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Balay-Dustrude E, Christensen R, Consolaro A, Ingrid Goh Y, Gottlieb BS, Horgan B, Horonjeff J, Maxwell LJ, Munro J, Pan N, Schultz G, Swart JF, Toupin-April K, Morgan EM. Defining patient perception of overall well-being and disease activity in the OMERACT Juvenile Idiopathic Arthritis (JIA) core domain set: A report from the JIA working group. Semin Arthritis Rheum 2024; 64:152340. [PMID: 38071831 DOI: 10.1016/j.semarthrit.2023.152340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE The OMERACT Juvenile Idiopathic Arthritis (JIA) Working Group (WG) aimed to reach agreement on a consensus-based definition and description of the core domain related to patient perception of overall well-being and disease activity. METHODS A committee of patient research partners, clinicians, methodologists, and researchers drafted working definitions and descriptions. The WG conducted two iterative electronic stakeholder surveys to obtain consensus on domain description, definition, and the distinction between patient perception of overall well-being and disease activity. These definitions were then presented at the OMERACT 2023 Special Interest Group (SIG) session for agreement. RESULTS Forty-five participants, from 7 countries and 4 continents, were comprised of six patients, 18 caregivers, and 21 healthcare providers. The consensus threshold (70%) was exceeded on all survey questions from both stakeholder groups (patients/caregivers, all others). Agreement was obtained on the new definition, description, and domain title, along with agreement on separate assessments of two target domains, patient perception of overall well-being as it relates to disease and patient perception of disease activity. CONCLUSION Through an iterative consensus process and achieving agreement from the OMERACT SIG session attendees, the JIA WG has created a detailed definition and description for the two target domains in the patient perception of overall well-being related to disease core domain of the JIA mandatory core domain set. The next phase of this work will be instrument selection using the OMERACT filter 2.2.
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Affiliation(s)
- Erin Balay-Dustrude
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, Washington, USA.
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Alessandro Consolaro
- Istituto Giannina Gaslini, Genova, Italy; Università degli Studi di Genova, Genova, Italy
| | - Y Ingrid Goh
- Division of Rheumatology, The Hospital for Sick Children, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, ON, Canada
| | - Beth S Gottlieb
- Pediatric Rheumatology, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine at Hofstra Northwell, New York, USA
| | | | - Jennifer Horonjeff
- Savvy Cooperative, New York, New York, USA; Patient research partner, USA
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jane Munro
- Rheumatology Unit, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, University of Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Nancy Pan
- Hospital for Special Surgery, New York, USA; Weill Medical College of Cornell University, New York, USA
| | | | - Joost F Swart
- Wilhelmina Children's Hospital/ UMC Utrecht, Utrecht, The Netherlands; Utrecht University, Utrecht, The Netherlands
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada; Institut du savoir Montfort, Ottawa, Canada
| | - Esi M Morgan
- Department of Pediatrics, University of Washington, Seattle, WA, USA; Seattle Children's Hospital, Seattle, Washington, USA
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2
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Bingham CA, Harris JG, Qiu T, Gilbert M, Vora SS, Yildirim-Toruner C, Ferraro K, Lovell DJ, Taylor J, Mannion ML, Weiss JE, Laxer RM, Shishov M, Oberle EJ, Gottlieb BS, Lee TC, Pan N, Burnham JM, Fair DC, Batthish M, Hazen MM, Spencer CH, Morgan EM. Pediatric Rheumatology Care and Outcomes Improvement Network's Quality Measure Set to Improve Care of Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2023; 75:2442-2452. [PMID: 37308458 DOI: 10.1002/acr.25168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/10/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the selection, development, and implementation of quality measures (QMs) for juvenile idiopathic arthritis (JIA) by the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), a multihospital learning health network using quality improvement methods and leveraging QMs to drive improved outcomes across a JIA population since 2011. METHODS An American College of Rheumatology-endorsed multistakeholder process previously selected initial process QMs. Clinicians in PR-COIN and parents of children with JIA collaboratively selected outcome QMs. A committee of rheumatologists and data analysts developed operational definitions. QMs were programmed and validated using patient data. Measures are populated by registry data, and performance is displayed on automated statistical process control charts. PR-COIN centers use rapid-cycle quality improvement approaches to improve performance metrics. The QMs are revised for usefulness, to reflect best practices, and to support network initiatives. RESULTS The initial QM set included 13 process measures concerning standardized measurement of disease activity, collection of patient-reported outcome assessments, and clinical performance measures. Initial outcome measures were clinical inactive disease, low pain score, and optimal physical functioning. The revised QM set has 20 measures and includes additional measures of disease activity, data quality, and a balancing measure. CONCLUSION PR-COIN has developed and tested JIA QMs to assess clinical performance and patient outcomes. The implementation of robust QMs is important to improve quality of care. PR-COIN's set of JIA QMs is the first comprehensive set of QMs used at the point-of-care for a large cohort of JIA patients in a variety of pediatric rheumatology practice settings.
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Affiliation(s)
- Catherine A Bingham
- Penn State Children's Hospital and Penn State College of Medicine, Hershey, Pennsylvania
| | - Julia G Harris
- Children's Mercy Hospitals and Clinics, Kansas City, Missouri
| | - Tingting Qiu
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Sheetal S Vora
- Levine Children's Hospital and Atrium Health, Charlotte, North Carolina
| | | | - Kerry Ferraro
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Janalee Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Jennifer E Weiss
- Hackensack University Medical Center and Hackensack Meridian Health, Hackensack, New Jersey
| | - Ronald M Laxer
- The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | | | - Edward J Oberle
- Nationwide Children's Hospital and The Ohio State University, Columbus
| | - Beth S Gottlieb
- Cohen Children's Medical Center of New York and Zucker School of Medicine at Hofstra/Northwell, Queens, New York
| | - Tzielan C Lee
- Stanford Medicine Children's Health, Stanford University, Stanford, California
| | - Nancy Pan
- Hospital for Special Surgery and Cornell University, New York, New York
| | - Jon M Burnham
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Danielle C Fair
- Medical College of Wisconsin and Children's Wisconsin, Milwaukee
| | - Michelle Batthish
- McMaster Children's Hospital and McMaster University, Hamilton, Ontario, Canada
| | | | | | - Esi M Morgan
- Seattle Children's Hospital and the University of Washington, Seattle
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3
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Backström M, Tarkiainen M, Gottlieb BS, Trincianti C, Qiu T, Morgan E, Lovell DJ, Bovis F, Löyttyniemi E, Ruperto N, Vähäsalo P, Consolaro A. Paediatric rheumatologists do not score the physician's global assessment of juvenile idiopathic arthritis disease activity in the same way. Rheumatology (Oxford) 2023; 62:3421-3426. [PMID: 37004166 PMCID: PMC10547524 DOI: 10.1093/rheumatology/kead151] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/17/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES To assess the heterogeneity in factors affecting physician's global assessment of disease activity (PhGA) and in PhGA scoring of multiple JIA patient's case scenarios. METHODS An electronic web-based questionnaire of factors potentially considered in PhGA was sent worldwide to members of PRINTO and the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN). The respondents were asked to rate from 0 to 100 the relevance of 17 factors possibly affecting PhGA scoring and to derive a PhGA score of 17 detailed JIA patient cases. The median and interquartile range was used to measure the heterogeneity in the scoring. To demonstrate the consistency among the PhGA scores of the patient cases provided by multiple physicians, we assessed the inter-rater reliability using intra-class correlation. RESULTS The questionnaire was completed by 491 respondents. A large individual variation was observed in the impact of different factors on PhGA when assessing JIA. For non-systemic JIA the presence of fever had the largest variation and swollen joint count had the smallest. For sJIA, the largest variation was seen in the presence of erosions and the smallest in the presence of fever. The intra-class correlation of the group for PhGA scoring of patient cases was 0.53 (95% CI 0.38, 0.72). CONCLUSIONS In a sample of worldwide respondents, the scoring of the PhGA is divergent. Consensus on PhGA scoring guidelines is required to obtain a consistent assessment of patients.
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Affiliation(s)
- Maria Backström
- Department of Pediatrics, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Maarit Tarkiainen
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, New Children’s Hospital, Helsinki, Finland
| | - Beth S Gottlieb
- Pediatric Rheumatology, Cohen Children’s Medical Center, Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | | | - Tingting Qiu
- Department of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, OH, USA
| | - Esi Morgan
- Department of Pediatrics, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA
| | - Daniel J Lovell
- Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati School of Medicine, OH, USA
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | | | - Nicolino Ruperto
- Pediatria II—PRINTO, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
| | - Paula Vähäsalo
- PEDEGO Research Unit, University of Oulu, Oulu, Finland
- Department of Paediatrics, Oulu University Hospital, Oulu, Finland
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Alessandro Consolaro
- Department of Health Sciences, University of Genoa, Genoa, Italy
- Pediatria II—PRINTO, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Italy
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Sahn B, Lu Y, Hui-Yuen JS, Fishbein J, Gottlieb BS, Eberhard BA, Walters HM. The safety of COVID-19 vaccination in immunocompromised children and young adults with immune-mediated inflammatory disease. Acta Paediatr 2023; 112:794-801. [PMID: 36583590 PMCID: PMC9880735 DOI: 10.1111/apa.16652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 12/17/2022] [Accepted: 12/29/2022] [Indexed: 12/31/2022]
Abstract
AIM To assess safety of COVID-19 vaccination in paediatric patients with immune-mediated inflammatory disease (IMID). METHODS Subjects of 5-21 years of age with IMID who received at least one COVID-19 vaccine completed electronic surveys after each vaccine to assess side effects within 1 week of vaccination, current medications and COVID-19 testing after vaccination. Charts were reviewed for COVID-19 polymerase chain reaction and IgG response to SARS-CoV-2 spike protein results and for disease flare during the study period. RESULTS Among 190 enrolled subjects, 71% were female, with median age 17 (range 6-21) years. The most common diagnosis was juvenile idiopathic arthritis/rheumatoid arthritis (55%). 78% of subjects were taking immunosuppressive medication. At least one side effect was reported in 65% of subjects after any dose of the vaccine; with side effects in 38%, 53% and 55% of subjects after the first, second and third vaccine doses, respectively. The most common side effects were injection site pain (59%), fatigue (54%) and headache (39%). No anaphylaxis or myocarditis was reported. Three subjects (2%) experienced disease flare. CONCLUSION In our cohort of paediatric patients with IMID, observed side effects were found to be mild and disease flare rates were found to be low following COVID-19 vaccination.
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Affiliation(s)
- Benjamin Sahn
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA.,Division of Pediatric Gastroenterology, Liver Disease, and Nutrition, Cohen Children's Medical Center of NY, New Hyde Park, New York, USA
| | - Ying Lu
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA.,Division of Pediatric Gastroenterology, Liver Disease, and Nutrition, Cohen Children's Medical Center of NY, New Hyde Park, New York, USA
| | - Joyce S Hui-Yuen
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA.,Division of Pediatric Rheumatology, Cohen Children's Medical Center of NY, New Hyde Park, New York, USA
| | - Joanna Fishbein
- Biostatistics Unit, Office of Academic Affairs, Northwell Health, New Hyde Park, New York, USA
| | - Beth S Gottlieb
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA.,Division of Pediatric Rheumatology, Cohen Children's Medical Center of NY, New Hyde Park, New York, USA
| | - Barbara A Eberhard
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA.,Division of Pediatric Rheumatology, Cohen Children's Medical Center of NY, New Hyde Park, New York, USA
| | - Heather M Walters
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA.,Division of Pediatric Rheumatology, Cohen Children's Medical Center of NY, New Hyde Park, New York, USA
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5
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Walters HM, Mian Z, Thomas L, Cerise J, Eberhard BA, Pagano E, Gottlieb BS, Steigerwald K, Hui-Yuen JS. Seroprevalence and Clinical Outcomes of SARS-CoV-2 in Paediatric Patients with Rheumatic Disease. Rheumatology (Oxford) 2021; 61:SI112-SI119. [PMID: 34599820 DOI: 10.1093/rheumatology/keab730] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Immunosuppressed paediatric patients with rheumatic disease (RD) may be at risk for severe or critical disease related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Data remain scarce on COVID-19 outcomes in paediatric RD patients. The aim of this study is to determine the seroprevalence of SARS-CoV-2 IgG and to describe COVID-19 outcomes in immunosuppressed paediatric RD patients. METHODS Patients diagnosed with RD before age 18 and treated with at least one immunosuppressive medication for at least three months were enrolled from a tertiary paediatric rheumatology practice in New York, and also underwent routine SARS-CoV-2 IgG testing from May to November 2020. Five hundred and seventy-one patients were screened and 262 were enrolled. SARS-CoV-2 IgG+ subjects were assessed for symptoms of COVID-19 infection. SARS-CoV-2 PCR results were recorded where available. Demographic, diagnostic, medication, and outcome data were collected. RESULTS Of 262 subjects (186 female), 35 (13%) were SARS-CoV-2 IgG+; 17 (49%) had symptoms suggestive of COVID-19. Of 17 patients who had SARS-CoV-2 PCR testing, 11 (65%) were PCR+; seven of whom were IgG+. Most SARS-CoV-2 IgG+ subjects were not PCR tested. The most common symptoms in IgG+ and/or PCR+ subjects were fever, fatigue, and cough. No SARS-CoV-2 IgG+ or PCR+ subject developed severe or critical COVID-19 or required hospitalisation. CONCLUSIONS This is the first report of clinical outcomes of SARS-CoV-2 infection and seroprevalence of SARS-CoV-2 IgG in a large cohort of paediatric RD patients. Most SARS-CoV-2 IgG+ subjects had no symptoms of COVID-19 infection. Symptomatic subjects all had mild COVID-19 symptoms, suggesting that risk of severe or critical COVID-19 in immunosuppressed paediatric RD patients is minimal.
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Affiliation(s)
- Heather M Walters
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Zanab Mian
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Lydia Thomas
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jane Cerise
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Biostatistics Unit, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - B Anne Eberhard
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eileen Pagano
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Beth S Gottlieb
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Katherine Steigerwald
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joyce S Hui-Yuen
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Center for Autoimmune, Musculoskeletal, and Hematopoietic Diseases Research, Feinstein Institutes for Medical Research, Manhasset, NY, USA
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6
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Hinze CH, Foell D, Johnson AL, Spalding SJ, Gottlieb BS, Morris PW, Kimura Y, Onel K, Li SC, Grom AA, Taylor J, Brunner HI, Huggins JL, Nocton JJ, Haines KA, Edelheit BS, Shishov M, Jung LK, Williams CB, Tesher MS, Costanzo DM, Zemel LS, Dare JA, Passo MH, Ede KC, Olson JC, Cassidy EA, Griffin TA, Wagner-Weiner L, Weiss JE, Vogler LB, Rouster-Stevens KA, Beukelman T, Cron RQ, Kietz D, Schikler K, Mehta J, Ting TV, Verbsky JW, Eberhard AB, Huang B, Giannini EH, Lovell DJ. Serum S100A8/A9 and S100A12 Levels in Children With Polyarticular Forms of Juvenile Idiopathic Arthritis: Relationship to Maintenance of Clinically Inactive Disease During Anti-Tumor Necrosis Factor Therapy and Occurrence of Disease Flare After Discontinuation of Therapy. Arthritis Rheumatol 2019; 71:451-459. [PMID: 30225949 DOI: 10.1002/art.40727] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/11/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To determine the relationship between serum levels of S100A8/A9 and S100A12 and the maintenance of clinically inactive disease during anti-tumor necrosis factor (anti-TNF) therapy and the occurrence of disease flare following withdrawal of anti-TNF therapy in patients with polyarticular forms of juvenile idiopathic arthritis (JIA). METHODS In this prospective, multicenter study, 137 patients with polyarticular-course JIA whose disease was clinically inactive while receiving anti-TNF therapy were enrolled. Patients were observed for an initial 6-month phase during which anti-TNF treatment was continued. For those patients who maintained clinically inactive disease over the 6 months, anti-TNF was withdrawn and they were followed up for 8 months to assess for the occurrence of flare. Serum S100 levels were measured at baseline and at the time of anti-TNF withdrawal. Spearman's rank correlation test, Mann-Whitney U test, Kruskal-Wallis test, receiver operating characteristic (ROC) curve, and Kaplan-Meier survival analyses were used to assess the relationship between serum S100 levels and maintenance of clinically inactive disease and occurrence of disease flare after anti-TNF withdrawal. RESULTS Over the 6-month initial phase with anti-TNF therapy, the disease state reverted from clinically inactive to clinically active in 24 (18%) of the 130 evaluable patients with polyarticular-course JIA; following anti-TNF withdrawal, 39 (37%) of the 106 evaluable patients experienced a flare. Serum levels of S100A8/A9 and S100A12 were elevated in up to 45% of patients. Results of the ROC analysis revealed that serum S100 levels did not predict maintenance of clinically inactive disease during anti-TNF therapy nor did they predict disease flare after treatment withdrawal. Elevated levels of S100A8/A9 were not predictive of the occurrence of a disease flare within 30 days, 60 days, 90 days, or 8 months following anti-TNF withdrawal, and elevated S100A12 levels had a modest predictive ability for determining the risk of flare within 30, 60, and 90 days after treatment withdrawal. Serum S100A12 levels at the time of anti-TNF withdrawal were inversely correlated with the time to disease flare (r = -0.36). CONCLUSION Serum S100 levels did not predict maintenance of clinically inactive disease or occurrence of disease flare in patients with polyarticular-course JIA, and S100A12 levels were only moderately, and inversely, correlated with the time to disease flare.
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Affiliation(s)
| | - Dirk Foell
- University Hospital Münster, Münster, Germany
| | - Anne L Johnson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Beth S Gottlieb
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - Yukiko Kimura
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | - Karen Onel
- University of Chicago, Comer Children's Hospital, Chicago, Illinois
| | - Suzanne C Li
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | - Alexei A Grom
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Janalee Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - Kathleen A Haines
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | | | | | - Calvin B Williams
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Melissa S Tesher
- University of Chicago, Comer Children's Hospital, Chicago, Illinois
| | | | | | - Jason A Dare
- University of Arkansas for Medical Science, Little Rock
| | | | - Kaleo C Ede
- Phoenix Children's Hospital, Phoenix, Arizona
| | | | | | | | | | - Jennifer E Weiss
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | | | | | | | - Daniel Kietz
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Jay Mehta
- Children's Hospital at Montefiore, Bronx, New York
| | - Tracy V Ting
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Anne B Eberhard
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | - Bin Huang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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7
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Lovell DJ, Johnson AL, Huang B, Gottlieb BS, Morris PW, Kimura Y, Onel K, Li SC, Grom AA, Taylor J, Brunner HI, Huggins JL, Nocton JJ, Haines KA, Edelheit BS, Shishov M, Jung LK, Williams CB, Tesher MS, Costanzo DM, Zemel LS, Dare JA, Passo MH, Ede KC, Olson JC, Cassidy EA, Griffin TA, Wagner-Weiner L, Weiss JE, Vogler LB, Rouster-Stevens KA, Beukelman T, Cron RQ, Kietz D, Schikler K, Schmidt KM, Mehta J, Wahezi DM, Ting TV, Verbsky JW, Eberhard BA, Spalding S, Chen C, Giannini EH. Risk, Timing, and Predictors of Disease Flare After Discontinuation of Anti-Tumor Necrosis Factor Therapy in Children With Polyarticular Forms of Juvenile Idiopathic Arthritis With Clinically Inactive Disease. Arthritis Rheumatol 2018; 70:1508-1518. [PMID: 29604189 DOI: 10.1002/art.40509] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the frequency, time to flare, and predictors of disease flare upon withdrawal of anti-tumor necrosis factor (anti-TNF) therapy in children with polyarticular forms of juvenile idiopathic arthritis (JIA) who demonstrated ≥6 months of continuous clinically inactive disease. METHODS In 16 centers 137 patients with clinically inactive JIA who were receiving anti-TNF therapy (42% of whom were also receiving methotrexate [MTX]) were prospectively followed up. If the disease remained clinically inactive for the initial 6 months of the study, anti-TNF was stopped and patients were assessed for flare at 1, 2, 3, 4, 6, and 8 months. Life-table analysis, t-tests, chi-square test, and Cox regression analysis were used to identify independent variables that could significantly predict flare by 8 months or time to flare. RESULTS Of 137 patients, 106 (77%) maintained clinically inactive disease while receiving anti-TNF therapy for the initial 6 months and were included in the phase of the study in which anti-TNF therapy was stopped. Stopping anti-TNF resulted in disease flare in 39 (37%) of 106 patients by 8 months. The mean/median ± SEM time to flare was 212/250 ± 9.77 days. Patients with shorter disease duration at enrollment, older age at onset and diagnosis, shorter disease duration prior to experiencing clinically inactive disease, and shorter time from onset of clinically inactive disease to enrollment were found to have significantly lower hazard ratios for likelihood of flare by 8 months (P < 0.05). CONCLUSION Over one-third of patients with polyarticular JIA with sustained clinically inactive disease will experience a flare by 8 months after discontinuation of anti-TNF therapy. Several predictors of lower likelihood of flare were identified.
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Affiliation(s)
- Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Anne L Johnson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bin Huang
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Beth S Gottlieb
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - Yukiko Kimura
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | - Karen Onel
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - Suzanne C Li
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | - Alexei A Grom
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Janalee Taylor
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | | | - Kathleen A Haines
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | | | | | | | - Melissa S Tesher
- University of Chicago, Comer Children's Hospital, Chicago, Illinois
| | - Denise M Costanzo
- The Steven and Alexandra Cohen Children's Medical Center of New York, New Hyde Park, New York
| | | | - Jason A Dare
- University of Arkansas for Medical Science, Little Rock
| | | | - Kaleo C Ede
- Phoenix Children's Hospital, Phoenix, Arizona
| | | | | | | | | | - Jennifer E Weiss
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | | | | | | | - Daniel Kietz
- Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Jay Mehta
- Children's Hospital at Montefiore, Bronx, New York
| | | | - Tracy V Ting
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - B Anne Eberhard
- Hackensack University Medical Center, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey
| | | | - Chen Chen
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Favier LA, Taylor J, Loiselle Rich K, Jones KB, Vora SS, Harris JG, Gottlieb BS, Robbins L, Lai JT, Lee T, Kohlheim M, Gill J, Bouslaugh L, Young A, Griffin N, Morgan EM, Modi AC. Barriers to Adherence in Juvenile Idiopathic Arthritis: A Multicenter Collaborative Experience and Preliminary Results. J Rheumatol 2018; 45:690-696. [PMID: 29419467 PMCID: PMC5932234 DOI: 10.3899/jrheum.171087] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Nonadherence is currently an underrecognized and potentially modifiable obstacle to care in juvenile idiopathic arthritis (JIA). The purpose of our study was to design and implement a standardized approach to identifying adherence barriers for youth with JIA across 7 pediatric rheumatology clinics through the Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN) and to assess the frequency of adherence barriers in patients and their caregivers across treatment modalities. METHODS An iterative process using coproduction among parents and providers of patients with JIA was used to design the Barriers Assessment Tool to screen for adherence barriers across 4 treatment modalities (i.e., oral medications, injectable medications, infusions, and physical/occupational therapy). This tool was implemented in 7 rheumatology clinics across the United States and patient responses were collected for analysis. RESULTS Data were collected from 578 parents and 99 patients (n = 44 parent-child dyads). Seventy-seven percent (n = 444) of caregivers and 70% (n = 69) of patients reported at least 1 adherence barrier across all treatment components. The most commonly reported adherence barriers included worry about future consequences of therapy, pain, forgetting, side effects, and embarrassment related to the therapy. There was no significant difference between endorsement of barriers between parents and adolescents. CONCLUSION Implementing a standardized tool assessing adherence barriers in the JIA population across multiple clinical settings is feasible. Systematic screening sheds light on the factors that make adherence difficult in JIA and identifies targets for future adherence interventions in clinical practice.
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Affiliation(s)
- Leslie A Favier
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA.
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati.
| | - Janalee Taylor
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Kristin Loiselle Rich
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Karla B Jones
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Sheetal S Vora
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Julia G Harris
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Beth S Gottlieb
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Lisa Robbins
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Jamie T Lai
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Tzielan Lee
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Melanie Kohlheim
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Jennifer Gill
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Laura Bouslaugh
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Angela Young
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Nancy Griffin
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Esi M Morgan
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
| | - Avani C Modi
- From the Division of Rheumatology, and Division of Behavioral and Clinical Psychology, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; University of Cincinnati, Cincinnati, Ohio; Division of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio; Division of Rheumatology, Levine Children's Hospital, Charlotte, North Carolina; Division of Rheumatology, Children's Mercy Hospital, Kansas City, Missouri; Division of Rheumatology, Cohen Children's Medical Center, New York, New York; Division of Rheumatology, Penn State Children's Hospital, Hershey, Pennsylvania; Division of Rheumatology, Stanford Children's Hospital, Palo Alto, California; The Pediatric Rheumatology Care and Outcomes Improvement Network (PR-COIN), Cincinnati, Ohio, USA
- L.A. Favier, MD, Division of Rheumatology, and the Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and the University of Cincinnati; J. Taylor, MSN, APRN, CNP, Division of Rheumatology, Cincinnati Children's Hospital Medical Center; K. Loiselle Rich, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati; K.B. Jones, APRN, Division of Rheumatology, Nationwide Children's Hospital; S.S. Vora, MD, Division of Rheumatology, Levine Children's Hospital; J.G. Harris, MD, Division of Rheumatology, Children's Mercy Hospital; B.S. Gottlieb, MD, MS, Division of Rheumatology, Cohen Children's Medical Center; L. Robbins, BSN, CPN, Division of Rheumatology, Penn State Children's Hospital; J.T. Lai, MD, Division of Rheumatology, Stanford Children's Hospital; T. Lee, MD, Division of Rheumatology, Stanford Children's Hospital; M. Kohlheim, Parent Representative, PR-COIN; J. Gill, LSW, Parent Representative, PR-COIN; L. Bouslaugh, Parent Representative, PR-COIN; A. Young, Parent Representative, PR-COIN; N. Griffin, BSN, MPA, PR-COIN, and the James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; E.M. Morgan, MD, MSCE, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, and PR-COIN, and James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center; A.C. Modi, PhD, Division of Behavioral and Clinical Psychology, Cincinnati Children's Hospital Medical Center, and University of Cincinnati
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9
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Mor‐Vaknin N, Rivas M, Legendre M, Mohan S, Yuanfan Y, Mau T, Johnson A, Huang B, Zhao L, Kimura Y, Spalding SJ, Morris PW, Gottlieb BS, Onel K, Olson JC, Edelheit BS, Shishov M, Jung LK, Cassidy EA, Prahalad S, Passo MH, Beukelman T, Mehta J, Giannini EH, Adams BS, Lovell DJ, Markovitz DM. High Levels of DEK Autoantibodies in Sera of Patients With Polyarticular Juvenile Idiopathic Arthritis and With Early Disease Flares Following Cessation of Anti-Tumor Necrosis Factor Therapy. Arthritis Rheumatol 2018; 70:594-605. [PMID: 29287303 PMCID: PMC5876119 DOI: 10.1002/art.40404] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 12/18/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The nuclear oncoprotein DEK is an autoantigen associated with juvenile idiopathic arthritis (JIA), especially the oligoarticular subtype. DEK is a secreted chemotactic factor. Abundant levels of DEK and DEK autoantibodies are found in inflamed synovium in JIA. We undertook this study to further characterize the nature of DEK autoantibodies in screening serum samples from 2 different cohorts that consisted mostly of patients with JIA. METHODS DEK autoantibody levels were analyzed in sera from 33 JIA patients, 13 patients with other inflammatory conditions, and 11 healthy controls, as well as in 89 serum samples from JIA patients receiving anti-tumor necrosis factor (anti-TNF) therapy. Recombinant His-tagged full-length DEK protein (1-375 amino acids [aa]) and the 187-375-aa and 1-350-aa His-tagged DEK fragments made in a baculovirus system were used for enzyme-linked immunosorbent assay (ELISA) and immunoblotting. The C-terminal 25-aa fragment of DEK was expressed in a glutathione S-transferase-tagged vector. ELISA results were calculated as area under the curve by the trapezoidal rule. RESULTS DEK autoantibody levels were significantly higher in patients with polyarticular JIA than in those with oligoarticular JIA, and were higher in patients with polyarticular JIA who had more active disease after cessation of anti-TNF therapy. Immunoblotting against the C-terminal 25-aa fragment of DEK confirmed that this section of the DEK molecule is the most immunogenic domain. CONCLUSION DEK autoantibody levels are higher in patients with polyarticular JIA than in those with oligoarticular JIA, and higher in patients who have disease flares after cessation of anti-TNF therapy. The C-terminal 25-aa fragment is the most immunogenic portion of DEK. These findings are significant with respect to the nature of DEK autoantibodies, their contribution to JIA pathogenesis, and their implications for JIA management.
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Affiliation(s)
| | | | | | | | | | | | - Anne Johnson
- Cincinnati Children's Hospital Medical CenterCincinnatiOhio
| | - Bin Huang
- Cincinnati Children's Hospital Medical Center and University of Cincinnati School of MedicineCincinnatiOhio
| | | | - Yukiko Kimura
- Joseph M. Sanzari Children's HospitalHackensack University Medical CenterHackensackNew Jersey
| | | | | | - Beth S. Gottlieb
- Cohen Children's Medical Center, Northwell HealthHofstra Norwell School of MedicineHempsteadNew York
| | - Karen Onel
- Joseph M. Sanzari Children's HospitalHackensack University Medical CenterHackensackNew Jersey
| | | | | | | | | | | | | | | | | | - Jay Mehta
- Children's Hospital at Montefiore/Albert Einstein College of MedicineBronxNew York
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10
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Knight AM, Vickery ME, Muscal E, Davis AM, Harris JG, Soybilgic A, Onel KB, Schanberg LE, Rubinstein T, Gottlieb BS, Mandell DS, von Scheven E. Identifying Targets for Improving Mental Healthcare of Adolescents with Systemic Lupus Erythematosus: Perspectives from Pediatric Rheumatology Clinicians in the United States and Canada. J Rheumatol 2016; 43:1136-45. [PMID: 27036378 DOI: 10.3899/jrheum.151228] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To identify targets for improving mental healthcare of adolescents with systemic lupus erythematosus (SLE) by assessing current practices and perceived barriers for mental health intervention by pediatric rheumatology clinicians. METHODS Members of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) completed a Web-based survey assessing current mental health practices, beliefs, and barriers. We examined associations between provider characteristics and the frequency of barriers to mental health screening and treatment using multivariable linear regression. RESULTS Of the 375 eligible CARRA members, 130 responded (35%) and 119 completed the survey. Fifty-two percent described identification of depression/anxiety in adolescents with SLE at their practice as inadequate, and 45% described treatment as inadequate. Seventy-seven percent stated that routine screening for depression/anxiety in pediatric rheumatology should be conducted, but only 2% routinely used a standardized instrument. Limited staff resources and time were the most frequent barriers to screening. Respondents with formal postgraduate mental health training, experience treating young adults, and practicing at sites with very accessible mental health staff, in urban locations, and in Canada reported fewer barriers to screening. Long waitlists and limited availability of mental health providers were the most frequent barriers to treatment. Male clinicians and those practicing in the Midwest and Canada reported fewer barriers to treatment. CONCLUSION Pediatric rheumatology clinicians perceive a need for improved mental healthcare of adolescents with SLE. Potential strategies to overcome barriers include enhanced mental health training for pediatric rheumatologists, standardized rheumatology-based mental health practices, and better integration of medical and mental health services.
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Affiliation(s)
- Andrea M Knight
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - Michelle E Vickery
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - Eyal Muscal
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - Alaina M Davis
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - Julia G Harris
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - Arzu Soybilgic
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - Karen B Onel
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - Laura E Schanberg
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - Tamar Rubinstein
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - Beth S Gottlieb
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
| | - David S Mandell
- From the Division of Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the Children's Hospital of Philadelphia (CHOP); Perelman School of Medicine, and Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, Pennsylvania; Baylor College of Medicine; Department of Pediatric Medicine, Division of Immunology, Allergy and Rheumatology, Texas Children's Hospital, Houston, Texas; Division of Pediatric Rheumatology, Vanderbilt University School of Medicine, Monroe Carell Junior Children's Hospital, Nashville, Tennessee; Division of Rheumatology, Children's Mercy Kansas City; Kansas City School of Medicine, University of Missouri, Kansas City, Missouri; Division of Pediatric Rheumatology, University of Illinois at Chicago; University of Illinois Hospital and Health Sciences System; Division of Pediatric Rheumatology, University of Chicago; University of Chicago Medicine, Chicago, Illinois; Division of Pediatric Rheumatology, Duke University Medical Center; Duke School of Medicine, Durham, North Carolina; Division of Pediatric Rheumatology, Albert Einstein College of Medicine, Children's Hospital at Montefiore; Division of Pediatric Rheumatology, Cohen Children's Medical Center of New York, New York; The Hofstra North Shore-LIJ School of Medicine, Hempstead; Clinical and Translational Sciences Institute, Rochester, New York; Division of Pediatric Rheumatology, University of California San Francisco School of Medicine, San Francisco, California, USA.A.M. Knight, MD, MSCE, Attending Physician, Faculty, Division of Pediatric Rheumatology, and Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP, and Assistant Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania; M.E. Vickery, MPH, Center for Pediatric Clinical Effectiveness, and PolicyLab at the CHOP; E. Muscal, MD, MS, Attending Physician, Department of Pediatric Medicine, Division of Immunology, Allergy and Rhe
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Ilowite NT, Prather K, Lokhnygina Y, Schanberg LE, Elder M, Milojevic D, Verbsky JW, Spalding SJ, Kimura Y, Imundo LF, Punaro MG, Sherry DD, Tarvin SE, Zemel LS, Birmingham JD, Gottlieb BS, Miller ML, O'Neil K, Ruth NM, Wallace CA, Singer NG, Sandborg CI. Randomized, double-blind, placebo-controlled trial of the efficacy and safety of rilonacept in the treatment of systemic juvenile idiopathic arthritis. Arthritis Rheumatol 2014; 66:2570-9. [PMID: 24839206 DOI: 10.1002/art.38699] [Citation(s) in RCA: 116] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 05/06/2014] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of rilonacept, an interleukin-1 inhibitor, in a randomized, double-blind, placebo-controlled trial. METHODS An initial 4-week double-blind placebo phase was incorporated into a 24-week randomized multicenter design, followed by an open-label phase. Seventy-one children who had active arthritis in ≥2 joints were randomized (1:1) to the 2 arms of the study. Patients in the rilonacept arm received rilonacept (loading dose 4.4 mg/kg followed by 2.2 mg/kg weekly, subcutaneously) beginning on day 0. Patients in the placebo arm received placebo for 4 weeks followed by a loading dose of rilonacept at week 4 followed by weekly maintenance doses. The primary end point was time to response, using the adapted American College of Rheumatology Pediatric 30 criteria coupled with the absence of fever and taper of the dosage of systemic corticosteroids, using prespecified criteria. RESULTS The time to response was shorter in the rilonacept arm than in the placebo arm (χ(2) = 7.235, P = 0.007). The secondary analysis, which used the same response criteria, showed that 20 (57%) of 35 patients in the rilonacept arm had a response at week 4 compared with 9 (27%) of 33 patients in the placebo arm (P = 0.016). Exacerbation of systemic juvenile idiopathic arthritis (JIA) was the most common severe adverse event. More patients in the rilonacept arm had elevated liver transaminase levels (including levels more than 3 times the upper limit of normal) compared with those in the placebo arm. Adverse events were similar in the 2 arms of the study. CONCLUSION Rilonacept was generally well tolerated and demonstrated efficacy in active systemic JIA.
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Affiliation(s)
- Norman T Ilowite
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
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Wallace CA, Ringold S, Bohnsack J, Spalding SJ, Brunner HI, Milojevic D, Schanberg LE, Higgins GC, O'Neil KM, Gottlieb BS, Hsu J, Punaro MG, Kimura Y, Hendrickson A. Extension study of participants from the trial of early aggressive therapy in juvenile idiopathic arthritis. J Rheumatol 2014; 41:2459-65. [PMID: 25179849 DOI: 10.3899/jrheum.140347] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To follow children with juvenile idiopathic arthritis (JIA) who had completed at least 6 months of the TRial of Early Aggressive Therapy (TREAT) clinical study for an additional 2 years, describing safety of early aggressive treatment, disease activity, function, and duration of clinical inactive disease (CID) during followup. METHODS Children were treated as per provider's discretion. Physician, patient/parent, and laboratory measures of disease status as well as safety information were collected at clinic visits every 3 months for up to 2 years. RESULTS Forty-eight children were followed for a mean of 28 months (range 12-42) beyond the end of the TREAT study. Half of patients were in CID for > 50% of their followup time. Overall, 88% of patients achieved CID at > 1 study visit and 54% achieved clinical remission while taking medication. Six patients were in CID for the duration of the study, and, of those, 2 achieved a full year of clinical remission while not taking medication. Active disease was mild: mean physician's global assessment 2.4, active joint count 3.5, parent global evaluation 2.4, Childhood Health Assessment Questionnaire 0.32, erythrocyte sedimentation rate 19 mm/h, and morning stiffness 23 min. There were no serious adverse events or adverse events reported at grade 3 or higher of Common Terminology Criteria for Adverse Events. CONCLUSION Early aggressive therapy in this cohort of patients with polyarticular JIA who had high initial disease activity was associated with prolonged periods of CID in the majority of patients during followup. Those not in CID had low levels of disease activity.
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Affiliation(s)
- Carol A Wallace
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute.
| | - Sarah Ringold
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - John Bohnsack
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Steven J Spalding
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Hermine I Brunner
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Diana Milojevic
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Laura E Schanberg
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Gloria C Higgins
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Kathleen M O'Neil
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Beth S Gottlieb
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Joyce Hsu
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Marilynn G Punaro
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Yukiko Kimura
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
| | - Audrey Hendrickson
- From the Seattle Children's Hospital and Research Institute, Seattle, Washington; University of Utah, Pediatrics, Salt Lake City, Utah; Cleveland Clinic, Cleveland, Ohio; Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of California at San Francisco, San Francisco, California; Duke University Medical Center, Pediatrics, Durham, North Carolina; Ohio State University and Nationwide Children's Hospital, Pediatrics, Columbus, Ohio; University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Steven and Alexandra Cohen Children's Medical Center of New York, New York; Stanford University School of Medicine, Palo Alto, California; Texas Scottish Rite Hospital, Dallas, Texas; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey, USA.C.A. Wallace, MD; S. Ringold, MD, MS, Seattle Children's Hospital and Research Institute; J. Bohnsack, MD, University of Utah; S.J. Spalding, MD, Cleveland Clinic; H.I. Brunner, MD, MSc, Cincinnati Children's Hospital Medical Center; D. Milojevic, MD, University of California at San Francisco; L.E. Schanberg, MD, Duke University Medical Center; G.C. Higgins, PhD, MD, Ohio State University and Nationwide Children's Hospital; K.M. O'Neil, MD, Oklahoma University Health Science Center, now at Riley Hospital for Children, Indianapolis, Indiana; B.S. Gottlieb, MD, MS, Steven and Alexandra Cohen Children's Medical Center of New York; J. Hsu, MD, MS, Stanford University School of Medicine; M.G. Punaro, MD, Texas Scottish Rite Hospital; Y. Kimura, MD, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center; A. Hendrickson, MPH, Seattle Children's Hospital and Research Institute
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Sobel RE, Lovell DJ, Brunner HI, Weiss JE, Morris PW, Gottlieb BS, Chalom EC, Jung LK, Onel KB, Petiniot L, Goldsmith DP, Nanda K, Shishov M, Abramsky S, Young JP, Giannini EH. Safety of celecoxib and nonselective nonsteroidal anti-inflammatory drugs in juvenile idiopathic arthritis: results of the Phase 4 registry. Pediatr Rheumatol Online J 2014; 12:29. [PMID: 25057265 PMCID: PMC4107597 DOI: 10.1186/1546-0096-12-29] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 07/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to assess long-term safety and developmental data on juvenile idiopathic arthritis (JIA) patients treated in routine clinical practice with celecoxib or nonselective nonsteroidal anti-inflammatory drugs (nsNSAIDs). METHODS Children aged ≥2 to <18 years with rheumatoid-factor-positive or -negative polyarthritis, persistent or extended oligoarthritis, or systemic arthritis were enrolled into this prospective, observational, multicenter standard-of-care registry. Eligible patients were newly or recently prescribed (≤6 months) an nsNSAID or celecoxib. Enrolled patients were followed to the end of the study, whether they remained on the original NSAID, switched, or discontinued therapy altogether. All adverse events (AEs) regardless of severity were captured in the database. RESULTS A total of 274 patients (nsNSAID, n = 219; celecoxib, n = 55) were observed for 410 patient-years of observation. Naproxen, meloxicam, and nabumetone were the most frequently used nsNSAIDs. At baseline, the celecoxib group was older, had a numerically longer median time since diagnosis, and a numerically higher proportion of patients with a history of gastrointestinal-related NSAID intolerance. AEs reported were those frequently observed with NSAID treatment and were similar across groups (nsNSAIDs: 52.0%; celecoxib: 52.9%). Twelve unique patients experienced a total of 18 serious AEs; the most frequent were infections, and none was attributed to NSAID use. CONCLUSIONS The safety profile of celecoxib and nsNSAIDs appears similar overall. The results from this registry, ongoing pharmacovigilance, and the phase 3 trial that led to the approval of celecoxib for children with JIA provide evidence that the benefit-risk for celecoxib treatment in JIA remains positive. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00688545.
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Affiliation(s)
- Rachel E Sobel
- Pfizer Inc, 235 East 42nd St, MS#219-9-1, New York, NY 10017, USA
| | - Daniel J Lovell
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Paula W Morris
- University of Arkansas for Medical Science, Little Rock, AR, USA
| | - Beth S Gottlieb
- Cohen Children’s Medical Center of New York, New Hyde Park, NY, USA
| | | | | | | | - Lisa Petiniot
- Specially for Children, Dell Children’s Medical Center, Austin, TX, USA
| | - Donald P Goldsmith
- St. Christopher’s Hospital for Children/Drexel College of Medicine, Philadelphia, PA, USA
| | - Kabita Nanda
- Rainbow Babies & Children’s Hospital, Cleveland, OH, USA
- Current address: Seattle Children’s Hospital, Seattle, WA, USA
| | | | - Staci Abramsky
- Pfizer Inc, 235 East 42nd St, MS#219-9-1, New York, NY 10017, USA
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Wallace CA, Giannini EH, Spalding SJ, Hashkes PJ, O’Neil KM, Zeft AS, Szer IS, Ringold S, Brunner HI, Schanberg LE, Sundel RP, Milojevic DS, Punaro MG, Chira P, Gottlieb BS, Higgins GC, Ilowite NT, Kimura Y, Johnson A, Huang B, Lovell DJ. Clinically Inactive Disease in a Cohort of Children with New-onset Polyarticular Juvenile Idiopathic Arthritis Treated with Early Aggressive Therapy: Time to Achievement, Total Duration, and Predictors. J Rheumatol 2014; 41:1163-70. [DOI: 10.3899/jrheum.131503] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine the elapsed time while receiving aggressive therapy to the first observation of clinically inactive disease (CID), total duration of CID and potential predictors of this response in a cohort of children with recent onset of polyarticular juvenile idiopathic arthritis (poly-JIA).Methods.Eighty-five children were randomized blindly to methotrexate (MTX), etanercept, and rapidly tapered prednisolone (MEP) or MTX monotherapy and assessed for CID over 1 year of treatment. Patients who failed to achieve intermediary endpoints were switched to open-label MEP treatment.Results.Fifty-eight (68.2%) of the 85 patients achieved CID at 1 or more visits including 18 who received blinded MEP, 11 while receiving MTX monotherapy, and 29 while receiving open-label MEP. Patients starting on MEP achieved CID earlier and had more study days in CID compared to those starting MTX, but the differences were not significantly different. Patients given MEP (more aggressive therapy) earlier in the disease course were statistically more likely to have a higher proportion of followup visits in CID than those with longer disease course at baseline. Those who achieved American College of Rheumatology Pediatric 70 response at 4 months had a significantly greater proportion of followup visits in CID, compared to those who failed to achieve this improvement (p < 0.0001). Of the 32 patients who met criteria for CID and then lost CID status, only 3 fulfilled the definition of disease flare.Conclusion.Shorter disease duration prior to treatment, a robust response at 4 months, and more aggressive therapy result in a higher likelihood and longer duration of CID in patients with poly-JIA. The original trial from which data for this analysis were obtained is registered on www.clinicaltrials.gov NCT 00443430.
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DeWitt EM, Fricke K, Bergheger L, Griffin N, Laxer RM, Jones KB, Gottlieb BS, Taylor J, Mims CC, Robbins LM, Lovell DJ, Noonan L. A147: Engaging Patients and Families in the Pediatric Rheumatology Care and Outcomes Improvement Network. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38568] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Kay Fricke
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | | | - Nancy Griffin
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | - Ronald M. Laxer
- The Hospital for Sick Children, University of Toronto; Toronto ON
| | | | | | - Janalee Taylor
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
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Bingham CA, Ardoin SP, Vora SS, Darbie LM, Lovell DJ, Weiss JE, Laxer RM, Olson JC, Passo MH, Gottlieb BS, Stock JA, DeWitt EM. A1: Clinical Inactive Disease in the Pediatric Rheumatology Care and Outcomes Improvement Network Cohort: Which Components of Clinical Inactive Disease Do Patients Not Achieve? Arthritis Rheumatol 2014; 66 Suppl 3:S1-243. [DOI: 10.1002/art.38412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Lynn M. Darbie
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | | | - Jennifer E. Weiss
- Joseph M Sanzari Children's Hospital Hackensack University Medical Center; Hackensack NJ
| | - Ronald M. Laxer
- The Hospital for Sick Children, University of Toronto; Toronto ON
| | | | | | | | - Jason A. Stock
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
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Harris JG, DeWitt EM, Laxer RM, Ardoin SP, Gottlieb BS, Olson JC, Passo MH, Weiss JE, Lovell DJ, Lee TC, Vora SS, Griffin N, Stock JA, Darbie LM, Bingham CA. A151: Pediatric Rheumatology Care and Outcomes Improvement Network Demonstrates Performance Improvement on Juvenile Idiopathic Arthritis Quality Measures. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Ronald M. Laxer
- The Hospital for Sick Children, University of Toronto; Toronto ON
| | | | | | | | | | - Jennifer E. Weiss
- Joseph M Sanzari Children's Hospital, Hackensack University Medical Center; Hackensack NJ
| | | | | | | | - Nancy Griffin
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | - Jason A. Stock
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | - Lynn M. Darbie
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
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Lovell DJ, Johnson A, Kimura Y, Spalding SJ, Morris PW, Gottlieb BS, Onel K, Olson JC, Edelheit B, Shishov M, Jung L, Cassidy E, Prahalad S, Passo MH, Beukelman T, Mehta J, Schmidt KM, Foell D, Huang B, Giannini EH. A20: Understanding the Use and Biology of TNF Therapy in JIA-Clinical Outcomes. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38436] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Anne Johnson
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jay Mehta
- Children's Hospital at Montefiore/Albert Einstein College of Medicine; Bronx NY
| | | | | | - Bin Huang
- Cincinnati Children's Hospital Medical Center/University of Cincinnati School of Medicine; Cincinnati OH
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Ardoin SP, Bingham CA, Gottlieb BS, Laxer RM, Passo MH, Lovell D, Weiss JE, Vora SS, Lee TC, Griffith N, DeWitt EM. A180: A Population Management Tool for Proactive Care of Juvenile Idiopathic Arthritis in the Pediatric Rheumatology Care and Outcomes Improvement Network. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | | | - Ronald M. Laxer
- The Hospital for Sick Children, University of Toronto; Toronto ON
| | | | - Daniel Lovell
- Cincinnati Children's Hospital Medical Center; Cincinnati OH
| | - Jennifer E. Weiss
- Joseph M Sanzari Children's Hospital Hackensack University Medical Center; Hackensack NJ
| | | | | | - Nancy Griffith
- Cincinnati Childrens Hospital Medical Center; Cincinnati OH
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Lovell DJ, Spalding SP, Onel K, Gottlieb BS, Brunner HI, Kimura Y, Morris PW, Olson JC, Johnson A, Giannini EH. Understanding the biology and use of anti-TNF agents in JIA – interim results. Pediatr Rheumatol Online J 2012. [PMCID: PMC3402964 DOI: 10.1186/1546-0096-10-s1-a48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Wallace CA, Giannini EH, Spalding SJ, Hashkes PJ, O’Neil KM, Zeft AS, Szer IS, Ringold SM, Brunner H, Schanberg LE, Sundel RP, Milojevic D, Punaro MG, Chira P, Gottlieb BS, Higgins GC, Ilowite NT, Kimura Y, Huang B, Lovell DJ. The effects of early aggressive therapy in JIA: results of the TREAT study. Pediatr Rheumatol Online J 2012. [PMCID: PMC3403027 DOI: 10.1186/1546-0096-10-s1-a56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Abstract
Juvenile idiopathic arthrithis (JIA) is the most common rheumatic disease of childhood.JIA is a chronic disease that is associated with periods of disease flares and periods of disease inactivity.Early, aggressive treatment with nonsteroidal anti-inflammatory drugs, intra-articular corticosteroid injections, or methotrexate, has significantly improved the outcome of most children who have JIA. Biologics have been shown to be both safe and effective for the treatment of more aggressive forms of arthritis and for uveitis. Long-term safety data of biologics is still uncertain. In the near future, it is hoped that genetic testing will allow earlier diagnosis of JIA as well as help predict the disease course of children who have JIA. Genetic analysis also may allow physicians to target therapies more effectively. It is hoped that development of more specific therapies will decrease overall immunosuppression and other associated toxicities.
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Affiliation(s)
- Maria Espinosa
- The Steven and Alexandra Cohen Children's Medical Center of New York, North Shore Long Island Jewish Health System, New Hyde Park, NY, USA
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Wallace CA, Giannini EH, Spalding SJ, Hashkes PJ, O'Neil KM, Zeft AS, Szer IS, Ringold S, Brunner HI, Schanberg LE, Sundel RP, Milojevic D, Punaro MG, Chira P, Gottlieb BS, Higgins GC, Ilowite NT, Kimura Y, Hamilton S, Johnson A, Huang B, Lovell DJ. Trial of early aggressive therapy in polyarticular juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2011; 64:2012-21. [PMID: 22183975 DOI: 10.1002/art.34343] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To determine whether aggressive treatment initiated early in the course of rheumatoid factor (RF)-positive or RF-negative polyarticular juvenile idiopathic arthritis (JIA) can induce clinical inactive disease within 6 months. METHODS Between May 2007 and October 2010, a multicenter, prospective, randomized, double-blind, placebo-controlled trial of 2 aggressive treatments was conducted in 85 children ages 2-16 years with polyarticular JIA of <12 months' duration. Patients received either methotrexate (MTX) 0.5 mg/kg/week (maximum 40 mg) subcutaneously, etanercept 0.8 mg/kg/week (maximum 50 mg), and prednisolone 0.5 mg/kg/day (maximum 60 mg) tapered to 0 by 17 weeks (arm 1), or MTX (same dosage as arm 1), etanercept placebo, and prednisolone placebo (arm 2). The primary outcome measure was clinical inactive disease at 6 months. An exploratory phase determined the rate of clinical remission on medication (6 months of continuous clinical inactive disease) at 12 months. RESULTS By 6 months, clinical inactive disease had been achieved in 17 (40%) of 42 patients in arm 1 and 10 (23%) of 43 patients in arm 2 (χ(2) = 2.91, P = 0.088). After 12 months, clinical remission on medication was achieved in 9 patients in arm 1 and 3 patients in arm 2 (P = 0.053). There were no significant interarm differences in adverse events. CONCLUSION Although this study did not meet its primary end point, early aggressive therapy in this cohort of children with recent-onset polyarticular JIA resulted in clinical inactive disease by 6 months and clinical remission on medication within 12 months of treatment in substantial proportions of patients in both arms.
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Lovell DJ, Henrickson M, DeWitt EM, Segerman J, Taylor J, Giannini EH, Passo MH, Beukelman T, Bowyer SL, Gottlieb BS, Ilowite NT, Kimura Y, Stein LD, Vehe RK. Reply. Arthritis Care Res (Hoboken) 2011. [DOI: 10.1002/acr.20513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Lovell DJ, Passo MH, Beukelman T, Bowyer SL, Gottlieb BS, Henrickson M, Ilowite NT, Kimura Y, DeWitt EM, Segerman J, Stein LD, Taylor J, Vehe RK, Giannini EH. Measuring process of arthritis care: a proposed set of quality measures for the process of care in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2011; 63:10-6. [PMID: 20842714 DOI: 10.1002/acr.20348] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The ability to assess quality of care is a necessary component of continuous quality improvement. The assessment typically is accomplished by determination of compliance with a defined set of quality measures (QMs). The objective of this effort was to establish a set of QMs for the assessment of the process of care in juvenile idiopathic arthritis (JIA). METHODS A 12-member working group composed of representatives from the American College of Rheumatology, American Academy of Pediatrics, American Board of Pediatrics, and Association of Rheumatology Health Professionals was assembled to guide the project. Delphi questionnaires were sent to 237 health professionals involved in the care of children with JIA. A total of 471 items in 23 domains were identified. The working group met via 4 live e-meetings during which results from the Delphi questionnaires were distilled to a reduced draft set. Each working group member selected a proposed QM to investigate and present evidence from the literature as to its attributes and appropriateness for inclusion into the set. Nominal group technique was used to come to consensus on a proposed set of QMs. RESULTS The proposed set contains 12 QMs within 4 health care domains. Each QM consists of a statement of 1) the assessment to be completed, 2) when the first assessment should be completed and a suggested frequency of assessment during followup, 3) recommendations of appropriate tools or methods of assessment, and 4) initial performance goals. CONCLUSION Implementation of the proposed QM set will improve the process of care, facilitate continuous quality improvement, and eventuate in improved health outcomes of children with JIA.
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Affiliation(s)
- Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Griffin TA, Barnes MG, Ilowite NT, Olson JC, Sherry DD, Gottlieb BS, Aronow BJ, Pavlidis P, Hinze CH, Thornton S, Thompson SD, Grom AA, Colbert RA, Glass DN. Gene expression signatures in polyarticular juvenile idiopathic arthritis demonstrate disease heterogeneity and offer a molecular classification of disease subsets. ACTA ACUST UNITED AC 2009; 60:2113-23. [PMID: 19565504 DOI: 10.1002/art.24534] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To determine whether peripheral blood mononuclear cells (PBMCs) from children with recent-onset polyarticular juvenile idiopathic arthritis (JIA) exhibit biologically or clinically informative gene expression signatures. METHODS Peripheral blood samples were obtained from 59 healthy children and 61 children with polyarticular JIA prior to treatment with second-line medications, such as methotrexate or biologic agents. RNA was extracted from isolated mononuclear cells, fluorescence labeled, and hybridized to commercial gene expression microarrays (Affymetrix HG-U133 Plus 2.0). Data were analyzed using analysis of variance at a 5% false discovery rate threshold after robust multichip analysis preprocessing and distance-weighted discrimination normalization. RESULTS Initial analysis revealed 873 probe sets for genes that were differentially expressed between polyarticular JIA patients and healthy controls. Hierarchical clustering of these probe sets distinguished 3 subgroups within the polyarticular JIA group. Prototypical patients within each subgroup were identified and used to define subgroup-specific gene expression signatures. One of these signatures was associated with monocyte markers, another with transforming growth factor beta-inducible genes, and a third with immediate early genes. Correlation of gene expression signatures with clinical and biologic features of JIA subgroups suggested relevance to aspects of disease activity and supported the division of polyarticular JIA into distinct subsets. CONCLUSION Gene expression signatures in PBMCs from patients with recent-onset polyarticular JIA reflect discrete disease processes and offer a molecular classification of disease.
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Affiliation(s)
- Thomas A Griffin
- William S. Rowe Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Barnes MG, Grom AA, Thompson SD, Griffin TA, Pavlidis P, Itert L, Fall N, Sowders DP, Hinze CH, Aronow BJ, Luyrink LK, Srivastava S, Ilowite NT, Gottlieb BS, Olson JC, Sherry DD, Glass DN, Colbert RA. Subtype-specific peripheral blood gene expression profiles in recent-onset juvenile idiopathic arthritis. Arthritis Rheum 2009; 60:2102-12. [PMID: 19565513 PMCID: PMC2782469 DOI: 10.1002/art.24601] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To identify differences in peripheral blood gene expression between patients with different subclasses of juvenile idiopathic arthritis (JIA) and healthy controls in a multicenter study of patients with recent-onset JIA prior to treatment with disease-modifying antirheumatic drugs (DMARDs) or biologic agents. METHODS Peripheral blood mononuclear cells (PBMCs) from 59 healthy children and 136 patients with JIA (28 with enthesitis-related arthritis [ERA], 42 with persistent oligoarthritis, 45 with rheumatoid factor [RF]-negative polyarthritis, and 21 with systemic disease) were isolated from whole blood. Poly(A) RNA was labeled using a commercial RNA amplification and labeling system (NuGEN Ovation), and gene expression profiles were obtained using commercial expression microarrays (Affymetrix HG-U133 Plus 2.0). RESULTS A total of 9,501 differentially expressed probe sets were identified among the JIA subtypes and controls (by analysis of variance; false discovery rate 5%). Specifically, 193, 1,036, 873, and 7,595 probe sets were different in PBMCs from the controls compared with those from the ERA, persistent oligoarthritis, RF-negative polyarthritis, and systemic JIA patients, respectively. In patients with persistent oligoarthritis, RF-negative polyarthritis, and systemic JIA subtypes, up-regulation of genes associated with interleukin-10 (IL-10) signaling was prominent. A hemoglobin cluster was identified that was underexpressed in ERA patients but overexpressed in systemic JIA patients. The influence of JAK/STAT, ERK/MAPK, IL-2, and B cell receptor signaling pathways was evident in patients with persistent oligoarthritis. In systemic JIA, up-regulation of innate immune pathways, including IL-6, Toll-like receptor/IL-1 receptor, and peroxisome proliferator-activated receptor signaling, were noted, along with down-regulation of gene networks related to natural killer cells and T cells. Complement and coagulation pathways were up-regulated in systemic JIA, with a subset of these genes being differentially expressed in other subtypes as well. CONCLUSION Expression analysis identified differentially expressed genes in PBMCs obtained early in the disease from patients with different subtypes of JIA and in healthy controls, providing evidence of immunobiologic differences between these forms of childhood arthritis.
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Affiliation(s)
- Michael G Barnes
- Division of Pediatric Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA.
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Fall N, Barnes M, Thornton S, Luyrink L, Olson J, Ilowite NT, Gottlieb BS, Griffin T, Sherry DD, Thompson S, Glass DN, Colbert RA, Grom AA. Gene expression profiling of peripheral blood from patients with untreated new-onset systemic juvenile idiopathic arthritis reveals molecular heterogeneity that may predict macrophage activation syndrome. ACTA ACUST UNITED AC 2007; 56:3793-804. [PMID: 17968951 DOI: 10.1002/art.22981] [Citation(s) in RCA: 192] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Systemic juvenile idiopathic arthritis (JIA) is frequently associated with the development of macrophage activation syndrome. This study was undertaken to better understand the relationship between systemic JIA and macrophage activation syndrome. METHODS Gene expression profiles were examined in 17 patients with untreated new-onset systemic JIA, 5 of whom showed evidence of subclinical macrophage activation syndrome (of whom 2 eventually developed overt macrophage activation syndrome). Peripheral blood mononuclear cells (PBMCs) were separated on Ficoll gradients, and purified RNA was analyzed using Affymetrix GeneChip expression arrays. A fraction of the PBMCs were used for flow cytometry to define the cellular composition of the samples. RESULTS Two hundred twenty-five differentially expressed genes (P < 0.05) that distinguished patients with systemic JIA from healthy controls (n = 30) were identified. Clustering analysis indicated that expression patterns correlated with serum ferritin levels. Three main clusters distinguished systemic JIA patients with highly elevated ferritin levels (including those with subclinical macrophage activation syndrome) from those with normal or only moderately elevated ferritin levels. The first cluster comprised genes involved in the synthesis of hemoglobins and structural proteins of erythrocytes. This transcriptional profile was consistent with immature nucleated red blood cells, likely reflective of high red blood cell turnover. Also included were transcripts indicating immature granulocytes. The second cluster was enriched for genes involved in cell cycle regulation. The third cluster was enriched for genes involved in innate immune responses, including those involved in the negative regulation of Toll-like receptor/interleukin-1 receptor-triggered inflammatory cascades and markers of the alternative pathway of macrophage differentiation. Additional differentially expressed genes of interest were those involved in the cytolytic pathway, including SH2D1A and Rab27a. CONCLUSION These data indicate that gene expression profiling can be a useful tool for identifying early macrophage activation syndrome in patients with systemic JIA.
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Affiliation(s)
- Ndate Fall
- Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA
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Weiss JE, Sison CP, Ilowite NT, Gottlieb BS, Eberhard BA. Flares in pediatric systemic lupus erythematosus. J Rheumatol 2007; 34:1341-4. [PMID: 17477466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE To determine the flare rate and the change in Safety of Estrogens in Lupus Erythematosus: National Assessment Systemic Lupus Erythematosus Disease Activity Index (SELENA SLEDAI) score with disease flare in pediatric systemic lupus erythematosus (pSLE). METHODS A retrospective chart review of 62 patients with pSLE (ages 5-20 yrs). A flare was defined as the start of, or increase in, the dose of corticosteroids and/or the addition of an immunosuppressive medication. All pre-flare, flare, and post-flare visits were recorded with a SELENA SLEDAI score calculated for each visit. The flare rate was calculated by dividing the total number of flares in the cohort by the total followup years. RESULTS Sixty-two patients were eligible. Forty-seven patients had 112 flares. The average number of flares/patient was 1.8 +/- 2.0 and the mean inter-flare time was 15.4 +/- 17.9 months. The flare rate in pSLE was 0.46 flares/patient-year of followup. The median time to first flare from the date of diagnosis was 14.3 months. Patients with cytopenia, pleuritis, or pericarditis, or a positive antibody to Smith nuclear antigen at the time of diagnosis had a significantly higher flare rate than those who did not. The average SELENA SLEDAI score at presentation was 12.5 +/- 5.4, at the pre-flare visit 6.3 +/- 3.5, and during a flare 7.9 +/- 5.1. CONCLUSION This is the first large study to report a flare rate (0.46 flares/patient-year of followup) in pSLE. The flare rate was similar to what has been reported in pSLE previously but significantly lower than that reported in adults with lupus. The average change in the SELENA SLEDAI score with disease flare is 2 points.
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Affiliation(s)
- Jennifer E Weiss
- Schneider Children's Hospital, North Shore-Long Island Jewish Health System, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA
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Jones OY, Spencer CH, Bowyer SL, Dent PB, Gottlieb BS, Rabinovich CE. A multicenter case-control study on predictive factors distinguishing childhood leukemia from juvenile rheumatoid arthritis. Pediatrics 2006; 117:e840-4. [PMID: 16651289 DOI: 10.1542/peds.2005-1515] [Citation(s) in RCA: 107] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Acute lymphocytic leukemia (ALL) often presents with musculoskeletal concerns such as pain or swelling, even before appearance of blasts in the peripheral blood. Such presentation may lead to misdiagnosis of a child with juvenile rheumatoid arthritis (JRA). This study was designed to identify the predictive factors for leukemia using basic clinical and laboratory information. METHODS A retrospective chart review was performed using a simple questionnaire to compare the clinical and laboratory findings present during the initial visit to a pediatric rheumatology clinic for 277 children who were ultimately diagnosed with either JRA (n = 206) or ALL (n = 71). Sensitivity and specificity analysis of a variety of parameters, both singly and in combination, was performed to identify predictive value for ALL. RESULTS The majority (75%) of children with ALL did not have blasts in the peripheral blood at the time of evaluation by pediatric rheumatologists. In children presenting with unexplained musculoskeletal complaints, the 3 most important factors that predicted a diagnosis of ALL were low white blood cell count (< 4 x 10(9)/L), low-normal platelet count (150-250 x 10(9)/L), and history of nighttime pain. In the presence of all 3, the sensitivity and specificity for a diagnosis of ALL were 100% and 85%, respectively. Other findings, including antinuclear antibody, rash, and objective signs of arthritis, were not helpful in differentiating between these diagnoses because they occurred at similar rates in both groups. CONCLUSIONS When a child develops new-onset bone-joint complaints, the presence of subtle complete blood count changes combined with nighttime pain should lead to consideration of leukemia as the underlying cause.
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Affiliation(s)
- Olcay Y Jones
- Department of Pediatric Rheumatology, Children's National Medical Center, George Washington University, Washington, DC 20010, USA.
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Degotardi PJ, Klass ES, Rosenberg BS, Fox DG, Gallelli KA, Gottlieb BS. Development and evaluation of a cognitive-behavioral intervention for juvenile fibromyalgia. J Pediatr Psychol 2005; 31:714-23. [PMID: 16120766 DOI: 10.1093/jpepsy/jsj064] [Citation(s) in RCA: 96] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe the development and test the efficacy of a cognitive-behavioral intervention (CBT) for juvenile fibromyalgia. METHOD Sixty-seven children with fibromyalgia and their parents were recruited to participate in an 8-week intervention that included modules of pain management, psychoeducation, sleep hygiene, and activities of daily living. Children were taught techniques of cognitive restructuring, thought stopping, distraction, relaxation, and self-reward. Additionally, they kept daily pain and sleep diaries. Children completed questionnaires of pre- and post-treatment measuring physical status and psychological functioning. RESULTS Following CBT, children reported significant reductions (p < .006) in pain, somatic symptoms, anxiety, and fatigue, as well as improvements in sleep quality. Additionally, children reported improved functional ability and had fewer school absences. CONCLUSION Children with fibromyalgia can be taught CBT strategies that help them effectively manage this chronic and disabling musculoskeletal pain disorder.
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Affiliation(s)
- Pamela J Degotardi
- Schneider Children's Hospital, and Honors Center, CUNY Honors College at Queens College, Room 133, 65-30 Kissena Boulevard, Flushing, NY 11367-1597, USA.
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Eberhard BA, Sison MC, Gottlieb BS, Ilowite NT. Comparison of the intraarticular effectiveness of triamcinolone hexacetonide and triamcinolone acetonide in treatment of juvenile rheumatoid arthritis. J Rheumatol 2004; 31:2507-12. [PMID: 15570659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To compare patients with juvenile rheumatoid arthritis (JRA) injected with triamcinolone hexacetonide (TH) or triamcinolone acetonide (TA) with respect to time to relapse. METHODS This was a retrospective chart review of 85 patients: 51 patients with JRA who had received a joint injection with TH during the period June 2000-April 2001 and 48 patients who had received a joint injection with TA during the period May 2001-March 2002 who were followed for a minimum of 15 months, after an intraarticular steroid injection. RESULTS The primary endpoint variable for the study was the time to relapse of the arthritis in the affected joint following an intraarticular injection. A total of 227 joints were injected, 114 with TH and 113 with TA. In the TH group the mean time to relapse (+/- SE) was 10.14 +/- 0.49 months compared to the TA group at 7.75 +/- 0.49 months (p < 0.0001) using the log-rank test. A proportional hazards (Cox) regression analysis revealed no statistical association between sex, duration of illness, or type of arthritis and relapse time. An analysis was performed on the first intraarticular injection for each patient, with the average time to relapse for all joints injected of 10.36 +/- 0.72 months for TH compared to 8.45 +/- 0.78 months for TA (p < 0.02). A further analysis of the first knee injections showed a relapse time in the TH group of 11.11 +/- 0.81 months compared to 7.95 +/- 0.95 months for TA (p < 0.008). CONCLUSION TH offers an advantage to TA, as there is a longer duration of action leading to an improved prolonged response rate in weight-bearing joints, particularly the knees. The results suggest that TH should be the intraarticular steroid of choice, particularly for the knee joint, in patients with JRA.
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Affiliation(s)
- Barbara A Eberhard
- Division of Rheumatology, Schneider Children's Hospital, 269-01 76th Avenue, New Hyde Park, NY 11040, USA.
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Weiss JE, Eberhard BA, Chowdhury D, Gottlieb BS. Infliximab as a novel therapy for refractory Kawasaki disease. J Rheumatol 2004; 31:808-10. [PMID: 15088313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
Kawasaki disease (KD) is a multisystem vasculitis of unknown etiology, with coronary artery aneurysms occurring in 25% of untreated cases. With conventional treatment of intravenous immunoglobulin (i.v.IG) and high dose aspirin (ASA) only 4% of patients develop coronary artery aneurysms. Children who are unresponsive present a challenge. Tumor necrosis factor-alpha levels peak during the acute and subacute phase of KD, especially in children who develop coronary artery aneurysms. We describe a 3-year-old male with KD and giant coronary artery aneurysms, unresponsive to multiple doses of i.v.IG and methylprednisolone, who was treated with infliximab. After the first dose he defervesced and his laboratory measures improved.
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Affiliation(s)
- Jennifer E Weiss
- Division of Pediatric Cardiology, Department of Pediatrics, Schneider Children's Hospital, North Shore-Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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Abstract
OBJECTIVE Children with juvenile rheumatoid arthritis (JRA) treated with methotrexate (MTX) were examined for their course after the discontinuation of the drug to define the relapse and remission rates and to identify predictors of relapse. METHODOLOGY A retrospective chart review of all patients with JRA was conducted in two pediatric rheumatology centers. A total of 101 patients being treated with MTX were identified. Dose, response to the drug, and length of time until reaching a state of complete control were noted. The outcome of patients with a complete response in whom the drug was discontinued was examined with regards to length of time to relapse or continued remission. RESULTS In 25 patients, MTX was discontinued after reaching complete control of the disease. There were no statistically significant predictors of response to MTX identified. Of 25 whose MTX was discontinued, relapse occurred in 13 (52%) after a mean of 11 months after discontinuation. There was no significant difference among patients who relapsed or those who remained in remission as to sex, subtype of JRA, number of months to complete control, or number of months in complete control until discontinuing MTX. Patients younger than 41/2 years at diagnosis were found to be more likely to relapse than patients diagnosed at a later age. In 10 of the patients who relapsed, complete control was induced within a mean of 7 months after restarting MTX. CONCLUSION The optimal time for discontinuing MTX in children with JRA who have achieved complete control is unknown. Relapse occurred in approximately half of the patients in whom MTX was discontinued. Because response to reinstitution of the drug is good, it is reasonable to discontinue MTX after prolonged complete control. It remains to be seen whether the relapse rate can be improved by waiting for longer periods of time in complete control before its discontinuation.
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Affiliation(s)
- B S Gottlieb
- Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA
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Abstract
Wegener granulomatosis traditionally has been treated with glucocorticoids and cyclophosphamide. Both the disease and its treatments are associated with significant morbidity and mortality rates. There has been an effort to find effective but less toxic alternative treatments. We describe three children with Wegener granulomatosis who responded well to treatment with glucocorticoids and methotrexate, similar to a regimen used in adults.
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Affiliation(s)
- B S Gottlieb
- Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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Stillman RM, Gottlieb BS, Sawyer PN. Alleviation of autotransfusion-induced haematological damage by corticosteroids. Br J Surg 1980; 67:99-100. [PMID: 7362957 DOI: 10.1002/bjs.1800670209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Thrombocytopenia and haemolysis in intraoperative autotransfusion result mainly from extravascular tissue contact and therefore are not correctable by mechanical improvements in the autotransfusion apparatus. Instead, attention must be directed towards prevention of blood 'recognition' of extravascular tissue or stabilization of blood components against this damage. Methylprednisolone is shown to be effective in alleviating red cell and platelet damage induced by intraoperative autotransfusion in the canine model.
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Abstract
Compared the effectiveness of several response exaggeration techniques. Socially anxious college males (N = 34) were instructed to exaggerate some component of social anxiety onset. One group exaggerated their attending to manifestations of their anxiety, two groups exaggerated either a relevant or irrelevant anxiety response, a fourth group imagined an exaggerated consequence of their anxiety, and a fifth group served as a placebo control. All groups reported a greater willingness to initiate and maintain an interaction with a female and displayed less anxiety in a role-playing situation; no differential treatment effects were found. These findings fail to support results from other studies that attested to the efficacy of response exaggeration techniques.
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