular mimics from the microbiota to the human immune system is likely to be involved in autoantibody production that contributes to the pathologies associated with immune-mediated inflammatory disorders. Here-in, examples of molecular mimics that have been identified among resident members of the human microbiome and their ability to induce autoimmune disease through cross-reactive autoantibody production are discussed. Improved awareness of the molecular mimics that exist among human colonisers will help elucidate the mechanisms involved in the breakdown of immune tolerance that ultimately lead to chronic inflammation and downstream disease.
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Affiliation(s)
- Jamie English
- Institute for Global Food Security, School of Biological Sciences, Queen's University, Belfast. 19 Chlorine Gardens, Belfast, BT9 5DL, UK
| | - Sheila Patrick
- Institute for Global Food Security, School of Biological Sciences, Queen's University, Belfast. 19 Chlorine Gardens, Belfast, BT9 5DL, UK; The Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Linda D Stewart
- Institute for Global Food Security, School of Biological Sciences, Queen's University, Belfast. 19 Chlorine Gardens, Belfast, BT9 5DL, UK.
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Quan L, Tan J, Hua L, You X. Genetic predisposition between coronavirus disease 2019 and rheumatic diseases: A 2-sample Mendelian randomization study. Int J Rheum Dis 2023; 26:710-717. [PMID: 36890668 DOI: 10.1111/1756-185x.14624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE The causalities between the coronavirus disease 2019 (COVID-19) and the risk of rheumatic diseases remain unclear. The purpose of this study was to investigate the causal effect of COVID-19 on rheumatic disease occurrence. METHODS Single nucleotide polymorphisms (SNPs), acquired from published genome-wide association studies, were used to perform 2-sample Mendelian randomization (MR) on cases diagnosed with COVID-19 (n = 13 464), rheumatic diseases (n = 444 199), juvenile idiopathic arthritis (JIA, n = 15 872), gout (n = 69 374), systemic lupus erythematosus (SLE, n = 3094), ankylosing spondylitis (n = 75 130), primary biliary cholangitis (PBC, n = 11 375) and primary Sjögren's syndrome (n = 95 046). Three MR methods were used in the analysis based on different heterogeneity and pleiotropy using the Bonferroni correction. RESULTS The results revealed a causality between COVID-19 and rheumatic diseases with an odds ratio (OR) of 1.010 (95% confidence interval [CI], 1.006-1.013; P = .014). In addition, we observed that COVID-19 was causally associated with an increased risk of JIA (OR 1.517; 95%CI, 1.144-2.011; P = .004), PBC (OR 1.370; 95%CI, 1.149-1.635; P = .005), but a decreased risk of SLE (OR 0.732; 95%CI, 0.590-0.908; P = .004). Using MR, 8 SNPs were identified to associate with COVID-19 and recognized as significant variables. None of them were previously reported in any other diseases. CONCLUSIONS This is the first study to use MR to explore the impact of COVID-19 on rheumatic diseases. From a genetic perspective, we found that COVID-19 could increase the risk of rheumatic diseases, such as PBC and JIA, but decrease that of SLE, thereby suggesting a potential surge in the disease burden of PBC and JIA following the COVID-19 pandemic.
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Affiliation(s)
- Liuliu Quan
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiangshan Tan
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College and National Clinical Research Center of Cardiovascular Diseases, Beijing, China
| | - Lu Hua
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College and National Clinical Research Center of Cardiovascular Diseases, Beijing, China
| | - Xin You
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,Key Laboratory of Rheumatology & Clinical Immunology, Ministry of Education, Beijing, China.,National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, China
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7
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Horneff G, Minden K, Rolland C, Daly ACH, Borlenghi C, Ruperto N. Efficacy and safety of TNF inhibitors in the treatment of juvenile idiopathic arthritis: a systematic literature review. Pediatr Rheumatol Online J 2023; 21:20. [PMID: 36829225 PMCID: PMC9951426 DOI: 10.1186/s12969-023-00798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/29/2023] [Indexed: 02/26/2023] Open
Abstract
OBJECTIVE A systematic literature review was conducted to summarize efficacy and safety data from studies that evaluated tumor necrosis factor inhibitors in patients with juvenile idiopathic arthritis (JIA). METHODS Relevant publications were identified via online searches (cutoff: March 16, 2021). After screening search results, outcome data were extracted if the treatment arm included ≥ 30 patients. Outcomes were described narratively, with efficacy assessed by JIA-American College of Rheumatology (ACR) response criteria and safety assessed by the incidence of serious adverse events (SAEs) per 100 patient-years (100PY). RESULTS Among 87 relevant publications included in the qualitative synthesis, 19 publications described 13 clinical trials. Across the 13 trials, the percentages of patients who achieved JIA-ACR30/50/70/90 responses at Week 12 with adalimumab ranged 71-94%, 68-90%, 55-61%, and 39-42%, respectively; with etanercept (Week 12), 73-94%, 53-78%, 36-59%, and 28%; with golimumab (Week 16), 89%, 79%, 66%, and 36%; and with infliximab (Week 14), 64%, 50%, and 22% (JIA-ACR90 not reported). SAE incidence across all time points ranged 0-13.7 SAE/100PY for adalimumab, 0-20.0 SAE/100PY for etanercept, and 10.4-24.3 SAE/100PY for golimumab (1 study). SAE incidence could not be estimated from the 2 infliximab publications. CONCLUSION Tumor necrosis factor inhibitors are effective and well tolerated in the treatment of JIA, but additional evidence from head-to-head studies and over longer periods of time, especially in the context of the transition from pediatric to adult care, would be useful.
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Affiliation(s)
- Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany. .,Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany.
| | - Kirsten Minden
- grid.413453.40000 0001 2224 3060German Rheumatism Research Centre Berlin (DRFZ), Leibniz Association, Berlin, Germany ,grid.6363.00000 0001 2218 4662Department of Pediatric Pulmonology, Immunology, and Intensive Care Medicine, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Nicolino Ruperto
- grid.419504.d0000 0004 1760 0109IRCCS Istituto Giannina Gaslini, UOSID Centro Trial, Genoa, Italy
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8
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Deficiencia de IgA y comorbilidades autoinmunes en la artritis idiopática juvenil. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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IgA deficiency and autoimmune comorbidities in Juvenile Idiopathic Arthritis. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2022; 97:172-178. [PMID: 35459637 DOI: 10.1016/j.anpede.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/14/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES (1) To describe the prevalence of IgA deficiency (IgAD), uveitis, coeliac disease (CD) and thyroid disorders in a multicentric cohort of patients diagnosed with JIA and, (2) to evaluate whether patients with JIA and IgAD present other autoimmune diseases more frequently than patients with normal serum levels of IgA. METHODS Retrospective chart review of a cohort of patients diagnosed with JIA followed at the paediatric rheumatology units of two hospitals in Madrid, Spain. RESULTS A total of 193 patients were included. Of them, 123 were females (64%). Median age at disease onset was 5.6 years (IQR 2.5-9.7) and the median time of follow-up was 5.1 years (IQR 2.2-8.1). The three most common ILAR categories were oligoarticular (53%), polyarticular RF negative (20%) and enthesitis related arthritis (10%). Serum IgA levels were available in 172/193 (89%); 25/172 (15%) had selective (<7mg/dl, n=8) or partial (7-69mg/dl, n=17) IgAD. All the patients had periodic eye exams. Eighteen children (9%) had anterior uveitis, 15/18 chronic and 3/18 acute. Serum anti transglutaminase IgA, or IgG in IgAD were obtained in 135/193 (70%). Four children (3%) were diagnosed with CD either by intestinal biopsy (n=3) or by the combination of characteristic clinical, serological and genetic features (n=1); two of them had IgAD (p=0.12; OR=6.4; 95% CI 0.9-47.6). Only 1/153 (0.7%) patient had hyperthyrotropinemia with positive anti-thyroid antibodies and required replacement therapy. CONCLUSION Patients with JIA frequently present autoimmune comorbidities. IgAD does not seem to increase their prevalence, with the possible exception of CD.
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Abstract
Health and health care disparities in pediatric rheumatology are prevalent among socially disadvantaged and marginalized populations based on race/ethnicity, socioeconomic position, and geographic region. These groups are more likely to experience greater disease severity, morbidity, mortality, decreased quality of life, and poor mental health outcomes, which are in part due to persistent structural and institutional barriers, including decreased access to quality health care. Most of the research on health and health care disparities in pediatric rheumatology focuses on juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus; there are significant gaps in the literature assessing disparities associated with other pediatric rheumatic diseases. Understanding the underlying causes of health care disparities will ultimately inform the development and implementation of innovative policies and interventions on a federal, local, and individual level.
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Affiliation(s)
- Alisha M Akinsete
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA. https://twitter.com/@akinsetemd
| | - Jennifer M P Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA. https://twitter.com/@jmpwoo
| | - Tamar B Rubinstein
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA.
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11
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Children hospitalized for juvenile arthritis in the United States. Reumatologia 2021; 59:270-272. [PMID: 34538959 PMCID: PMC8436787 DOI: 10.5114/reum.2021.108356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/27/2021] [Indexed: 11/25/2022] Open
Abstract
Juvenile arthritis (JA) is an autoimmune condition affecting children. We used the 2017 National Inpatient Sample (NIS) to evaluate the impact of JA in the United States. The admission data were converted to weighted form and patients between the ages of 0 and 18 (inclusive) were used in our study. 560 weighted cases were found in 2017. It was more common in females than males (340 females, 220 males), Whites (235 cases), and Medicaid covered 61.6% of all patients with JA (345 cases). The total hospital charges were $25,147,389 while the mean length of stay (LOS) was 4.55 days. The highest number of cases was reported in April 2017.
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12
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Lovell DJ, Huang B, Chen C, Angeles-Han ST, Simon TA, Brunner HI. Prevalence of autoimmune diseases and other associated conditions in children and young adults with juvenile idiopathic arthritis. RMD Open 2021; 7:rmdopen-2020-001435. [PMID: 33731444 PMCID: PMC7978075 DOI: 10.1136/rmdopen-2020-001435] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objective Many autoimmune diseases share common pathogenic mechanisms; however, there are limited studies quantifying the coexistence of autoimmune diseases and associated conditions in patients with juvenile idiopathic arthritis (JIA). This large US-based study estimated and compared the prevalence of multiple coexisting autoimmune diseases in patients with JIA with a general paediatric (GP) patient population. Methods This retrospective cohort study was conducted using registry data from the Cincinnati Children’s Hospital Medical Center (January 2010–October 2018). The prevalence of multiple autoimmune diseases was estimated in patients (age <21 years) with JIA and a control group from the GP patient population. Crude prevalences of 26 prespecified autoimmune diseases and associated conditions were compared using Bayesian Poisson regression modelling for each year up to the end of the study period. Results Overall, 2026 patients were included in the JIA cohort and 41 572 in the GP cohort. Of 26 autoimmune diseases and associated conditions evaluated, 14 (53.8%) had a significantly higher prevalence in the JIA cohort compared with the GP cohort. In total, seven (26.9%) autoimmune diseases or associated conditions had a >20-fold increased prevalence in the JIA cohort compared with the GP cohort. Conclusion In this study, patients with JIA had a greater prevalence of a large number of coexisting autoimmune diseases and associated conditions compared with the GP population. Physicians should consider coexisting autoimmune diseases in the treatment and management of patients with JIA.
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Affiliation(s)
- Daniel J Lovell
- Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Bin Huang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Chen Chen
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sheila T Angeles-Han
- Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Teresa A Simon
- Bristol Myers Squibb, Princeton, New Jersey, USA.,Physicians Research Center, LLC, Toms Rover, New Jersey, USA
| | - Hermine I Brunner
- Pediatric Rheumatology Collaborative Study Group, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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Xu D, Zhang Y, Zhang ZY, Tang XM. Association between high mobility group box 1 protein and juvenile idiopathic arthritis: a prospective longitudinal study. Pediatr Rheumatol Online J 2021; 19:112. [PMID: 34247641 PMCID: PMC8273958 DOI: 10.1186/s12969-021-00587-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/05/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To analyze the levels of high mobility group box 1 (HMGB1) protein on different courses of juvenile idiopathic arthritis (JIA). METHODS In our prospective longitudinal study, children with JIA were included with their blood samples collected at the first visit, 1-month, 3-month, and 6-month follow-up, respectively. Samples were also collected from healthy controls and children with reactive arthritis at the first visit. Levels of HMGB1 were determined using enzyme-linked immunosorbent assays. Clinical disease characteristics and routine laboratory findings were analyzed as well. RESULTS A total of 64 children were enrolled, of whom 31 (48.4%) were female. The median age at the first visit for participants with JIA was 9.25 years (range, 1.42-15.42) and the median duration of disease was 2.38 months (range, 1.53-49.31). Serum HMGB1 levels at the first visit were significantly elevated in children with systemic JIA compared with other groups, and so were in enthesitis-related arthritis versus healthy controls. Significant correlations were established at the first visit between HMGB1 levels and duration of disease, C-reactive protein, percentage of neutrophils, and ferritin. Data from all samples revealed that serum HMGB1 levels in JIA were significantly associated with erythrocyte sedimentation rates, C-reactive protein, percentage of neutrophils, and disease activity scores. CONCLUSIONS Serum HMGB1 may be associated with clinical disease activity of JIA and specifically increased at the first visit in children with systemic JIA, suggesting its function as a sensitive inflammatory marker. Further large-scale studies are warranted to explore its spectrum in JIA.
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Affiliation(s)
- Dan Xu
- grid.488412.3Department of Rheumatology and Immunology, Children’s Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014 People’s Republic of China ,grid.488412.3Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Yu Zhang
- grid.488412.3Department of Rheumatology and Immunology, Children’s Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014 People’s Republic of China ,grid.488412.3Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Zhi-Yong Zhang
- grid.488412.3Department of Rheumatology and Immunology, Children’s Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014 People’s Republic of China ,grid.488412.3Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children’s Hospital of Chongqing Medical University, Chongqing, People’s Republic of China
| | - Xue-Mei Tang
- Department of Rheumatology and Immunology, Children's Hospital of Chongqing Medical University, 136, Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, People's Republic of China. .,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Child Infection and Immunity, Children's Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
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Patterson EK, Vanin Moreno N, Fraser DD, Cepinskas G, Iida T, Berard RA. A Proteinase 3 Contribution to Juvenile Idiopathic Arthritis-Associated Cartilage Damage. PATHOPHYSIOLOGY 2021; 28:320-327. [PMID: 35366277 PMCID: PMC8830470 DOI: 10.3390/pathophysiology28030021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/18/2021] [Accepted: 06/22/2021] [Indexed: 11/16/2022] Open
Abstract
A full understanding of the molecular mechanisms implicated in the etiopathogenesis of juvenile idiopathic arthritis (JIA) is lacking. A critical role for leukocyte proteolytic activity (e.g., elastase and cathepsin G) has been proposed. While leukocyte elastase’s (HLE) role has been documented, the potential contribution of proteinase 3 (PR3), a serine protease present in abundance in neutrophils, has not been evaluated. In this study we investigated: (1) PR3 concentrations in the synovial fluid of JIA patients using ELISA and (2) the cartilage degradation potential of PR3 by measuring the hydrolysis of fluorescently labeled collagen II in vitro. In parallel, concentrations and collagen II hydrolysis by HLE were assessed. Additionally, the levels of the co-secreted primary granule protein myeloperoxidase (MPO) were assessed in synovial fluid of patients diagnosed with JIA. We report the following levels of analytes in JIA synovial fluid: PR3—114 ± 100 ng/mL (mean ± SD), HLE—1272 ± 1219 ng/mL, and MPO—1129 ± 1659 ng/mL, with a very strong correlation between the PR3 and HLE concentrations (rs = 0.898, p < 1 × 10–6). Importantly, PR3 hydrolyzed fluorescently labeled collagen II as efficiently as HLE. Taken together, these novel findings suggest that PR3 (in addition to HLE) contributes to JIA-associated joint damage.
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Affiliation(s)
- Eric K. Patterson
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON N6A 5W9, Canada; (E.K.P.); (N.V.M.); (G.C.); (T.I.)
| | - Nicolas Vanin Moreno
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON N6A 5W9, Canada; (E.K.P.); (N.V.M.); (G.C.); (T.I.)
| | - Douglas D. Fraser
- Lawson Health Research Institute, Children’s Health Research Institute, London, ON N6A 5W9, Canada;
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
| | - Gediminas Cepinskas
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON N6A 5W9, Canada; (E.K.P.); (N.V.M.); (G.C.); (T.I.)
- Department of Medical Biophysics, Western University, London, ON N6A 5C1, Canada
| | - Takaya Iida
- Centre for Critical Illness Research, Lawson Health Research Institute, London, ON N6A 5W9, Canada; (E.K.P.); (N.V.M.); (G.C.); (T.I.)
| | - Roberta A. Berard
- Lawson Health Research Institute, Children’s Health Research Institute, London, ON N6A 5W9, Canada;
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON N6A 5C1, Canada
- Division of Rheumatology, London Health Sciences Centre, Children’s Hospital, London, ON N6A 5W9, Canada
- Correspondence:
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15
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Feely A, Lim LS, Jiang D, Lix LM. A population-based study to develop juvenile arthritis case definitions for administrative health data using model-based dynamic classification. BMC Med Res Methodol 2021; 21:105. [PMID: 33993875 PMCID: PMC8127203 DOI: 10.1186/s12874-021-01296-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/27/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has shown that chronic disease case definitions constructed using population-based administrative health data may have low accuracy for ascertaining cases of episodic diseases such as rheumatoid arthritis, which are characterized by periods of good health followed by periods of illness. No studies have considered a dynamic approach that uses statistical (i.e., probability) models for repeated measures data to classify individuals into disease, non-disease, and indeterminate categories as an alternative to deterministic (i.e., non-probability) methods that use summary data for case ascertainment. The research objectives were to validate a model-based dynamic classification approach for ascertaining cases of juvenile arthritis (JA) from administrative data, and compare its performance with a deterministic approach for case ascertainment. METHODS The study cohort was comprised of JA cases and non-JA controls 16 years or younger identified from a pediatric clinical registry in the Canadian province of Manitoba and born between 1980 and 2002. Registry data were linked to hospital records and physician billing claims up to 2018. Longitudinal discriminant analysis (LoDA) models and dynamic classification were applied to annual healthcare utilization measures. The deterministic case definition was based on JA diagnoses in healthcare use data anytime between birth and age 16 years; it required one hospitalization ever or two physician visits. Case definitions based on model-based dynamic classification and deterministic approaches were assessed on sensitivity, specificity, and positive and negative predictive values (PPV, NPV). Mean time to classification was also measured for the former. RESULTS The cohort included 797 individuals; 386 (48.4 %) were JA cases. A model-based dynamic classification approach using an annual measure of any JA-related healthcare contact had sensitivity = 0.70 and PPV = 0.82. Mean classification time was 9.21 years. The deterministic case definition had sensitivity = 0.91 and PPV = 0.92. CONCLUSIONS A model-based dynamic classification approach had lower accuracy for ascertaining JA cases than a deterministic approach. However, the dynamic approach required a shorter duration of time to produce a case definition with acceptable PPV. The choice of methods to construct case definitions and their performance may depend on the characteristics of the chronic disease under investigation.
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Affiliation(s)
- Allison Feely
- Department of Epidemiology and Cancer Registry, CancerCare Manitoba, Winnipeg, Canada
| | - Lily Sh Lim
- Department of Paediatrics, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Depeng Jiang
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Canada
| | - Lisa M Lix
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, S113-750 Bannatyne Avenue, R3E 0W3, Winnipeg, Canada.
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Tominna M, Vega-Fernandez P, McLaurin W, Meyers AB. Imaging of the Pediatric Temporomandibular Joint. Semin Roentgenol 2021; 56:307-324. [PMID: 34281682 DOI: 10.1053/j.ro.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marie Tominna
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Wallace McLaurin
- Division of Oral and Maxillofacial Surgery, University of Cincinnati, Cincinnati, OH
| | - Arthur B Meyers
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Fortuna-Reyna BDJ, Peláez-Ballestas I, García-Rodríguez F, Faugier-Fuentes E, Mendieta-Zerón S, Villarreal-Treviño AV, Rosiles-De la Garza SG, Reyes-Cordero G, Jiménez-Hernández S, Guadarrama-Orozco JH, de la O-Cavazos ME, Rubio-Pérez N. Psychosocial and economic impact of rheumatic diseases on caregivers of Mexican children. Pediatr Rheumatol Online J 2021; 19:30. [PMID: 33731150 PMCID: PMC7967951 DOI: 10.1186/s12969-021-00524-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 03/04/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pediatric rheumatic disease (PRD) patients and their caregivers face a number of challenges, including the consequences of the PRD in patients and the impact on multiple dimensions of the caregivers' daily lives. The objective of this study is to measure the economic, psychological and social impact that PRD has on the caregivers of Mexican children. METHODS This is a multicenter, cross-sectional study including primary caregivers of children and adolescents with PRD (JIA, JDM and JSLE) during April and November, 2019. A trained interviewer conducted the CAREGIVERS questionnaire, a specific, 28-item multidimensional tool validated to measure the impact on different dimensions of the lives of caregivers. Sociodemographic, clinical, and healthcare system data were collected for further analysis. RESULTS Two hundred participants were recruited (women 169, 84.5%, aged 38 [IQR 33-44] years); 109 (54.5%) cared for patients with JIA, 28 (14%) JDM and 63 (31.5%) JSLE. The healthcare system was found to be determinant on the impact of the disease. The emotional impact was higher in all the participants, regardless of the specific diagnoses. The social dimension showed significant differences regarding PRD, healthcare system, time to reach the center, presence of disability, active disease, cutaneous and systemic manifestations, treatment and partner. Financial and work impacts were more frequent in those caring for JSLE and less so in those with a partner. Family relationships changed in 81 caregivers (25 [12.5%] worsened and 56 [28%] improved). No variables affecting spirituality were found. For caregivers without a partner, the social networks impact increased. CONCLUSION The influence of sociodemographic factors can be devastating on families with children with a PRD. These data will help physicians to identify the areas with the greatest need for intervention to achieve comprehensive care for caregivers and their patients.
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Affiliation(s)
- Brenda de Jesús Fortuna-Reyna
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Ingris Peláez-Ballestas
- grid.414716.10000 0001 2221 3638Rheumatology Unit, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City, Mexico
| | - Fernando García-Rodríguez
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Enrique Faugier-Fuentes
- grid.414757.40000 0004 0633 3412Hospital Infantil de México Federico Gómez, Servicio de Reumatología, Mexico City, Mexico
| | - Samara Mendieta-Zerón
- Instituto de Seguridad Social del Estado de México y Municipios, Hospital Regional Toluca, Toluca, Mexico
| | - Ana Victoria Villarreal-Treviño
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Sara Georgina Rosiles-De la Garza
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Greta Reyes-Cordero
- grid.440441.10000 0001 0695 3281Hospital Infantil de Especialidades del Estado de Chihuahua, Facultad de Medicina y Ciencias Biomédicas, Universidad Autónoma de Chihuahua, Chihuahua, Mexico
| | - Sol Jiménez-Hernández
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Jessica Haydee Guadarrama-Orozco
- grid.414757.40000 0004 0633 3412Departamento de Cuidados Paliativos y Calidad de Vida, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - Manuel Enrique de la O-Cavazos
- grid.464574.00000 0004 1760 058XDepartment of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario “Dr. José E. González”, Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460 Monterrey, Mexico
| | - Nadina Rubio-Pérez
- Department of Pediatrics, Universidad Autónoma de Nuevo León, Hospital Universitario "Dr. José E. González", Madero y Gonzalitos SN, Col. Mitras Centro, C.P, 64460, Monterrey, Mexico.
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Rosen P, Mullett C. Lessons From Starting a New Subspecialty in a Rural State. J Patient Exp 2021; 7:986-988. [PMID: 33457534 PMCID: PMC7786679 DOI: 10.1177/2374373520942093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
In starting a new pediatric rheumatology service in a rural state, we designed the practice to focus on patient access, patient quality, and patient experience. We created a clinical experience that starts with an intake call to optimize the face-to-face visit. A team-based care approach is used. Weekend appointments are offered to avoid school and work absence. The social determinants of health are addressed. In our first year, our patients have reported their appreciation for a high-touch, patient-centered experience.
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Affiliation(s)
- Paul Rosen
- WVU Medicine Children's, Morgantown, WV, USA
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Are psychological symptoms a risk factor for musculoskeletal pain in adolescents? Eur J Pediatr 2021; 180:2173-2183. [PMID: 33655417 PMCID: PMC8195761 DOI: 10.1007/s00431-021-04002-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/31/2021] [Accepted: 02/18/2021] [Indexed: 12/21/2022]
Abstract
Adolescent musculoskeletal pain is common and is associated with musculoskeletal pain in adulthood. Psychological symptoms, also common in adolescence, have been shown to be associated with musculoskeletal pain, but the current evidence is mixed and may be dependent on effect modifiers. This study investigated whether adolescents with psychological symptoms (internalizing and externalizing constructs) at age 13 years were at higher odds for musculoskeletal pain at age 17 years and whether the associations were modified by pubertal status and sex. A prospective cohort design examined data on 3865 adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC). Associations between baseline (aged 13 years) internalizing and externalizing symptoms and musculoskeletal pain at follow-up (aged 17 years) were investigated using logistic regression producing odds ratios (OR) and 95% confidence intervals (95% CI). In total 43.1% of adolescents reported musculoskeletal pain at follow-up. Externalizing symptoms at baseline increased the odds of musculoskeletal pain (OR 1.68, 95% CI 1.28, 2.20), and internalizing symptoms demonstrated a non-significant increase (OR 1.26, 95% CI 0.98, 1.62). Effect modification analysis showed an increased effect dependent on pubertal status.Conclusion: Adolescents with externalizing symptoms, and to some extent internalizing symptoms, are at increased odds of later musculoskeletal pain. Future research is now required to understand the reasons for these associations. What is Known: • Current evidence regarding the association between internalizing symptoms and externalizing symptoms and future musculoskeletal pain in adolescents is mixed. What is New: • This study found that adolescents with externalizing symptoms, and to some extent internalizing symptoms, are at increased odds for musculoskeletal pain, with an increased influence dependent on pubertal status. • These results are of interest for the development of timely preventative interventions designed to reduce the risk of musculoskeletal pain.
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Räisänen L, Viljakainen H, Sarkkola C, Kolho KL. Perinatal risk factors for pediatric onset type 1 diabetes, autoimmune thyroiditis, juvenile idiopathic arthritis, and inflammatory bowel diseases. Eur J Pediatr 2021; 180:2115-2123. [PMID: 33624160 PMCID: PMC8195774 DOI: 10.1007/s00431-021-03987-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/11/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023]
Abstract
Type 1 diabetes mellitus (DM), autoimmune thyroiditis (AIT), juvenile idiopathic arthritis (JIA), and inflammatory bowel diseases (IBD) are common pediatric autoimmune diseases with unknown risk factors. Using nationwide registers, we searched for their perinatal risk factors. Our study followed up 11,407 children (born 2000-2005) for a median of 16.6 years (from birth to 2018). Of them, 2.15% received primary diagnosis and 0.08% also secondary: 0.89% had DM, 0.60% had AIT, 0.48% had JIA, and 0.25% had IBD. The incidences per 100,000 children/year were 106.1 for DM, 46.0 for AIT, 55.0 for JIA, and 23.7 for IBD. There were more preterm births (< 37 weeks) among children with studied autoimmune diseases compared with the rest of the cohort (8.6% vs. 5.3%, p = 0.035). Among those born preterm, children with studied autoimmune diseases received more postnatal antibiotics compared with other preterm children in the cohort (47.6% vs. 27.7%, p = 0.046). Children with IBD were born to older mothers compared with those without studied diagnoses (33.0 vs 30.2, p = 0.004).Conclusion: Preterm birth was a shared risk factor for autoimmune diseases in our study, especially when combined with postnatal antibiotic treatments. High maternal age was associated with IBD. What is Known: • Type 1 diabetes (DM), autoimmune thyroiditis (AIT), juvenile idiopathic arthritis (JIA), and inflammatory bowel diseases (IBD) are common pediatric autoimmune diseases • It is unclear whether these diseases have shared risk factors, since there are no previous simultaneous epidemiological nor follow-up studies on them in one cohort What is New: • Preterm births were more common in children with DM, AIT, JIA, or IBD compared with other children in the cohort, and preterm children who developed these diseases recieved more postnatal antibiotics compared with other preterm children • High maternal age was associated with IBD.
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Affiliation(s)
- Laura Räisänen
- Faculty of Medicine and Health Technology (MET), Tampere University, Tampere, Finland. .,Folkhälsan Research Center, Helsinki, Finland.
| | - Heli Viljakainen
- grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland ,grid.7737.40000 0004 0410 2071Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Catharina Sarkkola
- grid.428673.c0000 0004 0409 6302Folkhälsan Research Center, Helsinki, Finland
| | - Kaija-Leena Kolho
- grid.502801.e0000 0001 2314 6254Faculty of Medicine and Health Technology (MET), Tampere University, Tampere, Finland ,grid.7737.40000 0004 0410 2071Faculty of Medicine and Children´s Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Butler S, Sculley D, Santos DS, Fellas A, Gironès X, Singh-Grewal D, Coda A. Usability of eHealth and Mobile Health Interventions by Young People Living With Juvenile Idiopathic Arthritis: Systematic Review. JMIR Pediatr Parent 2020; 3:e15833. [PMID: 33258786 PMCID: PMC7738264 DOI: 10.2196/15833] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 01/27/2020] [Accepted: 10/03/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Considering the changing landscape of internet use and rising ownership of digital technology by young people, new methods could be considered to improve the current model of juvenile idiopathic arthritis (JIA) management. OBJECTIVE This systematic review aims to evaluate the usability of eHealth and mobile health (mHealth) interventions currently available for young people living with JIA. METHODS The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to oversee this review. We systematically searched 15 databases for 252 potential studies; 2 authors independently screened all quantitative studies reporting the use of eHealth and mHealth interventions for young people (aged 1-18 years) diagnosed with JIA. Studies were excluded if they did not report outcome measures or were reviews, commentaries, or qualitative studies. Study methodological quality was scored using the Down and Black (modified) checklist. A narrative descriptive methodology was used to quantify the data because of heterogeneity across the studies. RESULTS A total of 11 studies were included in this review, reporting 7 eHealth and mHealth interventions for young people (aged 4-18 years) living with JIA, targeting health issues such as pain, health-related quality of life, physical activity, and chronic disease self-management. The usability of the interventions was facilitated through training and ongoing support. The engagement was promoted by a combination of persuasive influences, and barriers preventing adherence were removed through personal reminders and flexible program schedules to cater to JIA and non-JIA illnesses or other commonly seen activities in childhood. The feedback obtained was that most young people and their parents liked the interventions. CONCLUSIONS The results of this review need to be considered cautiously because of the lack of rigorous testing and heterogeneity, which limits the detailed descriptions of data synthesis. Further research is needed to consider gender differences, associated costs, and the effectiveness of the interventions on health outcomes to better support young people living with JIA.
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Affiliation(s)
- Sonia Butler
- School of Bioscience and Pharmacy, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Dean Sculley
- School of Bioscience and Pharmacy, University of Newcastle, Ourimbah, New South Wales, Australia
| | - Derek Santos Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Antoni Fellas
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Xavier Gironès
- Director of Research and Innovation, University of Vic-Central University of Catalonia, Manresa (Barcelona), Spain
| | - Davinder Singh-Grewal
- Department of Rheumatology, Sydney Children's Hospitals Network, Randwick and Westmead, Sydney, New South Wales, Australia
- Department of Rheumatology, John Hunter Children's Hospital, Newcastle, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Andrea Coda
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
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Seth A, Yen YM, Tourn D, Smit K, Carsen S. A Unique and Characteristic Cam FAI Morphology in Young Patients with Comorbid Inflammatory Conditions. J Bone Joint Surg Am 2020; 102:15-21. [PMID: 32453107 DOI: 10.2106/jbjs.20.00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between femoroacetabular impingement (FAI) and inflammatory medical comorbidities has not been established in the pediatric population. The purpose of this study was to investigate the prevalence of inflammatory conditions in pediatric patients with FAI and the morphology of the associated deformity. METHODS We performed a retrospective cohort study of 90 patients who were diagnosed with FAI in our institution's adolescent hip clinic from January 2016 to March 2018. Patients with an inflammatory comorbidity were identified. Standard quantitative radiographic FAI measurements as well as qualitative femoral head-neck junction morphology were analyzed. RESULTS Eight patients (8.9%) with 11 symptomatic hips were found to have an inflammatory condition. These 8 patients all had cam deformities. Nine of the symptomatic hips in this subset of patients had a negative femoral offset, where the cam deformity extended beyond the anterior margin of the femoral head. Qualitative assessment revealed a unique head-neck morphology with a prominent and "sharp-edged" bump at the head-neck junction, which resembled an inflammatory beak. In comparing patients with and without inflammatory comorbidities, a marked difference was found for alpha angles (difference, 26.6°; 95% confidence interval [CI], 18.2° to 35.0°) but not for age at diagnosis (difference, 0.5 years; 95% CI, -0.8 to 1.6 years) or the lateral center-edge angle (difference, 1.9°; 95% CI, -3.9° to 7.7°). CONCLUSIONS At our institution, 8.9% of pediatric patients with FAI were found to have an inflammatory comorbidity. These patients presented with a characteristic prominent "sharp-edged" head-neck morphology that standard radiographic measurements captured as a negative femoral offset and a larger alpha angle than was seen in patients without systemic inflammatory disease. Awareness of the characteristic cam deformity that was found in these patients may help to identify patients with undiagnosed inflammatory conditions. This unique deformity also raises questions regarding the possible role of physeal inflammation in the development of cam deformities and indicates a need for additional studies to investigate the relationship between systemic inflammatory diseases and FAI. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Akshay Seth
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Diego Tourn
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kevin Smit
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Klinkhardt C, Tanaka P, Adriano A. Anesthesia for Patients with Juvenile Idiopathic Arthritis Current Practice: A Review. Open Orthop J 2020. [DOI: 10.2174/1874325002014010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
Juvenile Idiopathic Arthritis is one of the most common chronic diseases in children. The disease affects one or multiple joints. Additionally, systemic involvement can be present either due to the condition itself or due to pharmacologic side effects resulting from treatment. This article reviews different aspects of perioperative management of patients with Juvenile Idiopathic Arthritis. It outlines the risks and difficulties secondary to articular damage, and also pharmacologic treatment strategies interfering with the anesthetic plan.
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Khodra B, M Stevens A, Ferucci ED. Prevalence of Juvenile Idiopathic Arthritis in the Alaska Native Population. Arthritis Care Res (Hoboken) 2020; 72:1152-1158. [PMID: 31150159 DOI: 10.1002/acr.23997] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/28/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the prevalence and clinical characteristics of juvenile idiopathic arthritis (JIA) in Alaska Native children. METHODS Potential cases of JIA were identified by querying administrative data from hospitals and clinics in the Alaska Tribal Health System for codes possibly identifying JIA. Medical record abstraction was performed to confirm criteria met for JIA, demographic and clinical characteristics, and treatment patterns. Individuals age ≤18 years with a confirmed diagnosis of JIA were included. The denominator for prevalence was the 2015 Alaska Area Indian Health Service user population age of ≤18 years. RESULTS The unadjusted prevalence of JIA in Alaska Native children was 74.6 per 100,000 (age-adjusted 79.0 per 100,000). JIA was more common in females than males (unadjusted prevalence 105.8 versus 45.0 per 100,000). Oligoarthritis was the most common subtype (31% of cases), but polyarthritis and enthesitis-related arthritis were also common (26% and 24% of cases, respectively), with a notably high prevalence of enthesitis-related arthritis. The median age at diagnosis was 9 years. Of the combined cohort with results available, 56% were antinuclear antibody positive, 23% were rheumatoid factor positive, 19% were anti-cyclic citrullinated peptide antibody positive, and 57% had the presence of HLA-B27. Uveitis had been diagnosed in 16% of cases. CONCLUSION The prevalence of JIA in Alaska Native children may be higher than the general US population. Enthesitis-related arthritis makes up a higher proportion of cases than in other populations described likely because of the high prevalence of HLA-B27 in this population.
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Affiliation(s)
| | - Anne M Stevens
- Seattle Children's Research Institute, Seattle, Washington
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26
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Toupin April K, Stinson J, Cavallo S, Proulx L, Wells GA, Duffy CM, ElHindi T, Longmuir PE, Brosseau L. Yoga and Aerobic Dance for Pain Management in Juvenile Idiopathic Arthritis: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2020; 9:e12823. [PMID: 32442139 PMCID: PMC7381073 DOI: 10.2196/12823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 02/18/2020] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
Background Juvenile idiopathic arthritis (JIA) is one of the most common types of arthritis among children. According to JIA guidelines for physical activity (PA), structured PA interventions led to improved health outcomes. However, many PA programs, such as yoga and aerobic dance, have not been studied in this population despite being popular among youth. Web-based PA programs could provide patients with accessible and affordable interventions. Objective The primary aims of the proposed pilot randomized controlled trial (RCT) are to examine (1) the feasibility of conducting a full-scale RCT to evaluate the effectiveness of two popular types of PA: a yoga training program and an aerobic dance training program, in female adolescents (aged 13-18 years) with JIA compared with an electronic pamphlet control group; and (2) the acceptability of these interventions. Methods A three-arm prospective randomized open-label study with a parallel group design will be used. A total of 25 female adolescents with JIA who have pain will be randomized in a ratio of 2:2:1 to one of the 3 groups: (1) online yoga training program (group A: n=10); (2) online aerobic dance training program (group B: n=10); and (3) electronic pamphlet control group (group C: n=5). Participants in groups A and B will complete 3 individual 1-hour sessions per week using online exercise videos, as well as a 1-hour virtual group session per week using a videoconferencing platform for 12 weeks. Participants from all groups will have access to an electronic educational pamphlet on PA for arthritis developed by the Arthritis Society. All participants will also take part in weekly online consultations with a research coordinator and discussions on Facebook with participants from their own group. Feasibility (ie, recruitment rate, self-reported adherence to the interventions, dropout rates, and percentage of missing data), acceptability, and usability of Facebook and the videoconferencing platform will be assessed at the end of the program. Pain intensity, participation in general PA, morning stiffness, functional status, fatigue, self-efficacy, patient global assessment, disease activity, and adverse events will be assessed using self-administered electronic surveys at baseline and then weekly until the end of the 12-week program. Results This pilot RCT has been funded by the Arthritis Health Professions Association. This protocol was approved by the Children’s Hospital of Eastern Ontario Research Ethics Board (#17/08X). As of May 11, 2020, recruitment and data collection have not started. Conclusions To our knowledge, this is the first study to evaluate the effectiveness of yoga and aerobic dance as pain management interventions for female adolescents with JIA. The use of online programs to disseminate these 2 PA interventions may facilitate access to alternative methods of pain management. This study can lead to a full-scale RCT. International Registered Report Identifier (IRRID) PRR1-10.2196/12823
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Affiliation(s)
- Karine Toupin April
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Sabrina Cavallo
- École de Réadaptation, Université de Montréal, Montréal, QC, Canada
| | - Laurie Proulx
- Canadian Arthritis Patient Alliance, Ottawa, ON, Canada
| | - George A Wells
- Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ciarán M Duffy
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Division of Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | - Patricia E Longmuir
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Lucie Brosseau
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
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Valentino R, Rongo R, Alessio M, Alstergren P, Bucci R, Leone G, D’Antò V, Michelotti A. “Pressure pain threshold over masticatory muscles and temporomandibular joint in patients with juvenile idiopathic arthritis”. J Oral Rehabil 2020; 47:944-950. [DOI: 10.1111/joor.13024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/05/2020] [Accepted: 05/16/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Roberta Valentino
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Roberto Rongo
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Maria Alessio
- Department of Translational Medicine University Naples Federico II Naples Italy
| | - Per Alstergren
- Orofacial Pain and Jaw Function Institute of Dental Medicine Karolinska Institutet Huddinge Sweden
- Orofacial Pain Unit Faculty of Odontology Malmö University Malmö Sweden
| | - Rosaria Bucci
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Giovanna Leone
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Vincenzo D’Antò
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
| | - Ambrosina Michelotti
- School of Orthodontics Department of Neurosciences, Reproductive Sciences and Oral Sciences University of Naples Federico II Naples Italy
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Juvenile idiopathic arthritis in Southeast Asia: the Singapore experience over two decades. Clin Rheumatol 2020; 39:3455-3464. [PMID: 32418038 DOI: 10.1007/s10067-020-05081-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 03/23/2020] [Accepted: 04/01/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To examine the clinical characteristics, treatment and outcomes of juvenile idiopathic arthritis (JIA) patients evaluated in Singapore and compare those with reports elsewhere. METHODS Patients with JIA were recruited from our Singapore pediatric rheumatology registry from January 1997 to December 2015. Demographic, clinical, treatment, and outcome data were retrospectively collected. Nonparametric statistics were used to describe the data. Chi-squared, Mann-Whitney U, or Kruskal-Wallis tests were applied to compare differences between groups where appropriate. Multivariate logistic regression analyses were used to identify predictors for clinical parameters. RESULTS Two hundred eighty-seven JIA patients with 60.6% males of predominantly Chinese descent were included in the study. The median onset age was 9 years (IQR 5.3-12.6), and the median follow-up duration was 30.1 months (IQR 9.1-61.7). Enthesitis-related arthritis (ERA, 32.8%) followed by persistent oligoarthritis (31.0%) was the most common. Elbow or ankle involvement predicted oligoarthritis extension (OR 15.8 (95% CI: 2.3-108.3, p = 0.005), 8.1 (95% CI: 1.5-45.3, p = 0.017)). JIA-associated uveitis was rare (2.8%) which paralleled the less common positive-ANA rate. Majority of our ERA patients had HLA-B27 (79.8%), together with older age predicted sacroiliitis (OR 4.7 (95% CI: 2.0-11.1, p < 0.05), OR 1.2 (95% CI: 1.1-1.3, p = 0.002)). TMJ involvement was under-reported. Methotrexate remained the most common DMARD used, but 36% of patients required biologics for which ERA and polyarthritis were the majority. Joint damage was rare. CONCLUSION This study highlights geographical and ethnic differences in JIA epidemiology. Compared with reports elsewhere, our JIA population had many unique findings and good functional outcomes requiring regional study validation. Key points • ERA is the most prominent JIA subtype in Singapore with high prevalence of HLA-B27. • JIA-associated uveitis is rare in SEA and is not associated with ANA or JIA-subtypes. • Elbow and/or ankle involvement at presentation is associated with oligoarthritis extension in our JIA cohort.
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Tripalo Batoš A, Potočki K, Žutelija Fattorini M, Posarić V, Roić G, Gagro A. Is axial magnetic resonance imaging useful in early juvenile spondyloarthritis-preliminary report. Clin Rheumatol 2020; 39:3017-3025. [PMID: 32297033 DOI: 10.1007/s10067-020-05037-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 12/23/2019] [Accepted: 03/05/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION/OBJECTIVES Magnetic resonance imaging (MRI) is recommended for evaluation of changes in juvenile spondyloarthropathies (JSpA). To our knowledge, there is no previous prospective study analysing early changes on axial MRI. The objective is to investigate incidence of reparable changes on axial MRI in patients with established JSpA, lasting for less than 6 months. MATERIALS AND METHODS The pilot study included 27 patients with confirmed diagnosis of JSpA examined within 2 years. Prior to imaging, basic demographic and laboratory data and HLA-B27 were collected. Patients filled out a visual analogue scale for pain and a childhood health assessment questionnaire. A paediatric rheumatologist and a paediatric physiatrist examined patients and measured indices of flexion, extension and sagittal flexibility. Contrast-enhanced axial MRI examination and cervical x-ray were performed. Three experienced paediatric radiologists independently reviewed x-ray and MRI images of all patients. RESULTS There was no significant correlation between early changes detected on MRI and other parameters. The study revealed early changes of the cervical spine to be the most common finding. More patients had positive cervical MRI than positive sacroiliac joint (SIJ) MRI. Cervical x-ray and MRI were equally useful for diagnosis regardless of other parameters. CONCLUSION Study showed new information on axial involvement, striking cervical spine as the most involved part. The biggest study limitation is the small number of patients. Establishing early JSpA diagnosis is of utmost importance, especially in the light of novel therapy introduced in every day practice. It seems that cervical spine involvement is more represented than previously described in literature, especially in comparison with SIJ. Key Points • Contrast-enhanced MRI is considered the gold standard for detection early changes in JSpA. • Standardization of diagnostic criteria and better classification of changes using the unique scoring system for children are necessary. • It seems that cervical spine involvement is more represented than previously described in the literature, especially in comparison with SIJ involvement.
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Affiliation(s)
- Ana Tripalo Batoš
- Department of Paediatric Radiology, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia.,University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia
| | - Kristina Potočki
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia.,Department for Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb, Croatia
| | - Matija Žutelija Fattorini
- Department of Orthopaedic, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia.,Fattorini Clinic For Paediatric and Adolescent Physical Therapy and Rehabilitation, Zagreb, Croatia
| | - Vesna Posarić
- Department of Paediatric Radiology, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia
| | - Goran Roić
- Department of Paediatric Radiology, Children's Hospital Zagreb, Klaićeva 16, Zagreb, Croatia.,University of Applied Health Sciences, Mlinarska 38, Zagreb, Croatia.,School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia
| | - Alenka Gagro
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia. .,Department of Pulmonology, Allergology, Immunology and Rheumatology, Department of Paediatrics, Children's Hospital Zagreb, Klaićeva 16, 10000, Zagreb, Croatia. .,Faculty of Medicine, Josip Juraj Strossmayerr, Josipa Huttlera 4, University of Osijek, Osijek, Croatia.
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Lee JJY, Duffy CM, Guzman J, Oen K, Barrowman N, Rosenberg AM, Shiff NJ, Boire G, Stringer E, Spiegel L, Morishita KA, Lang B, Reddy D, Huber AM, Cabral DA, Feldman BM, Yeung RSM, Tucker LB, Watanabe Duffy K. Prospective Determination of the Incidence and Risk Factors of New-Onset Uveitis in Juvenile Idiopathic Arthritis: The Research in Arthritis in Canadian Children Emphasizing Outcomes Cohort. Arthritis Care Res (Hoboken) 2020; 71:1436-1443. [PMID: 30320957 DOI: 10.1002/acr.23783] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 10/09/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Identification of the incidence of juvenile idiopathic arthritis (JIA)-associated uveitis and its risk factors is essential to optimize early detection. Data from the Research in Arthritis in Canadian Children Emphasizing Outcomes inception cohort were used to estimate the annual incidence of new-onset uveitis following JIA diagnosis and to identify associated risk factors. METHODS Data were reported every 6 months for 2 years, then yearly to 5 years. Incidence was determined by Kaplan-Meier estimators with time of JIA diagnosis as the reference point. Univariate log-rank analysis identified risk factors and Cox regression determined independent predictors. RESULTS In total, 1,183 patients who enrolled within 6 months of JIA diagnosis met inclusion criteria, median age at diagnosis of 9.0 years (interquartile range [IQR] 3.8-12.9), median follow-up of 35.2 months (IQR 22.7-48.3). Of these patients, 87 developed uveitis after enrollment. The incidence of new-onset uveitis was 2.8% per year (95% confidence interval [95% CI] 2.0-3.5) in the first 5 years. The annual incidence decreased during follow-up but remained at 2.1% (95% CI 0-4.5) in the fifth year, although confidence intervals overlapped. Uveitis was associated with young age (<7 years) at JIA diagnosis (hazard ratio [HR] 8.29, P < 0.001), positive antinuclear antibody (ANA) test (HR 3.20, P < 0.001), oligoarthritis (HR 2.45, P = 0.002), polyarthritis rheumatoid factor negative (HR 1.65, P = 0.002), and female sex (HR 1.80, P = 0.02). In multivariable analysis, only young age at JIA diagnosis and ANA positivity were independent predictors of uveitis. CONCLUSION Vigilant uveitis screening should continue for at least 5 years after JIA diagnosis, and priority for screening should be placed on young age (<7 years) at JIA diagnosis and a positive ANA test.
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Affiliation(s)
- Jennifer J Y Lee
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Natalie J Shiff
- University of Florida Health Shands Children's Hospital and University of Florida, Gainesville
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Elizabeth Stringer
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Kimberly A Morishita
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Deepti Reddy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - David A Cabral
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian M Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
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Schanberg LE, Ramanan AV, De Benedetti F, Beukelman T, Eakin GS, Del Gaizo V, Ringold S, Vesely R, Schrandt S, Jaki T, Bili A, Chung JB, De Bono S, Douglass W, Enejosa JV, Kanik KS, Knobe K, Kunder R, Leite-Schnell JC, Suehiro RM, Wong RL, Mieszkalski KL, Marrow LC, Siebenaler K, Fraulo E, Kimura Y. Toward Accelerated Authorization and Access to New Medicines for Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2019; 71:1976-1984. [PMID: 31313532 DOI: 10.1002/art.41043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 07/11/2019] [Indexed: 12/14/2022]
Abstract
A meeting was organized to bring together multiple stakeholders involved in the testing and authorization of new medications for juvenile idiopathic arthritis (JIA) to discuss current issues surrounding clinical trials and access to new medications for children and adolescents with JIA. The Childhood Arthritis and Rheumatology Research Alliance invited representatives of regulatory agencies (Food and Drug Administration and European Medicines Agency), and major pharmaceutical companies with JIA-approved products or products in development, patient and parent representatives, representatives of an advocacy organization (Arthritis Foundation), and pediatric rheumatology clinicians/investigators to a 1-day meeting in April 2018. The participants engaged in discussion regarding issues in clinical trials. As the pharmacologic options to treat inflammatory arthritis rapidly expand, registration trial designs to test medications in JIA patients must adapt. Many methodologies successfully used in the recent past are no longer feasible. The pool of patients meeting entry criteria who are willing to participate is shrinking while the number of medications to be tested is growing. Suggested solutions included proposing innovative clinical trial methods to regulatory agencies, as well as open discussions among stakeholders. Ensuring that new medications are authorized in a timely manner to meet the needs of JIA patients worldwide is critical. Approaches should include open dialog between regulatory agencies, pharmaceutical companies, and other stakeholders to develop and implement novel study designs, including patient and clinician perspectives to define meaningful trial outcomes, and changing existing study plans.
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Affiliation(s)
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | - Vincent Del Gaizo
- Childhood Arthritis and Rheumatology Research Alliance, Milwaukee, Wisconsin
| | | | | | | | | | | | | | | | | | | | - Keith S Kanik
- Global Product Development, Pfizer Inc., New London, Connecticut
| | | | | | | | | | | | - Kelly L Mieszkalski
- Childhood Arthritis and Rheumatology Research Alliance, Milwaukee, Wisconsin
| | | | | | | | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, New Jersey
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Kolstad KD, Mayo JA, Chung L, Chaichian Y, Kelly VM, Druzin M, Stevenson DK, Shaw GM, Simard JF. Preterm birth phenotypes in women with autoimmune rheumatic diseases: a population-based cohort study. BJOG 2019; 127:70-78. [PMID: 31571337 DOI: 10.1111/1471-0528.15970] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate preterm birth (PTB) phenotypes in women with different autoimmune rheumatic diseases in a large population-based cohort. DESIGN Retrospective cohort study. SETTING California, USA. POPULATION All live singleton births in California between 2007 and 2011 were analysed. Patients with autoimmune disease at delivery were identified by International Classification of Diseases, Ninth Revision , Clinical Modification (ICD-9-CM), codes for systemic lupus erythematosus (SLE), systemic sclerosis (SSc), rheumatoid arthritis (RA), polymyositis/dermatomyositis (DM/PM), and juvenile idiopathic arthritis (JIA). METHODS Maternally linked hospital and birth certificate records of 2 481 516 deliveries were assessed (SLE n = 2272, RA n = 1501, SSc n = 88, JIA n = 187, DM/PM n = 38). Multivariable Poisson regression models estimated the risk ratios (RRs) for different PTB phenotypes (relative to term deliveries) for each autoimmune disease compared with the general obstetric population, adjusting for maternal age, race/ethnicity, body mass index, smoking, education, payer, parity, and prenatal care. MAIN OUTCOME MEASURES Preterm birth (PTB) was assessed overall (20-36 weeks of gestation) and by subphenotype: preterm prelabour rupture of membranes (PPROM), spontaneous birth, or medically indicated PTB. The risk of PTB overall and for each phenotype was partitioned by gestational age: early (20-31 weeks of gestation) and late (32-36 weeks of gestation). RESULTS Risks for PTB were elevated for each autoimmune disease evaluated: SLE (RR 3.27, 95% CI 3.01-3.56), RA (RR 2.04, 95% CI 1.79-2.33), SSc (RR 3.74, 95% CI 2.51-5.58), JIA (RR 2.23, 95% CI 1.54-3.23), and DM/PM (RR 5.26, 95% CI 3.12-8.89). These elevated risks were observed for the majority of PTB phenotypes as well. CONCLUSIONS Women with systemic autoimmune diseases appear to have an elevated risk of various PTB phenotypes. Therefore, preconception counselling and close monitoring during pregnancy is crucial. TWEETABLE ABSTRACT This study found that women with systemic autoimmune diseases have an elevated risk of preterm birth phenotypes.
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Affiliation(s)
- K D Kolstad
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - J A Mayo
- March of Dimes Prematurity Research Center at Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - L Chung
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Palo Alto VA and Stanford University Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Y Chaichian
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - V M Kelly
- Department of Rheumatology, Palo Alto Medical Foundation, Palo Alto, California, USA
| | - M Druzin
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA
| | - D K Stevenson
- March of Dimes Prematurity Research Center at Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - G M Shaw
- March of Dimes Prematurity Research Center at Stanford University School of Medicine, Department of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Stanford, California, USA.,Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, California, USA.,Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
| | - J F Simard
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Division of Epidemiology, Department of Health Research and Policy, Stanford University School of Medicine, Stanford, California, USA
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Berthold E, Månsson B, Kahn R. Outcome in juvenile idiopathic arthritis: a population-based study from Sweden. Arthritis Res Ther 2019; 21:218. [PMID: 31661011 PMCID: PMC6816211 DOI: 10.1186/s13075-019-1994-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/05/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND As the treatment arsenal for children with juvenile idiopathic arthritis (JIA) has expanded during the last decades, follow-up studies are needed on children diagnosed in the era of biological treatment to evaluate if this has improved the outcome. Our aim was to study the epidemiology and outcome of JIA in southern Sweden using a population-based cohort of children with a validated diagnosis of JIA collected over 9 years. METHODS Potential cases of JIA between 2002 and 2010 were collected after a database search, using the ICD codes M08-M09. The study area was Skåne, the southernmost county of Sweden (population 1.24 million; 17.6% aged < 16 years). The JIA diagnosis was validated and subcategorized through medical record review based on the criteria defined by the International League of Associations for Rheumatism (ILAR). Parameters on disease activity and pharmacologic treatment were recorded annually until the end of the study period (December 31, 2015). RESULTS In total, 251 cases of JIA were confirmed. The mean annual incidence rate for JIA was estimated to be 12.8/100,000 children < 16 years, with the highest age-specific annual incidence at the age of 2 years (36/100,000). Oligoarthritis was the largest subgroup (44.7%), and systemic JIA was the smallest subgroup (2.8%). Methotrexate was the most common disease-modifying anti-rheumatic drug prescribed (60.6%). Tumor necrosis factor alpha inhibitors were used as treatment for 23.9% of the children. Only 40.0% of the follow-up years, with a median follow-up time of 8 years, were free of arthritis or uveitis. Uveitis occurred in 10.8% of the children (8.0% chronic uveitis), and the need for joint corrective orthopedic surgery was 9.2%. CONCLUSIONS The incidence of JIA in this well-defined, population-based cohort is slightly lower than in previously published studies from Scandinavia. The need for orthopedic surgery and the presence of uveitis are diminished compared to studies with patients diagnosed more than 20 years ago. Children with JIA however still experience disease activity more than 50% of the time. In conclusion, we still have long-term challenges in the care for children with JIA, in spite of state-of-the-art treatment.
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Affiliation(s)
- Elisabet Berthold
- Department of Rheumatology, Clinical Sciences Lund, Lund University, 221 85, Lund, Sweden.
| | - Bengt Månsson
- Department of Rheumatology, Clinical Sciences Lund, Lund University, 221 85, Lund, Sweden
| | - Robin Kahn
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.,Wallenberg Centre of Molecular Medicine, Lund University, Lund, Sweden
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Glerup M, Thiel S, Rypdal V, Arnstad ED, Ekelund M, Peltoniemi S, Aalto K, Rygg M, Nielsen S, Fasth A, Berntson L, Nordal E, Herlin T. Complement lectin pathway protein levels reflect disease activity in juvenile idiopathic arthritis: a longitudinal study of the Nordic JIA cohort. Pediatr Rheumatol Online J 2019; 17:63. [PMID: 31500626 PMCID: PMC6734250 DOI: 10.1186/s12969-019-0367-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To determine the serum levels of the lectin pathway proteins early in the disease course and 17 years after disease onset and to correlate the protein levels to markers of disease activity in participants from a population-based Nordic juvenile idiopathic arthritis (JIA) cohort. Additionally, to assess the predictive value of lectin pathway proteins with respect to remission status. METHODS A population-based cohort study of consecutive cases of JIA with a disease onset from 1997 to 2000 from defined geographical areas of Finland, Sweden, Norway and Denmark with 17 years of follow-up was performed. Clinical characteristics were registered and H-ficolin, M-ficolin, MASP-1, MASP-3, MBL and CL-K1 levels in serum were analyzed. RESULTS In total, 293 patients with JIA were included (mean age 23.7 ± 4.4 years; mean follow-up 17.2 ± 1.7 years). Concentrations of the lectin protein levels in serum were higher at baseline compared to the levels 17 years after disease onset (p ≤ 0.006, n = 164). At baseline, the highest level of M-ficolin was observed in systemic JIA. Further, high M-ficolin levels at baseline and at 17-year follow-up were correlated to high levels of ESR. In contrast, high MASP-1 and MASP-3 tended to correlate to low ESR. CL-K1 showed a negative correlation to JADAS71 at baseline. None of the protein levels had prognostic abilities for remission status 17 years after disease onset. CONCLUSION We hypothesize that increased serum M-ficolin levels are associated with higher disease activity in JIA and further, the results indicate that MASP-1, MASP-3 and CL-K1 are markers of inflammation.
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Affiliation(s)
- Mia Glerup
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark
| | - Steffen Thiel
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Veronika Rypdal
- Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ellen Dalen Arnstad
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Maria Ekelund
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Ryhov County Hospital, Jonkoping, Sweden
| | - Suvi Peltoniemi
- New Children’s Hospital, Pediatric Research Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Kristiina Aalto
- New Children’s Hospital, Pediatric Research Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
| | - Marite Rygg
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - Susan Nielsen
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Anders Fasth
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lillemor Berntson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Ellen Nordal
- Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Troels Herlin
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark
| | - for the Nordic Study Group of Pediatric Rheumatology (NoSPeR)
- Department of Pediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Pediatrics, University Hospital of North Norway, and Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Department of Pediatrics, Ryhov County Hospital, Jonkoping, Sweden
- New Children’s Hospital, Pediatric Research Center, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
- Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
- Department of Pediatrics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Bourdier P, Saidi O, Rochette E, Ratel S, Merlin E, Pereira B, Duché P. Physical activity and sedentary levels in children with juvenile idiopathic arthritis and inflammatory bowel disease. A systematic review and meta-analysis. Pediatr Res 2019; 86:149-156. [PMID: 31029060 DOI: 10.1038/s41390-019-0409-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 03/28/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Physical activity (PA) is essential for children throughout their growth and maturation. It improves physiological and psychological health and limits the risk of developing metabolic disorders. However, some chronic physiological and metabolic diseases may lead to decreased PA. The diversity of outcomes in the literature offers no consensus for physical activity and sedentary levels in children with juvenile idiopathic arthritis (JIA) or inflammatory bowel disease (IBD). METHODS A literature review and a meta-analysis were carried out with original studies from a Medline database search. Only high-quality studies (STROBE checklist) written in English comparing PA level or sedentary behavior (SB) between children with the disorders and their healthy peers were considered. The aim was to examine PA and SB in children with JIA or IBD compared to their healthy peers. RESULTS The literature review and meta-analysis identified decreased PA and increased time spent in SB in these populations, which may exacerbate both their lower physical fitness and the symptoms of their health disorders. CONCLUSION Results nevertheless show discrepancies due to the different materials and methods used and the variables measured. Further studies are needed to establish a gold standard method for assessing PA level in these populations.
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Affiliation(s)
- Pierre Bourdier
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Oussama Saidi
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- CRNH-Auvergne, 63000, Clermont-Ferrand, France.,CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, 63000, Clermont-Ferrand, France.,Université de Toulon, Laboratoire IAPS, 83041, Toulon, France
| | - Sébastien Ratel
- Laboratoire des Adaptations Métaboliques en conditions Physiologiques et Physiopathologiques (AME2P), Université Clermont Auvergne, 3533, Clermont-Ferrand, France.,CRNH-Auvergne, 63000, Clermont-Ferrand, France
| | - Etienne Merlin
- CHU Clermont-Ferrand, Pédiatrie, Hôpital Estaing, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM, CIC 1405, Unité CRECHE, 63000, Clermont-Ferrand, France.,Université Clermont Auvergne, INRA, UMR 1019 UNH, ECREIN, 63000, Clermont-Ferrand, France
| | - Bruno Pereira
- CHU Clermont-Ferrand, Délégation de la Recherche Clinique et Innovations, 63000, Clermont-Ferrand, France
| | - Pascale Duché
- Université de Toulon, Laboratoire IAPS, 83041, Toulon, France.
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Pavo MR, de Inocencio J. Pediatrician Beliefs about Juvenile Idiopathic Arthritis May Result in Referral Delays: A Spanish National Survey. J Pediatr 2019; 209:236-239.e2. [PMID: 30679051 DOI: 10.1016/j.jpeds.2018.12.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 12/13/2022]
Abstract
We explored, through a national survey, pediatrician beliefs and misconceptions that could interfere with early referral of patients with juvenile idiopathic arthritis. A total of 831 pediatricians participated. Approximately one-half of the respondents underestimated the incidence of the disease and thought that pain was the leading symptom of oligoarticular forms.
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Affiliation(s)
- María Rosa Pavo
- Pediatric Primary Care, Centro de Salud García Noblejas, Madrid
| | - Jaime de Inocencio
- Pediatric Rheumatology Unit, University Hospital 12 de Octubre, Madrid, Spain; Department of Public Health and Maternal and Pediatric Health, Complutense University of Madrid, Madrid, Spain.
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Shiff NJ, Oen K, Kroeker K, Lix LM. Trends in Population‐Based Incidence and Prevalence of Juvenile Idiopathic Arthritis in Manitoba, Canada. Arthritis Care Res (Hoboken) 2019; 71:413-418. [DOI: 10.1002/acr.23606] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 05/22/2018] [Indexed: 01/17/2023]
Affiliation(s)
- Natalie J. Shiff
- University of FloridaGainesville and University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Kiem Oen
- University of Manitoba Winnipeg Manitoba Canada
| | | | - Lisa M. Lix
- University of Manitoba Winnipeg Manitoba Canada
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38
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Mahmud SA, Binstadt BA. Autoantibodies in the Pathogenesis, Diagnosis, and Prognosis of Juvenile Idiopathic Arthritis. Front Immunol 2019; 9:3168. [PMID: 30693002 PMCID: PMC6339949 DOI: 10.3389/fimmu.2018.03168] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 12/24/2018] [Indexed: 12/26/2022] Open
Abstract
Autoantibody production occurs in juvenile idiopathic arthritis (JIA) and numerous other autoimmune diseases. In some conditions, the autoantibodies are clearly pathogenic, whereas in others the roles are less defined. Here we review various autoantibodies associated with JIA, with a particular focus on antinuclear antibodies and antibodies recognizing citrullinated self-antigens. We explore potential mechanisms that lead to the development of autoantibodies and the use of autoantibody testing in diagnosis and prognosis. Finally, we compare and contrast JIA-associated autoantibodies with those found in adults with rheumatoid arthritis (RA).
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Affiliation(s)
- Shawn A Mahmud
- Division of Pediatric Rheumatology, Department of Pediatrics, and the Center for Immunology, University of Minnesota, Minneapolis, MN, United States
| | - Bryce A Binstadt
- Division of Pediatric Rheumatology, Department of Pediatrics, and the Center for Immunology, University of Minnesota, Minneapolis, MN, United States
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39
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Brunner HI, Martini A, Lovell DJ, Ruperto N. Clinical trials in children and adolescents with systemic lupus erythematosus: methodological aspects, regulatory landscape and future opportunities. Ann Rheum Dis 2018; 78:162-170. [PMID: 30232192 DOI: 10.1136/annrheumdis-2018-213198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 08/10/2018] [Accepted: 08/11/2018] [Indexed: 11/04/2022]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is rare in many regions of the world, including Europe. Access to approved medications for cSLE is currently limited, among others, due to a lack of high-quality evidence from clinical trials. The objectives of the study were to evaluate the current regulatory framework regarding medication approvals, delineate barriers to clinical trial conduct, and strategies to improve access to new medications for cSLE. Relevant methodological and regulatory aspects, epidemiological data, study designs and outcome measures are reviewed, and the results of a survey among Paediatric Rheumatology International Trials Organisation/Pediatric Rheumatology Collaborative Study Group investigators are presented. Laws and regulations in the USA and Europe necessitate that novel medicines are studied in paediatric populations, if similar or the same diseases in adults have been found to benefit from them. Regulatory agencies consider cSLE the paediatric form of SLE in adults. For medicines that have been found safe and effective in adult SLE, paediatric extrapolation strategies can limit the number and complexity of studies needed to support the labelling of these medicines for use in cSLE. In this setting, specialised research networks, validated outcome measures, stakeholder input, study designs as well as statistical methods successfully used in other uncommon diseases will help improve study efficiency in an effort to enhance the speed with which new drugs for cSLE can be studied. Open-label pharmacokinetic-pharmacodynamic studies are preferred by paediatric rheumatologists over double-blind parallel designs for cSLE trials. Appropriate infrastructure, outcome measures and sufficient numbers of patients are available for the testing of new medicines for children with cSLE.
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Affiliation(s)
- Hermine I Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Alberto Martini
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, Genova, Italy
| | - Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, Genova, Italy
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40
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Ferguson ID, Griffin P, Michel JJ, Yano H, Gaffen SL, Mueller RG, Dvergsten JA, Piganelli JD, Rosenkranz ME, Kietz DA, Vallejo AN. T Cell Receptor-Independent, CD31/IL-17A-Driven Inflammatory Axis Shapes Synovitis in Juvenile Idiopathic Arthritis. Front Immunol 2018; 9:1802. [PMID: 30127787 PMCID: PMC6087740 DOI: 10.3389/fimmu.2018.01802] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/23/2018] [Indexed: 12/19/2022] Open
Abstract
T cells are considered autoimmune effectors in juvenile idiopathic arthritis (JIA), but the antigenic cause of arthritis remains elusive. Since T cells comprise a significant proportion of joint-infiltrating cells, we examined whether the environment in the joint could be shaped through the inflammatory activation by T cells that is independent of conventional TCR signaling. We focused on the analysis of synovial fluid (SF) collected from children with oligoarticular and rheumatoid factor-negative polyarticular JIA. Cytokine profiling of SF showed dominance of five molecules including IL-17A. Cytometric analysis of the same SF samples showed enrichment of αβT cells that lacked both CD4 and CD8 co-receptors [herein called double negative (DN) T cells] and also lacked the CD28 costimulatory receptor. However, these synovial αβT cells expressed high levels of CD31, an adhesion molecule that is normally employed by granulocytes when they transit to sites of injury. In receptor crosslinking assays, ligation of CD31 alone on synovial CD28nullCD31+ DN αβT cells effectively and sufficiently induced phosphorylation of signaling substrates and increased intracytoplasmic stores of cytokines including IL-17A. CD31 ligation was also sufficient to induce RORγT expression and trans-activation of the IL-17A promoter. In addition to T cells, SF contained fibrocyte-like cells (FLC) expressing IL-17 receptor A (IL-17RA) and CD38, a known ligand for CD31. Stimulation of FLC with IL-17A led to CD38 upregulation, and to production of cytokines and tissue-destructive molecules. Addition of an oxidoreductase analog to the bioassays suppressed the CD31-driven IL-17A production by T cells. It also suppressed the downstream IL-17A-mediated production of effectors by FLC. The levels of suppression of FLC effector activities by the oxidoreductase analog were comparable to those seen with corticosteroid and/or biologic inhibitors to IL-6 and TNFα. Collectively, our data suggest that activation of a CD31-driven, αβTCR-independent, IL-17A-mediated T cell-FLC inflammatory circuit drives and/or perpetuates synovitis. With the notable finding that the oxidoreductase mimic suppresses the effector activities of synovial CD31+CD28null αβT cells and IL-17RA+CD38+ FLC, this small molecule could be used to probe further the intricacies of this inflammatory circuit. Such bioactivities of this small molecule also provide rationale for new translational avenue(s) to potentially modulate JIA synovitis.
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Affiliation(s)
- Ian D Ferguson
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Patricia Griffin
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States
| | - Joshua J Michel
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Hiroshi Yano
- Graduate Program in Microbiology and Immunology School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah L Gaffen
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Robert G Mueller
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Jeffrey A Dvergsten
- Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Jon D Piganelli
- Department of Immunology, University of Pittsburgh, Pittsburgh, PA, United States.,Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States
| | - Margalit E Rosenkranz
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Daniel A Kietz
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Abbe N Vallejo
- Department of Pediatrics, University of Pittsburgh, Pittsburgh, PA, United States.,Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.,Department of Immunology, University of Pittsburgh, Pittsburgh, PA, United States
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Abstract
Systemic juvenile idiopathic arthritis (sJIA) is a distinctive subtype of juvenile idiopathic arthritis, characterized by fever and arthritis, often accompanied by rash, sometimes by generalized lymphadenopathy, hepatosplenomegaly, and serositis. The diagnosis requires adequate exclusion of infectious, oncologic, autoimmune, and autoinflammatory diseases. Macrophage activation syndrome, a serious and potentially fatal complication of sJIA, requires prompt evaluation and treatment. Newer biologic agents, particularly interleukin-1 and interleukin-6 inhibitors, are highly effective and have transformed the treatment approach by reducing the use of systemic glucocorticoids. Primary care providers have a crucial role in monitoring children with sJIA for disease-related complications and medication-related adverse events.
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Affiliation(s)
- Jennifer J Y Lee
- Department of Paediatrics, Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada
| | - Rayfel Schneider
- Department of Paediatrics, Division of Rheumatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada.
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Brunner HI, Rider LG, Kingsbury DJ, Co D, Schneider R, Goldmuntz E, Onel KB, Giannini EH, Lovell DJ. Pediatric Rheumatology Collaborative Study Group - over four decades of pivotal clinical drug research in pediatric rheumatology. Pediatr Rheumatol Online J 2018; 16:45. [PMID: 29996857 PMCID: PMC6042275 DOI: 10.1186/s12969-018-0261-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 06/20/2018] [Indexed: 11/10/2022] Open
Abstract
IMPORTANCE Specialized research networks are essential to achieve drug approvals for rare pediatric diseases. Such networks help realize the potential of global legislation enacted upon the recognition that most children are treated with drugs whose most beneficial dose and regimen have not been established in pediatric patients. The Pediatric Rheumatology Collaborative Study Group (PRCSG) is a North American clinical trials network that is specialized in the performance of clinical trials of new therapies for pediatric populations with rheumatic diseases. This review provides an overview of the strategies employed by this research network to achieve drug and biologic approvals for children with pediatric rheumatic diseases, particularly juvenile idiopathic arthritis. OBSERVATIONS Clinical trial conduct in rare pediatric diseases has required global recruitment. Supported or led by the PRCSG, highly responsive, validated, composite measures have been established to assess drug efficacy. For pediatric orphan diseases with high disease burdens, specialized investigative sites and study designs are needed to complete adequately powered trials at the high standard necessary to enable drug labeling by regulatory agencies. Novel trial designs have been utilized for more efficient testing of innovative drug candidates. All these have been developed or co-developed by the PRCSG research network. CONCLUSIONS AND RELEVANCE Specialized research networks in pediatric rheumatology, such as the PRCSG, have changed the landscape of available therapies and improved overall disease outcomes for children with pediatric rheumatic diseases.
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Affiliation(s)
- Hermine I Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center & Cincinnati Children's Research Foundation, MLC 4010, Cincinnati, OH, 45229, USA.
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | | | - Dominic Co
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Rayfel Schneider
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Ellen Goldmuntz
- Division of Allergy, Immunology, and Transplantation, Rheumatologic Autoimmune Diseases Section, National Institutes of Health, Bethesda, MD, USA
| | - Karen B Onel
- Hospital for Special Surgery, Weill Cornell Medicine, New York, NY, USA
| | - Edward H Giannini
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center & Cincinnati Children's Research Foundation, MLC 4010, Cincinnati, OH, 45229, USA
| | - Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center & Cincinnati Children's Research Foundation, MLC 4010, Cincinnati, OH, 45229, USA
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Lee WJ, Lee TA, Suda KJ, Calip GS, Briars L, Schumock GT. Risk of serious bacterial infection associated with tumour necrosis factor-alpha inhibitors in children with juvenile idiopathic arthritis. Rheumatology (Oxford) 2018; 57:273-282. [PMID: 28431162 DOI: 10.1093/rheumatology/kex049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Indexed: 01/29/2023] Open
Abstract
Objectives TNF-α inhibitors (TNFIs) have a black box warning for increased risk of serious infection that was based on evidence from studies of adults. Evidence of the association is lacking for children. We aimed to examine the risk of infection posed by TNFIs compared with DMARDs in children with JIA. Methods We conducted a cohort study using the 2009-13 Truven MarketScan Commercial Claims and Encounters database. Children <16 years old with JIA who initiated monotherapy with TNFIs or DMARDs were identified and followed for occurrence of serious bacterial infection requiring hospitalization. Cox proportional hazard models were used to estimate hazard ratios for infection associated with TNFIs compared with DMARDs, adjusting for potential confounders with high-dimensional propensity scores and time-varying CS use. Results We identified 2013 DMARD initiators and 482 TNFI initiators with a mean follow-up of 255 and 307 days, respectively. We identified 18 and 11 patients with a serious infection in the DMARD and TNFI groups, resulting in crude rates of 1.28 (95% CI 0.76-2.02) and 2.72 (95%CI 1.36-4.86) per 100 person-years, respectively. In adjusted models, TNFIs were associated with an increased risk of serious bacterial infection compared with DMARDs (adjusted hazard ratio 2.72, 95% CI: 1.08, 6.86). Conclusion Use of TNFIs poses a higher risk of serious infection compared with DMARDs in children with JIA. Our analysis confirms the US Food and Drug Administration warning about TNFI-associated infection in children with JIA.
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Affiliation(s)
- Wan-Ju Lee
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA
| | - Todd A Lee
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA.,Center of Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Katie J Suda
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA.,Center of Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA.,Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Chicago, IL, USA
| | - Gregory S Calip
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA.,Center of Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Leslie Briars
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
| | - Glen T Schumock
- Department of Pharmacy Systems, Outcomes and Policy, Chicago, IL, USA.,Center of Pharmacoepidemiology and Pharmacoeconomic Research, College of Pharmacy, University of Illinois at Chicago, Chicago, IL, USA
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Ruperto N, Brunner HI, Zuber Z, Tzaribachev N, Kingsbury DJ, Foeldvari I, Horneff G, Smolewska E, Vehe RK, Hazra A, Wang R, Mebus CA, Alvey C, Lamba M, Krishnaswami S, Stock TC, Wang M, Suehiro R, Martini A, Lovell DJ. Pharmacokinetic and safety profile of tofacitinib in children with polyarticular course juvenile idiopathic arthritis: results of a phase 1, open-label, multicenter study. Pediatr Rheumatol Online J 2017; 15:86. [PMID: 29282090 PMCID: PMC5745974 DOI: 10.1186/s12969-017-0212-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/12/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) is the most common pediatric rheumatic disease and a leading cause of childhood disability. The objective of this study was to characterize the PK, safety, and taste acceptability of tofacitinib in patients with JIA. METHODS This Phase 1, open-label, multiple-dose (twice daily [BID] for 5 days) study of tofacitinib in patients with active (≥ 5 joints) polyarticular course JIA was conducted from March 2013-December 2015. Patients were allocated to one of three age-based cohorts: Cohort 1, 12 to < 18 years; Cohort 2, 6 to < 12 years; and Cohort 3, 2 to < 6 years. Tofacitinib was administered according to age and body weight as tablets or oral solution (grape flavor). PK were assessed on Day 5; safety was assessed at screening, Day 1, and Day 5. Taste acceptability of the oral solution was evaluated. RESULTS Twenty-six patients (age range 2-17 years) were enrolled: Cohort 1, N = 8; Cohort 2, N = 9; Cohort 3, N = 9; median tofacitinib doses were 5.0, 2.5, and 3.0 mg BID, respectively. The higher median tofacitinib dose in Cohort 3 versus Cohort 2 reflected implementation of an amended dosing scheme following an interim PK analysis after Cohort 2 recruitment. Geometric mean AUC at steady state (AUCtau) was 156.6 ng•h/mL in Cohort 1, 118.8 ng•h/mL in Cohort 2, and 142.5 ng•h/mL in Cohort 3; Cmax (ng/mL) was 47.0, 41.7, and 66.2, respectively. Ctrough, Cmin, and t1/2 were similar in Cohorts 2 and 3, but higher in Cohort 1. Median time to Cmax (Tmax) was similar between cohorts. Apparent clearance and volume of distribution decreased with decreasing age. Tofacitinib was well tolerated, with no serious adverse events or discontinuations due to adverse events reported. Taste acceptability was confirmed. CONCLUSIONS PK findings from this study in children with polyarticular course JIA established dosing regimens and acceptable taste for use in subsequent studies within the tofacitinib pediatric development program. TRIAL REGISTRATION ClinicalTrials.gov: NCT01513902 .
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Affiliation(s)
- Nicolino Ruperto
- Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy.
| | - Hermine I. Brunner
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, PRCSG, Cincinnati, OH USA
| | - Zbigniew Zuber
- St Louis Children’s Hospital ODS Rheumatology and Neurology, Krakow, Poland
| | | | | | - Ivan Foeldvari
- Hamburger Zentrum für Kinder- und Jugendrheumatologie, Hamburg, Germany
| | - Gerd Horneff
- Centre of General Pediatrics and Neonatology, Asklepios Klinik, Sankt Augustin, Germany
| | - Elzbieta Smolewska
- 0000 0001 2165 3025grid.8267.bDepartment of Pediatric Rheumatology, Medical University of Lodz, Lodz, Poland
| | - Richard K. Vehe
- 0000000419368657grid.17635.36University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Anasuya Hazra
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Collegeville, PA USA
| | - Rong Wang
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Groton, CT USA
| | | | | | - Manisha Lamba
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Groton, CT USA
| | | | - Thomas C. Stock
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Collegeville, PA USA
| | - Min Wang
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Collegeville, PA USA
| | - Ricardo Suehiro
- 0000 0000 8800 7493grid.410513.2Pfizer Inc, Collegeville, PA USA
| | - Alberto Martini
- 0000 0004 1760 0109grid.419504.dIstituto Giannina Gaslini, Direzione Scientifica, Genoa, Italy
| | - Daniel J. Lovell
- 0000 0000 9025 8099grid.239573.9Cincinnati Children’s Hospital Medical Center, PRCSG, Cincinnati, OH USA
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45
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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] [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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46
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Al Marri M, Qari A, Al-Mayouf SM. Juvenile idiopathic arthritis in multiplex families: longitudinal follow-up. Int J Rheum Dis 2017; 20:898-902. [DOI: 10.1111/1756-185x.13092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Munira Al Marri
- Pediatric Rheumatology; King Faisal Specialist Hospital and Research Center; Riyadh Saudi Arabia
| | - Alya Qari
- Medical Genetic; King Faisal Specialist Hospital and Research Center; Riyadh Saudi Arabia
| | - Sulaiman M. Al-Mayouf
- Pediatric Rheumatology; King Faisal Specialist Hospital and Research Center; Riyadh Saudi Arabia
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47
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Shiff NJ, Oen K, Rabbani R, Lix LM. Validation of administrative case ascertainment algorithms for chronic childhood arthritis in Manitoba, Canada. Rheumatol Int 2017; 37:1575-1584. [PMID: 28502061 DOI: 10.1007/s00296-017-3734-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 05/04/2017] [Indexed: 12/19/2022]
Abstract
We validated case ascertainment algorithms for juvenile idiopathic arthritis (JIA) in the provincial health administrative databases of Manitoba, Canada. A population-based pediatric rheumatology clinical database from April 1st 1980 to March 31st 2012 was used to test case definitions in individuals diagnosed at ≤15 years of age. The case definitions varied the number of diagnosis codes (1, 2, or 3), time frame (1, 2 or 3 years), time between diagnoses (ever, >1 day, or ≥8 weeks), and physician specialty. Positive predictive value (PPV), sensitivity, and specificity with 95% confidence intervals (CIs) are reported. A case definition of 1 hospitalization or ≥2 diagnoses in 2 years by any provider ≥8 weeks apart using diagnosis codes for rheumatoid arthritis and ankylosing spondylitis produced a sensitivity of 89.2% (95% CI 86.8, 91.6), specificity of 86.3% (95% CI 83.0, 89.6), and PPV of 90.6% (95% CI 88.3, 92.9) when seronegative enthesopathy and arthropathy (SEA) was excluded as JIA; and sensitivity of 88.2% (95% CI 85.7, 90.7), specificity of 90.4% (95% CI 87.5, 93.3), and PPV of 93.9% (95% CI 92.0, 95.8) when SEA was included as JIA. This study validates case ascertainment algorithms for JIA in Canadian administrative health data using diagnosis codes for both rheumatoid arthritis (RA) and ankylosing spondylitis, to better reflect current JIA classification than codes for RA alone. Researchers will be able to use these results to define cohorts for population-based studies.
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Affiliation(s)
- Natalie Jane Shiff
- Division of Immunology, Rheumatology and Allergy, Department of Pediatrics, University of Florida, Box 100296, 1600 SW Archer Road, Gainesville, Florida, 32610, USA.
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lisa M Lix
- George and Fay Yee Center for Healthcare Innovation, University of Manitoba/Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
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48
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Lee WJ, Briars L, Lee TA, Calip GS, Suda KJ, Schumock GT. Use of Tumor Necrosis Factor-Alpha Inhibitors in Children and Young Adults With Juvenile Idiopathic Arthritis or Rheumatoid Arthritis. Pharmacotherapy 2016; 36:1201-1209. [DOI: 10.1002/phar.1856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Wan-Ju Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Leslie Briars
- Department of Pharmacy Practice; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Todd A. Lee
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Gregory S. Calip
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
| | - Katie J. Suda
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center of Innovation for Complex Chronic Healthcare; Hines VA Hospital; Hines Illinois
| | - Glen T. Schumock
- Department of Pharmacy Systems, Outcomes and Policy; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
- Center for Pharmacoepidemiology and Pharmacoeconomic Research; College of Pharmacy; University of Illinois at Chicago; Chicago Illinois
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49
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Turnier JL, Brunner HI. Tocilizumab for treating juvenile idiopathic arthritis. Expert Opin Biol Ther 2016; 16:559-66. [DOI: 10.1517/14712598.2016.1150997] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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50
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Gidman W, Meacock R, Symmons D. The humanistic and economic burden of juvenile idiopathic arthritis in the era of biologic medication. Curr Rheumatol Rep 2016; 17:31. [PMID: 25874347 DOI: 10.1007/s11926-015-0508-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Juvenile idiopathic arthritis (JIA) is a poorly understood, heterogeneous, incurable, inflammatory syndrome. Long-term outcomes are uncertain, and this painful condition can result in lifelong disability. JIA is associated with considerable financial and humanistic burden for those affected and the healthcare system. Early diagnosis and effective treatment are indicated to optimise outcomes. Modern treatment aims to achieve remission and preserve joint function by using disease-modifying antirheumatic drugs (DMARDs) early. DMARDs can be classified as conventional/traditional or biologic. Biologic medications may be more effective but cost approximately ten times more than traditional DMARDs. Decision-makers in healthcare are increasingly comparing the cost and consequences of alternative treatment strategies to guide resource allocation decisions. There have been few economic evaluations to date to guide medicines optimisation in JIA. This systematic review highlights the lack of existing evidence relating to the humanistic and economic burden of JIA in the era of biologic medication.
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Affiliation(s)
- Wendy Gidman
- Centre for Health Economics, University of Manchester, Oxford Road, Manchester, UK,
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