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Hussain A, Maheshwari MV, Khalid N, Patel PD, Alghareeb R. Diagnostic Delays and Psychosocial Outcomes of Childhood-Onset Systemic Lupus Erythematosus. Cureus 2022; 14:e26244. [PMID: 35911281 PMCID: PMC9313193 DOI: 10.7759/cureus.26244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/15/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that manifests in affected individuals with a variety of clinical features and involves multiple organs. Despite recent advances over the past decades, higher morbidity and mortality have been reported by studies in patients with childhood-onset systemic lupus erythematosus (cSLE) compared to patients with adult-onset. The interplay of several factors can cause diagnostic delays resulting in worse disease activity, multiple organ damage, increased risk of hospitalization, and management with aggressive treatment. Significant factors include demographic, clinical, and socioeconomic characteristics of patients with cSLE. Moreover, despite recent advances in lupus treatment, prolonged disease duration in these young patients can result in debilitating psychosocial outcomes and can significantly impact their health-related and general quality of life (QOL). Important domains affected include patient self-esteem, education, employment, healthcare utilization, and mental health. In this review, we examined the barriers that lead to a delay in diagnosing lupus in the pediatric population and addressed cSLE morbimortality and its long-term impact on patient health-related and general QOL.
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Rosina S, Tibaldi J, Mazzoni M, Bava C, Natoli V, Ravelli A. Update on Outcome Measures for Pediatric Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:163-170. [PMID: 33091272 DOI: 10.1002/acr.24212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/07/2020] [Indexed: 11/11/2022]
Affiliation(s)
| | - Jessica Tibaldi
- IRCCS Istituto Giannina Gaslini and Università degli Studi di Genova, Genoa, Italy
| | | | | | | | - Angelo Ravelli
- Sechenov First Moscow State Medical University, Moscow, Russia
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Ganguli SK, Hui-Yuen JS, Jolly M, Cerise J, Eberhard BA. Performance and psychometric properties of lupus impact tracker in assessing patient-reported outcomes in pediatric lupus: Report from a pilot study. Lupus 2020; 29:1781-1789. [DOI: 10.1177/0961203320951264] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To evaluate the reliability, validity, feasibility and psychometric performance of the Lupus Impact Tracker (LIT) as a patient reported outcome (PRO) measure tool in pediatric systemic lupus erythematosus (pSLE). Methods This is a prospective, observational, pilot study where patients aged between 12 and 25 years, fulfilling the 1997 ACR classification criteria for SLE, were enrolled. Over 3 consecutive, routine, clinical visits, the patients completed the LIT alongside the Patient-Reported Outcomes Measurement Information System-Short Forms (PROMIS-SFs), Childhood Health Assessment Questionnaire (CHAQ). Rheumatologists completed the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC-ACR) Damage Index. Demographic, clinical and laboratory data were also collected. Results Of 46 patients enrolled, 38 patients completed 2 visits and 31 completed all 3 visits. Seventy-eight percent were female, 33% African American, 28% Asian, 15% Caucasian and 17% Hispanic. The mean (SD) age was 17.2 (2.7) years, with a mean (SD) disease duration of 4.6 (3.1) years. The mean (SD) SLEDAI-2K at enrollment was 3.54 (2.96). In the 38 patients who completed two or more visits, intra-class correlation coefficient and Cronbach alpha were calculated to be 0.70 and 0.91 respectively, signifying good reliability of LIT. The LIT showed positive correlation with CHAQ-Disability Index and majority of the PROMIS-SFs parameters. Construct validity was established against clinical disease activity (SLEDAI-2K). Conclusion The preliminary results indicate that the LIT is a reliable and valid instrument to capture PRO in p-SLE. Prospective validation with a larger, multicenter cohort is the next step.
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Affiliation(s)
- Suhas K Ganguli
- Department of Pediatric Rheumatology, Marshfield Clinic, Marshfield, WI, USA
| | - Joyce S Hui-Yuen
- Department of Pediatric Rheumatology, Cohen Children’s Medical Center, Lake Success, NY, USA
- Department of Pediatrics, School of Medicine, Hofstra University, Hempstead, NY, USA
| | - Meenakshi Jolly
- Department of Rheumatology, Rush University Medical Center, Chicago, IL, USA
| | - Jane Cerise
- Department of Biostatistics, The Feinstein Institute of Medical Research, Manhasset, NY, USA
| | - Barbara Anne Eberhard
- Department of Pediatric Rheumatology, Cohen Children’s Medical Center, Lake Success, NY, USA
- Department of Pediatrics, School of Medicine, Hofstra University, Hempstead, NY, USA
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Brunner HI, Holland MJ, Beresford MW, Ardoin SP, Appenzeller S, Silva CA, Flores F, Goilav B, Aydin POA, Wenderfer SE, Levy DM, Ravelli A, Khubchandani R, Avcin T, Klein-Gitelman MS, Ruperto N, Feldman BM, Ying J. American College of Rheumatology Provisional Criteria for Clinically Relevant Improvement in Children and Adolescents With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2019; 71:579-590. [PMID: 30680946 PMCID: PMC6483875 DOI: 10.1002/acr.23834] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 01/08/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a Childhood Lupus Improvement Index (CHILI) as a tool to measure response to therapy in childhood-onset systemic lupus erythematosus (cSLE), with a focus on clinically relevant improvement (CRIc SLE ). METHODS Pediatric nephrology and rheumatology subspecialists (n = 213) experienced in cSLE management were invited to define CRIc SLE and rate a total of 433 unique patient profiles for the presence/absence of CRIc SLE . Patient profiles included the following cSLE core response variables (CRVs): global assessment of patient well-being (patient-global), physician assessment of cSLE activity (MD-global), disease activity index score (here, we used the Systemic Lupus Erythematosus Disease Activity Index), urine protein-to-creatinine ratio, and Child Health Questionnaire physical summary score. Percentage and absolute changes in these cSLE-CRVs (baseline versus follow-up) were considered in order to develop candidate algorithms and validate their performance (sensitivity, specificity, area under the receiver operating characteristic curve [AUC]; range 0-1). RESULTS During an international consensus conference, unanimous agreement on a definition of CRIc SLE was achieved; cSLE experts (n = 13) concurred (100%) that the preferred CHILI algorithm considers absolute changes in the cSLE-CRVs. After transformation to a range of 0-100, a CHILI score of ≥54 had outstanding accuracy for identifying CRIc SLE (AUC 0.93, sensitivity 81.1%, and specificity 84.2%). CHILI scores also reflect minor, moderate, and major improvement for values exceeding 15, 68, and 92, respectively (all AUC ≥0.92, sensitivity ≥93.1%, and specificity ≥73.4%). CONCLUSION The CHILI is a new, seemingly highly accurate index for measuring CRI in cSLE over time. This index is useful to categorize the degree of response to therapy in children and adolescents with cSLE.
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Affiliation(s)
- Hermine I. Brunner
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael J. Holland
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Michael W. Beresford
- Department of Paediatric Rheumatology, Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Stacy P. Ardoin
- Department of Pediatrics and Internal Medicine, Ohio State University, Division of Rheumatology, Nationwide Children’s Hospital and Wexner Medical Center, Columbus, OH
| | - Simone Appenzeller
- Rheumatology Unit-School of Medical Science; University of Campinas, Campinas, Brazil
| | - Clovis A. Silva
- Children’s Institute, Hospital das Clinicas HCFMUSP; Faculdade de Medicina da Universidade de São Paulo, Brazil
| | - Francisco Flores
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Nephrology & Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Beatrice Goilav
- Department of Pediatrics, The Children’s Hospital at Montefiore, Division of Nephrology and Albert Einstein College of Medicine, Bronx, NY
| | - Pinar Ozge Avar Aydin
- Department of Pediatrics, University of Cincinnati College of Medicine and Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Scott E. Wenderfer
- Department of Pediatrics, Baylor College of Medicine; Renal Section, Texas Children’s Hospital Houston, TX
| | - Deborah M. Levy
- Department of Pediatrics, University of Toronto and Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Angelo Ravelli
- Istituto G. Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | | | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Centre Ljubljana, Slovenia
| | - Marisa S. Klein-Gitelman
- Department of Pediatrics, Northwestern University Feinberg School of Medicine and Division of Rheumatology, Ann and Robert Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Nicolino Ruperto
- Istituto G. Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Brian M. Feldman
- Department of Pediatrics, University of Toronto and Division of Rheumatology, The Hospital for Sick Children, Toronto, Canada
| | - Jun Ying
- Department of Environmental Health Sciences, University of Cincinnati, Cincinnati, OH
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Costa N, Ferreira ML, Cross M, Makovey J, Hodges PW. How is symptom flare defined in musculoskeletal conditions: A systematic review. Semin Arthritis Rheum 2018; 48:302-317. [DOI: 10.1016/j.semarthrit.2018.01.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 01/19/2018] [Accepted: 01/24/2018] [Indexed: 01/10/2023]
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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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Harry O, Yasin S, Brunner H. Childhood-Onset Systemic Lupus Erythematosus: A Review and Update. J Pediatr 2018; 196:22-30.e2. [PMID: 29703361 DOI: 10.1016/j.jpeds.2018.01.045] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 10/30/2017] [Accepted: 01/12/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Onengiya Harry
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Shima Yasin
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Hermine Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
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Brunner HI, Holland M, Beresford MW, Ardoin SP, Appenzeller S, Silva CA, Flores F, Goilav B, Wenderfer SE, Levy DM, Ravelli A, Khunchandani R, Avcin T, Klein-Gitelman MS, Feldman BM, Ruperto N, Ying J. American College of Rheumatology Provisional Criteria for Global Flares in Childhood-Onset Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2018; 70:813-822. [PMID: 29693328 DOI: 10.1002/acr.23557] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 03/08/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To validate the preliminary criteria of global flare for childhood-onset SLE (cSLE). METHODS Pediatricians experienced in cSLE care (n = 268) rated unique patient profiles; results of standard cSLE laboratory testing and information about the cSLE flare descriptors were presented as follows: global assessment of patient well-being, physician global assessment of disease activity (MD-global), Disease Activity Index score, protein/creatinine ratio (PCR), and erythrocyte sedimentation rate (ESR). Using rater interpretation of the course of cSLE (baseline versus followup as the gold standard), performance (sensitivity, specificity, area under the receiver operating characteristic curve [AUC]) of the preliminary flare criteria was tested. An international consensus conference was held to rank the preliminary flare criteria as per the American College of Rheumatology recommendations and delineate threshold scores for minor, moderate, and major flares. RESULTS The accuracy of the 2 highest-ranked candidate criteria that consider absolute changes (∆) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG) (numeric scoring: A = 12, B = 8, C = 1, and D/E = 0), MD-global, PCR, and ESR were confirmed (both AUC >0.93). For the SLEDAI-based criteria (0.5 × ∆SLEDAI + 0.45 × ∆PCR + 0.5 × ∆MD-global + 0.02 × ∆ESR) flare scores ≥6.4/3.0/0.6 constituted major/moderate/minor flares, respectively. For the BILAG-based algorithm (0.4 × ∆BILAG + 0.65 × ∆PCR + 0.5 × ∆MD-global + 0.02 × ∆ESR) flare scores ≥7.4/3.7/2.2 delineated major/moderator/minor flares, respectively. These threshold values (SLEDAI, BILAG) were all >82% sensitive and specific for capturing flare severity. CONCLUSION Provisional criteria for global flares in cSLE are available to identify patients who experienced a flare. These criteria also allow for discrimination of the severity of cSLE exacerbations.
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Affiliation(s)
- Hermine I Brunner
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael Holland
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Michael W Beresford
- Institute of Translational Medicine and Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Stacy P Ardoin
- Ohio State University, Nationwide Children's Hospital, and Wexner Medical Center, Columbus, Ohio
| | | | - Clovis A Silva
- Children's Institute, Hospital das Clinicas HCFMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Flores
- University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Beatrice Goilav
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Scott E Wenderfer
- Baylor College of Medicine and Texas Children's Hospital Houston, Texas
| | - Deborah M Levy
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Angelo Ravelli
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, and Università degli Studi di Genova, Genoa, Italy
| | | | - Tadej Avcin
- University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Marisa S Klein-Gitelman
- Northwestern University Feinberg School of Medicine and Ann and Robert Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Brian M Feldman
- University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, Istituto Giannina Gaslini, and Università degli Studi di Genova, Genoa, Italy
| | - Jun Ying
- University of Cincinnati, Cincinnati, Ohio
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Setchell J, Costa N, Ferreira M, Makovey J, Nielsen M, Hodges PW. What constitutes back pain flare? A cross sectional survey of individuals with low back pain. Scand J Pain 2017; 17:294-301. [PMID: 28866119 DOI: 10.1016/j.sjpain.2017.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/27/2017] [Accepted: 08/01/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Low back pain (LBP) is a lifelong problem for many. In acute episodes, or as a persistent condition, LBP is fluctuating in nature, with pain and other features of the condition varying in intensity and duration over time. Symptom flares (also known as flare ups) contribute to this variation and can have a great impact on the lives of those who have LBP. An important goal of treatments for, and research on, LBP is arguably to decrease symptom flare in both frequency and severity. However, this goal is problematic with little research, and no consensus, on how to define LBP flare. In particular, patients' understandings of LBP flare have received limited attention in the literature. To appropriately address this issue, we sought to understand how flares are conceptualized by individuals with LBP. METHODS We used an inductive, predominantly qualitative methodology, conducting an online survey with 130 individuals who self-reported experiencing LBP. The survey investigated participants' views on LBP flare including its meaning, features and symptoms, and whether 'flare' and 'pain increase' were synonymous. Qualitative analysis of responses involved thematic and content analysis with descriptive statistics used for the quantitative component. RESULTS Our data analysis found that participants identified many aspects of a flare to be important. Qualitative analyses highlighted a number of themes including that LBP flare was conceptualized as: (1) an increase in pain and other uncomfortable sensations such as paraesthesia or muscle tension, (2) an increase in the area, quality and/or duration of symptoms, (3) a reduction in physical, cognitive and/or social functioning, and (4) negative psychological and/or emotional factors. Flare was also discussed as a change that was difficult to settle. When participants considered whether 'flare' and 'pain increase' were synonymous, responses were evenly divided between 'no' (47%) and 'yes' (46%) with remaining participants 'unsure'. CONCLUSIONS The key finding was that many people with LBP do not consider their condition to be flared simply on the basis of a pain increase. In general, other features were required to also change. Results highlighted that a narrow focus on pain is unlikely to differentiate minor pain events from a flare. These findings are important as they contrast with most commonly used definitions of a flare that focus predominantly on pain increase. IMPLICATIONS Our findings have implications for understanding the trajectory of LBP over time. Understandings derived from perspectives of individuals with LBP highlight that defining flare in LBP is complex. In order to provide person-centred care, individual context and experiences should be taken into account. Therefore, understandings of LBP flare require consideration of factors beyond simply an increase in pain. A comprehensive, person-centred understanding of flare that includes a number of features beyond simply an increase in pain intensity is likely to be useful to better identify flares in research settings, assisting endeavours to understand and reduce LBP. Similarly, in clinical settings a nuanced conceptualisation of flare is likely to help health professionals communicate understandings of flare when working with individuals to manage their LBP.
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Affiliation(s)
- Jenny Setchell
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia.
| | - Nathalia Costa
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Manuela Ferreira
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia; Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Joanna Makovey
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia; Institute of Bone and Joint Research/The Kolling Institute, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Mandy Nielsen
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
| | - Paul W Hodges
- The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Australia
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Toupin April K, Stinson J, Boon H, Duffy CM, Huber AM, Gibbon M, Descarreaux M, Spiegel L, Vohra S, Tugwell P. Development and Preliminary Face and Content Validation of the "Which Health Approaches and Treatments Are You Using?" (WHAT) Questionnaires Assessing Complementary and Alternative Medicine Use in Pediatric Rheumatology. PLoS One 2016; 11:e0149809. [PMID: 26964088 PMCID: PMC4786318 DOI: 10.1371/journal.pone.0149809] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 02/04/2016] [Indexed: 11/18/2022] Open
Abstract
Objective Complementary and alternative medicine (CAM) is commonly used by children with juvenile idiopathic arthritis (JIA), yet no validated questionnaires assess that use. The objective of this study was to develop child self- and parent proxy-report questionnaires assessing CAM use and to determine the face and content validity of the “Which Health Approaches and Treatments are you using?” (WHAT) questionnaires in pediatric rheumatology. Methods A sequential phased mixed methods approach was used to develop the questionnaires. A Delphi Survey of 126 experts followed by an interdisciplinary consensus conference of 14 stakeholders in CAM, general pediatrics and pediatric rheumatology was held to develop consensus on the content of the questionnaires using a nominal group technique. To determine face and content validity of the questionnaires, two groups, including (a) a purposive sample of 22 children with JIA 8 to 18 years and their parents from the Children’s Hospital of Eastern Ontario and the Hospital for Sick Children, and (b) 21 Canadian pediatric rheumatology experts, participated in interviews. Participants were independently asked about the goal, understandability and comprehensiveness of the WHAT questionnaires, as well as the relevance of items. Results Consensus was reached on 17 items of the WHAT questionnaires. The domains found to be relevant were child’s CAM use, factors associated with CAM use, perceived impact of CAM use, and communication about CAM. A total of 15 items in the parent proxy-report questionnaire and 13 items in the child report questionnaire showed adequate content validity. Conclusions Consensus was reached by experts on the content of a pediatric CAM questionnaire. Face and content validity testing and modifications made to the WHAT questionnaires have helped ensure adequate preliminary validity for use in pediatric rheumatology. This constitutes the basis for further testing of these questionnaires in pediatric rheumatology and for adaptation to other chronic diseases.
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Affiliation(s)
- Karine Toupin April
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Heather Boon
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M. Duffy
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Adam M. Huber
- IWK Health Centre, Halifax, Nova Scotia, Canada
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michele Gibbon
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Martin Descarreaux
- Département des sciences de l’activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Lynn Spiegel
- Department of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Vohra
- CARE Program, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- Integrative Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Peter Tugwell
- Centre for Global Health, Institute of Population Health, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Rai SK, Yazdany J, Fortin PR, Aviña-Zubieta JA. Approaches for estimating minimal clinically important differences in systemic lupus erythematosus. Arthritis Res Ther 2015; 17:143. [PMID: 26036334 PMCID: PMC4453215 DOI: 10.1186/s13075-015-0658-6] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A minimal clinically important difference (MCID) is an important concept used to determine whether a medical intervention improves perceived outcomes in patients. Prior to the introduction of the concept in 1989, studies focused primarily on statistical significance. As most recent clinical trials in systemic lupus erythematosus (SLE) have failed to show significant effects, determining a clinically relevant threshold for outcome scores (that is, the MCID) of existing instruments may be critical for conducting and interpreting meaningful clinical trials as well as for facilitating the establishment of treatment recommendations for patients. To that effect, methods to determine the MCID can be divided into two well-defined categories: distribution-based and anchor-based approaches. Distribution-based approaches are based on statistical characteristics of the obtained samples. There are various methods within the distribution-based approach, including the standard error of measurement, the standard deviation, the effect size, the minimal detectable change, the reliable change index, and the standardized response mean. Anchor-based approaches compare the change in a patient-reported outcome to a second, external measure of change (that is, one that is more clearly understood, such as a global assessment), which serves as the anchor. Finally, the Delphi technique can be applied as an adjunct to defining a clinically important difference. Despite an abundance of methods reported in the literature, little work in MCID estimation has been done in the context of SLE. As the MCID can help determine the effect of a given therapy on a patient and add meaning to statistical inferences made in clinical research, we believe there ought to be renewed focus on this area. Here, we provide an update on the use of MCIDs in clinical research, review some of the work done in this area in SLE, and propose an agenda for future research.
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Affiliation(s)
- Sharan K Rai
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.,Department of Experimental Medicine, University of British Columbia, Vancouver General Hospital, 10226-2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jinoos Yazdany
- Department of Medicine, University of California, 1001 Potrero Ave, San Francisco, CA, 94143, USA
| | - Paul R Fortin
- Centre de recherche du CHU de Québec, Division de Rhumatologie, Département de Médecine, Université Laval, 2705 boulevard Laurier, Québec, QC, G1V 2L9, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada. .,Division of Rheumatology, Department of Medicine, University of British Columbia, Suite 802 - 1200 Burrard Street, Vancouver, BC, V6Z 2C7, Canada.
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Mina R, Klein-Gitelman MS, Nelson S, Eberhard BA, Higgins G, Singer NG, Onel K, Tucker L, O'Neil KM, Punaro M, Levy DM, Haines K, Ying J, Brunner HI. Effects of obesity on health-related quality of life in juvenile-onset systemic lupus erythematosus. Lupus 2014; 24:191-7. [PMID: 25335488 DOI: 10.1177/0961203314555537] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study evaluated the effects of obesity on health-related quality of life (HRQOL) measures in juvenile-onset systemic lupus erythematosus (jSLE). METHODS Obesity was defined as a body mass index (BMI) ≥ 95 th percentile according to the Sex-specific Center for Disease Control BMI-For-Age Charts and determined in a multicenter cohort of jSLE patients. In this secondary analysis, the domain and summary scores of the Pediatric Quality of Life (PedsQL) Inventory and the Child Health Questionnaire (CHQ) of obese jSLE patients were compared to those of non-obese jSLE patients as well as historical obese and non-obese healthy controls. Mixed-effects modeling was performed to evaluate the relationship between obesity and HRQOL measures. RESULTS Among the 202 jSLE patients, 25% (n = 51) were obese. Obesity had a significant negative impact on HRQOL in jSLE, even after adjusting for differences in current corticosteroid use, disease activity, disease damage, gender and race between groups. Obese jSLE patients had lower physical functioning compared to non-obese jSLE patients, and to non-obese and obese healthy controls. Compared to their non-obese counterparts, obese jSLE patients also had worse school functioning, more pain, worse social functioning and emotional functioning. Parents of obese jSLE patients worry more. The CHQ scores for obese jSLE patients were also worse compared to non-obese jSLE patients in several other domains. CONCLUSION Our study demonstrates the detrimental effects of obesity on patient-reported outcomes in jSLE. This supports the importance of weight management for the therapeutic plan of jSLE.
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Affiliation(s)
- R Mina
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA University of Cincinnati, Cincinnati, OH, USA
| | - M S Klein-Gitelman
- Division of Pediatric Rheumatology, Children's Memorial Hospital, Chicago, IL, USA
| | - S Nelson
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - B A Eberhard
- Division of Pediatric Rheumatology, Steven and Alexandra Cohen Children's Medical Center of NY, New York, USA
| | - G Higgins
- Division of Pediatric Rheumatology, Nationwide Children's Hospital and Ohio State University, Columbus, OH, USA
| | - N G Singer
- Division of Rheumatology, MetroHealth Medical Center & Case Western Reserve University, Cleveland, OH, USA
| | - K Onel
- Division of Pediatric Rheumatology, University of Chicago Comer Children's Hospital, Chicago, IL, USA
| | - L Tucker
- Division of Pediatric Rheumatology, BC Children's Hospital, Vancouver, BC, Canada
| | - K M O'Neil
- Section of Rheumatology, Riley Hospital for Children, Indianapolis, IN, USA
| | - M Punaro
- Division of Pediatric Rheumatology, Texas Scottish Rite Hospital, Dallas, TX, USA
| | - D M Levy
- Division of Rheumatology, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - K Haines
- Section of Pediatric Rheumatology & Immunology, Joseph M. Sanzari Children's Hospital, Hackensack UMC, Hackensack, NJ, USA
| | - J Ying
- University of Cincinnati, Cincinnati, OH, USA
| | - H I Brunner
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Mina R, Brunner HI. Update on differences between childhood-onset and adult-onset systemic lupus erythematosus. Arthritis Res Ther 2013; 15:218. [PMID: 23998441 PMCID: PMC3978647 DOI: 10.1186/ar4256] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a complex autoimmune disease and occurs worldwide in both children and adults. The estimated annual incidence among children is 2.22/100,000 and among adults is 23.2/100,000 in the United States. There is increasing understanding about differences in disease manifestations, medication use, and disease severity between those with childhood-onset SLE as compared with adult-onset SLE. Children have a more fulminant disease onset and course than adults with SLE, resulting in two to three times higher mortality. In future years, we anticipate more insight into the genetics between childhood-onset SLE and adult-onset SLE to help delineate the best therapies for both subsets of patients.
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Gaffo AL, Schumacher HR, Saag KG, Taylor WJ, Dinnella J, Outman R, Chen L, Dalbeth N, Sivera F, Vázquez-Mellado J, Chou CT, Zeng X, Perez-Ruiz F, Kowalski SC, Goldenstein-Schainberg C, Chen L, Bardin T, Singh JA. Developing a provisional definition of flare in patients with established gout. ACTA ACUST UNITED AC 2012; 64:1508-17. [PMID: 22083456 DOI: 10.1002/art.33483] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Various nonvalidated criteria for disease flare have been used in studies of gout. Our objective was to develop empirical definitions for a gout flare from patient-reported features. METHODS Possible elements for flare criteria were previously reported. Data were collected from 210 gout patients at 8 international sites to evaluate potential gout flare criteria against the gold standard of an expert rheumatologist definition. Flare definitions based on the presence of the number of criteria independently associated with the flare and classification and regression tree approaches were developed. RESULTS The mean ± SD age of the study participants was 56.2 ± 15 years, 207 of them (98%) were men, and 54 of them (26%) had flares of gout. The presence of any patient-reported warm joint, any patient-reported swollen joint, patient-reported pain at rest score of >3 (0-10 scale), and patient-reported flare were independently associated with the study gold standard. The greatest discriminating power was noted for the presence of 3 or more of the above 4 criteria (sensitivity 91% and specificity 82%). Requiring all 4 criteria provided the highest specificity (96%) and positive predictive value (85%). A classification tree identified pain at rest with a score of >3, followed by patient self-reported flare, as the rule associated with the gold standard (sensitivity 83% and specificity 90%). CONCLUSION We propose definitions for a disease flare based on self-reported items in patients previously diagnosed as having gout. Patient-reported flare, joint pain at rest, warm joints, and swollen joints were most strongly associated with presence of a gout flare. These provisional definitions will next be validated in clinical trials.
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Affiliation(s)
- Angelo L Gaffo
- Birmingham VA Medical Center and University of Alabama at Birmingham, AL, USA
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Mina R, Klein-Gitelman MS, Ravelli A, Beresford MW, Avcin T, Espada G, Eberhard BA, Schanberg LE, O'Neil KM, Silva CA, Higgins GC, Onel K, Singer NG, von Scheven E, Imundo LF, Nelson S, Giannini EH, Brunner HI. Inactive disease and remission in childhood-onset systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2012; 64:683-93. [PMID: 22238253 DOI: 10.1002/acr.21612] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To define inactive disease (ID) and clinical remission (CR) and to delineate variables that can be used to measure ID/CR in childhood-onset systemic lupus erythematosus (cSLE). METHODS Delphi questionnaires were sent to an international group of pediatric rheumatologists. Respondents provided information about variables to be used in future algorithms to measure ID/CR. The usefulness of these variables was assessed in 35 children with ID and 31 children with minimally active lupus (MAL). RESULTS While ID reflects cSLE status at a specific point in time, CR requires the presence of ID for >6 months and considers treatment. There was consensus that patients in ID/CR can have <2 mild nonlimiting symptoms (i.e., fatigue, arthralgia, headaches, or myalgia) but not Raynaud's phenomenon, chest pain, or objective physical signs of cSLE; antinuclear antibody positivity and erythrocyte sedimentation rate elevation can be present. Complete blood count, renal function testing, and complement C3 all must be within the normal range. Based on consensus, only damage-related laboratory or clinical findings of cSLE are permissible with ID. The above parameters were suitable to differentiate children with ID/CR from those with MAL (area under the receiver operating characteristic curve >0.85). Disease activity scores with or without the physician global assessment of disease activity and patient symptoms were well suited to differentiate children with ID from those with MAL. CONCLUSION Consensus has been reached on common definitions of ID/CR with cSLE and relevant patient characteristics with ID/CR. Further studies must assess the usefulness of the data-driven candidate criteria for ID in cSLE.
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Affiliation(s)
- Rina Mina
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, William S. Rowe Division of Rheumatology, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA
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Stinson JN, Connelly M, Jibb LA, Schanberg LE, Walco G, Spiegel LR, Tse SML, Chalom EC, Chira P, Rapoff M. Developing a standardized approach to the assessment of pain in children and youth presenting to pediatric rheumatology providers: a Delphi survey and consensus conference process followed by feasibility testing. Pediatr Rheumatol Online J 2012; 10:7. [PMID: 22490427 PMCID: PMC3366881 DOI: 10.1186/1546-0096-10-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 04/10/2012] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Pain in children with rheumatic conditions such as arthritis is common. However, there is currently no standardized method for the assessment of this pain in children presenting to pediatric rheumatologists. A more consistent and comprehensive approach is needed to effectively assess, treat and monitor pain outcomes in the pediatric rheumatology population. The objectives of this study were to: (a) develop consensus regarding a standardized pain assessment tool for use in pediatric rheumatology practice and (b) test the feasibility of three mediums (paper, laptop, and handheld-based applications) for administration. METHODS In Phase 1, a 2-stage Delphi technique (pediatric rheumatologists and allied professionals) and consensus meeting (pediatric pain and rheumatology experts) were used to develop the self- and proxy-report pain measures. In Phase 2, 24 children aged 4-7 years (and their parents), and 77 youth, aged 8-18 years, with pain, were recruited during routine rheumatology clinic appointments and completed the pain measure using each medium (order randomly assigned). The participant's rheumatologist received a summary report prior to clinical assessment. Satisfaction surveys were completed by all participants. Descriptive statistics were used to describe the participant characteristics using means and standard deviations (for continuous variables) and frequencies and proportions (for categorical variables) RESULTS Completing the measure using the handheld device took significantly longer for youth (M = 5.90 minutes) and parents (M = 7.00 minutes) compared to paper (M = 3.08 and 2.28 minutes respectively p = 0.001) and computer (M = 3.40 and 4.00 minutes respectively; p < 0.001). There was no difference in the number of missed responses between mediums for children or parents. For youth, the number of missed responses varied across mediums (p = 0.047) with the greatest number of missed responses occurring with the handheld device. Most children preferred the computer (65%, p = 0.008) and youth reported no preference between mediums (p = 0.307). Most physicians (60%) would recommend the computer summary over the paper questionnaire to a colleague. CONCLUSIONS It is clinically feasible to implement a newly developed consensus-driven pain measure in pediatric rheumatology clinics using electronic or paper administration. Computer-based administration was most efficient for most users, but the medium employed in practice may depend on child age and economic and administrative factors.
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Affiliation(s)
- Jennifer N Stinson
- University of Toronto Lawrence S, Bloomberg Faculty of Nursing, 155 College Street, Toronto ON M5T 1P8, Canada.
| | - Mark Connelly
- Children's Mercy Hospitals and Clinics, Pain Management Program, 2401 Gillham Road, Kansas City MO 64108, USA
| | - Lindsay A Jibb
- University of Toronto Lawrence S. Bloomberg Faculty of Nursing, 155 College Street, Toronto ON M5T 1P8, Canada
| | - Laura E Schanberg
- Duke Medical Center, Department of Pediatrics, DUMC 3212, Durham NC 27710, USA
| | - Gary Walco
- Seattle Children's Hospital, Department of Anesthesia and Pain Medicine, 4800 Sand Point, Way NE Seattle WA 98105, USA
| | - Lynn R Spiegel
- University of Toronto, Department of Pediatrics, 1 King's College Circle, Toronto ON M5S 1A8, Canada,The Hospital for Sick Children, Department of Pediatrics, 555 University Avenue, Toronto ON M5G 1X8, Canada
| | - Shirley ML Tse
- University of Toronto, Department of Pediatrics, 1 King's College Circle, Toronto ON M5S 1A8, Canada,The Hospital for Sick Children, Department of Pediatrics, 555 University Avenue, Toronto ON M5G 1X8, Canada
| | - Elizabeth C Chalom
- Saint Barnabas Medical Center, Department of Pediatrics, 94 Old Shore Hills Road, Livingston NJ 07039, USA
| | - Peter Chira
- Indiana University School of Medicine, Department of Pediatrics, 705 Riley Hospital Drive, Indianapolis IN 46202, USA
| | - Michael Rapoff
- University of Kansas Medical Center, Department of Pediatrics, 3901 Rainbow Boulevard, Kansas City KS 66160, USA
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Hersh A. Measures of health-related quality of life in pediatric systemic lupus erythematosus: Childhood Health Assessment Questionnaire (C-HAQ), Child Health Questionnaire (CHQ), Pediatric Quality of Life Inventory Generic Core Module (PedsQL-GC), Pediatric Quali. Arthritis Care Res (Hoboken) 2011; 63 Suppl 11:S446-53. [DOI: 10.1002/acr.20559] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brunner HI, Mina R, Pilkington C, Beresford MW, Reiff A, Levy DM, Tucker LB, Eberhard BA, Ravelli A, Schanberg LE, Saad-Magalhaes C, Higgins GC, Onel K, Singer NG, von Scheven E, Itert L, Klein-Gitelman MS, Punaro M, Ying J, Giannini EH. Preliminary criteria for global flares in childhood-onset systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2011; 63:1213-23. [PMID: 21618452 DOI: 10.1002/acr.20507] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To develop widely acceptable preliminary criteria of global flare for childhood-onset systemic lupus erythematosus (cSLE). METHODS Pediatric rheumatologists (n = 138) rated a total of 358 unique patient profiles with information about the cSLE flare descriptors from 2 consecutive visits: patient global assessment of well-being, physician global assessment of disease activity (MD-global), health-related quality of life, anti-double-stranded DNA antibodies, disease activity index scores, protein:creatinine (P:C) ratio, complement levels, and erythrocyte sedimentation rate (ESR). Based on 2,996 rater responses about the course of cSLE (baseline versus followup), the accuracy (sensitivity, specificity, and area under the receiver operating characteristic curve) of candidate flare criteria was assessed. An international consensus conference was held to rank these candidate flare criteria as per the American College of Rheumatology recommendations for the development and validation of criteria sets. RESULTS The highest-ranked candidate criteria considered absolute changes (Δ) of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) or British Isles Lupus Assessment Group (BILAG), MD-global, P:C ratio, and ESR; flare scores can be calculated (0.5 × ΔSLEDAI + 0.45 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR), where values of ≥1.04 are reflective of a flare. Similarly, BILAG-based flare scores (0.4 × ΔBILAG + 0.65 × ΔP:C ratio + 0.5 × ΔMD-global + 0.02 × ΔESR) of ≥1.15 were diagnostic of a flare. Flare scores increased with flare severity. CONCLUSION Consensus has been reached on preliminary criteria for global flares in cSLE. Further validation studies are needed to confirm the usefulness of the cSLE flare criteria in research and for clinical care.
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DAVÌ SERGIO, CONSOLARO ALESSANDRO, GUSEINOVA DINARA, PISTORIO ANGELA, RUPERTO NICOLINO, MARTINI ALBERTO, CRON RANDYQ, RAVELLI ANGELO. An International Consensus Survey of Diagnostic Criteria for Macrophage Activation Syndrome in Systemic Juvenile Idiopathic Arthritis. J Rheumatol 2011; 38:764-8. [DOI: 10.3899/jrheum.100996] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective.To identify candidate diagnostic criteria for macrophage activation syndrome (MAS) complicating systemic juvenile idiopathic arthritis (sJIA) using international consensus formation through a Delphi questionnaire survey.Methods.A questionnaire listing 28 clinical, laboratory, and histopathologic features of MAS elicited by literature review was sent to 505 pediatric rheumatologists worldwide. Respondents were asked to select the 10 features that they felt were most important and useful in the diagnosis of MAS, and to order the 10 selected features by assigning the number 10 to the most important, and ending with 1 as the least important.Results.The response rate was 46% (232 physicians from 47 countries). The items selected by more than 50% of respondents were, in order of frequency, falling platelet count, hyperferritinemia, evidence of macrophage hemophagocytosis in the bone marrow, increased liver enzymes, falling leukocyte count, persistent continuous fever ≥ 38°C, falling erythrocyte sedimentation rate, hypofibrinogenemia, and hypertriglyceridemia.Conclusion.Our process led to identification of features that were felt to be most important as candidate diagnostic criteria for MAS by a large sample of international pediatric rheumatologists.
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