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Githumbi R, Kuhn S, Osiowy C, Day J, deBruyn JCC, Fritzler MJ, Johnson NA, Vanderkooi O, Schmeling H. A randomized controlled trial of two hepatitis a vaccine doses among adolescents with juvenile idiopathic arthritis and Crohn's disease on immunosuppressive therapy: a pilot study. J Travel Med 2024:taae065. [PMID: 38652172 DOI: 10.1093/jtm/taae065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 04/12/2024] [Indexed: 04/25/2024]
Abstract
This pilot randomized controlled trial assessed the immunogenicity of paediatric versus adult Hepatitis A vaccine doses in immunosuppressed adolescents (12-15 years) with Juvenile Idiopathic Arthritis and Crohn's Disease. The study aimed to assess if a single, higher dose provides better immunogenicity, particularly beneficial before travel.
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Affiliation(s)
- Racheal Githumbi
- Department of Pediatrics, Cumming School of Medicine, University of Calgary
| | - Susan Kuhn
- Department of Pediatrics, Cumming School of Medicine, University of Calgary
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada
| | - Jacqueline Day
- National Microbiology Laboratory, Public Health Agency of Canada
| | | | - Marvin J Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary
| | - Nicole A Johnson
- Department of Pediatrics, Cumming School of Medicine, University of Calgary
| | - Otto Vanderkooi
- Department of Pediatrics, Cumming School of Medicine, University of Calgary
| | - Heinrike Schmeling
- Department of Pediatrics, Cumming School of Medicine, University of Calgary
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Semalulu T, Berard R, Beattie K, Basodan D, Boire G, Bolaria R, Cabral D, Chhabra A, Gerschman T, Johnson N, Herrington J, Houghton K, Lim L, Miettunen PMH, Park J, Proulx-Gauthier JP, Schmeling H, Scuccimarri R, Tam H, Tucker L, Guzman J, Batthish M. Clinical Characteristics of Adolescents With Juvenile Idiopathic Arthritis Transitioning to Adult Rheumatology Care in Canada: Results From the CAPRI Registry. J Rheumatol 2024; 51:403-407. [PMID: 38302168 DOI: 10.3899/jrheum.2023-0783] [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] [Accepted: 12/22/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Using Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) juvenile idiopathic arthritis (JIA) registry data, we describe (1) clinical characteristics of patients with JIA transitioning to adult care, (2) prevalence of disease-related damage and complications, and (3) changes in disease activity during the final year prior to transfer. METHODS Registry participants who turned 17 years between February 2017 and November 2021 were included. Clinical characteristics and patient-reported outcomes (PROs) at the last recorded pediatric rheumatology visit, and changes observed in the year prior to that visit were analyzed. Physicians completed an additional questionnaire characterizing cumulative disease-related damage and adverse events by age 17 years. RESULTS At their last visit, 88 of 131 participants (67%) had inactive and 42 (32%) had active disease. Overall, 96 (73%) were on medications and 41 (31%) were on biologic disease-modifying antirheumatic drugs. Among 80 participants for whom the additional questionnaire was completed, 26% had clinically detected joint damage, 31% had joint damage on imaging, 14% had uveitis, and 7.5% had experienced at least 1 serious adverse event. During the final year, 44.2% of patients were in remission, 28.4% attained inactive disease, and 27.4% became or remained active. Mean scores of PROs were stable overall during that last year, but a minority reported marked worsening. CONCLUSION A substantial proportion of youth with JIA transitioning to adult care in Canada had a high disease burden, which was reflected by their degree of disease activity, joint damage, or ongoing medication use. These results will inform pediatric and adult providers of anticipated needs during transition of care.
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Affiliation(s)
- Teresa Semalulu
- T. Semalulu, MD, Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario
| | - Roberta Berard
- R. Berard, MD, MSc, J. Park, MD, Division of Rheumatology, Department of Pediatrics, Western University, London, Ontario
| | - Karen Beattie
- K. Beattie, PhD, J. Herrington, PT, MSc, M. Batthish, MD, MSc, Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Daniah Basodan
- D. Basodan, MBBS, L. Lim, MD, MPH, Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Gilles Boire
- G. Boire, MD, MSc, Division of Rheumatology, Department of Medicine, Sherbrooke University, Sherbrooke, Quebec
| | - Roxana Bolaria
- R. Bolaria, MD, D. Cabral, MD, T. Gerschman, MD, MSc, K. Houghton, MD, H. Tam, MBBS, MSc, L. Tucker, MD, J. Guzman, MD, Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - David Cabral
- R. Bolaria, MD, D. Cabral, MD, T. Gerschman, MD, MSc, K. Houghton, MD, H. Tam, MBBS, MSc, L. Tucker, MD, J. Guzman, MD, Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Amieleena Chhabra
- A. Chhabra, MD, Interior Health Authority, Mary Pack Arthritis Society, University of British Columbia, Vancouver, British Columbia
| | - Tommy Gerschman
- R. Bolaria, MD, D. Cabral, MD, T. Gerschman, MD, MSc, K. Houghton, MD, H. Tam, MBBS, MSc, L. Tucker, MD, J. Guzman, MD, Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Nicole Johnson
- N. Johnson, MD, MSc, P.M.H. Miettunen, MD, H. Schmeling, MD, Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta
| | - Julie Herrington
- K. Beattie, PhD, J. Herrington, PT, MSc, M. Batthish, MD, MSc, Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Kristin Houghton
- R. Bolaria, MD, D. Cabral, MD, T. Gerschman, MD, MSc, K. Houghton, MD, H. Tam, MBBS, MSc, L. Tucker, MD, J. Guzman, MD, Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Lillian Lim
- D. Basodan, MBBS, L. Lim, MD, MPH, Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Paivi Maria Hannele Miettunen
- N. Johnson, MD, MSc, P.M.H. Miettunen, MD, H. Schmeling, MD, Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta
| | - Jonathan Park
- R. Berard, MD, MSc, J. Park, MD, Division of Rheumatology, Department of Pediatrics, Western University, London, Ontario
| | - Jean-Philippe Proulx-Gauthier
- J.P. Proulx-Gauthier, MD, Division of Rheumatology, Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Quebec
| | - Heinrike Schmeling
- N. Johnson, MD, MSc, P.M.H. Miettunen, MD, H. Schmeling, MD, Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta
| | - Rosie Scuccimarri
- R. Scuccimarri, MD, Division of Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Herman Tam
- R. Bolaria, MD, D. Cabral, MD, T. Gerschman, MD, MSc, K. Houghton, MD, H. Tam, MBBS, MSc, L. Tucker, MD, J. Guzman, MD, Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Lori Tucker
- R. Bolaria, MD, D. Cabral, MD, T. Gerschman, MD, MSc, K. Houghton, MD, H. Tam, MBBS, MSc, L. Tucker, MD, J. Guzman, MD, Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Jaime Guzman
- R. Bolaria, MD, D. Cabral, MD, T. Gerschman, MD, MSc, K. Houghton, MD, H. Tam, MBBS, MSc, L. Tucker, MD, J. Guzman, MD, Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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Nguyen K, Barsalou J, Basodan D, Batthish M, Benseler SM, Berard RA, Blanchette N, Boire G, Bolaria R, Bruns A, Cabral DA, Cameron B, Campillo S, Cellucci T, Chan M, Chédeville G, Chetaille AL, Chhabra A, Couture J, Dancey P, De Bruycker JJ, Demirkaya E, Dhalla M, Duffy CM, Feldman BM, Feldman DE, Gerschman T, Haddad E, Heale L, Herrington J, Houghton K, Huber AM, Human A, Johnson N, Jurencak R, Lang B, Larché M, Laxer RM, LeBlanc CM, Lee JJY, Levy DM, Lim L, Lim LSH, Luca N, McGrath T, McMillan T, Miettunen PM, Morishita KA, Ng HY, Oen K, Park J, Petty RE, Proulx-Gauthier JP, Ramsey S, Roth J, Rosenberg AM, Rozenblyum E, Rumsey DG, Schmeling H, Schneider R, Scuccimarri R, Shiff NJ, Silverman E, Soon G, Spiegel L, Stringer E, Tam H, Tse SM, Tucker L, Turvey S, Twilt M, Duffy KW, Yeung RSM, Guzman J. A decade of progress in juvenile idiopathic athritis treatments and outcomes in Canada: results from ReACCh-Out and the CAPRI registry. Rheumatology (Oxford) 2023:kead560. [PMID: 37851400 DOI: 10.1093/rheumatology/kead560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/11/2023] [Accepted: 09/27/2023] [Indexed: 10/19/2023] Open
Abstract
OBJECTIVE To assess changes in juvenile idiopathic arthritis (JIA) treatments and outcomes in Canada, comparing a 2005-2010 and a 2017-2021 inception cohorts. METHODS Patients enrolled within three months of diagnosis in the Research in Arthritis in Canadian Children Emphasizing Outcomes (ReACCh-Out) and the Canadian Alliance of Pediatric Rheumatology Investigators Registry (CAPRI) cohorts were included. Cumulative incidences of drug starts and outcome attainment within 70 weeks of diagnosis were compared with Kaplan Meier survival analysis and multivariable Cox regression. RESULTS The 2005-2010 and 2017-2021 cohorts included 1128 and 721 patients, respectively. JIA category distribution and baseline clinical juvenile idiopathic arthritis disease activity (cJADAS10) scores at enrolment were comparable. By 70 weeks, 6% of patients (95% CI 5, 7) in the 2005-2010 and 26% (23, 30) in the 2017-2021 cohort had started a biologic DMARD (bDMARD), and 43% (40, 47) and 60% (56, 64) had started a conventional DMARD (cDMARD), respectively. Outcome attainment was 64% (61, 67) and 83% (80, 86) for Inactive disease (Wallace criteria), 69% (66, 72) and 84% (81, 87) for minimally active disease (cJADAS10 criteria), 57% (54, 61) and 63% (59, 68) for pain control (<1/10), and 52% (47, 56) and 54% (48, 60) for a good health-related quality of life. CONCLUSION Although baseline disease characteristics were comparable in the 2005-2010 and 2017-2021 cohorts, cDMARD and bDMARD use increased with a concurrent increase in minimally active and inactive disease. Improvements in parent and patient reported outcomes were smaller than improvements in disease activity.
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Affiliation(s)
- Kelly Nguyen
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | | | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Roxana Bolaria
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - David A Cabral
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Mercedes Chan
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Paul Dancey
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | | | | | | | | | | | | | - Tommy Gerschman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Elie Haddad
- Université de Montréal, Montréal, Quebec, Canada
| | - Liane Heale
- McMaster University, Hamilton, Ontario, Canada
| | | | - Kristin Houghton
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam M Huber
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Andrea Human
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Bianca Lang
- Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Lillian Lim
- University of Alberta, Edmonton, Alberta, Canada
| | - Lily S H Lim
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Nadia Luca
- University of Ottawa, Ottawa, Ontario, Canada
| | - Tara McGrath
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | - Hon Yan Ng
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Ross E Petty
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Dax G Rumsey
- University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | - Gordon Soon
- Health Sciences North, Sudbury, Ontario, Canada
- North York General Hospital, North York, Toronto, Ontario, Canada
| | | | | | - Herman Tam
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori Tucker
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Stuart Turvey
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | - Jaime Guzman
- University of British Columbia, Vancouver, British Columbia, Canada
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Renson T, Forkert ND, Amador K, Miettunen P, Parsons SJ, Dhalla M, Johnson NA, Luca N, Schmeling H, Stevenson R, Twilt M, Hamiwka L, Benseler S. Distinct phenotypes of multisystem inflammatory syndrome in children: a cohort study. Pediatr Rheumatol Online J 2023; 21:33. [PMID: 37046304 PMCID: PMC10092941 DOI: 10.1186/s12969-023-00815-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Multisystem inflammatory syndrome in children (MIS-C) is a severe disease with an unpredictable course and a substantial risk of cardiogenic shock. Our objectives were to (a) compare MIS-C phenotypes across the COVID-19 pandemic, (b) identify features associated with intensive care need and treatment with biologic agents. METHODS Youth aged 0-18 years, fulfilling the World Health Organization case definition of MIS-C, and admitted to the Alberta Children's Hospital during the first four waves of the COVID-19 pandemic (May 2020-December 2021) were included in this cohort study. Demographic, clinical, biochemical, imaging, and treatment data were captured. RESULTS Fifty-seven MIS-C patients (median age 6 years, range 0-17) were included. Thirty patients (53%) required intensive care. Patients in the third or fourth wave (indicated as phase 2 of the pandemic) presented with higher peak ferritin (µg/l, median (IQR) = 1134 (409-1806) vs. 370 (249-629), P = 0.001), NT-proBNP (ng/l, median (IQR) = 12,217 (3013-27,161) vs. 3213 (1216-8483), P = 0.02) and D-dimer (mg/l, median (IQR) = 4.81 (2.24-5.37) vs. 2.01 (1.27-3.34), P = 0.004) levels, and higher prevalence of liver enzyme abnormalities (n(%) = 17 (68) vs. 11 (34), P = 0.02), hypoalbuminemia (n(%) = 24 (100) vs. 25 (81), P = 0.03) and thrombocytopenia (n(%) 18 (72) vs. 11 (34), P = 0.007) compared to patients in the first two waves (phase 1). These patients had a higher need of non-invasive/mechanical ventilation (n(%) 4 (16) vs. 0 (0), P = 0.03). Unsupervised clustering analyses classified 47% of the patients in the correct wave and 74% in the correct phase of the pandemic. NT-proBNP was the only significant contributor to the need for intensive care in all applied multivariate regression models. Treatment with biologic agents was significantly associated with peak CRP (mg/l (median, IQR = 240.9 (132.9-319.4) vs. 155.8 (101.0-200.7), P = 0.02) and ferritin levels (µg/l, median (IQR) = 1380 (509-1753) vs. 473 (280-296)). CONCLUSIONS MIS-C patients in a later stage of the pandemic displayed a more severe phenotype, reflecting the impact of distinct SARS-CoV-2 variants. NT-proBNP emerged as the most crucial feature associated with intensive care need, underscoring the importance of monitoring.
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Affiliation(s)
- Thomas Renson
- Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
- Nephrology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, Calgary, AB, Canada.
| | - Nils D Forkert
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Kimberly Amador
- Department of Radiology, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Paivi Miettunen
- Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Simon J Parsons
- Critical Care Medicine, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Muhammed Dhalla
- Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Nicole A Johnson
- Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Nadia Luca
- Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Heinrike Schmeling
- Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Rebeka Stevenson
- Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Marinka Twilt
- Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Lorraine Hamiwka
- Nephrology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
| | - Susanne Benseler
- Rheumatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary Cumming School of Medicine, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
- Alberta Children's Hospital Research Institute, University of Calgary Cumming School of Medicine, Calgary, AB, Canada
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Houghton K, McPherson M, Surjanovic N, Loughin T, Berard R, Proulx-Gauthier JP, Chédeville G, Rumsey D, Schmeling H, Luca N, Johnson N, Gerschman T, Miettunen P, Tam H, Lim L, Morishita K, Scuccimarri R, Roth J, Duffy C, Tucker L, Feldman BM, Guzman J. Development and validation of the Kids Disability Screen for children with juvenile idiopathic arthritis: results from the CAPRI Registry. Rheumatology (Oxford) 2022; 61:4835-4844. [PMID: 35438140 DOI: 10.1093/rheumatology/keac146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/01/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The aim of this study was to develop and validate a brief disability screen for children with JIA, the Kids Disability Screen (KDS). METHODS A total of 216 children enrolled in the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry in 2017-2018 formed a development cohort, and 220 children enrolled in 2019-2020 formed a validation cohort. At every clinic visit, parents answered two questions derived from the Childhood Health Assessment Questionnaire (CHAQ): 'Is it hard for your child to run and play BECAUSE OF ARTHRITIS?' ('Hard' 0-10), and 'Does your child usually need help from you or another person BECAUSE OF ARTHRITIS?' ('Help', 0-10). We used 36-fold cross-validation and tested nine different mathematical methods to combine the answers and optimize psychometric properties. The results were confirmed in the validation cohort. RESULTS Expressed as the mean of the two answers, KDS best balanced ease of use and psychometric properties, while a LASSO regression model combining the two answers with other patient characteristics [estimated CHAQ [eCHAQ]) had the highest responsiveness. In the validation cohort, 22.7%, 25.9% and 28.6% of patients had a score of 0 at enrolment for the KDS, eCHAQ and CHAQ, respectively. Responsiveness was 0.67, 0.74 and 0.62, respectively. Sensitivity to detect a CHAQ > 0 was 0.90 and specificity 0.56, KDS detecting some disability in 44% of children with a CHAQ = 0. CONCLUSION This simple KDS has psychometric properties comparable with those of a full CHAQ and may be used at every clinic visit to identify those children who need a full disability assessment.
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Affiliation(s)
- Kristin Houghton
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Meghan McPherson
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | | | | | - Roberta Berard
- London Health Sciences Centre and Western University, London
| | | | | | - Dax Rumsey
- The Stollery Children's Hospital and University of Alberta, Edmonton
| | | | - Nadia Luca
- The Alberta Children's Hospital and University of Calgary, Calgary
| | - Nicole Johnson
- The Alberta Children's Hospital and University of Calgary, Calgary
| | - Tommy Gerschman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Paivi Miettunen
- The Alberta Children's Hospital and University of Calgary, Calgary
| | - Herman Tam
- The Stollery Children's Hospital and University of Alberta, Edmonton
| | - Lillian Lim
- The Stollery Children's Hospital and University of Alberta, Edmonton
| | - Kimberly Morishita
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | | | - Johannes Roth
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa
| | - Ciaran Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa
| | - Lori Tucker
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Brian M Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
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7
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Amlani A, Choi MY, Buhler KA, Hudson M, Tarnopolsky M, Brady L, Schmeling H, Swain MG, Stingl C, Reed A, Fritzler MJ. Anti-Valosin-Containing Protein (VCP/p97) Autoantibodies in Inclusion Body Myositis and Other Inflammatory Myopathies. ACR Open Rheumatol 2022; 5:10-14. [PMID: 36373433 PMCID: PMC9837394 DOI: 10.1002/acr2.11510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/29/2022] [Accepted: 09/27/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The rationale for this study was based on reports that valosin-containing protein (VCP) mutations are found in hereditary inclusion body myositis (IBM) and VCP was detected in rimmed vacuoles of sporadic IBM (sIBM) muscle biopsies. Autoantibodies to VCP have not been reported in sIBM or other inflammatory myopathies (IIMs). The aim of this study was to determine the frequency and clinical significance of anti-VCP antibodies in sIBM and other IIMs. METHODS Sera were collected from 73 patients with sIBM and 383 comparators or controls, including patients with IIM (n = 69), those with juvenile dermatomyositis (JDM) (n = 67), those with juvenile idiopathic arthritis (JIA) (n = 47), those with primary biliary cholangitis (PBC) (n = 105), controls that were age matched to patients with sIBM (similarly aged controls [SACs]) (n = 63), and healthy controls (HCs) (n = 32). Immunoglobulin G antibodies to VCP were detected by addressable laser bead immunoassay using a full-length recombinant human protein. RESULTS Among patients with sIBM, 26.0% (19/73) were positive for anti-VCP. The frequency in disease controls was 15.0% (48/320). Among SACs, the frequency was 1.6% (1/63), and in HCs 0% (0/32). Frequencies were 17.5% (11/63) for IIM, 25.7% (27/105) for PBC, 3.0% (2/67) for JDM, and 17.0% (8/47) for JIA. The sensitivity, specificity, positive predictive value, and negative predictive value of anti-VCP for sIBM were 26.0%, 87.2%, 28.4%, and 85.9%, respectively. Of patients with sIBM, 15.1% (11/73) were positive for both anti-VCP and anti-cytosolic 5'-nucleotidase 1A (NT5c1A). Eleven percent of patients (8/73) were positive for anti-VCP, but negative for anti-NT5c1A. CONCLUSION Anti-VCP has low sensitivity and moderate specificity for sIBM but may help fill the seronegative gap in sIBM. Further studies are needed to determine whether anti-VCP is a biomarker for a clinical phenotype that may have clinical value.
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Affiliation(s)
- Adam Amlani
- Cumming School of Medicine, University of CalgaryAlbertaCanada
| | - May Y. Choi
- Cumming School of Medicine, University of CalgaryAlbertaCanada
| | | | - Marie Hudson
- Jewish General Hospital and McGill UniversityMontrealQuebecCanada
| | | | - Lauren Brady
- McMaster University Medical CenterHamiltonOntarioCanada
| | | | - Mark G. Swain
- Cumming School of Medicine, University of CalgaryAlbertaCanada
| | - Cory Stingl
- Duke University School of MedicineDurhamNorth Carolina
| | - Ann Reed
- Duke University School of MedicineDurhamNorth Carolina
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Renson T, Miettunen P, Parsons S, Dhalla M, Johnson N, Luca N, Schmeling H, Stevenson R, Twilt M, Hamiwka L, Benseler S. POS1257 READING THE WAVES: IDENTIFYING DISTINCT PHENOTYPES OF MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN IN A SINGLE CANADIAN CENTER DURING THE 2020-2021 COVID-19 PANDEMIC. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundThe COVID-19-associated multisystem inflammatory syndrome in children (MIS-C) is characterized by Kawasaki disease (KD)-like features and circulatory shock [1]. The genesis of SARS-CoV-2 variants triggered successive waves of mass infections followed by MIS-C outbreaks.ObjectivesTo compare MIS-C phenotypes across the waves of the COVID-19 pandemic. To identify predictors of pediatric intensive care unit (PICU) admission and treatment with biologic agents.MethodsYouth aged 0-18 years, fulfilling the WHO case definition of MIS-C, and admitted to the Alberta Children’s Hospital during the COVID-19 pandemic (May 2020-December 2021) were included. Clinical, laboratory, imaging, and treatment data were captured (KD-like manifestations, signs of shock and/or hypotension, peak C-reactive protein (CRP) and ferritin, platelet count nadir, peak NT-proBNP and troponin, liver enzyme abnormalities, sodium and albumin nadir, echocardiogram findings, biologic agents).Results57 consecutive MIS-C patients (median age 6 years, IQR 4-6; 72% males) were included. 31 patients (54%) required PICU admission. All received immunoglobulins, 44 (77%) received corticosteroids, 8 patients (14%) were treated with biologic agents. Patients presenting during the third (mainly driven by Alpha variant) or fourth wave (mainly driven by Delta variant) presented with higher ferritin and NT-proBNP levels, and more liver enzyme abnormalities, hypoalbuminemia and thrombocytopenia compared to those presenting during the first or second wave (Table 1, Figure 1). PICU admission was associated with the presence of shock/hypotension, higher CRP, ferritin, and NT-proBNP levels, lower albumin levels, and the presence of ventricular dysfunction on echocardiogram (Table 1). A logistic regression model combining peak NT-proBNP, troponin and ferritin levels explained 70% (Nagelkerke R2) of the variance in PICU admission and correctly classified 91% of the cases. NT-proBNP was the sole significant contributor (p=0.017). Treatment with biologic agents was associated with higher CRP (mean 148.8 mg/l versus 251.7 mg/l; p=0.024) and ferritin (797 μg/l versus 1280 μg/l; p=0.049) levels.Table 1.Upper panel: Differences in MIS-C features of patients presenting during the first phase of the COVID-19 pandemic (first + second wave) compared to those presenting during the second phase (third + fourth wave) (*one missing value). Lower panel: Differences regarding MIS-C features between patients admitted to PICU compared to those managed on the general ward.Phase 1(n = 31)Phase 2(n = 26)P-valuePeak ferritin, μg/l (mean, SD)548 (529)1129 (724)<0.001Liver enzyme abnormalities (n, %)10 (32)18 (69)0.008Peak NT-proBNP, ng/l (mean, SD)5250 (4721)13366 (11211)0.012Hypoalbuminemia (n, %)24 (80)*25 (100)*0.027Thrombocytopenia (n, %)11 (35)18 (69)0.017PICUNo(n = 26)Yes(n = 31)P-valueShock/hypotension (n, %)19 (73)31 (100)0.002Peak CRP, mg/l (mean, SD)140.7 (92)203.8 (84)0.008Peak ferritin, μg/l (mean, SD)612 (676)1183 (627)0.002Peak NT-proBNP, ng/l (mean, SD)3772 (5074)15584 (9662)<0.001Albumin nadir, g/l (mean, SD)24 (4)19 (3)0.014Ventricular dysfunction (n, %)2 (8)18 (58)<0.001Figure 1.Violin plots depicting differences in key laboratory MIS-C features between the waves (A) and both phases (phase 1 = wave 1 + 2, phase 2 = wave 3 + 4; B) of the COVID-19 pandemic.ConclusionA shift in MIS-C phenotype was identified across the successive COVID-19 waves, including the predominance of features associated with macrophage activation syndrome in later stages. These findings may reflect the impact of distinct SARS-CoV-2 variants. NT-proBNP emerged as the most important MIS-C feature predicting PICU admission, underscoring the importance of monitoring.References[1]Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet 2020;395(10237):1607–8Disclosure of InterestsNone declared
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Storwick JA, Brett A, Buhler K, Chin A, Schmeling H, Johnson N, Fritzler MJ, Choi MY. Prevalence and titres of antinuclear antibodies in juvenile idiopathic arthritis: A systematic review and meta-analysis. Clin Exp Rheumatol 2022; 21:103086. [DOI: 10.1016/j.autrev.2022.103086] [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] [Received: 03/02/2022] [Accepted: 04/05/2022] [Indexed: 11/02/2022]
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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Deakin CT, Bowes J, Rider LG, Miller FW, Pachman LM, Sanner H, Rouster-Stevens K, Mamyrova G, Curiel R, Feldman BM, Huber AM, Reed AM, Schmeling H, Cook CG, Marshall LR, Wilkinson MGL, Eyre S, Raychaudhuri S, Wedderburn LR. Association with HLA-DRβ1 position 37 distinguishes juvenile Dermatomyositis from adult-onset myositis. Hum Mol Genet 2022; 31:2471-2481. [PMID: 35094092 PMCID: PMC9307311 DOI: 10.1093/hmg/ddac019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 01/14/2022] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Juvenile dermatomyositis (JDM) is a rare, severe autoimmune disease and the most common idiopathic inflammatory myopathy (IIM) of children. JDM and adult-onset dermatomyositis (DM) have similar clinical, biological and serological features, although these features differ in prevalence between childhood-onset and adult-onset disease, suggesting age of disease onset may influence pathogenesis. Therefore, a JDM-focused genetic analysis was performed using the largest collection of JDM samples to date.
Methods
Caucasian JDM samples (n = 952) obtained via international collaboration were genotyped using the Illumina HumanCoreExome chip. Additional non-assayed HLA loci and genome-wide SNPs were imputed.
Results
HLA-DRB1*03:01 was confirmed as the classical HLA allele most strongly associated with JDM (OR 1.66; 95% CI 1.46, 1.89; P = 1.4 × 10−14), with an independent association at HLA-C*02:02 (OR = 1.74; 95% CI 1.42, 2.13, P = 7.13 × 10−8). Analyses of amino acid positions within HLA-DRB1 indicated the strongest association was at position 37 (omnibus P = 3.3 × 10−19), with suggestive evidence this association was independent of position 74 (omnibus P = 5.1 × 10−5), the position most strongly associated with adult-onset DM. Conditional analyses also suggested the association at position 37 of HLA-DRB1 was independent of some alleles of the Caucasian HLA 8.1 ancestral haplotype (AH8.1) such as HLA-DQB1*02:01 (OR = 1.62; 95% CI 1.36, 1.93; P = 8.70 × 10−8), but not HLA-DRB1*03:01 (OR = 1.49; 95% CR 1.24, 1.80; P = 2.24 × 10−5). No associations outside the HLA region were identified.
Conclusions
Our findings confirm previous associations with AH8.1 and HLA-DRB1*03:01, HLA-C*02:02 and identify a novel association with amino acid position 37 within HLA-DRB1 which may distinguish JDM from adult DM.
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Affiliation(s)
- Claire T Deakin
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospital and Great Ormond Street Hospital, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Frederick W Miller
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, Maryland, USA
| | - Lauren M Pachman
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Helga Sanner
- Department of Rheumatology, University of Oslo, Oslo, Norway
- Oslo New University College, Oslo, Norway
| | | | - Gulnara Mamyrova
- Division of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Rodolfo Curiel
- Division of Rheumatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Brian M Feldman
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ann M Reed
- Pediatrics, Duke University, Durham, North Carolina, USA
| | - Heinrike Schmeling
- Alberta Children's Hospital and Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Charlotte G Cook
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Lucy R Marshall
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospital and Great Ormond Street Hospital, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Meredyth G Ll Wilkinson
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospital and Great Ormond Street Hospital, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
| | - Stephen Eyre
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Soumya Raychaudhuri
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA
| | - Lucy R Wedderburn
- Infection, Immunity and Inflammation Research and Teaching Department, UCL Great Ormond Street Institute of Child Health, London, UK
- Centre for Adolescent Rheumatology Versus Arthritis at UCL, UCL Hospital and Great Ormond Street Hospital, London, UK
- NIHR Biomedical Research Centre at Great Ormond Street Hospital, London, UK
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Ruperto N, Brunner HI, Synoverska O, Ting TV, Mendoza CA, Spindler A, Vyzhga Y, Marzan K, Grebenkina L, Tirosh I, Imundo L, Jerath R, Kingsbury DJ, Sozeri B, Vora SS, Prahalad S, Zholobova E, Butbul Aviel Y, Chasnyk V, Lerman M, Nanda K, Schmeling H, Tory H, Uziel Y, Viola DO, Posner HB, Kanik KS, Wouters A, Chang C, Zhang R, Lazariciu I, Hsu MA, Suehiro RM, Martini A, Lovell DJ. Tofacitinib in juvenile idiopathic arthritis: a double-blind, placebo-controlled, withdrawal phase 3 randomised trial. Lancet 2021; 398:1984-1996. [PMID: 34767764 DOI: 10.1016/s0140-6736(21)01255-1] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [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] [Received: 03/01/2021] [Revised: 04/30/2021] [Accepted: 05/25/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Tofacitinib is an oral Janus kinase inhibitor. This trial assessed the efficacy and safety of tofacitinib versus placebo in patients with polyarticular course juvenile idiopathic arthritis (JIA). METHODS This double-blind, withdrawal phase 3 trial enrolled patients with polyarticular course JIA (extended oligoarthritis, rheumatoid factor-positive or rheumatoid factor-negative polyarthritis, or systemic JIA without active systemic features) aged 2 years to younger than 18 years, and was done at 64 centres of the Paediatric Rheumatology International Trials Organisation and Pediatric Rheumatology Collaborative Study Group networks in 14 countries. Patients with psoriatic arthritis or enthesitis-related arthritis were enrolled for exploratory endpoints. During part 1 of the study, patients received oral open-label tofacitinib (weight-based doses; 5 mg twice daily or lower) for 18 weeks. Patients achieving at least JIA/American College of Rheumatology 30 response were randomly assigned (1:1) using an Interactive Response Technology system to continue tofacitinib or switch to placebo in part 2 of the study for 26 weeks. The primary endpoint was JIA flare rate by week 44 in part 2 in patients with polyarticular course JIA; the intention-to-treat principle was applied. Safety was evaluated throughout part 1 and part 2 of the study in all patients who received one dose or more of study medication. This trial is registered with ClinicalTrials.gov, NCT02592434. FINDINGS Between June 10, 2016, and May 16, 2019, of 225 patients enrolled, 184 (82%) patients had polyarticular course JIA, 20 (9%) had psoriatic arthritis, and 21 (9%) had enthesitis-related arthritis. 147 (65%) of 225 patients received concomitant methotrexate. In part 2, 142 patients with polyarticular course JIA were assigned to tofacitinib (n=72) or placebo (n=70). Flare rate by week 44 was significantly lower with tofacitinib (21 [29%] of 72 patients) than with placebo (37 [53%] of 70 patients; hazard ratio 0·46, 95% CI 0·27-0·79; p=0·0031). In part 2 of the study, adverse events occurred in 68 (77%) of 88 patients receiving tofacitinib and 63 (74%) of 85 in the placebo group. Serious adverse events occurred in one (1%) and two (2%), respectively. In the entire tofacitinib exposure period, 107 (48%) of 225 patients had infections or infestations. There were no deaths during this study. INTERPRETATION The results of this pivotal trial show that tofacitinib is an effective treatment in patients with polyarticular course JIA. New oral therapies are particularly relevant for children and adolescents, who might prefer to avoid injections. FUNDING Pfizer.
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Affiliation(s)
- Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, UOSID Centro Trial, PRINTO, Genova, Italy.
| | - Hermine I Brunner
- College of Medicine, University of Cincinnati, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Tracy V Ting
- College of Medicine, University of Cincinnati, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Carlos Abud Mendoza
- Regional Unit of Rheumatology and Osteoporosis at Central Hospital, Faculty of Medicine, San Luis Potosí, Mexico
| | | | - Yulia Vyzhga
- Vinnytsya National Medical University N Pirogov, Vinnytsya, Ukraine
| | - Katherine Marzan
- Division of Rheumatology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Irit Tirosh
- Pediatric Rheumatology Unit and Department of Pediatrics, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lisa Imundo
- Adolescent Rheumatology Columbia University Medical Center, New York, NY, USA
| | - Rita Jerath
- Augusta University Medical Center, Augusta, GA, USA
| | - Daniel J Kingsbury
- Augusta University Medical Center, Augusta, GA, USA; Randall Children's Hospital at Legacy Emanuel, Portland, OR, USA
| | - Betul Sozeri
- Department of Pediatric Rheumatology, Ümraniye Training and Research Hospital, Istanbul, Turkey
| | - Sheetal S Vora
- Pediatric Rheumatology, Atrium Health Levine Children's Hospital, Charlotte, NC, USA
| | - Sampath Prahalad
- Departments of Pediatrics and Human Genetics, Emory University School of Medicine, and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Elena Zholobova
- Institute of Children's Health, University Children's Clinical Hospital, Sechenov University, Moscow, Russia
| | - Yonatan Butbul Aviel
- Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Medical Center, Haifa, Israel
| | - Vyacheslav Chasnyk
- Saint Petersburg State Pediatric Medical University, Saint-Petersburg, Russia
| | - Melissa Lerman
- Division of Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kabita Nanda
- Division of Rheumatology, Seattle Children's Hospital, Seattle, WA, USA
| | - Heinrike Schmeling
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Heather Tory
- Division of Rheumatology, Connecticut Children's Medical Center, Hartford, and Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA
| | - Yosef Uziel
- Pediatric Rheumatology Unit, Department of Pediatrics, Meir Medical Centre, Kfar Saba, and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | | | | | | | | | | | | | | | | | | | - Daniel J Lovell
- College of Medicine, University of Cincinnati, and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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14
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Chomistek K, Barnabe C, Naqvi SF, Birnie KA, Johnson N, Luca N, Miettunen P, Santana MJ, Stinson J, Schmeling H. Acceptability of an Adolescent Self-Management Program for Juvenile Idiopathic Arthritis. ACR Open Rheumatol 2021; 4:142-151. [PMID: 34791829 PMCID: PMC8843737 DOI: 10.1002/acr2.11373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/03/2021] [Accepted: 10/11/2021] [Indexed: 11/26/2022] Open
Abstract
Objective The study objective was to test the acceptability of a self‐management program (SMP) for adolescents with juvenile idiopathic arthritis (JIA) focused on disease information, self‐management, and social support needs. Methods This study was conducted using inductive qualitative methods to explore the acceptability of an in‐person/videoconference SMP. Two groups of four adolescents with JIA (mean age = 13.5, SD = 0.8) and two groups of pediatric rheumatology health care professionals (n = 4, n = 5) participated in four feedback sessions each. The SMP was presented to study participants, and feedback was provided on the content, format, and structure of the program. Thematic analysis was used to analyze the data. Results Adolescents felt that the content was appropriate and would be effective in supporting self‐management of their arthritis. Participants advised that the trustworthiness of the information would be increased if a rheumatology health care provider facilitated the session. Potential barriers to participation included distance and availability (weekdays and times), but the option for videoconference‐based participation was an appropriate solution to both of these issues. Minor changes were made to content and format, and required changes were made to address participant recommendations for improvement. Conclusion This study confirmed the acceptability of an in‐person/videoconference SMP for patients with JIA. Modifications were made to the SMP based on the focus group feedback, and future directions include a pilot randomized controlled trial to assess feasibility and preliminary effectiveness of the program.
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Affiliation(s)
- Kelsey Chomistek
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Syeda Farwa Naqvi
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn A Birnie
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of medicine, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Johnson
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Nadia Luca
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Paivi Miettunen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Maria J Santana
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Heinrike Schmeling
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Cumming School of medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
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15
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Dushnicky MJ, Campbell C, Beattie KA, Berard R, Cellucci T, Chan M, Gerschman T, Johnson N, Lim L, Luca N, Miettunen P, Morishita KA, Proulx-Gauthier JP, Rumsey DG, Schmeling H, Scuccimarri R, Tam H, Guzman J, Batthish M. Impact of the COVID-19 Pandemic on Juvenile Idiopathic Arthritis Presentation and Research Recruitment: Results from the CAPRI Registry. Rheumatology (Oxford) 2021; 61:SI157-SI162. [PMID: 34726738 PMCID: PMC8689883 DOI: 10.1093/rheumatology/keab812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has disrupted healthcare delivery and clinical research worldwide, with data from areas most affected demonstrating an impact on rheumatology care. This study aimed to characterize the impact of the pandemic on the initial presentation of JIA and JIA-related research in Canada. METHODS Data collected from the Canadian Alliance of Pediatric Rheumatology Investigators JIA Registry from the year pre-pandemic (March 11, 2019-March 10, 2020) was compared with data collected during the first year of the pandemic (March 11, 2020-March 10, 2021). Outcomes included time from symptom onset to first assessment, disease severity at presentation and registry recruitment. Proportions and medians were used to describe categorical and continuous variables, respectively. RESULTS The median time from symptom onset to first assessment was 138 days (IQR 64-365) pre-pandemic vs 146 days (IQR 83-359) during the pandemic. The JIA category frequencies remained overall stable, (44% oligoarticular JIA pre-pandemic, 46.8% pandemic), except for systemic JIA (12 cases pre-pandemic, 1 pandemic). Clinical features, disease activity (cJADAS10), disability (CHAQ) and quality of life (JAQQ) scores were similar between the two cohorts. Pre-pandemic, 225 patients were enrolled, compared with 111 in the pandemic year, with the greatest decrease from March to June 2020. CONCLUSIONS We did not observe the anticipated delay in time to presentation or increased severity at presentation, suggesting that, within Canada, care adapted well to provide support to new patient consults without negative impacts. The COVID-19 pandemic was associated with an initial 50% decrease in registry enrolment but has since improved.
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Affiliation(s)
- Molly J Dushnicky
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Campbell
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Karen A Beattie
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Roberta Berard
- Division of Rheumatology, Department of Pediatrics, Western University, London, Ontario, Canada
| | - Tania Cellucci
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Mercedes Chan
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tommy Gerschman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Johnson
- Section of Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lillian Lim
- Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Nadia Luca
- Section of Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paivi Miettunen
- Section of Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kimberly A Morishita
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Dax G Rumsey
- Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Heinrike Schmeling
- Section of Rheumatology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Rosie Scuccimarri
- Division of Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Herman Tam
- Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jaime Guzman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
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16
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Grazziotin LR, Currie G, Twilt M, Ijzerman MJ, Kip MMA, Koffijberg H, Benseler SM, Swart JF, Vastert SJ, Wulffraat NM, Yeung RSM, Johnson N, Luca NJ, Miettunen PM, Schmeling H, Marshall DA. Evaluation of Real-World Healthcare Resource Utilization and Associated Costs in Children with Juvenile Idiopathic Arthritis: A Canadian Retrospective Cohort Study. Rheumatol Ther 2021; 8:1303-1322. [PMID: 34275124 PMCID: PMC8380593 DOI: 10.1007/s40744-021-00331-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/03/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Juvenile idiopathic arthritis (JIA) is a chronic rheumatic disease, whose multifaceted care path can lead to significant expenditure for the healthcare system. We aim to assess the real-world healthcare resource use (HCRU) and associated cost for children with JIA in a single center in Canada. METHODS A single-center consecutive cohort of newly diagnosed patients with JIA attending the pediatric rheumatology clinic from 2011 to 2019 was identified using an administrative data algorithm and electronic medical charts. HCRU was estimated from six administrative health databases that included hospital admissions, emergency, outpatient care, practitioners' visits, medication, and laboratory and imaging tests. Costs were assigned using appropriate sources. We reported the yearly overall and JIA-associated HCRU and costs 5 years prior to and 6 years after the first visit to the pediatric rheumatologist. The Zhao and Tian estimator was used to calculate cumulative mean costs over a 6-year timeframe. Results were stratified by disease subtype. RESULTS A total of 389 patients were identified. The yearly total overall mean costs per patient ranged between $804 and $4460 during the 5 years prior to the first visit to the pediatric rheumatologist and $8529 and $10,651 for the 6 years after. Medication cost, driven by use of biologic therapies, and outpatient visits were the greatest contributor to the total cost. The overall cumulative mean cost for 6 years of care was $48,649 per patient, while the JIA-associated cumulative mean cost was $26,820 per patient. During the first year of rheumatology care, systemic onset JIA had the highest cumulative mean overall cost, while oligoarticular JIA had the lowest cumulative mean cost. CONCLUSION The care pathway for children with JIA can be expensive, and complex-and varies by JIA subtype. Although the yearly total mean cost per patient was constant, the distribution of costs changes over time with the introduction of biologic therapies later in the care pathway. This study provides a better understanding of the JIA costs profile and can help inform future economic studies.
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Affiliation(s)
- Luiza R Grazziotin
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Gillian Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marinka Twilt
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Maarten J Ijzerman
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Michelle M A Kip
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Susanne M Benseler
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Health Services, Calgary, AB, Canada
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sebastiaan J Vastert
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital / UMC Utrech, Utrecht, The Netherlands
- Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Rae S M Yeung
- Departments of Paediatrics, Immunology and Medical Science, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Nicole Johnson
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nadia J Luca
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Paivi M Miettunen
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Heinrike Schmeling
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
- Section of Rheumatology, Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah A Marshall
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Room 3C56, Health Research Innovation Centre, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
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17
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Sabbagh SE, Neely J, Chow A, DeGuzman M, Lai J, Lvovich S, McGrath T, Pereira M, Pinal-Fernandez I, Roberts J, Rouster-Stevens K, Schmeling H, Sura A, Tarshish G, Tucker L, Rider LG, Kim S. Risk factors associated with Pneumocystis jirovecii pneumonia in juvenile myositis in North America. Rheumatology (Oxford) 2021; 60:829-836. [PMID: 32889531 DOI: 10.1093/rheumatology/keaa436] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 05/04/2020] [Revised: 06/24/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Pneumocystis jirovecii pneumonia (PJP) is associated with significant morbidity and mortality in adult myositis patients; however, there are few studies examining PJP in juvenile myositis [juvenile idiopathic inflammatory myopathy (JIIM)]. The purpose of this study was to determine the risk factors and clinical phenotypes associated with PJP in JIIM. METHODS An research electronic data capture (REDCap) questionnaire regarding myositis features, disease course, medications and PJP infection characteristics was completed by treating physicians for 13 JIIM patients who developed PJP (PJP+) from the USA and Canada. Myositis features and medications were compared with 147 JIIM patients without PJP (PJP-) from similar geographic regions who enrolled in National Institutes of Health natural history studies. RESULTS PJP+ patients were more often of Asian ancestry than PJP- patients [odds ratio (OR) 8.7; 95% CI 1.3, 57.9]. Anti- melanoma differentiation associated protein 5 (MDA5) autoantibodies (OR 12.5; 95% CI 3.0, 52.4), digital infarcts (OR 43.8; 95% CI 4.2, 460.2), skin ulcerations (OR 12.0; 95% CI 3.5, 41.2) and interstitial lung disease (OR 10.6; 95% CI 2.1, 53.9) were more frequent in PJP+ patients. Before PJP diagnosis, patients more frequently received pulse steroids, rituximab and more immunosuppressive therapy compared with PJP- patients. Seven PJP+ patients were admitted to the intensive care unit and four patients died due to PJP or its complications. CONCLUSIONS PJP is a severe infection in JIIM that can be associated with mortality. Having PJP was associated with more immunosuppressive therapy, anti-MDA5 autoantibodies, Asian race and certain clinical features, including digital infarcts, cutaneous ulcerations and interstitial lung disease. Prophylaxis for PJP should be considered in juvenile myositis patients with these features.
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Affiliation(s)
- Sara E Sabbagh
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA.,Division of Rheumatology, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jessica Neely
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
| | - Albert Chow
- Division of Pediatric Rheumatology, Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA.,Division of Pediatric Rheumatology, Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Marietta DeGuzman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - Jamie Lai
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA.,University of Colorado School of Medicine, Division of Pediatric Rheumatology, Children's Hospital Colorado, Aurora, CO, USA
| | - Svetlana Lvovich
- Section of Rheumatology, Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Tara McGrath
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, USA.,BC Children's Hospital, Vancouver, BC, Canada
| | - Maria Pereira
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Division of Rheumatology, Texas Children's Hospital, Houston, TX, USA
| | - Iago Pinal-Fernandez
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health (NIH), Bethesda, MD, USA.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Faculty of Health Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
| | - Jordan Roberts
- Division of Immunology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kelly Rouster-Stevens
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Heinrike Schmeling
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Anjali Sura
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA.,Department of Pediatrics, Upstate University Hospital, Syracuse, NY, USA
| | - Gabriel Tarshish
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore, Bronx, NY, USA
| | - Lori Tucker
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, BC, USA.,BC Children's Hospital, Vancouver, BC, Canada
| | - Lisa G Rider
- Environmental Autoimmunity Group, Clinical Research Branch, National Institute of Environmental Health Sciences, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Susan Kim
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, USA
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18
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Lalloo C, Harris LR, Hundert AS, Berard R, Cafazzo J, Connelly M, Feldman BM, Houghton K, Huber A, Laxer RM, Luca N, Schmeling H, Spiegel L, Tucker LB, Pham Q, Davies-Chalmers CC, Stinson JN. The iCanCope pain self-management application for adolescents with juvenile idiopathic arthritis: a pilot randomized controlled trial. Rheumatology (Oxford) 2021; 60:196-206. [PMID: 32613229 DOI: 10.1093/rheumatology/keaa178] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 01/07/2020] [Revised: 03/14/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To evaluate the feasibility and preliminary effectiveness of iCanCope with Pain (iCanCope), a smartphone-based pain self-management program, in adolescents with JIA. iCanCope featured symptom tracking, goal-setting, pain coping skills and social support. METHODS A two-arm pilot randomized controlled trial was used to evaluate the iCanCope app compared with a version with symptom tracking only. Primary (feasibility) outcomes were: participant accrual/attrition rates, success of app deployment, acceptability and adherence. Secondary (preliminary effectiveness) outcomes were: pain intensity, pain-related activity limitations and health-related quality of life. Outcomes were assessed at baseline and 8 weeks. Adherence was defined as the proportion of completed symptom reports: 'low' (≤24%); 'low-moderate' (25-49%); 'high-moderate' (50-75%); or 'high' (76-100%). Linear mixed models were applied for preliminary effectiveness analyses as per intention-to-treat. RESULTS Adolescents (N = 60) were recruited from three paediatric rheumatology centres. Rates of accrual and attrition were 82 and 13%, respectively. Both apps were deployed with high success (over 85%) and were rated as highly acceptable. Adherence was similar for both groups, with most participants demonstrating moderate-to-high adherence. Both groups exhibited a clinically meaningful reduction in pain intensity (≥1 point) that did not statistically differ between groups. There were no significant changes in activity limitations or health-related quality of life. CONCLUSION The iCanCope pilot randomized controlled trial was feasible to implement in a paediatric rheumatology setting. Both apps were deployed successfully, with high acceptability, and were associated with moderate-to-high adherence. Preliminary reductions in pain intensity warrant a future trial to evaluate effectiveness of iCanCope in improving health outcomes in adolescents with JIA. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02764346.
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Affiliation(s)
- Chitra Lalloo
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario
| | - Lauren R Harris
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Amos S Hundert
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario
| | - Roberta Berard
- Division of Rheumatology, Children's Hospital London Health Sciences Centre, London, Ontario
| | - Joseph Cafazzo
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Mark Connelly
- Division of Developmental and Behavioural Health, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario
| | - Kristin Houghton
- Division of Rheumatology, BC Children's Hospital, Vancouver, British Columbia
| | - Adam Huber
- Division of Rheumatology, IWK Health Centre, Halifax, Nova Scotia
| | - Ronald M Laxer
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario
| | - Nadia Luca
- Section of Pediatric Rheumatology, Alberta Children's Hospital, Calgary, Alberta
| | - Heinrike Schmeling
- Section of Pediatric Rheumatology, Alberta Children's Hospital, Calgary, Alberta
| | - Lynn Spiegel
- Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario
| | - Lori B Tucker
- Division of Rheumatology, BC Children's Hospital, Vancouver, British Columbia
| | - Quynh Pham
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | | | - Jennifer N Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario.,Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, Ontario.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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19
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Chédeville G, McGuire K, Cabral DA, Shiff NJ, Rumsey DG, Proulx-Gauthier JP, Schmeling H, Berard RA, Batthish M, Soon G, Gerhold K, Gerschman T, Bruns A, Duffy CM, Tucker LB, Guzman J. Parent-Reported Medication Side-Effects and Their Impact on Health-Related Quality of Life in Children with Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2021; 74:1567-1574. [PMID: 33787074 DOI: 10.1002/acr.24610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 02/16/2021] [Accepted: 03/25/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe frequency and severity of parent-reported medication side effects (SE) in children with Juvenile Idiopathic Arthritis (JIA), relative to physician-reported actionable adverse events (AAE); and to assess their impact on health-related quality of life (HRQoL). METHODS Newly diagnosed JIA patients recruited between 2017 and 2019 to the Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) Registry were included. Parents reported presence and severity (0=no problem, 10=very severe) of medication SE at every clinic visit. Physicians were asked to report any AAE. HRQoL was assessed using the Quality of My Life (QoML) questionnaire (0=the worst, 10=the best) and parent's global assessment (0=very well, 10=very poor). Analyses included proportion of visits with SE or AAE, cumulative incidence by Kaplan-Meier methods, and HRQoL impact measured with longitudinal mixed effects models. RESULTS SE were reported at 371/884 (42%) visits (95% CI 39-45%) in 249 patients with a median of 2 SE per visit (IQR 1,3), and median severity of 3 (IQR 1.5,5). Most SE were gastrointestinal (32.5% of visits) or behavioral/psychiatric (22.4%). SE frequency was lowest with NSAID alone (34.7%) and highest with prednisone and methotrexate combinations (66%). SE cumulative incidence was 67% (95% CI 59-75) within 1y of diagnosis, and 36% (95% CI 28-44) for AAE. Parent global and QoML scores were worse with SE present, the impact persisted after adjusting for pain and number of active joints. CONCLUSION Parents report 2/3 children with JIA experience SE impacting their HRQoL within 1y of diagnosis. SE mitigation strategies are needed in managing JIA.
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Affiliation(s)
- Gaëlle Chédeville
- Division of Pediatric Rheumatology. Department of Pediatrics. McGill
| | | | - David A Cabral
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
| | - Natalie J Shiff
- University of Saskatchewan, Department of Community Health and Epidemiology, Saskatoon, SK, Canada
| | - Dax G Rumsey
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | | | - Roberta A Berard
- Department of Pediatrics, Children's Hospital, London Health Sciences Centre and Western University, London, ON, Canada
| | | | - Gordon Soon
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Kerstin Gerhold
- Department of Pediatrics and Child Health, University of Manitoba, Manitoba, MB, Canada
| | - Tommy Gerschman
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
| | - Alessandra Bruns
- Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Ciaran M Duffy
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Lori B Tucker
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia, Columbia, BC, Canada
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20
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Ruperto N, Brunner HI, Ramanan AV, Horneff G, Cuttica R, Henrickson M, Anton J, Boteanu AL, Penades IC, Minden K, Schmeling H, Hufnagel M, Weiss JE, Pardeo M, Nanda K, Roth J, Rubio-Pérez N, Hsu JC, Wimalasundera S, Wells C, Bharucha K, Douglass W, Bao M, Mallalieu NL, Martini A, Lovell D, De Benedetti F. Subcutaneous dosing regimens of tocilizumab in children with systemic or polyarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 2021; 60:4568-4580. [PMID: 33506875 PMCID: PMC8487273 DOI: 10.1093/rheumatology/keab047] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/09/2020] [Indexed: 01/20/2023] Open
Abstract
Objectives To determine s.c. tocilizumab (s.c.-TCZ) dosing regimens for systemic JIA (sJIA) and polyarticular JIA (pJIA). Methods In two 52-week phase 1 b trials, s.c.-TCZ (162 mg/dose) was administered to sJIA patients every week or every 2 weeks (every 10 days before interim analysis) and to pJIA patients every 2 weeks or every 3 weeks with body weight ≥30 kg or <30 kg, respectively. Primary end points were pharmacokinetics, pharmacodynamics and safety; efficacy was exploratory. Comparisons were made to data from phase 3 trials with i.v. tocilizumab (i.v.-TCZ) in sJIA and pJIA. Results Study participants were 51 sJIA patients and 52 pJIA patients aged 1–17 years who received s.c.-TCZ. Steady-state minimum TCZ concentration (Ctrough) >5th percentile of that achieved with i.v.-TCZ was achieved by 49 (96%) sJIA and 52 (100%) pJIA patients. In both populations, pharmacodynamic markers of disease were similar between body weight groups. Improvements in Juvenile Arthritis DAS-71 were comparable between s.c.-TCZ and i.v.-TCZ. By week 52, 53% of sJIA patients and 31% of pJIA patients achieved clinical remission on treatment. Safety was consistent with that of i.v.-TCZ except for injection site reactions, reported by 41.2% and 28.8% of sJIA and pJIA patients, respectively. Infections were reported in 78.4% and 69.2% of patients, respectively. Two sJIA patients died; both deaths were considered to be related to TCZ. Conclusion s.c.-TCZ provides exposure and risk/benefit profiles similar to those of i.v.-TCZ. S.c. administration provides an alternative administration route that is more convenient for patients and caregivers and that has potential for in-home use. Trial registration ClinicalTrials.gov, http://clinicaltrials.gov, NCT01904292 and NCT01904279
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Affiliation(s)
- Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia-PRINTO, Genoa, Italy
| | - Hermine I Brunner
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Athimalaipet V Ramanan
- University Hospitals Bristol NHS Foundation Trust & Bristol Medical School, University of Bristol, Bristol, UK
| | - Gerd Horneff
- Department of General Paediatrics, Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany.,Department of Paediatric and Adolescents Medicine, University Hospital of Cologne, Cologne, Germany
| | - Rubén Cuttica
- Rheumatology Section, Hospital Pedro de Elizalde, Buenos Aires, Argentina
| | - Michael Henrickson
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jordi Anton
- Hospital Sant Joan de Déu, Universitat de Barcelona, Unidad de Reumatología Pediátrica, Esplugues de Llobregat (Barcelona), Spain
| | | | | | - Kirsten Minden
- German Rheumatism Research Centre Berlin, and Department of Rheumatology and Clinical Immunology, Charité University Medicine, Berlin, Germany
| | - Heinrike Schmeling
- Department of Pediatrics, Alberta Children's Hospital and Cumming School of Medicine/University of Calgary, Alberta, Canada
| | - Markus Hufnagel
- University Medical Center Freiburg, Department of Pediatrics and Adolescent Medicine, Division of Pediatric Infectious Diseases and Rheumatology, Medical Faculty, University of Freiburg, Freiburg, Germany
| | - Jennifer E Weiss
- Hackensack University Medical Center, Pediatric Rheumatology, Hackensack, NJ, USA
| | - Manuela Pardeo
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Johannes Roth
- University of Ottawa and Division of Pediatric Dermatology & Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Nadina Rubio-Pérez
- Universidad Autónoma de Nuevo León, Facultad de Medicina, Departamento de Pediatria, Hospital Universitario "Dr. J. E. González", Monterrey, NL, Mexico
| | - Joy C Hsu
- Roche Innovation Center, New York, NY, USA
| | | | | | | | | | - Min Bao
- Genentech, South San Francisco, CA, USA
| | | | - Alberto Martini
- Università degli Studi di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Genoa, Italy
| | - Daniel Lovell
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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21
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Ruperto N, Brunner HI, Pacheco-Tena C, Louw I, Vega-Cornejo G, Spindler AJ, Kingsbury DJ, Schmeling H, Borzutzky A, Cuttica R, Inman CJ, Malievskiy V, Scott C, Keltsev V, Terreri MT, Viola DO, Xavier RM, Fernandes TAP, Velázquez MDRM, Henrickson M, Clark MB, Bensley KA, Li X, Lo KH, Leu JH, Hsu CH, Hsia EC, Xu Z, Martini A, Lovell DJ. Open-Label Phase 3 Study of Intravenous Golimumab in Patients With Polyarticular Juvenile Idiopathic Arthritis. Rheumatology (Oxford) 2021; 60:4495-4507. [PMID: 33493312 PMCID: PMC8487314 DOI: 10.1093/rheumatology/keab021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/23/2020] [Indexed: 11/12/2022] Open
Abstract
Objectives To assess efficacy, pharmacokinetics (PK) and safety of intravenous (i.v.) golimumab in patients with polyarticular-course JIA (pc-JIA). Methods Children aged 2 to <18 years with active pc-JIA despite MTX therapy for ≥2 months received 80 mg/m2 golimumab at weeks 0, 4, then every 8 weeks through week 52 plus MTX weekly through week 28. The primary and major secondary endpoints were PK exposure and model-predicted steady-state area under the curve (AUCss) over an 8-week dosing interval at weeks 28 and 52, respectively. JIA ACR response and safety were also assessed. Results In total, 127 children were treated with i.v. golimumab. JIA ACR 30, 50, 70, and 90 response rates were 84%, 80%, 70% and 47%, respectively, at week 28 and were maintained through week 52. Golimumab serum concentrations and AUCss were 0.40 µg/ml and 399 µg ⋅ day/ml at week 28. PK exposure was maintained at week 52. Steady-state trough golimumab concentrations and AUCss were consistent across age categories and comparable to i.v. golimumab dosed 2 mg/kg in adults with rheumatoid arthritis. Golimumab antibodies and neutralizing antibodies were detected via a highly sensitive drug-tolerant assay in 31% (39/125) and 19% (24/125) of patients, respectively. Median trough golimumab concentration was lower in antibody-positive vs antibody-negative patients. Serious infections were reported in 6% of patients, including one death due to septic shock. Conclusion Body surface area-based dosing of i.v. golimumab was well tolerated and provided adequate PK exposure for clinical efficacy in paediatric patients with active pc-JIA. ClinicalTrials.gov number NCT02277444
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Affiliation(s)
- Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Genoa, Italy
| | - Hermine I Brunner
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - César Pacheco-Tena
- Facultad de Medicina, Universidad Autónoma de Chihuahua, Circuito Universitario Campus II, Chihuahua, México
| | - Ingrid Louw
- Panorama Medical Centre, Rheumatology Private Practice, Cape Town, South Africa
| | - Gabriel Vega-Cornejo
- Centro de Reumatología y Autoinmunidad (CREA)/Hospital México Americano, Guadalajara, Jalisco, México
| | - Alberto J Spindler
- Centro Médico Privado de Reumatología, Rheumatology Section, San Miguel de Tucuman, Tucuman, Argentina
| | - Daniel J Kingsbury
- Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, United States of America
| | - Heinrike Schmeling
- Alberta Children's Hospital and Department of Pediatrics, Cumming School of Medicine/University of Calgary, Calgary, Alberta, Canada
| | - Arturo Borzutzky
- Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rubén Cuttica
- Rheumatology Section, Hospital Pedro de Elizalde, Buenos Aires, Argentina
| | - C J Inman
- Pediatric Rheumatology, University of Utah, Salt Lake City, Utah, United States of America
| | - Victor Malievskiy
- Federal State Budget Educational Institution of Higher Education, Bashkir State Medical University of the Ministry of Healthcare of Russian Federation, Cape Town, South Africa
| | - Christiaan Scott
- Red Cross War Memorial Children's Hospital and Groote Schuur Hospital, Paediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - Vladimir Keltsev
- Pediatric Department, Togliatti City Clinical Hospital No. 5, Togliatti, Russian Federation
| | - Maria Teresa Terreri
- Escola Paulista de Medicina/Universidade Federal de São Paulo, Pediatrics, São Paulo, Brazil
| | | | - Ricardo M Xavier
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | - Michael Henrickson
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States of America
| | - Michael B Clark
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Karen A Bensley
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Xiaoming Li
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Kim Hung Lo
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Jocelyn H Leu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Chyi-Hung Hsu
- Janssen Research & Development, LLC, Raritan, New Jersey, United States of America
| | - Elizabeth C Hsia
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Zhenhua Xu
- Janssen Research & Development, LLC, Spring House, Pennsylvania, United States of America
| | - Alberto Martini
- Università degli Studi di Genova, Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Genova, Italy
| | - Daniel J Lovell
- Cincinnati Children's Hospital Medical Center, Division of Rheumatology, University of Cincinnati, Cincinnati, Ohio, United States of America
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22
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de Jesus AA, Hou Y, Brooks S, Malle L, Biancotto A, Huang Y, Calvo KR, Marrero B, Moir S, Oler AJ, Deng Z, Montealegre Sanchez GA, Ahmed A, Allenspach E, Arabshahi B, Behrens E, Benseler S, Bezrodnik L, Bout-Tabaku S, Brescia AC, Brown D, Burnham JM, Caldirola MS, Carrasco R, Chan AY, Cimaz R, Dancey P, Dare J, DeGuzman M, Dimitriades V, Ferguson I, Ferguson P, Finn L, Gattorno M, Grom AA, Hanson EP, Hashkes PJ, Hedrich CM, Herzog R, Horneff G, Jerath R, Kessler E, Kim H, Kingsbury DJ, Laxer RM, Lee PY, Lee-Kirsch MA, Lewandowski L, Li S, Lilleby V, Mammadova V, Moorthy LN, Nasrullayeva G, O'Neil KM, Onel K, Ozen S, Pan N, Pillet P, Piotto DG, Punaro MG, Reiff A, Reinhardt A, Rider LG, Rivas-Chacon R, Ronis T, Rösen-Wolff A, Roth J, Ruth NM, Rygg M, Schmeling H, Schulert G, Scott C, Seminario G, Shulman A, Sivaraman V, Son MB, Stepanovskiy Y, Stringer E, Taber S, Terreri MT, Tifft C, Torgerson T, Tosi L, Van Royen-Kerkhof A, Wampler Muskardin T, Canna SW, Goldbach-Mansky R. Distinct interferon signatures and cytokine patterns define additional systemic autoinflammatory diseases. J Clin Invest 2020; 130:1669-1682. [PMID: 31874111 DOI: 10.1172/jci129301] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 12/18/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUNDUndifferentiated systemic autoinflammatory diseases (USAIDs) present diagnostic and therapeutic challenges. Chronic interferon (IFN) signaling and cytokine dysregulation may identify diseases with available targeted treatments.METHODSSixty-six consecutively referred USAID patients underwent underwent screening for the presence of an interferon signature using a standardized type-I IFN-response-gene score (IRG-S), cytokine profiling, and genetic evaluation by next-generation sequencing.RESULTSThirty-six USAID patients (55%) had elevated IRG-S. Neutrophilic panniculitis (40% vs. 0%), basal ganglia calcifications (46% vs. 0%), interstitial lung disease (47% vs. 5%), and myositis (60% vs. 10%) were more prevalent in patients with elevated IRG-S. Moderate IRG-S elevation and highly elevated serum IL-18 distinguished 8 patients with pulmonary alveolar proteinosis (PAP) and recurrent macrophage activation syndrome (MAS). Among patients with panniculitis and progressive cytopenias, 2 patients were compound heterozygous for potentially novel LRBA mutations, 4 patients harbored potentially novel splice variants in IKBKG (which encodes NF-κB essential modulator [NEMO]), and 6 patients had de novo frameshift mutations in SAMD9L. Of additional 12 patients with elevated IRG-S and CANDLE-, SAVI- or Aicardi-Goutières syndrome-like (AGS-like) phenotypes, 5 patients carried mutations in either SAMHD1, TREX1, PSMB8, or PSMG2. Two patients had anti-MDA5 autoantibody-positive juvenile dermatomyositis, and 7 could not be classified. Patients with LRBA, IKBKG, and SAMD9L mutations showed a pattern of IRG elevation that suggests prominent NF-κB activation different from the canonical interferonopathies CANDLE, SAVI, and AGS.CONCLUSIONSIn patients with elevated IRG-S, we identified characteristic clinical features and 3 additional autoinflammatory diseases: IL-18-mediated PAP and recurrent MAS (IL-18PAP-MAS), NEMO deleted exon 5-autoinflammatory syndrome (NEMO-NDAS), and SAMD9L-associated autoinflammatory disease (SAMD9L-SAAD). The IRG-S expands the diagnostic armamentarium in evaluating USAIDs and points to different pathways regulating IRG expression.TRIAL REGISTRATIONClinicalTrials.gov NCT02974595.FUNDINGThe Intramural Research Program of the NIH, NIAID, NIAMS, and the Clinical Center.
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Affiliation(s)
- Adriana A de Jesus
- Translational Autoinflammatory Diseases Section (TADS), NIAID/NIH, Bethesda, Maryland, USA
| | - Yangfeng Hou
- Department of Rheumatology, Shandong Provincial Qianfoshan Hospital, Shandong University, Shandong, China
| | - Stephen Brooks
- Biomining and Discovery Section, NIAMS/NIH, Bethesda, Maryland, USA
| | - Louise Malle
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Angelique Biancotto
- Immunology & Inflammation Research Therapeutic Area, Sanofi, Boston, Massachusetts, USA
| | - Yan Huang
- Translational Autoinflammatory Diseases Section (TADS), NIAID/NIH, Bethesda, Maryland, USA
| | - Katherine R Calvo
- Department of Laboratory Medicine (DLM), Clinical Center/NIH, Bethesda, Maryland, USA
| | | | | | - Andrew J Oler
- Bioinformatics and Computational Biosciences Branch (BCBB), Office of Cyber Infrastructure and Computational Biology (OCICB), NIAID/NIH, Bethesda, Maryland, USA
| | - Zuoming Deng
- Biomining and Discovery Section, NIAMS/NIH, Bethesda, Maryland, USA
| | | | - Amina Ahmed
- The Autoinflammatory Diseases Consortium.,Levine Children's Hospital, Charlotte, North Carolina, USA
| | - Eric Allenspach
- The Autoinflammatory Diseases Consortium.,Divisions of Immunology & Rheumatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Bita Arabshahi
- The Autoinflammatory Diseases Consortium.,Virginia Commonwealth University & Pediatric Specialists of Virginia, Fairfax, Virginia, USA
| | - Edward Behrens
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Susanne Benseler
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, Pediatric Rheumatology Section, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Liliana Bezrodnik
- The Autoinflammatory Diseases Consortium.,Immunology Unit, Pediatric Hospital R. Gutierrez, Buenos Aires, Argentina
| | - Sharon Bout-Tabaku
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Medicine, Sidra Medicine, Qatar Foundation, Doha, Qatar
| | - AnneMarie C Brescia
- The Autoinflammatory Diseases Consortium.,Nemours/Alfred I. DuPont Hospital for Children, Wilmington, Delaware, USA
| | - Diane Brown
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital Los Angeles & USC, Los Angeles, California, USA
| | - Jon M Burnham
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria Soledad Caldirola
- The Autoinflammatory Diseases Consortium.,Immunology Unit, Pediatric Hospital R. Gutierrez, Buenos Aires, Argentina
| | - Ruy Carrasco
- The Autoinflammatory Diseases Consortium.,Pediatric Rheumatology, Dell Children's Medical Center of Central Texas, Austin, Texas, USA
| | - Alice Y Chan
- The Autoinflammatory Diseases Consortium.,Divisions of Pediatric AIBMT & Rheumatology, UCSF, San Francisco, California, USA
| | - Rolando Cimaz
- The Autoinflammatory Diseases Consortium.,Department of Clinical Sciences and Community Health, University of Milano, Milan, Italy
| | - Paul Dancey
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Janeway Children's Hospital & Rehabilitation Centre, Saint John's, Newfoundland and Labrador, Canada
| | - Jason Dare
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Marietta DeGuzman
- The Autoinflammatory Diseases Consortium.,Department of Immunology, Allergy and Rheumatology, Baylor College of Medicine, Houston, Texas, USA
| | - Victoria Dimitriades
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Allergy, Immunology & Rheumatology, UC Davis Health, Sacramento, California, USA
| | - Ian Ferguson
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics/Pediatric Rheumatology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Polly Ferguson
- The Autoinflammatory Diseases Consortium.,Pediatrics Department, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Laura Finn
- The Autoinflammatory Diseases Consortium.,Pathology Department, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Marco Gattorno
- The Autoinflammatory Diseases Consortium.,Center for Autoinflammatory Diseases and Immunedeficiencies, IRCCS Giannina Gaslini, Genoa, Italy
| | - Alexei A Grom
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Eric P Hanson
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Philip J Hashkes
- The Autoinflammatory Diseases Consortium.,Pediatric Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Christian M Hedrich
- The Autoinflammatory Diseases Consortium.,Department of Women's & Children's Health, Institute of Translational Medicine, University of Liverpool & Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, Liverpool, United Kingdom
| | - Ronit Herzog
- The Autoinflammatory Diseases Consortium.,Department of Otolaryngology, Division of Allergy and Immunology, New York University, New York, New York, USA
| | - Gerd Horneff
- The Autoinflammatory Diseases Consortium.,Asklepios Klinik Sankt, Augustin GmbH, St. Augustin, Germany and Department of Pediatric and Adolescents Medicine, University of Cologne, Cologne, Germany
| | - Rita Jerath
- The Autoinflammatory Diseases Consortium.,Augusta University Medical Center, Augusta, Georgia, USA
| | - Elizabeth Kessler
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Mercy, Kansas City and University of Missouri, Kansas City, Missouri, USA
| | - Hanna Kim
- The Autoinflammatory Diseases Consortium.,Pediatric Translational Research Branch, NIAMS/NIH, Bethesda, Maryland, USA
| | - Daniel J Kingsbury
- The Autoinflammatory Diseases Consortium.,Randall Children's Hospital at Legacy Emanuel, Portland, Oregon, USA
| | - Ronald M Laxer
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, University of Toronto and The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Pui Y Lee
- The Autoinflammatory Diseases Consortium.,Division of Allergy, Immunology and Rheumatology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Min Ae Lee-Kirsch
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Laura Lewandowski
- The Autoinflammatory Diseases Consortium.,Systemic Autoimmunity Branch, NIAMS/NIH, Bethesda, Maryland, USA
| | - Suzanne Li
- The Autoinflammatory Diseases Consortium.,Hackensack University Medical Center, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, New Jersey, USA
| | - Vibke Lilleby
- The Autoinflammatory Diseases Consortium.,Department of Rheumatology, Pediatric Section, Oslo University Hospital, Oslo, Norway
| | - Vafa Mammadova
- The Autoinflammatory Diseases Consortium.,Azerbaijan Medical University, Baku, Azerbaijan
| | - Lakshmi N Moorthy
- The Autoinflammatory Diseases Consortium.,Rutgers - Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gulnara Nasrullayeva
- The Autoinflammatory Diseases Consortium.,Azerbaijan Medical University, Baku, Azerbaijan
| | - Kathleen M O'Neil
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics Indiana University School of Medicine and Riley Hospital for Children, Indianapolis, Indiana, USA
| | - Karen Onel
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, Weill Cornell Medicine & Hospital for Special Surgery, New York, New York, USA
| | - Seza Ozen
- The Autoinflammatory Diseases Consortium.,Hacettepe University, Department of Pediatrics, Ankara, Turkey
| | - Nancy Pan
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, Weill Cornell Medicine & Hospital for Special Surgery, New York, New York, USA
| | - Pascal Pillet
- The Autoinflammatory Diseases Consortium.,Children Hospital Pellegrin-Enfants, Bordeaux, France
| | - Daniela Gp Piotto
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Marilynn G Punaro
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Andreas Reiff
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital Los Angeles, Keck School of Medicine, USC, Los Angeles, California, USA
| | - Adam Reinhardt
- The Autoinflammatory Diseases Consortium.,University of Nebraska Medical Center/Children's Hospital and Medical Center, Omaha, Nebraska, USA
| | - Lisa G Rider
- The Autoinflammatory Diseases Consortium.,Environmental Autoimmunity Group, NIEHS/NIH, Bethesda, Maryland, USA
| | - Rafael Rivas-Chacon
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Rheumatology, Nicklaus Children's Hospital, Miami, Florida, USA
| | - Tova Ronis
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, Children's National Health System, Washington, DC, USA
| | - Angela Rösen-Wolff
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, Medizinische Fakultät Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Johannes Roth
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Natasha Mckerran Ruth
- The Autoinflammatory Diseases Consortium.,Medical University of South Carolina, Charleston, South Carolina, USA
| | - Marite Rygg
- The Autoinflammatory Diseases Consortium.,Department of Clinical and Molecular Medicine, NTNU - Norwegian University of Science and Technology, and Department of Pediatrics, St. Olavs Hospital, Trondheim, Norway
| | - Heinrike Schmeling
- The Autoinflammatory Diseases Consortium.,Department of Pediatrics, Pediatric Rheumatology Section, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Grant Schulert
- The Autoinflammatory Diseases Consortium.,Division of Rheumatology, Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Christiaan Scott
- The Autoinflammatory Diseases Consortium.,University of Cape Town, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Gisella Seminario
- The Autoinflammatory Diseases Consortium.,Immunology Unit, Pediatric Hospital R. Gutierrez, Buenos Aires, Argentina
| | - Andrew Shulman
- The Autoinflammatory Diseases Consortium.,Pediatric Rheumatology, Children's Hospital of Orange County, UC Irvine, Irvine, California, USA
| | - Vidya Sivaraman
- The Autoinflammatory Diseases Consortium.,Section of Rheumatology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mary Beth Son
- The Autoinflammatory Diseases Consortium.,Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Yuriy Stepanovskiy
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Infectious Diseases and Immunology, Shupyk National Medical Academy for Postgraduate Education, Kiev, Ukraine
| | - Elizabeth Stringer
- The Autoinflammatory Diseases Consortium.,IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sara Taber
- The Autoinflammatory Diseases Consortium.,Division of Pediatric Rheumatology, Department of Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Maria Teresa Terreri
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Rheumatology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Cynthia Tifft
- The Autoinflammatory Diseases Consortium.,Undiagnosed Diseases Program, NHGRI/NIH, Bethesda, Maryland, USA
| | - Troy Torgerson
- The Autoinflammatory Diseases Consortium.,Divisions of Immunology & Rheumatology, Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington, USA
| | - Laura Tosi
- The Autoinflammatory Diseases Consortium.,Bone Health Program, Children's National Health System, Washington, DC, USA
| | - Annet Van Royen-Kerkhof
- The Autoinflammatory Diseases Consortium.,Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital Utrecht, Utrecht, Netherlands
| | - Theresa Wampler Muskardin
- The Autoinflammatory Diseases Consortium.,New York University School of Medicine, New York, New York, USA
| | - Scott W Canna
- Children's Hospital Pittsburgh, Pittsburgh, Pennsylvania, USA
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Brunner HI, Chen C, Bovis F, De Benedetti F, Espada G, Joos R, Akikusa J, Chaitow J, Boteanu AL, Kimura Y, Rietschel C, Siri D, Smolewska E, Schmeling H, Brown DE, Martini A, Lovell DJ, Huang B, Ruperto N. Functional Ability and Health-Related Quality of Life in Randomized Controlled Trials of Tocilizumab in Patients With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2020; 73:1264-1274. [PMID: 32702212 DOI: 10.1002/acr.24384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 07/14/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate changes in health-related quality of life (HRQoL) and disability in children with systemic juvenile idiopathic arthritis (JIA) or polyarticular JIA treated with tocilizumab. METHODS Secondary analyses of two double-blind, placebo-controlled trials of intravenous tocilizumab in children with active systemic JIA or polyarticular JIA were conducted. Patient-reported outcomes of disability (Childhood Health Assessment Questionnaire [C-HAQ]), HRQoL (Child Health Questionnaire Parent Form 50 [CHQ-P50], health concepts, physical summary score [CHQ-P50-PhS], psychosocial summary score [CHQ-P50-PsS]), pain, and well-being (100-mm visual analog scale [VAS]) were measured at weeks 0 and 12 for systemic JIA, weeks 16 and 40 for polyarticular JIA, and week 104 for both JIA subgroups. RESULTS The trial included 112 patients with systemic JIA and 188 patients with polyarticular JIA. In patients with polyarticular JIA, the mean ± SD C-HAQ score decreased from 1.39 ± 0.74 at baseline to 0.67 ± 0.65 at week 16 (P < 0.001). In patients with systemic JIA, the mean ± SD CHQ-P50-PhS improved more with tocilizumab therapy than with placebo at week 12 (7.3 ± 10.2 versus 2.4 ± 10.6) (P < 0.05). Almost all mean CHQ-P50 health concept scores, CHQ-P50-PsS, and CHQ-P50-PhS improved (P ≤ 0.002) by week 104 for patients with systemic JIA. Patients with polyarticular JIA and patients with systemic JIA showed significant reductions in disability (mean ± SD C-HAQ scores of -1.09 ± 0.71 and -1.17 ± 0.80, respectively), improvements in well-being (mean ± SD well-being VAS scores of -43.76 ± 26.61 and -51.53 ± 23.57, respectively), and decreases in pain (mean ± SD pain VAS scores of -41.56 ± 31.06 and -51.26 ± 26.79, respectively) (P < 0.001); in patients with polyarticular JIA and patients with systemic JIA who were treated with tocilizumab, 92.9% of polyarticular JIA patients and 96.8% of systemic JIA patients reported no more than minimal pain (a score of ≤35 mm on the VAS) at week 104. CONCLUSION Tocilizumab treatment was associated with significantly reduced disability and pain and improved HRQoL in patients with systemic JIA and polyarticular JIA.
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Affiliation(s)
- Hermine I Brunner
- PRCSG, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Chen Chen
- PRCSG, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | | | - Graciela Espada
- Hospital de Ninos Ricardo Gutierrez, Buenos Aires, Argentina
| | - Rik Joos
- Ghent University Hospital, Ghent, Belgium
| | | | | | | | - Yukiko Kimura
- Joseph M. Sanzari Children's Hospital, Hackensack Meridian School of Medicine, Hackensack, New Jersey
| | | | | | | | - Heinrike Schmeling
- Alberta Children's Hospital and Cumming School of Medicine/University of Calgary, Calgary, Alberta, Canada
| | - Diane E Brown
- Children's Hospital of Los Angeles, and University of Southern California, Los Angeles, California
| | - Alberto Martini
- Pediatric and Rheumatology Clinic, PRINTO, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniel J Lovell
- PRCSG, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Bin Huang
- PRCSG, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nicolino Ruperto
- Pediatric and Rheumatology Clinic, PRINTO, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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24
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Chhabra A, Oen K, Huber AM, Shiff NJ, Boire G, Benseler SM, Berard RA, Scuccimarri R, Feldman BM, Lim LSH, Barsalou J, Bruns A, Cabral DA, Chédeville G, Ellsworth J, Houghton K, Lang B, Morishita K, Rumsey DG, Rosenberg AM, Tse SM, Watanabe Duffy K, Duffy CM, Guzman J, Bolaria R, Gross K, Turvey SE, Chan M, Tucker LB, Petty R, Johnson N, Luca N, Miettunen P, Schmeling H, Gerhold K, Larché M, Levy DM, Laxer RM, Feldman D, Spiegel L, Schneider R, Silverman E, Cameron B, Yeung RSM, Roth J, Jurencak R, Gibbon M, Chetaille A, Dorval J, Campillo S, LeBlanc C, Chédeville G, Haddad E, Cyr CS, Ramsey SE, Stringer E, Dancey P. Real‐World Effectiveness of Common Treatment Strategies for Juvenile Idiopathic Arthritis: Results From a Canadian Cohort. Arthritis Care Res (Hoboken) 2020; 72:897-906. [DOI: 10.1002/acr.23922] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/26/2019] [Indexed: 01/13/2023]
Affiliation(s)
- Amieleena Chhabra
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Kiem Oen
- University of Manitoba Winnipeg Manitoba Canada
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University Halifax Nova Scotia Canada
| | - Natalie J. Shiff
- Shands Children's Hospital and University of Florida Gainesville
| | - Gilles Boire
- Centre intégré universitaire de santé et de services sociaux de l'EstrieCentre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke Sherbrooke Quebec Canada
| | - Susanne M. Benseler
- Alberta Children's Hospital and University of Calgary Calgary Alberta Canada
| | - Roberta A. Berard
- London Health Sciences Centre and Western University London Ontario Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University Montreal Quebec Canada
| | - Brian M. Feldman
- Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | | | - Julie Barsalou
- Centre hospitalier universitaire Sainte‐Justine and Université de Montréal Montreal Quebec Canada
| | - Alessandra Bruns
- Centre intégré universitaire de santé et de services sociaux de l'EstrieCentre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke Sherbrooke Quebec Canada
| | - David A. Cabral
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University Montreal Quebec Canada
| | - Janet Ellsworth
- Stollery Children's Hospital and University of Alberta Edmonton Alberta Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University Halifax Nova Scotia Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Dax G. Rumsey
- Stollery Children's Hospital and University of Alberta Edmonton Alberta Canada
| | - Alan M. Rosenberg
- Royal University Hospital and University of Saskatchewan Saskatoon Saskatchewan Canada
| | - Shirley M. Tse
- Hospital for Sick Children and University of Toronto Toronto Ontario Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa Ottawa Ontario Canada
| | - Ciaran M. Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa Ottawa Ontario Canada
| | - Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia Vancouver British Columbia Canada
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25
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Ruperto N, Synoverska O, Ting T, Abud-Mendoza C, Spindler A, Vyzhga Y, Marzan K, Keltsev V, Tirosh I, Imundo L, Jerath R, Kingsbury D, Sözeri B, Vora S, Prahalad S, Zholobova E, Butbul Aviel Y, Chasnyk V, Lerman M, Nanda K, Schmeling H, Tory H, Uziel Y, Viola DO, Posner H, Kanik K, Wouters A, Chang C, Zhang R, Lazariciu I, Hsu MA, Suehiro R, Martini A, Lovell DJ, Brunner H. OP0291 TOFACITINIB FOR THE TREATMENT OF POLYARTICULAR COURSE JUVENILE IDIOPATHIC ARTHRITIS: RESULTS OF A PHASE 3, RANDOMISED, DOUBLE-BLIND, PLACEBO-CONTROLLED WITHDRAWAL STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Tofacitinib is an oral JAK inhibitor that is being investigated for JIA.Objectives:To assess tofacitinib efficacy and safety in JIA patients (pts).Methods:This was a Phase 3, randomised, double-blind (DB), placebo (PBO)-controlled withdrawal study in pts aged 2−<18 years with polyarticular course JIA (pcJIA), PsA or ERA (NCT02592434). In the 18-week open-label Part 1, pts received weight-based tofacitinib doses (5 mg BID or lower). Pts with ≥JIA ACR30 response at Week (W)18 were randomised 1:1 in the DB Part 2 (W18−44) to continue tofacitinib or switch to PBO. Primary endpoint: disease flare rate by W44. Key secondary endpoints: JIA ACR50/30/70 response rates; change from Part 2 baseline (Δ) in CHAQ-DI at W44. Other efficacy endpoints: time to disease flare in Part 2; JADAS27-CRP in Parts 1 and 2. PsA/ERA pts were excluded from these efficacy analyses. Safety was evaluated in all pts up to W44.Results:225 enrolled pts with pcJIA (n=184), PsA (n=20) or ERA (n=21) received tofacitinib in Part 1. At W18, 173/225 (76.9%) pts entered Part 2 (pcJIA n=142, PsA n=15, ERA n=16). In pcJIA pts, disease flare rate in Part 2 was significantly lower with tofacitinib vs PBO by W44 (p=0.0031; Fig 1a). JIA ACR50/30/70 response rates (Fig 1b) and ΔCHAQ-DI (Fig 1c) at W44, and time to disease flare in Part 2 (Fig 2a), were improved with tofacitinib vs PBO. Tofacitinib reduced JADAS27-CRP in Part 1; this effect was sustained in Part 2 (Fig 2b). Overall, safety was similar with tofacitinib or PBO (Table): 77.3% and 74.1% had adverse events (AEs); 1.1% and 2.4% had serious AEs. In Part 1, 2 pts had herpes zoster (non-serious) and 3 pts had serious infections (SIs). In Part 2, SIs occurred in 1 tofacitinib pt and 1 PBO pt. No pts died.Conclusion:In pcJIA pts, tofacitinib vs PBO resulted in significantly fewer disease flares, and improved time to flare, disease activity and physical functioning. Tofacitinib safety was consistent with that in RA pts.Table.Safety in all ptsPart 1Part 2TofacitinibaN=225TofacitinibaN=88PBO N=85Pts with events, n (%)AEs153 (68.0)68 (77.3)63 (74.1)SAEs7 (3.1)1 (1.1)2 (2.4)Permanent discontinuations due to AEs26 (11.6)16 (18.2)29 (34.1)AEs of special interest Death000 Gastrointestinal perforationb000 Hepatic eventb3 (1.3)00 Herpes zoster (non-serious and serious)2 (0.9)c00 Interstitial lung diseaseb000 Major adverse cardiovascular eventsb000 Malignancy (including non-melanoma skin cancer)b000 Macrophage activation syndromeb000 Opportunistic infectionb000 SI3 (1.3)1 (1.1)d1 (1.2) Thrombotic event (deep vein thrombosis, pulmonary embolismbor arterial thromboembolism)000 Tuberculosisb000a5 mg BID or equivalent weight-based lower dose in pts <40 kgbAdjudicated eventscBoth non-seriousdOne SAE of pilonidal cyst repair was coded to surgical procedures instead of infections, and was inadvertently not identified as an SI. Following adjudication, the SAE did not meet opportunistic infection criteria; it is also included in the table as an SIAE, adverse event; BID, twice daily; PBO, placebo; pts, patients; SAE, serious AE; SI, serious infectionAcknowledgments:Study sponsored by Pfizer Inc. Medical writing support was provided by Sarah Piggott of CMC Connect and funded by Pfizer Inc.Disclosure of Interests:Nicolino Ruperto Grant/research support from: Bristol-Myers Squibb, Eli Lily, F Hoffmann-La Roche, GlaxoSmithKline, Janssen, Novartis, Pfizer, Sobi (paid to institution), Consultant of: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Speakers bureau: Ablynx, AbbVie, AstraZeneca-Medimmune, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Eli Lily, EMD Serono, GlaxoSmithKline, Hoffmann-La Roche, Janssen, Merck, Novartis, Pfizer, R-Pharma, Sanofi, Servier, Sinergie, Sobi, Takeda, Olga Synoverska Speakers bureau: Sanofi, Tracy Ting: None declared, Carlos Abud-Mendoza Speakers bureau: Eli Lilly, Pfizer Inc, Alberto Spindler Speakers bureau: Eli Lilly, Yulia Vyzhga Grant/research support from: Pfizer Inc, Katherine Marzan Grant/research support from: Novartis, Vladimir Keltsev: None declared, Irit Tirosh: None declared, Lisa Imundo: None declared, Rita Jerath: None declared, Daniel Kingsbury: None declared, Betül Sözeri: None declared, Sheetal Vora: None declared, Sampath Prahalad Grant/research support from: Novartis, Elena Zholobova Grant/research support from: Novartis and Pfizer Inc, Speakers bureau: AbbVie, Novartis, Pfizer Inc and Roche, Yonatan Butbul Aviel: None declared, Vyacheslav Chasnyk: None declared, Melissa Lerman Grant/research support from: Amgen, Kabita Nanda Grant/research support from: Abbott, AbbVie, Amgen and Roche, Heinrike Schmeling Grant/research support from: Janssen, Pfizer Inc, Roche and USB Bioscience, Heather Tory: None declared, Yosef Uziel Speakers bureau: Pfizer Inc, Diego O Viola Grant/research support from: Bristol-Myers Squibb, GSK, Janssen and Pfizer Inc, Speakers bureau: AbbVie and Bristol-Myers Squibb, Holly Posner Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Keith Kanik Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Ann Wouters Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Cheng Chang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Richard Zhang Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Irina Lazariciu Consultant of: Pfizer Inc, Employee of: IQVIA, Ming-Ann Hsu Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Ricardo Suehiro Shareholder of: Pfizer Inc, Employee of: Pfizer Inc, Alberto Martini Consultant of: AbbVie, Eli Lily, EMD Serono, Janssen, Novartis, Pfizer, UCB, Daniel J Lovell Consultant of: Abbott (consulting and PI), AbbVie (PI), Amgen (consultant and DSMC Chairperson), AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb (PI), Celgene, Forest Research (DSMB Chairman), GlaxoSmithKline, Hoffman-La Roche, Janssen (co-PI), Novartis (consultant and PI), Pfizer (consultant and PI), Roche (PI), Takeda, UBC (consultant and PI), Wyeth, Employee of: Cincinnati Children’s Hospital Medical Center, Speakers bureau: Wyeth, Hermine Brunner Consultant of: Hoffman-La Roche, Novartis, Pfizer, Sanofi Aventis, Merck Serono, AbbVie, Amgen, Alter, AstraZeneca, Baxalta Biosimilars, Biogen Idec, Boehringer, Bristol-Myers Squibb, Celgene, EMD Serono, Janssen, MedImmune, Novartis, Pfizer, and UCB Biosciences, Speakers bureau: GSK, Roche, and Novartis
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26
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Barber CEH, Twilt M, Pham T, Currie GR, Benseler S, Yeung RSM, Batthish M, Blanchette N, Guzman J, Lang B, LeBlanc C, Levy DM, O'Brien C, Schmeling H, Soon G, Spiegel L, Whitney K, Marshall DA. A Canadian evaluation framework for quality improvement in childhood arthritis: key performance indicators of the process of care. Arthritis Res Ther 2020; 22:53. [PMID: 32192528 PMCID: PMC7083048 DOI: 10.1186/s13075-020-02151-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 03/09/2020] [Indexed: 01/22/2023] Open
Abstract
Background The evaluation of quality of care in juvenile idiopathic arthritis (JIA) is critical for advancing patient outcomes but is not currently part of routine care across all centers in Canada. The study objective is to review the current landscape of JIA quality measures and use expert panel consensus to define key performance indicators (KPIs) that are important and feasible to collect for routine monitoring in JIA care in Canada. Methods Thirty-seven candidate KPIs identified from a systematic review were reviewed for inclusion by a working group including 3 pediatric rheumatologists. A shortlist of 14 KPIs was then assessed using a 3-round modified Delphi panel based on the RAND/UCLA Appropriateness Method. Ten panelists across Canada participated based on their expertise in JIA, quality measurement, or lived experience as a parent of a child with JIA. During rounds 1 and 3, panelists rated each KPI on a 1–9 Likert scale on themes of importance, feasibility, and priority. In round 2, panelists participated in a moderated in-person discussion that resulted in minor modifications to some KPIs. KPIs with median scores of ≥ 7 on all 3 questions without disagreement were included in the framework. Results Ten KPIs met the criteria for inclusion after round 3. Five KPIs addressed patient assessments: pain, joint count, functional status, global assessment of disease activity, and the clinical Juvenile Arthritis Disease Activity Score (cJADAS). Three KPIs examined access to care: wait times for consultation, access to pediatric rheumatologists within 1 year of diagnosis, and frequency of clinical follow-up. Safety was addressed through KPIs on tuberculous screening and laboratory monitoring. KPIs examining functional status using the Childhood Health Assessment Questionnaire (CHAQ), quality of life, uveitis, and patient satisfaction were excluded due to concerns about feasibility of measurement. Conclusions The proposed KPIs build upon existing KPIs and address important processes of care that should be measured to improve the quality of JIA care. The feasibility of capturing these measures will be tested in various data sources including the Understanding Childhood Arthritis Network (UCAN) studies. Subsequent work should focus on development of meaningful outcome KPIs to drive JIA quality improvement in Canada and beyond.
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Affiliation(s)
- Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marinka Twilt
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Tram Pham
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gillian R Currie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Susanne Benseler
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Rae S M Yeung
- Departments of Pediatrics, Immunology and Medical Science, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Batthish
- Department of Pediatrics, McMaster University and McMaster Children's Hospital, Hamilton, ON, Canada
| | - Nicholas Blanchette
- The Hospital for Sick Children, Toronto, ON, Canada.,Trillium Health Partners, Mississauga, ON, Canada
| | - Jaime Guzman
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bianca Lang
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Claire LeBlanc
- Department of Pediatrics, McGill University, Montreal, QC, Canada
| | - Deborah M Levy
- Departments of Pediatrics, Immunology and Medical Science, University of Toronto, Toronto, ON, Canada.,The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Heinrike Schmeling
- Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Gordon Soon
- The Hospital for Sick Children, Toronto, ON, Canada
| | - Lynn Spiegel
- The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Deborah A Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
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Rumsey DG, Guzman J, Rosenberg AM, Huber AM, Scuccimarri R, Shiff NJ, Bruns A, Feldman BM, Eurich DT, Benseler S, Berard R, Boire G, Bolaria R, Cabral D, Cameron B, Campillo S, Chan M, Chédeville G, Chetaille A, Dancey P, Dorval J, Duffy C, Ellsworth J, Feldman D, Gross K, Haddad E, Houghton K, Johnson N, Jurencak R, Lang B, Larché M, Laxer R, LeBlanc C, Levy D, Luca N, Miettunen P, Morishita K, Oen K, Petty R, Ramsey S, Roth J, Saint‐Cyr C, Schmeling H, Schneider R, Silverman E, Spiegel L, Stringer E, Tse S, Tucker L, Turvey S, Watanabe Duffy K, Yeung R. Worse Quality of Life, Function, and Pain in Children With Enthesitis, Irrespective of Their Juvenile Arthritis Category. Arthritis Care Res (Hoboken) 2020; 72:441-446. [DOI: 10.1002/acr.23844] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 02/05/2019] [Indexed: 11/07/2022]
Affiliation(s)
| | - Jaime Guzman
- University of British Columbia Vancouver British Columbia Canada
| | | | | | | | | | | | - Brian M. Feldman
- The Hospital for Sick Children and University of Toronto Toronto Ontario Canada
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Batthish M, Berard R, Cabral D, Bolaria R, Chédeville G, Duffy C, Gerhold K, Gerschman T, Huber A, Proulx-Gauthier JP, Rosenberg A, Rumsey D, Schmeling H, Shiff N, Soon G, Bruns A, Tucker L, Guzman J. A new Canadian inception cohort for juvenile idiopathic arthritis: The Canadian Alliance of Pediatric Rheumatology Investigators Registry. Rheumatology (Oxford) 2020; 59:2796-2805. [DOI: 10.1093/rheumatology/keaa006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 12/19/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
The aim was to describe the design, methods and initial findings of a new Canadian inception cohort of children with JIA, The Canadian Alliance of Pediatric Rheumatology Investigators (CAPRI) JIA Registry.
Methods
The CAPRI JIA Registry was started in 2017 to collect information prospectively on children enrolled within 3 months of JIA diagnosis across Canada. The registry has a non-traditional modular design, with no artificially set times for registry visits to occur, streamlined multi-method data collection that requires 2–4 min per visit, and reports cumulative incidence of treatments, outcomes and adverse events calculated by Kaplan–Meier survival methods.
Results
A total of 166 patients, enrolled a median of 6 weeks after JIA diagnosis at 10 centres, were included. The median age at diagnosis was 9 years [interquartile range (IQR) 3, 13], 61% were female and 51% had oligoarticular JIA. The median three-variable clinical Juvenile Arthritis Disease Activity Score was 6.5 (IQR 4, 10) at enrolment, and the median time to first attainment of clinically inactive disease (CID) was 24 weeks (by 1 year, 81%). Within 1 year of diagnosis, 70% of patients had started a DMARD and 35% a biologic agent. The rates of adverse events and serious adverse events were 60 and 5.8 per 100 patient-years, respectively.
Conclusion
This streamlined and flexible registry minimizes the burden of data collection and interference with clinic operations. Initial findings suggest that treatments for newly diagnosed patients with JIA in Canada have intensified, and now 81% of patients attain CID within 1 year of diagnosis.
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Affiliation(s)
- Michelle Batthish
- Division of Rheumatology, Department of Pediatrics, McMaster University, Hamilton, Ontario
| | - Roberta Berard
- Division of Rheumatology, Department of Pediatrics, Western University, London, Ontario
| | - David Cabral
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Roxana Bolaria
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Gaëlle Chédeville
- Division of Rheumatology, Department of Pediatrics, McGill University, Montreal, Quebec
| | - Ciaran Duffy
- Division of Rheumatology, Department of Pediatrics, University of Ottawa, Ottawa, Ontario
| | - Kerstin Gerhold
- Division of Rheumatology, Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba
| | - Tommy Gerschman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Adam Huber
- Division of Rheumatology, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | | | - Alan Rosenberg
- Division of Rheumatology, Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Dax Rumsey
- Division of Rheumatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta
| | - Heinrike Schmeling
- Division of Rheumatology, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Natalie Shiff
- Division of Rheumatology, Department of Pediatrics, University of Florida, Gainesville, FL, USA
| | - Gordon Soon
- Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Alessandra Bruns
- Division of Rheumatology, Department of Pediatrics, University de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Lori Tucker
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
| | - Jaime Guzman
- Division of Rheumatology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia
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Barber CE, Lix LM, Lacaille D, Marshall DA, Kroeker K, Benseler S, Twilt M, Schmeling H, Barnabe C, Hazlewood GS, Bykerk V, Homik J, Thorne JC, Burt J, Mosher D, Katz S, Shiff NJ. Testing population-based performance measures identifies gaps in juvenile idiopathic arthritis (JIA) care. BMC Health Serv Res 2019; 19:572. [PMID: 31412858 PMCID: PMC6694666 DOI: 10.1186/s12913-019-4379-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 07/30/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND The study evaluates Performance Measures (PMs) for Juvenile Idiopathic Arthritis (JIA): The percentage of patients with new onset JIA with at least one visit to a pediatric rheumatologist in the first year of diagnosis (PM1); and the percentage of patients with JIA under rheumatology care seen in follow-up at least once per year (PM2). METHODS Validated JIA case ascertainment algorithms were used to identify cases from provincial health administrative databases in Manitoba, Canada in patients < 16 years between 01/04/2005 and 31/03/2015. PM1: Using a 3-year washout period, the percentage of incident JIA patients with ≥1 visit to a pediatric rheumatologist in the first year was calculated. For each fiscal year, the proportion of patients expected to be seen in follow-up who had a visit were calculated (PM2). The proportion of patients with gaps in care of > 12 and > 14 months between consecutive visits were also calculated. RESULTS One hundred ninety-four incident JIA cases were diagnosed between 01/04/2008 and 03/31/2015. The median age at diagnosis was 9.1 years and 71% were female. PM1: Across the years, 51-81% of JIA cases saw a pediatric rheumatologist within 1 year. PM2: Between 58 and 78% of patients were seen in yearly follow-up. Gaps > 12, and > 14, months were observed once during follow-up in 52, and 34%, of cases, and ≥ twice in 11, and 5%, respectively. CONCLUSIONS Suboptimal access to pediatric rheumatologist care was observed which could lead to diagnostic and treatment delays and lack of consistent follow-up, potentially negatively impacting patient outcomes.
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Affiliation(s)
- Claire E.H. Barber
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Lisa M. Lix
- University of Manitoba, S113-750 Bannatyne Ave, Winnipeg, MB R3E 0W3 Canada
| | - Diane Lacaille
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
- Department of Medicine, University of British Columbia, Vancouver, BC Canada
| | - Deborah A. Marshall
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB T2N 4Z6 Canada
| | - Kristine Kroeker
- George & Fay Yee Centre for Healthcare Innovation, 3rd floor, 753 McDermot Ave, Winnipeg, MB R3E 0T6 Canada
| | - Susanne Benseler
- Alberta Children’s Hospital, 28 Oki Drive, Calgary, T3B 6A8 AB Canada
| | - Marinka Twilt
- Alberta Children’s Hospital, 28 Oki Drive, Calgary, T3B 6A8 AB Canada
| | | | - Cheryl Barnabe
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Glen S. Hazlewood
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC V6X 2C7 Canada
| | - Vivian Bykerk
- Hospital for Special Surgery, 535 E 70th St, New York, NY USA
| | - Joanne Homik
- 3A Medicine Clinic, Third Floor, Edmonton Clinic, 11400 University Ave, Edmonton, AB T6G 1Z1 Canada
| | | | - Jennifer Burt
- Rheumatology Services, St. Clare’s Mercy Hospital, 154 LeMarchant Road, St. John’s, NL A1C 5B8 Canada
| | - Dianne Mosher
- Department of Medicine, Division of Rheumatology, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - Steven Katz
- Third Floor, Edmonton Clinic, 11400 University Ave, Edmonton, AB T6G 1Z1 Canada
| | - Natalie J. Shiff
- Department of Community Health & Epidemiology, University of Saskatchewan, Box 7, 107 Wiggins Road, Saskatoon, SK S7N 5E5 Canada
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30
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Chomistek K, Johnson N, Stevenson R, Luca N, Miettunen P, Benseler SM, Veeramreddy D, Schmeling H. Patient-Reported Barriers at School for Children with Juvenile Idiopathic Arthritis. ACR Open Rheumatol 2019; 1:182-187. [PMID: 31777793 PMCID: PMC6858049 DOI: 10.1002/acr2.1023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Objective The objective of this study was to identify patient‐reported school barriers and their associated impact in juvenile idiopathic arthritis (JIA). Methods A cross‐sectional observational study of children aged 8 to 17, diagnosed with JIA, and followed in the rheumatology clinic/Alberta Children's Hospital was performed. Demographics, diagnosis, and disease course were obtained from health records. A questionnaire was administered to the child to assess the barriers experienced by JIA patients at school. The questionnaire collected information about school attendance/performance, impact of JIA symptoms (eg, pain and fatigue), physical challenges and accommodations, communication, participation and peers, and school support. Descriptive statistics were used to analyze the data. Results A total of 98 children with JIA were recruited into the study. The median age of participants was 13 years (interquartile range 11‐15). The JIA subtypes in this cohort reflected the normal JIA distribution. Physical challenges at school (eg, gym, writing, and sitting for long periods of time) were reported by 42.1% of patients. Accommodations (eg, modified gym, accommodation letter, and computer access) were used by 23% of patients. The inability to participate in activities in class or outside with their peers occurred for 32.2% of patients and in gym for 40.7% of patients. Social concerns included embarrassment from talking about their illness, worry regarding being treated differently, and being told they were fabricating their illness. Conclusion Children with JIA experienced barriers at school, especially physical challenges, with a need for accommodations in a proportion of children. Decreased participation and increased social anxiety were additional key barriers.
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Affiliation(s)
| | | | | | - Nadia Luca
- University of Calgary Calgary Alberta Canada
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31
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Amlani A, Choi MY, Tarnopolsky M, Brady L, Clarke AE, Garcia-De La Torre I, Mahler M, Schmeling H, Barber CE, Jung M, Fritzler MJ. Anti-NT5c1A Autoantibodies as Biomarkers in Inclusion Body Myositis. Front Immunol 2019; 10:745. [PMID: 31024569 PMCID: PMC6465553 DOI: 10.3389/fimmu.2019.00745] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 03/19/2019] [Indexed: 11/13/2022] Open
Abstract
Objective: Sporadic Inclusion Body Myositis (sIBM) is an inflammatory myopathy (IIM) without a specific diagnostic biomarker until autoantibodies to the cytosolic 5′-nucleotidase 1A (NT5c1A/Mup44) were reported. The objectives of our study were to determine the sensitivity and specificity of anti-NT5c1A for sIBM, demonstrate demographic, clinical and serological predictors for anti-NT5c1A positivity and determine if anti-nuclear antibody (ANA) indirect immunofluorescence (IIF) staining on HEp-2 cells is a reliable screening method for anti-NT5c1A. Methods: Sera from sIBM patients and controls were stored at −80°C until required for analysis. IgG antibodies to NT5c1A were detected by an addressable laser bead immunoassay (ALBIA) using a full-length human recombinant protein. Autoantibodies to other autoimmune myopathy antigens (Jo-1, OJ, TIF1y, PL-12, SAE, EJ, MDA5, PL7, SRP, NXP2, MI-2) were detected by line immunoassay (LIA), chemiluminescence immunoassay (CIA) or enzyme linked immunosorbent assay (ELISA) and ANA detected by IIF on HEp-2 substrate. Demographic, clinical and serological data were obtained by chart review. Results: Forty-three patients with sIBM, 537 disease control patients with other autoimmune, degenerative and neuromuscular diseases, and 78 healthy controls were included. 48.8% (21/43) of sIBM patients were positive for anti-NT5c1A. The overall sensitivity, specificity, positive predictive value, and negative predictive value of anti-NT5c1A for sIBM were 0.49, 0.92, 0.29, and 0.96, respectively. Compared to sIBM, the frequency of anti-NT5c1A was lower in both the disease control group (8.8%, OR 0.10 [95%CI: 0.05–0.20], p < 0.0001) and in the apparently healthy control group (5.1%, OR 0.06 [95%CI: 0.02–0.18], p < 0.0001). In the univariable analysis, sIBM patients with more severe muscle weakness were more likely to be anti-NT5c1A positive (OR 4.10 [95% CI: 1.17, 14.33], p = 0.027), although this was not statistically significant (adjusted OR 4.30 [95% CI: 0.89, 20.76], p = 0.069) in the multivariable analysis. The ANA of sIBM sera did not demonstrate a consistent IIF pattern associated with anti-NT5c1A. Conclusions: Anti-NT5c1A has moderate sensitivity and high specificity for sIBM using ALBIA. The presence of anti-NT5c1A antibodies may be associated with muscle weakness. Anti-NT5c1A antibodies were not associated with a specific IIF staining pattern, hence screening using HEp-2 substrate is unlikely to be a useful predictor for presence of these autoantibodies.
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Affiliation(s)
- Adam Amlani
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - May Y Choi
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Mark Tarnopolsky
- Department of Pediatrics, McMaster University Medical Center, Hamilton, ON, Canada
| | - Lauren Brady
- Department of Pediatrics, McMaster University Medical Center, Hamilton, ON, Canada
| | - Ann E Clarke
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ignacio Garcia-De La Torre
- Hospital General de Occidente and University of Guadalajara, Guadalajara, Mexico.,PANLAR Myositis Study Group, Guadalajara, Mexico
| | | | | | - Claire E Barber
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michelle Jung
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marvin J Fritzler
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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32
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Ramanan AV, Brunner HI, Ruperto N, Martini A, Cuttica RJ, Weiss JE, Henrickson M, Schmeling H, Antón J, Minden K, Horneff G, Gámir-Gámir ML, Hufnagel M, Douglass W, Wells C, Wimalasundera S, Mallalieu NL, Lovell DJ, Benedetti FD. 170 Safety and efficacy of subcutaneous tocilizumab in patients with systemic and polyarticular juvenile idiopathic arthritis. Rheumatology (Oxford) 2019. [DOI: 10.1093/rheumatology/kez108.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Hermine I Brunner
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Nicola Ruperto
- n/a, Pediatric Rheumatology International Trial Organization (PRINTO) Coordinating Centre, Genoa, ITALY
| | - Alberto Martini
- n/a, Pediatric Rheumatology International Trial Organization (PRINTO) Coordinating Centre, Genoa, ITALY
| | - Rubén J Cuttica
- n/a, Hospital Gral de Niños Pedro Elizalde, Buenos Aires, ARGENTINA
| | | | - Michael Henrickson
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Heinrike Schmeling
- Department of Paediatrics, Alberta Children’s Hospital/University of Calgary, Calgary, AB, CANADA
| | - Jordi Antón
- Paediatric Rheumatology, Hospital Sant Joan de Deu, Barcelona, SPAIN
| | - Kirsten Minden
- n/a, Charité–Universitätsmedizin Berlin, Berlin, GERMANY
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, and University Hospital of Cologne, Cologne, GERMANY
| | | | - Markus Hufnagel
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Medical Faculty, University of Freiburg, Freiburg, GERMANY
| | - Wendy Douglass
- n/a, Roche Products Ltd., Welwyn Garden City, UNITED KINGDOM
| | - Chris Wells
- n/a, Roche Products Ltd., Welwyn Garden City, UNITED KINGDOM
| | | | | | - Daniel J Lovell
- Pediatric Rheumatology Collaborative Study Group (PRCSG), Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Fabrizio De Benedetti
- Dipartimento di Medicina Pediatrica, IRCCS Ospedale Pediatrico Bambino Gesù, Roma, ITALY
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33
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Bharucha KN, Brunner HI, Calvo Penadés I, Nikishina I, Rubio-Pérez N, Oliveira S, Kobusinska K, Schmeling H, Sztajnbok F, Weller-Heinemann F, Zholobova E, Zulian F, Allen R, Chaitow J, Frane J, Wells C, Ruperto N, De Benedetti F. Growth During Tocilizumab Therapy for Polyarticular-course Juvenile Idiopathic Arthritis: 2-year Data from a Phase III Clinical Trial. J Rheumatol 2018; 45:1173-1179. [PMID: 29961686 DOI: 10.3899/jrheum.170326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2018] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Evaluate growth in patients with polyarticular-course juvenile idiopathic arthritis (pcJIA) treated with tocilizumab (TCZ) for up to 2 years in a phase III trial. METHODS Patients with pcJIA lasting at least 6 months and inadequate response to methotrexate received open-label TCZ intravenously every 4 weeks (randomly assigned to 8 or 10 mg/kg if they weighed < 30 kg; received 8 mg/kg if they weighed ≥ 30 kg) for 16 weeks. Patients with JIA American College of Rheumatology 30 response at Week 16 were randomly assigned to TCZ or placebo for 24 weeks, with an open-label extension through Week 104. Mean ± SD height velocity (cm/yr) and World Health Organization (WHO) height SD score (SDS) were measured in patients receiving ≥ 1 dose of TCZ who did not receive growth hormone and in patients whose baseline Tanner stage was ≤ 3. RESULTS The study included 187 of 188 patients (99.5%) with mean WHO height SDS -0.5 ± 1.2, which was unrelated to age or disease duration (Spearman rank correlations r = 0.08 and r = -0.12, respectively). There were 123 patients at Tanner stage ≤ 3 at baseline, among whom 103 completed the study with 2 years of height SDS data. Mean height SDS increased from baseline to year 2 (+0.40, p < 0.0001). In 74 of 103 patients (72%), height SDS was greater than at baseline, and mean height velocity was 6.7 ± 2.0 cm/year. CONCLUSION Among patients with pcJIA at Tanner stage ≤ 3 at baseline, 72% (74/103) had increased height SDS at the end of the study.
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Affiliation(s)
- Kamal N Bharucha
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Hermine I Brunner
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Inmaculada Calvo Penadés
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Irina Nikishina
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Nadina Rubio-Pérez
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Sheila Oliveira
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Katarzyna Kobusinska
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Heinrike Schmeling
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Flavio Sztajnbok
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Frank Weller-Heinemann
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Elena Zholobova
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Francesco Zulian
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Roger Allen
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Jeffrey Chaitow
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - James Frane
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Chris Wells
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Nicolino Ruperto
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK.,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù
| | - Fabrizio De Benedetti
- From Genentech, San Francisco; Consultant, Santa Monica, California, USA; Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children's Hospital Medical Center (CCHMC), Pediatric Rheumatology Collaborative Study Group (PRCSG) Coordinating Center, Cincinnati, Ohio, USA; Paediatric Rheumatology Department, Hospital Universitario La Fe, Valencia, Spain; Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy, Moscow, Russia; Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo, Monterrey, Mexico; Universidade Federal do Rio de Janeiro, Instituto de Puericultura e Pediatria Martagao Gesteira (IPPMG); Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii, Bydgoszcz, Poland; Department of Pediatrics, Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada; Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin, Bremen, Germany; Rheumatology Unit, Department of Woman and Child Health, University of Padua, Padua; Istituto Giannina Gaslini, Pediatria II, Rheumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO) Coordinating Centre, Genoa; Institute for Research and Health Care (IRCCS) Ospedale Pediatrico Bambino Gesù, Rome, Italy; Royal Children's Hospital, Pediatric Rheumatology, Melbourne, Victoria; Department of Rheumatology, Sydney Children's Hospital Network, Randwick and Westmead, Sydney, Australia; Roche Products Ltd., Welwyn Garden City, UK. .,K.N. Bharucha, PhD, MD, Genentech; H.I. Brunner, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Cincinnati, CCHMC, PRCSG Coordinating Center; I. Calvo Penadés, MD, PhD, Paediatric Rheumatology Department, Hospital Universitario La Fe; I. Nikishina, MD, PhD, Pediatric Department, V.A. Nasonova Research Institute of Rheumatology; N. Rubio-Pérez, MD, Department of Pediatrics, Hospital Universitario Dr. J.E. González, Universidad Autónoma de Nuevo; S. Oliveira, MD, Universidade Federal do Rio de Janeiro, IPPMG; K. Kobusinska, MD, Wojewodzki Szpital Dzieciecy, Oddzial Pediatrii, Hematologii Onkologii i Reumatologii; H. Schmeling, MD, Department of Pediatrics, Alberta Children's Hospital and University of Calgary; F. Sztajnbok, MD, Hospital Universitario Pedro Ernesto, Nucleo de Estudos da Saúde do Adolescente, Universidade do Estado do Rio de Janeiro; F. Weller-Heinemann, MD, Klinikum Bremen-Mitte, Professor Hess-Kinderklinik, Pädiatrische Intensivmedizin; E. Zholobova, MD, Department of Pediatric Rheumatology, Hospital of Childhood Diseases, JCA-UNIT, Sechenov Moscow Medical Academy; F. Zulian, MD, Rheumatology Unit, Department of Woman and Child Health, University of Padua; R. Allen, MD, Royal Children's Hospital, Pediatric Rheumatology; J. Chaitow, MD, Department of Rheumatology, Sydney Children's Hospital Network; J. Frane, PhD, Consultant; C. Wells, Roche Products Ltd.; N. Ruperto, MD, MPH, Istituto Giannina Gaslini, Pediatria II, Rheumatologia, PRINTO Coordinating Centre; F. De Benedetti, MD, PhD, IRCCS Ospedale Pediatrico Bambino Gesù.
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Cellucci T, Guzman J, Petty RE, Batthish M, Benseler SM, Ellsworth JE, Houghton KM, LeBLANC CMA, Huber AM, Luca N, Schmeling H, Shiff NJ, Soon GS, Tse SML. Management of Juvenile Idiopathic Arthritis 2015: A Position Statement from the Pediatric Committee of the Canadian Rheumatology Association. J Rheumatol 2018; 43:1773-1776. [PMID: 27698103 DOI: 10.3899/jrheum.160074] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Tania Cellucci
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Jaime Guzman
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ross E Petty
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada;
| | - Michelle Batthish
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Susanne M Benseler
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Janet E Ellsworth
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Kristin M Houghton
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Adam M Huber
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Nadia Luca
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Heinrike Schmeling
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Natalie J Shiff
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Gordon S Soon
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Shirley M L Tse
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Oen K, Guzman J, Dufault B, Tucker LB, Shiff NJ, Duffy KW, Lee JJY, Feldman BM, Berard RA, Dancey P, Huber AM, Scuccimarri R, Cabral DA, Morishita KA, Ramsey SE, Rosenberg AM, Boire G, Benseler SM, Lang B, Houghton K, Miettunen PM, Chédeville G, Levy DM, Bruns A, Schmeling H, Haddad E, Yeung RSM, Duffy CM. Health-Related Quality of Life in an Inception Cohort of Children With Juvenile Idiopathic Arthritis: A Longitudinal Analysis. Arthritis Care Res (Hoboken) 2017; 70:134-144. [PMID: 28320056 DOI: 10.1002/acr.23236] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 03/14/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe changes in health-related quality of life (HRQoL) over time in children with juvenile idiopathic arthritis (JIA), relative to other outcomes, and to identify predictors of unfavorable HRQoL trajectories. METHODS Children with JIA in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) cohort were included. The Juvenile Arthritis Quality of Life Questionnaire (JAQQ, a standardized instrument), health-related Quality of My Life (HRQoML, an instrument based on personal valuations), and JIA core variables were completed serially. Analyses included median values, Kaplan-Meier survival curves, and latent trajectory analysis. RESULTS A total of 1,249 patients enrolled at a median of 0.5 months after diagnosis were followed for a median of 34.2 months. The degree of initial HRQoL impairment and probabilities of reaching the best possible HRQoL scores varied across JIA categories (best for oligoarthritis, worst for rheumatoid factor-positive polyarthritis). Median times to attain best possible HRQoL scores (JAQQ 59.3 months, HRQoML 34.5 months), lagged behind those for disease activity, pain, and disability measures. Most patients followed trajectories with minimal or mild impairment; however, 7.6% and 13.8% of patients, respectively, followed JAQQ and HRQoML trajectories with persistent major impairment in HRQoL. JIA category, aboriginal ethnicity, and baseline disease activity measures distinguished between membership in trajectories with major and minimal impairments. CONCLUSION Improvement in HRQoL is slower than for disease activity, pain, and disability. Improvement of a measure based on respondents' preferences (HRQoML) is more rapid than that of a standardized measure (JAQQ). Higher disease activity at diagnosis heralds an unfavorable HRQoL trajectory.
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Affiliation(s)
- Kiem Oen
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jaime Guzman
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori B Tucker
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Natalie J Shiff
- University of Florida, Gainesville, Florida, and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | | | - Brian M Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roberta A Berard
- Children's Hospital, London Health Sciences Centre, and Western University, London, Ontario, Canada
| | - Paul Dancey
- Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - David A Cabral
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kimberly A Morishita
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Suzanne E Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Gilles Boire
- Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Susanne M Benseler
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kristin Houghton
- British Columbia's Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Paivi M Miettunen
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | | | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Elie Haddad
- CHU Ste. Justine and Université de Montréal, Montreal, Quebec, Canada
| | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
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Jafri S, Ramanan AV, De Benedetti F, Ruperto N, Lovell D, Cuttica R, Weiss JE, Henrickson M, Schmeling H, Anton J, Minden K, Hsu J, Bharucha K, Wimalasundera S, Kadva AK, Upmanyu R, Mallalieu NL, Martini A, Brunner H. 06. Identification of optimal subcutaneous doses of tocilizumab in children with polyarticular-course juvenile idiopathic arthritis. Rheumatology (Oxford) 2017. [DOI: 10.1093/rheumatology/kex356.052] [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: 11/14/2022] Open
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Guzman J, Kerr T, Ward LM, Ma J, Oen K, Rosenberg AM, Feldman BM, Boire G, Houghton K, Dancey P, Scuccimarri R, Bruns A, Huber AM, Watanabe Duffy K, Shiff NJ, Berard RA, Levy DM, Stringer E, Morishita K, Johnson N, Cabral DA, Larché M, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey SE, Roth J, Campillo S, Benseler S, Chédeville G, Schneider R, Tse SML, Bolaria R, Gross K, Feldman D, Cameron B, Jurencak R, Dorval J, LeBlanc C, St. Cyr C, Gibbon M, Yeung RSM, Duffy CM, Tucker LB. Growth and weight gain in children with juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Pediatr Rheumatol Online J 2017; 15:68. [PMID: 28830457 PMCID: PMC5567720 DOI: 10.1186/s12969-017-0196-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND With modern treatments, the effect of juvenile idiopathic arthritis (JIA) on growth may be less than previously reported. Our objective was to describe height, weight and body mass index (BMI) development in a contemporary JIA inception cohort. METHODS Canadian children newly-diagnosed with JIA 2005-2010 had weight and height measurements every 6 months for 2 years, then yearly up to 5 years. These measurements were used to calculate mean age- and sex-standardized Z-scores, and estimate prevalence and cumulative incidence of growth impairments, and the impact of disease activity and corticosteroids on growth. RESULTS One thousand one hundred forty seven children were followed for median 35.5 months. Mean Z-scores, and the point prevalence of short stature (height < 2.5th percentile, 2.5% to 3.4%) and obesity (BMI > 95th percentile, 15.8% to 16.4%) remained unchanged in the whole cohort. Thirty-three children (2.9%) developed new-onset short stature, while 27 (2.4%) developed tall stature (>97.5th percentile). Children with systemic arthritis (n = 77) had an estimated 3-year cumulative incidence of 9.3% (95%CI: 4.3-19.7) for new-onset short stature and 34.4% (23-49.4) for obesity. Most children (81.7%) received no systemic corticosteroids, but 1 mg/Kg/day prednisone-equivalent maintained for 6 months corresponded to a drop of 0.64 height Z-scores (0.56-0.82) and an increase of 0.74 BMI Z-scores (0.56-0.92). An increase of 1 in the 10-cm physician global assessment of disease activity maintained for 6 months corresponded to a drop of 0.01 height Z-scores (0-0.02). CONCLUSIONS Most children in this modern JIA cohort grew and gained weight as children in the general population. About 1 in 10 children who had systemic arthritis, uncontrolled disease and/or prolonged corticosteroid use, had increased risk of growth impairment.
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Affiliation(s)
- Jaime Guzman
- From British Columbia Children's Hospital and University of British Columbia, Vancouver, Canada. .,Division of Pediatric Rheumatology, BC Children's Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC, V6H 3N1, Canada.
| | - Tristan Kerr
- 0000 0001 0684 7788grid.414137.4Division of Pediatric Rheumatology, BC Children’s Hospital, 4500 Oak St, Suite K4-122, Vancouver, BC V6H 3N1 Canada
| | - Leanne M. Ward
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Jinhui Ma
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Kiem Oen
- 0000 0004 1936 9609grid.21613.37Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
| | - Alan M. Rosenberg
- 0000 0004 0462 8356grid.412271.3Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Brian M. Feldman
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Gilles Boire
- 0000 0001 0081 2808grid.411172.0Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Kristin Houghton
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Paul Dancey
- grid.477424.6Janeway Children’s Health and Rehabilitation Centre and Memorial University, Saint John, ’s Canada
| | - Rosie Scuccimarri
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Alessandra Bruns
- 0000 0001 0081 2808grid.411172.0Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Adam M. Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Karen Watanabe Duffy
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Natalie J. Shiff
- 0000 0004 1936 8091grid.15276.37Shands Children’s Hospital and University of Florida, Gainesville, USA
| | - Roberta A. Berard
- 0000 0000 9132 1600grid.412745.1London Health Sciences Centre and Western University, London, Canada
| | - Deborah M. Levy
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | - Kimberly Morishita
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Nicole Johnson
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - David A. Cabral
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Maggie Larché
- 0000 0004 1936 8227grid.25073.33McMaster University, Hamilton, Canada
| | - Ross E. Petty
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Ronald M. Laxer
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Earl Silverman
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paivi Miettunen
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | | | - Elie Haddad
- 0000 0001 2292 3357grid.14848.31Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada
| | - Lynn Spiegel
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stuart E. Turvey
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
| | - Heinrike Schmeling
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Janet Ellsworth
- 0000 0004 0633 3703grid.416656.6Stollery Children’s Hospital and University of Alberta, Edmonton, Canada
| | | | - Johannes Roth
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Sarah Campillo
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Susanne Benseler
- 0000 0001 0684 7358grid.413571.5Alberta Children’s Hospital and University of Calgary, Calgary, Canada
| | - Gaëlle Chédeville
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Rayfel Schneider
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Shirley M. L. Tse
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roxana Bolaria
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics University of British Columbia, Vancouver, Canada
| | - Katherine Gross
- 0000 0001 2288 9830grid.17091.3eDepartment of Pediatrics University of British Columbia, Vancouver, Canada
| | - Debbie Feldman
- 0000 0001 2292 3357grid.14848.31Université de Montréal, Montréal, Canada
| | - Bonnie Cameron
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Roman Jurencak
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Jean Dorval
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Canada
| | - Claire LeBlanc
- 0000 0000 9064 4811grid.63984.30McGill University Health Centre and McGill University, Montreal, Canada
| | - Claire St. Cyr
- 0000 0001 2292 3357grid.14848.31Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Canada
| | - Michele Gibbon
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Rae S. M. Yeung
- 0000 0004 0473 9646grid.42327.30Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ciarán M. Duffy
- 0000 0000 9402 6172grid.414148.cChildren’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
| | - Lori B. Tucker
- 0000 0001 2288 9830grid.17091.3eFrom British Columbia Children’s Hospital and University of British Columbia, Vancouver, Canada
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Spencer CH, Rouster-Stevens K, Gewanter H, Syverson G, Modica R, Schmidt K, Emery H, Wallace C, Grevich S, Nanda K, Zhao YD, Shenoi S, Tarvin S, Hong S, Lindsley C, Weiss JE, Passo M, Ede K, Brown A, Ardalan K, Bernal W, Stoll ML, Lang B, Carrasco R, Agaiar C, Feller L, Bukulmez H, Vehe R, Kim H, Schmeling H, Gerstbacher D, Hoeltzel M, Eberhard B, Sundel R, Kim S, Huber AM, Patwardhan A. Biologic therapies for refractory juvenile dermatomyositis: five years of experience of the Childhood Arthritis and Rheumatology Research Alliance in North America. Pediatr Rheumatol Online J 2017; 15:50. [PMID: 28610606 PMCID: PMC5470177 DOI: 10.1186/s12969-017-0174-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/17/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The prognosis of children with juvenile dermatomyositis (JDM) has improved remarkably since the 1960's with the use of corticosteroid and immunosuppressive therapy. Yet there remain a minority of children who have refractory disease. Since 2003 the sporadic use of biologics (genetically-engineered proteins that usually are derived from human genes) for inflammatory myositis has been reported. In 2011-2016 we investigated our collective experience of biologics in JDM through the Childhood Arthritis and Rheumatology Research Alliance (CARRA). METHODS The JDM biologic study group developed a survey on the CARRA member experience using biologics for Juvenile DM utilizing Delphi consensus methods in 2011-2012. The survey was completed online by the CARRA members interested in JDM in 2012. A second survey was similarly developed that provided more opportunity to describe their experiences with biologics in JDM in detail and was completed by CARRA members in Feb 2013. During three CARRA meetings in 2013-2015, nominal group techniques were used for achieving consensus on the current choices of biologic drugs. A final survey was performed at the 2016 CARRA meeting. RESULTS One hundred and five of a potential 231 pediatric rheumatologists (42%) responded to the first survey in 2012. Thirty-five of 90 had never used a biologic for Juvenile DM at that time. Fifty-five of 91 (denominators vary) had used biologics for JDM in their practice with 32%, 5%, and 4% using rituximab, etanercept, and infliximab, respectively, and 17% having used more than one of the three drugs. Ten percent used a biologic as monotherapy, 19% a biologic in combination with methotrexate (mtx), 52% a biologic in combination with mtx and corticosteroids, 42% a combination of a biologic, mtx, corticosteroids (steroids), and an immunosuppressive drug, and 43% a combination of a biologic, IVIG and mtx. The results of the second survey supported these findings in considerably more detail with multiple combinations of drugs used with biologics and supported the use of rituximab, abatacept, anti-TNFα drugs, and tocilizumab in that order. One hundred percent recommended that CARRA continue studying biologics for JDM. The CARRA meeting survey in 2016 again supported the study and use of these four biologic drug groups. CONCLUSIONS Our CARRA JDM biologic work group developed and performed three surveys demonstrating that pediatric rheumatologists in North America have been using multiple biologics for refractory JDM in numerous scenarios from 2011 to 2016. These survey results and our consensus meetings determined our choice of four biologic therapies (rituximab, abatacept, tocilizumab and anti-TNFα drugs) to consider for refractory JDM treatment when indicated and to evaluate for comparative effectiveness and safety in the future. Significance and Innovations This is the first report that provides a substantial clinical experience of a large group of pediatric rheumatologists with biologics for refractory JDM over five years. This experience with biologic therapies for refractory JDM may aid pediatric rheumatologists in the current treatment of these children and form a basis for further clinical research into the comparative effectiveness and safety of biologics for refractory JDM.
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Affiliation(s)
- CH Spencer
- 0000 0004 0392 3476grid.240344.5Nationwide Children’s Hospital and Ohio State University, Columbus, OH USA
| | - K Rouster-Stevens
- 0000 0001 0941 6502grid.189967.8Emory University School of Medicine, Atlanta, GA USA
| | - H Gewanter
- Pediatric and Adolescent Health Partners, Richmond, VA USA
| | - G Syverson
- 0000 0001 2167 3675grid.14003.36University of Wisconsin-Madison, Madison, WI USA
| | - R Modica
- 0000 0004 1936 8091grid.15276.37University of Florida, Gainesville, FL USA
| | - K Schmidt
- 0000 0001 2113 1622grid.266623.5University of Louisville, Louisville, KY USA
| | - H Emery
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - C Wallace
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - S Grevich
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - K Nanda
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - YD Zhao
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - S Shenoi
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - S Tarvin
- Riley Hospital for Children, Indiana University Medical Center, Indianapolis, IN India
| | - S Hong
- grid.412984.2University of Iowa Health Care, Iowa City, IA USA
| | - C Lindsley
- 0000 0001 2177 6375grid.412016.0University of Kansas Medical Center, Kansas City, KS USA
| | - JE Weiss
- 0000 0004 0407 6328grid.239835.6Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ USA
| | - M Passo
- 0000 0000 9075 106Xgrid.254567.7University of South Carolina, Charleston, SC USA
| | - K Ede
- 0000 0001 0381 0779grid.417276.1Phoenix Children’s Hospital, Phoenix, AZ USA
| | - A Brown
- 0000 0001 2200 2638grid.416975.8Texas Children’s Hospital, Houston, TX USA
| | - K Ardalan
- 0000 0004 0388 2248grid.413808.6Lurie Children’s Hospital, Chicago, IL USA
| | - W Bernal
- 0000 0001 2297 6811grid.266102.1University of California, San Francisco, San Francisco, CA USA
| | - ML Stoll
- 0000000106344187grid.265892.2University of Alabama at Birmingham, Birmingham, AL USA
| | - B Lang
- 0000 0004 1936 8200grid.55602.34WK Health Center and Dalhousie University, Halifax, NS Canada
| | - R Carrasco
- Dell Children’s Hospital, Austin, TX USA
| | - C Agaiar
- Children’s Hospital of The Kings Daughter, Norfolk, VA USA
| | - L Feller
- Inland Rheumatology, Waterville, ME USA
| | - H Bukulmez
- 0000 0001 0035 4528grid.411931.fMetro Health Medical Center and Case Western Reserve University, Cleveland, OH USA
| | - R Vehe
- 0000000419368657grid.17635.36University of Minnesota, Minneapolis, MN USA
| | - H Kim
- 0000 0001 2237 2479grid.420086.8National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - H Schmeling
- 0000 0004 1936 7697grid.22072.35Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - D Gerstbacher
- 0000000419368956grid.168010.eLucille Packard Children’s Hospital, Stanford University, Stanford, CA USA
| | - M Hoeltzel
- 0000000086837370grid.214458.eMott Children’s Hospital, University of Michigan, Ann Arbor, MI USA
| | - B Eberhard
- grid.415338.8Cohen Children’s Medical Center of New York, New york, USA
| | - R Sundel
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - S Kim
- 0000 0001 2297 6811grid.266102.1University of California, San Francisco, San Francisco, CA USA
| | - AM Huber
- 0000 0004 1936 8200grid.55602.34WK Health Center and Dalhousie University, Halifax, NS Canada
| | - A Patwardhan
- 0000 0001 2162 3504grid.134936.aSchool of Medicine, University of Missouri, Columbia, MO USA
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Lomakina O, Alekseeva E, Valieva S, Bzarova T, Nikishina I, Zholobova E, Rodionovskaya S, Kaleda M, Nakagishi Y, Shimizu M, Mizuta M, Yachie A, Sugita Y, Okamoto N, Shabana K, Murata T, Tamai H, Smith EM, Yin P, Jorgensen AL, Beresford MW, Smith EM, Eleuteri A, Goilav B, Lewandowski L, Phuti A, Wahezi D, Rubinstein T, Jones C, Newland P, Marks S, Corkhill R, Ekdawy D, Pilkington C, Tullus K, Putterman C, Scott C, Fisher AC, Beresford MW, Smith EM, Lewandowski L, Phuti A, Jorgensen A, Scott C, Beresford MW, Batu ED, Kosukcu C, Taskiran E, Akman S, Ozturk K, Sozeri B, Unsal E, Ekinci Z, Bilginer Y, Alikasifoglu M, Ozen S, Lythgoe H, Beresford MW, Brunner HI, Gulati G, Jones JT, Altaye M, Eaton J, Difrancesco M, Yeo JG, Leong J, Bathi LDT, Arkachaisri T, Albani S, Abdelrahman N, Beresford MW, Leone V, Groot N, Shaikhani D, Bultink IEM, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Wright RD, Smith EM, Beresford MW, Abdawani R, Al Shaqshi L, Al Zakwani I, Gormezano NW, Kern D, Pereira OL, Esteves GCC, Sallum AM, Aikawa NE, Pereira RM, Silva CA, Bonfa E, Beckmann J, Bartholomä N, Foeldvari I, Bohnsack J, Milojevic D, Rabinovich C, Kingsbury D, Marzan K, Quartier P, Minden K, Chalom E, Horneff G, Venhoff N, Kuester RM, Dare J, Heinrich M, Kupper H, Kalabic J, Martini A, Brunner HI, Consolaro A, Horneff G, Burgos-Vargas R, Henneke P, Constantin T, Foeldvari I, Vojinovic J, Dehoorne J, Panaviene V, Susic G, Stanevica V, Kobusinska K, Zuber Z, Mouy R, Salzer U, Rumba-Rozenfelde I, Dolezalova P, Job-Deslandre C, Wulffraat N, Pederson R, Bukowski J, Hinnershitz T, Vlahos B, Martini A, Ruperto N, Janda A, Keskitalo P, Kangas S, Vähäsalo P, Valencia RAC, Martino D, Munro J, Ponsonby AL, Chiaroni-Clarke R, Meyer B, Allen RC, Boteanu AL, Akikusa JD, Craig JM, Saffrey R, Ellis JA, Davì S, Minoia F, Horne A, Wulffraat N, Wouters C, Wallace C, Corral SG, Uziel Y, Sterba G, Schneider R, Russo R, Ramanan AV, Schmid JP, Ozen S, Nichols KE, Miettunen P, Lovell DJ, Giraldo AS, Lehmberg K, Kitoh T, Khubchandani R, Ilowite NT, Henter JI, Grom AA, De Benedetti F, Behrens EM, Avcin T, Aricò M, Gámir MG, Martini A, Ruperto N, Cron RQ, Ravelli A, Grevich S, Lee P, Ringold S, Leroux B, Leahey H, Yuasa M, Mendoza AZ, Foster J, Sokolove J, Lahey L, Robinson W, Newson J, Stevens A, Shoop SJW, Hyrich KL, Verstappen SMM, Thomson W, Adrovic A, McDonagh JE, Beukelman T, Kimura Y, Natter M, Ilowite N, Mieszkalski K, Burrell G, Best B, Bristow H, Carr S, Dedeoglu R, Dennos A, Kaufmann R, Schanberg L, Parissenti I, Insalaco A, Taddio A, Mauro A, Pardeo M, Ricci F, Simonini G, Sahin S, Cattalini M, Montesano P, Parissenti I, Ricci F, Bonafini B, Medeghini V, Lancini F, Cattalini M, Gerbaux M, Lê PQ, Barut K, Goffin L, Badot V, La C, Caspers L, Willermain F, Ferster A, Ceci M, Licciardi F, Turco M, Santarelli F, Koka A, Montin D, Toppino C, Maggio MC, Alizzi C, Papia B, Vergara B, Corpora U, Messina L, Corsello G, Tsinti M, Oztunc F, Dermentzoglou V, Tziavas P, Tsitsami E, Perica M, Vidović M, Lamot L, Harjaček M, Bukovac LT, Çakan M, Ayaz NA, Kasapcopur O, Keskindemirci G, Miettunen P, Lang M, Laing C, Benseler S, Gerschman T, Luca N, Schmeling H, Dropol A, Taiani J, Rodriguez-Lozano AL, Johnson N, Rusted B, Nalbanti P, Trachana M, Pratsidou P, Pardalos G, Tzimouli V, Taparkou A, Stavrakidou M, Papachristou F, Rivas-Larrauri F, Kanakoudi-Tsakalidou F, Bale P, Robinson E, Palman J, Pilkington C, Ralph E, Gilmour K, Heard C, Wedderburn LR, Carlomagno R, de la Puente SG, Barrense-Dias Y, Gregory A, Amira D, Paolo S, Sylviane H, Michaël H, Panko N, Shokry S, Rakovska L, Pino S, Alves AGF, Diaz-Maldonado A, Guarnizo P, Torreggiani S, Cressoni P, Garagiola U, Di Landro G, Farronato G, Corona F, Filocamo G, Shenoi S, Giacomin MFDA, Bell S, Bhatti P, Nelson L, Mueller BA, Simon TA, Baheti A, Ray N, Guo Z, Ruperto N, Brunner HI, Farhat J, Hazra A, Stock T, Wang R, Mebus C, Alvey C, Lamba M, Krishnaswami S, Conte U, Wang M, Tzaribachev N, Braga ALF, Foeldvari I, Horneff G, Kingsbury D, Koskova E, Smolewska E, Vehe RK, Zuber Z, Martini A, Lovell D, Kubota T, Sallum AME, Shimizu M, Yasumura J, Nakagishi Y, Kizawa T, Yashiro M, Wakiguchi H, Yamatou T, Yamasaki Y, Takei S, Kawano Y, Campos LMDA, Nykvist UJ, Magnusson B, Wicksell R, Palmblad K, Olsson GL, Ziaee V, Modaressi M, Moradinejad MH, Seraya V, Zholobova E, Pereira LAA, Vitebskaya A, Moshe V, Amarilyo G, Harel L, Hashkes PJ, Mendelson A, Rabinowicz N, Reis Y, Uziel Y, Dāvidsone Z, Lichtenfels AJDFC, Lazareva A, Šantere R, Bērziņa D, Staņēviča V, Varnier GC, Consolaro A, Pilkington C, Maillard S, Ferrari C, Zaffarano S, Silva CA, Martini A, Ravelli A, Wienke J, Enders FB, van den Hoogen LL, Mertens JS, Radstake TR, Hotten HG, Fritsch R, de Jager W, Farhat SCL, Wedderburn L, Nistala K, Pilkington C, Prakken B, van Royen-Kerkhof A, van Wijk F, Alhemairi M, Muzaffer M, Van Dijkhuizen P, Deakin CT, Acar B, Simou S, Wedderburn LR, De Iorio M, Wu Q, Amin T, Simou S, Dossetter L, Wedderburn LR, Pilkington C, Campanilho-Marques R, Ozcakar ZB, Deakin C, Simou S, Wedderburn LR, Pilkington CA, Rosina S, Consolaro A, van Dijkhuizen P, Nistala K, Ruperto N, Pilkington C, Çakar N, Ravelli A, Soponkanaporn S, Simou S, Deakin CT, Wedderburn LR, Arıcı ZS, Tuğcu GD, Batu ED, Sönmez HE, Doğru-Ersöz D, Uncu N, Bilginer Y, Talim B, Kiper N, Özen S, Solyom A, Hügle B, Makay B, Magnusson B, Batu E, Mitchell J, Gür G, Kariminejad A, Hadipour F, Hadipour Z, Torcoletti M, Agostoni C, Di Rocco M, Tanpaiboon P, Superti-Furga A, Bonafé L, Arslan N, Özdel S, Guelbert N, Kostik M, Ehlert K, Grigelioniene G, Puri R, Ozen S, Schuchman E, Malagon C, Gomez P, Mosquera AC, Yalçınkaya F, Gonzalez T, Yepez R, Vargas C, Fernanda F, Lepri G, Ferrari A, Rigante D, Matucci-Cerinic M, Meini A, Moneta GM, Scott C, Caiello I, Marasco E, Nicolai R, Pardeo M, Bracaglia C, Insalaco A, Bracci-Laudiero L, De Benedetti F, Kopchak O, Kostik M, Brice N, Mushkin A, Maletin A, Makay B, Batu ED, Hügle B, Arslan N, Solyom A, Mitchell J, Schuchman E, Ozen S, Nourse P, Magnusson B, Malagon C, Gomez P, Mosquera C, Gonzalez T, Yepez R, Vargas C, Amorim RA, Len CA, Molina J, Lewandowski L, Moreira G, Santos FH, Fraga M, Keppeke L, Silva VM, Hirotsu C, Tufik S, Terreri MT, Braga VL, Fonseca MB, Arango C, Len CA, Fraga M, Schinzel V, Terreri MTR, Molina J, Len CA, Jorge L, Guerra L, Santos FH, Terreri MT, Mosquera AC, Junior EA, Fonseca MB, Braga VL, Len CA, Fraga M, Schinzel V, Terreri MTR, Alizzi C, Maggio MC, Castiglione MC, Malagon C, Tricarico A, Corsello G, Boulter E, Schultz A, Murray K, Falcini F, Lepri G, Stagi S, Bellucci E, Matucci-Cerinic M, Sakamoto AP, Grein IHR, Groot N, Pileggi G, Pinto NBF, de Oliveira AL, Wulffraat N, Chyzheuskaya I, Belyaeva L, Filonovich R, Khrustaleva H, Silva CA, Zajtseva L, Ilisson J, Pruunsild C, Kostik M, Kopchak O, Mushkin A, Maletin A, Gilliaux O, Corazza F, Lelubre C, Silva MFCD, Ferster A, Suárez RG, Morel Z, Espada G, Malagon C, C CSM, Lira L, Ladino M, Eraso R, Arroyo I, Lopes AS, Sztajnbok F, Silva C, Rose C, Russo GCS, Sallum AEM, Kozu K, Bonfá E, Saad-Magalhães C, Pereira RMR, Len CA, Terreri MT, Suri D, Didel S, Rawat A, Singh S, Maritsi D, Onoufriou MA, Vougiouka O, Tsolia M, Bosak EP, Vidović M, Lamot M, Lamot L, Harjaček M, Van Nieuwenhove E, Liston A, Wouters C, Tahghighi F, Ziaee V, Raeeskarami SR, Aguiar F, Pereira S, Rodrigues M, Moura C, Rocha G, Guimarães H, Brito I, Aguiar F, Fonseca R, Rodrigues M, Brito I, Horneff G, Klein A, Minden K, Huppertz HI, Weller-Heinemann F, Kuemmerle-Deschner J, Haas JP, Hospach A, Menendez-Castro R, Huegle B, Haas JP, Swart J, Giancane G, Bovis F, Castagnola E, Groll A, Horneff G, Huppertz HI, Lovell DJ, Wolfs T, Hofer M, Alekseeva E, Panaviene V, Nielsen S, Anton J, Uettwiller F, Stanevicha V, Trachana M, Marafon DP, Ailioaie C, Tsitsami E, Kamphuis S, Herlin T, Doležalová P, Susic G, Flatø B, Sztajnbok F, Pistorio A, Martini A, Wulffraat N, Ruperto N, Gattorno M, Brucato A, Finetti M, Lazaros G, Maestroni S, Carraro M, Cumetti D, Carobbio A, Lorini M, Rimini A, Marcolongo R, Valenti A, Erre GL, Belli R, Gaita F, Sormani MP, Ruperto N, Imazio M, Martini A, Abinun M, Smith N, Rapley T, McErlane F, Kearsley-Fleet L, Hyrich KL, Foster H, Ruperto N, Lovell DJ, Tzaribachev N, Zeft A, Cimaz R, Stanevicha V, Horneff G, Bohnsack J, Griffin T, Carrasco R, Trachana M, Dare J, Foeldvari I, Vehe R, Bovis F, Simon T, Martini A, Brunner H, Verazza S, Davì S, Consolaro A, Insalaco A, Gerloni V, Cimaz R, Zulian F, Pastore S, Corona F, Conti G, Barone P, Cattalini M, Cortis E, Breda L, Olivieri AN, Civino A, Podda R, Rigante D, La Torre F, D’Angelo G, Jorini M, Gallizzi R, Maggio MC, Consolini R, De Fanti A, Alpigiani MG, Martini A, Ravelli A, Sozeri B, Kısaarslan AP, Gunduz Z, Dusunsel R, Dursun I, Poyrazoglu H, Kuchinskaya E, Abduragimova F, Kostik M, Sundberg E, Omarsdottir S, Klevenvall L, Erlandsson-Harris H, Basbozkurt G, Erdemli O, Simsek D, Yazici F, Karsioglu Y, Tezcaner A, Keskin D, Ozkan H, Acikel C, Ozen S, Demirkaya E, Orbán I, Sevcic K, Brodszky V, Kiss E, Tekko IA, Rooney M, McElnay J, Taggart C, McCarthy H, Donnelly RF, Abinun M, Slatter M, Nademi Z, Friswell M, Foster H, Jandial S, McErlane F, Flood T, Hambleton S, Gennery A, Cant A, Finetti M, Bovis F, Swart J, Doležalová P, Tsitsami E, Trachana M, Demirkaya E, Duong PN, Koné-Paut I, Vougiouka O, Marafon DP, Cimaz R, Filocamo G, Gamir ML, Stanevicha V, Sanner H, Carenini L, Wulffraat N, Martini A, Ruperto N, Topdemir M, Basbozkurt G, Karslioglu Y, Ozkan H, Acikel C, Demirkaya E, Gok F, Zholobova E, Tsurikova N, Ligostaeva E, Ramchurn NR, Friswell M, Kostareva O, Nikishina I, Arsenyeva S, Rodionovskaya S, Kaleda M, Alexeev D, Dursun ID, Sozeri B, Kısaarslan AP, Dusunsel R, Poyrazoglu H, Poyrazoglu H, Murias S, Barral E, Alcobendas R, Enriquez E, Remesal A, de Inocencio J, Castro TM, Lotufo SA, Freye T, Carlomagno R, Zumbrunn T, Bonhoeffer J, Schneider EC, Kaiser D, Hofer M, Hentgen V, Woerner A, Schwarz T, Klotsche J, Niewerth M, Horneff G, Haas JP, Hospach A, Huppertz HI, Ganser G, Minden K, Jeyaratnam J, ter Haar N, Kasapcopur O, Rigante D, Dedeoglu F, Baris E, Vastert S, Wulffraat N, Frenkel J, Hausmann JS, Lomax KG, Shapiro A, Durrant KL, Brogan PA, Hofer M, Kuemmerle-Deschner JB, Lauwerys B, Speziale A, Leon K, Wei X, Laxer RM, Signa S, Rusmini M, Campione E, Chiesa S, Grossi A, Omenetti A, Caorsi R, Viglizzo G, Martini A, Ceccherini I, Gattorno M, Federici S, Frenkel J, Ozen S, Lachmann H, Finetti M, Martini A, Ruperto N, Gattorno M, Federici S, Vanoni F, Ozen S, Hofer M, Frenkel J, Lachmann H, Martini A, Ruperto N, Gattorno M, Gomes SM, Omoyinmi E, Arostegui JI, Gonzalez-Roca E, Eleftheriou D, Klein N, Brogan P, Volpi S, Santori E, Picco P, Pastorino C, Caorsi R, Rice G, Tesser A, Martini A, Crow Y, Candotti F, Gattorno M, Barut K, Sahin S, Adrovic A, Sinoplu AB, Yucel G, Pamuk G, Kasapcopur O, Damian LO, Lazea C, Sparchez M, Vele P, Muntean L, Albu A, Rednic S, Lazar C, Mendonça LO, Pontillo A, Kalil J, Castro FM, Barros MT, Pardeo M, Messia V, De Benedetti F, Insalaco A, Malighetti G, Gorio C, Ricci F, Parissenti I, Montesano P, Bonafini B, Medeghini V, Cattalini M, Giordano L, Zani G, Ferraro R, Vairo D, Giliani S, Cattalini M, Maggio MC, Luppino G, Corsello G, Fernandez MIG, Montesinos BL, Vidal AR, Gorospe JIA, Penades IC, Rafiq NK, Wynne K, Hussain K, Brogan PA, Ang E, Ng N, Kacar A, Gucenmez OA, Makay B, Unsal SE, Sahin Y, Barut K, Kutlu T, Cullu-Cokugras F, Sahin S, Adrovic A, Ayyildiz-Civan H, Kasapcopur O, Erkan T, Abdawani R, Al Zuhbi S, Abdalla E, Russo RA, Katsicas MM, Caorsi R, Minoia F, Viglizzo G, Grossi A, Chiesa S, Picco P, Ravelli A, Gattorno M, Bhattad S, Rawat A, Gupta A, Suri D, Pandiarajan V, Nada R, Tiewsoh K, Hawkins P, Rowczenio D, Singh S, Fingerhutova S, Franova J, Prochazkova L, Hlavackova E, Dolezalova P, Evrengül H, Yüksel S, Doğan M, Gürses D, Evrengül H, De Pauli S, Pastore S, Bianco AM, Severini GM, Taddio A, Tommasini A, Salugina SO, Fedorov E, Kamenets E, Zaharova E, Kaleda M, Salugina SO, Fedorov E, Kamenets E, Zaharova E, Kaleda M, Sleptsova T, Alexeeva E, Savostyanov K, Pushkov A, Bzarova T, Valieva S, Denisova R, Isayeva K, Chistyakova E, Lomakina O, Soloshenko M, Kaschenko E, Kaneko U, Imai C, Saitoh A, Teixeira VA, Ramos FO, Costa M, Aviel YB, Fahoum S, Brik R, Özçakar ZB, Çakar N, Uncu N, Celikel BA, Yalcinkaya F, Schiappapietra B, Davi’ S, Mongini F, Giannone L, Bava C, Alpigiani MG, Martini A, Ravelli A, Consolaro A, Lazarevic DS, Vojinovic J, Susic G, Basic J, Giancane G, Muratore V, Marzetti V, Quilis N, Benavente BS, Alongi A, Civino A, Quartulli L, Consolaro A, Martini A, Ravelli A, Januskeviciute G, van Dijkhuizen P, Muratore V, Giancane G, Schiappapietra B, Martini A, Ravelli A, Consolaro A, Groot N, van Dijk W, Bultink IEM, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Groot N, Kardolus A, Bultink IEM, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Suárez RG, Nordal EB, Rypdal VG, Berntson L, Ekelund M, Aalto K, Peltoniemi S, Zak M, Nielsen S, Glerup M, Herlin T, Arnstad ED, Fasth A, Rygg M, Duarte AC, Sousa S, Teixeira L, Cordeiro A, Santos MJ, Mourão AF, Santos MJ, Eusébio M, Lopes A, Oliveira-Ramos F, Salgado M, Estanqueiro P, Melo-Gomes J, Martins F, Costa J, Furtado C, Figueira R, Brito I, Branco JC, Fonseca JE, Canhão H, Mourão AF, Santos MJ, Eusébio M, Lopes A, Oliveira-Ramos F, Salgado M, Estanqueiro P, Melo-Gomes J, Martins F, Costa J, Furtado C, Figueira R, Brito I, Branco JC, Fonseca JE, Canhão H, Coda A, Cassidy S, West K, Hendry G, Grech D, Jones J, Hawke F, Grewal DS, Coda A, Jones J, Grech D, Grewal DS, Foley C, Killeen O, MacDermott E, Veale D, Fearon U, Konukbay D, Demirkaya E, Tarakci E, Arman N, Barut K, Şahin S, Adrovic A, Kasapcopur O, Munro J, Consolaro A, Morgan E, Riebschleger M, Horonjeff J, Strand V, Bingham C, Collante MTM, Ganeva M, Stefanov S, Telcharova A, Mihaylova D, Saraeva R, Tzveova R, Kaneva R, Tsakova A, Temelkova K, Picarelli MMC, Danzmann LC, Barbé-Tuana F, Grun LK, Jones MH, Frković M, Ištuk K, Birkić I, Sršen S, Jelušić M, Smith N, Jandial S, Easton A, Quarmby R, Khubchandani R, Chan M, Rapley T, Foster H, Srp R, Kobrova K, Franova J, Fingerhutova S, Nemcova D, Hoza J, Uher M, Saifridova M, Linkova L, Dolezalova P, Charuvanij S, Leelayuwattanakul I, Pacharapakornpong T, Vallipakorn SAO, Lerkvaleekul B, Vilaiyuk S, Muratore V, Giancane G, Lanni S, Alongi A, Alpigiani MG, Martini A, Ravelli A, Consolaro A, Alongi A, Bovis F, Minoia F, Davì S, Martini A, Ruperto N, Cron RQ, Ravelli A, Passarelli C, Pardeo M, Pisaneschi E, Novelli A, De Benedetti F, Bracaglia C, Bracaglia C, Marafon DP, Caiello I, de Graaf K, Guilhot F, Ferlin W, Davi’ S, Schulert G, Ravelli A, Grom AA, Nelson R, de Min C, De Benedetti F, Holzinger D, Kessel C, Fall N, Grom A, de Jager W, Vastert S, Strippoli R, Bracaglia C, Sundberg E, Horne A, Ehl S, Ammann S, Lehmberg K, De Benedetti F, Beutel K, Foell D, Minoia F, Horne A, Bovis F, Davì S, Pagani L, Espada G, Gao YJ, Insalaco A, Lehmberg K, Sanner H, Shenoi S, Weitzman S, Ruperto N, Martini A, Cron RQ, Ravelli A, Prencipe G, Caiello I, Pascarella A, Bracaglia C, Ferlin WG, Chatel L, Strippoli R, de Min C, De Benedetti F, Jacqmin P, De Graaf K, Ballabio M, Nelson R, Johnson Z, Ferlin W, Lapeyre G, de Benedetti F, Cristina DM, Wakiguchi H, Hasegawa S, Hirano R, Okazaki F, Nakamura T, Kaneyasu H, Ohga S, Yamazaki K, Nozawa T, Kanetaka T, Ito S, Yokota S, McLellan K, MacGregor I, Martin N, Davidson J, Kuemmerle-Deschner J, Hansmann S, Wulffraat N, Eikelberg A, Haug I, Schuller S, Benseler SM, Nazarova LS, Danilko KV, Malievsky VA, Viktorova TV, Mauro A, Omoyinmi E, Barnicoat A, Brogan P, Foley C, Killeen O, MacDermott E, Veale D, Foley C, Killeen O, MacDermott E, Veale D, Gomes SM, Omoyinmi E, Hurst J, Canham N, Eleftheriou D, Klein N, Lacassagne S, Brogan P, Wiener A, Hügle B, Denecke B, Costa-Filho I, Haas JP, Tenbrock K, Popp D, Boltjes A, Rühle F, Herresthal S, de Jager W, van Wijk F, Schultze J, Stoll M, Klotz L, Vogl T, Roth J, Quesada-Masachs E, de la Sierra DÁ, Prat MG, Sánchez AMM, Borrell RP, Barril SM, Gallo MM, Caballero CM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Giner T, Hackl L, Albrecht J, Würzner R, Brunner J, Pastore S, Minute M, Parentin F, Tesser A, Nocerino A, Taddio A, Tommasini A, Nørgaard M, Herlin T, Alberdi-Saugstrup M, Zak MS, Nielsen SM, Herlin T, Nordal E, Berntson L, Fasth A, Rygg M, Müller KG, Avramovič MZ, Dolžan V, Toplak N, Avčin T, Ruperto N, Lovell DJ, Wallace C, Toth M. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part two. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461533 DOI: 10.1186/s12969-017-0142-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Musset L, Allenbach Y, Benveniste O, Boyer O, Bossuyt X, Bentow C, Phillips J, Mammen A, Van Damme P, Westhovens R, Ghirardello A, Doria A, Choi MY, Fritzler MJ, Schmeling H, Muro Y, García-De La Torre I, Ortiz-Villalvazo MA, Bizzaro N, Infantino M, Imbastaro T, Peng Q, Wang G, Vencovský J, Klein M, Krystufkova O, Franceschini F, Fredi M, Hue S, Belmondo T, Danko K, Mahler M. Anti-HMGCR antibodies as a biomarker for immune-mediated necrotizing myopathies: A history of statins and experience from a large international multi-center study. Autoimmun Rev 2016; 15:983-93. [DOI: 10.1016/j.autrev.2016.07.023] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/09/2016] [Indexed: 01/15/2023]
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Barber CE, Marshall DA, Mosher DP, Akhavan P, Tucker L, Houghton K, Batthish M, Levy DM, Schmeling H, Ellsworth J, Tibollo H, Grant S, Khodyakov D, Lacaille D. Development of System-level Performance Measures for Evaluation of Models of Care for Inflammatory Arthritis in Canada. J Rheumatol 2016; 43:530-40. [DOI: 10.3899/jrheum.150839] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 12/21/2022]
Abstract
Objective.To develop system-level performance measures for evaluating the care of patients with inflammatory arthritis (IA), including rheumatoid arthritis (RA), psoriatic arthritis, ankylosing spondylitis, and juvenile idiopathic arthritis.Methods.This study involved several methodological phases. Over multiple rounds, various participants were asked to help define a set of candidate measurement themes. A systematic search was conducted of existing guidelines and measures. A set of 6 performance measures was defined and presented to 50 people, including patients with IA, rheumatologists, allied health professionals, and researchers using a 3-round, online, modified Delphi process. Participants rated the validity, feasibility, relevance, and likelihood of use of the measures. Measures with median ratings ≥ 7 for validity and relevance were included in the final set.Results.Six performance measures were developed evaluating the following aspects of care, with each measure being applied separately for each type of IA except where specified: waiting times for rheumatology consultation for patients with new onset IA, percentage of patients with IA seen by a rheumatologist, percentage of patients with IA seen in yearly followup by a rheumatologist, percentage of patients with RA treated with a disease-modifying antirheumatic drug (DMARD), time to DMARD therapy in RA, and number of rheumatologists per capita.Conclusion.The first set of system-level performance measures for IA care in Canada has been developed with broad input. The measures focus on timely access to care and initiation of appropriate treatment for patients with IA, and are likely to be of interest to other arthritis care systems internationally.
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Schmeling H, Mahler M, Levy DM, Moore K, Stevens AM, Wick J, McMillan JD, Horneff G, Assassi S, Charles J, Salazar G, Mayes MD, Silverman ED, Klien-Gitelman M, Lee T, Brunner HI, Reed AM, Fritzler MJ. Autoantibodies to Dense Fine Speckles in Pediatric Diseases and Controls. J Rheumatol 2015; 42:2419-26. [PMID: 26472409 DOI: 10.3899/jrheum.150567] [Citation(s) in RCA: 28] [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] [Accepted: 07/30/2015] [Indexed: 12/26/2022]
Abstract
OBJECTIVE Autoantibodies to the dense fine speckled 70 kDa antigen (DFS70) are reported to be more common in individuals who do not have an antinuclear antibody (ANA)-associated rheumatic disease (AARD) than in patients with AARD. The frequency of anti-DFS70 antibodies has been thoroughly studied in adult but not in pediatric populations. The primary objective of this observational study was to determine the frequency of anti-DFS70 in pediatric AARD and reference cohorts. METHODS Sera from 743 children with AARD and related conditions, and 345 samples from reference cohorts (healthy children and those being investigated for AARD) were studied for anti-DFS70 autoantibodies as measured by a chemiluminescence immunoassay. A de-identified administrative database was used to retrieve demographic, serologic, and clinical data. RESULTS Anti-DFS70 antibodies were seen in 2.1% of healthy children and in 4.5% of sera from pediatric individuals referred for ANA testing. The frequency of anti-DFS70 was highest in juvenile localized scleroderma (LS; 4/29, 13.8%), juvenile dermatomyositis (JDM; 2/11, 18.2%), childhood systemic lupus erythematosus (cSLE; 19/331, 5.7%), diffuse cutaneous systemic sclerosis (1/22, 4.5%), celiac disease (2/49, 4.1%), and juvenile idiopathic arthritis (JIA; 5/202, 2.5%). Of note, anti-DFS70 antibodies were observed in 3/26 children (11.5%) with uveitis and JIA-associated uveitis. CONCLUSION The frequency of anti-DFS70 autoantibodies in healthy pediatric subjects is within the lower range of that reported in adults. Anti-DFS70 antibodies can be found in childhood SSc and cSLE, but has a remarkably high frequency in children with LS, JDM, and uveitis.
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Affiliation(s)
- Heinrike Schmeling
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Michael Mahler
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Deborah M Levy
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Katharine Moore
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Anne M Stevens
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - James Wick
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Jacob D McMillan
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Gerd Horneff
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Shervin Assassi
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Julio Charles
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Gloria Salazar
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Maureen D Mayes
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Earl D Silverman
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Marissa Klien-Gitelman
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Tzelan Lee
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Hermine I Brunner
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Ann M Reed
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
| | - Marvin J Fritzler
- From the Department of Paediatrics, Alberta Children's Hospital, and McCaig Institute for Bone and Joint Health, and Faculty of Medicine, University of Calgary; Alberta Children's Hospital Research Institute, Calgary, Alberta; Hospital for Sick Children; University of Toronto, Toronto, Ontario, Canada; Inova Diagnostics Inc., San Diego, California; Stanford University/Lucile Packard Children's Hospital, Stanford, California; Seattle Children's Research Institute, Department of Pediatrics, University of Washington, Seattle, Washington; Division of Rheumatology, University of Texas Houston Medical School, Houston, Texas; Northwestern University/Lurie Children's Hospital, Chicago, Illinois; University of Cincinnati; Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio; Department of Pediatrics, Duke University, Durham, North Carolina, USA; Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics, Sankt Augustin, Germany.H. Schmeling, MD, Department of Paediatrics, Alberta Children's Hospital, University of Calgary, and Alberta Children's Hospital Research Institute, and McCaig Institute for Bone and Joint Health; M. Mahler, PhD, Inova Diagnostics Inc.; D.M. Levy, PhD, Hospital for Sick Children, and University of Toronto; K. Moore, MD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; A.M. Stevens, MD, PhD, Seattle Children's Research Institute, Department of Pediatrics, University of Washington; J. Wick, BSc, Faculty of Medicine, University of Calgary; J.D. McMillan, Faculty of Medicine, University of Calgary; G. Horneff, MD, Department of General Paediatrics, Centre of Paediatrics and Neonatology, Asklepios Clinics; S. Assassi, MD, Division of Rheumatology, University of Texas Houston Medical School; J. Charles, BSc, MSc, Division of Rheumatology, University of Texas Houston Medical School; G. Salazar, MD, Division of Rheumatology, University of Texas Houston Medical School; M
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Guzman J, Oen K, Huber AM, Watanabe Duffy K, Boire G, Shiff N, Berard RA, Levy DM, Stringer E, Scuccimarri R, Morishita K, Johnson N, Cabral DA, Rosenberg AM, Larché M, Dancey P, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Houghton K, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey SE, Bruns A, Roth J, Campillo S, Benseler S, Chédeville G, Schneider R, Tse SML, Bolaria R, Gross K, Feldman B, Feldman D, Cameron B, Jurencak R, Dorval J, LeBlanc C, St Cyr C, Gibbon M, Yeung RSM, Duffy CM, Tucker LB. The risk and nature of flares in juvenile idiopathic arthritis: results from the ReACCh-Out cohort. Ann Rheum Dis 2015; 75:1092-8. [PMID: 25985972 DOI: 10.1136/annrheumdis-2014-207164] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/01/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe probabilities and characteristics of disease flares in children with juvenile idiopathic arthritis (JIA) and to identify clinical features associated with an increased risk of flare. METHODS We studied children in the Research in Arthritis in Canadian Children emphasizing Outcomes (ReACCh-Out) prospective inception cohort. A flare was defined as a recurrence of disease manifestations after attaining inactive disease and was called significant if it required intensification of treatment. Probability of first flare was calculated with Kaplan-Meier methods, and associated features were identified using Cox regression. RESULTS 1146 children were followed up a median of 24 months after attaining inactive disease. We observed 627 first flares (54.7% of patients) with median active joint count of 1, physician global assessment (PGA) of 12 mm and duration of 27 weeks. Within a year after attaining inactive disease, the probability of flare was 42.5% (95% CI 39% to 46%) for any flare and 26.6% (24% to 30%) for a significant flare. Within a year after stopping treatment, it was 31.7% (28% to 36%) and 25.0% (21% to 29%), respectively. A maximum PGA >30 mm, maximum active joint count >4, rheumatoid factor (RF)-positive polyarthritis, antinuclear antibodies (ANA) and receiving disease-modifying antirheumatic drugs (DMARDs) or biological agents before attaining inactive disease were associated with increased risk of flare. Systemic JIA was associated with the lowest risk of flare. CONCLUSIONS In this real-practice JIA cohort, flares were frequent, usually involved a few swollen joints for an average of 6 months and 60% led to treatment intensification. Children with a severe disease course had an increased risk of flare.
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Affiliation(s)
- Jaime Guzman
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Kiem Oen
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karen Watanabe Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Natalie Shiff
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Roberta A Berard
- London Health Sciences Centre and Western University, London, Ontario, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Stringer
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Johnson
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - David A Cabral
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Maggie Larché
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Newfoundland, Canada
| | - Ross E Petty
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald M Laxer
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Earl Silverman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Paivi Miettunen
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Anne-Laure Chetaille
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Elie Haddad
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Stuart E Turvey
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Ellsworth
- Stollery Children's Hospital and University of Alberta, Edmonton, Alberta, Canada
| | - Suzanne E Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alessandra Bruns
- Centre Hospitalier Universitaire de Sherbrooke and Departments of Medicine and Pediatrics, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Johannes Roth
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Sarah Campillo
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Susanne Benseler
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Rayfel Schneider
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Shirley M L Tse
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roxana Bolaria
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Gross
- Department of Pediatrics University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Feldman
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | | | - Bonnie Cameron
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Roman Jurencak
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Jean Dorval
- Centre Hospitalier Universitaire de Laval and Université Laval, Quebec, Québec, Canada
| | - Claire LeBlanc
- McGill University Health Centre and McGill University, Montréal, Québec, Canada
| | - Claire St Cyr
- Centre Hospitalier Universitaire Ste. Justine and Université de Montréal, Montréal, Québec, Canada
| | - Michele Gibbon
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Rae S M Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
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Rawn S, Miettunen P, Brown HA, Schmeling H. Purpura, petechiae, and bullae as first signs of juvenile granulomatosis with polyangiitis. Eur J Pediatr 2014; 173:1685-9. [PMID: 24677133 DOI: 10.1007/s00431-014-2298-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 03/12/2014] [Accepted: 03/14/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED We present a case of a 14-year-old girl who had a severe form of granulomatosis with polyangiitis (GPA) with extensive dermatological involvement, whose initial presentation was nonspecific leading to diagnostic confusion and initial consideration of infectious and other vasculitis causes. The patient presented with fever, congestion, malaise, and sinus pain. She was diagnosed with bacterial sinusitis and treated with antibiotics. Within weeks, she developed abdominal pain, hematuria, migratory arthritis, and palpable purpura and was diagnosed with Henoch-Schonlein purpura. She went on to develop hemoptysis and progression of the rash into erosive bullae. Investigations revealed that she was ANCA positive and had pauci-immune glomerulonephritis. Given her upper airway, pulmonary and renal involvement, and antineutrophil cytoplasmic antibodies positivity, a definitive diagnosis of a severe form of GPA was made. GPA is a chronic relapsing, life threatening vasculitis that predominantly affects small vessels. CONCLUSION Our case demonstrates that GPA can present initially with nonspecific symptoms, including extensive dermatological involvement, leading to diagnostic confusion, and delays in treatment. In the case of a severe peripheral rash in the juvenile population and/or resistant upper airway symptoms, it is vital to consider a diagnosis of GPA to avoid serious organ or life threatening consequences.
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Affiliation(s)
- Saara Rawn
- Northern Ontario School of Medicine, Sudbury, Canada,
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Schmeling H, Minden K, Foeldvari I, Ganser G, Hospach T, Horneff G. Efficacy and safety of adalimumab as the first and second biologic agent in juvenile idiopathic arthritis: the German Biologics JIA Registry. Arthritis Rheumatol 2014; 66:2580-9. [PMID: 24942886 DOI: 10.1002/art.38741] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 06/03/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the efficacy and safety of adalimumab in patients with juvenile idiopathic arthritis (JIA). METHODS Baseline demographic and clinical characteristics and disease activity parameters were prospectively documented in the German Biologics JIA Registry. Efficacy was determined using the American College of Rheumatology (ACR) Pediatric (Pedi) response criteria and the Juvenile Arthritis Disease Activity Score based on a 10-joint count (JADAS-10). Safety assessments were based on adverse event reports from the responsible physician. RESULTS Two hundred eighty-nine patients with a total of 1,046 visits were identified (435.7 patient-years). A high proportion of patients demonstrated a significant response to treatment, with a marked decrease in the JADAS-10 score in both the biologics-naive group (which consisted of patients who had not received therapy with a biologic agent prior to initiation of adalimumab) and the biologic-switcher group (which consisted of patients who had been treated with a different biologic agent prior to initiation of adalimumab). The median JADAS-10 score at treatment start was significantly higher in the biologics-naive group than in the biologic-switcher group (12.9 versus 8.5; P = 0.00044), although the score in the biologics-naive group was lower over the course of adalimumab treatment. ACR Pedi 30, 50, 70, and 90 scores were achieved in 63.4%, 61.0%, 48.8%, and 34.2% of biologics-naive patients, respectively, at 6 months of treatment, while ACR Pedi 30, 50, 70, and 90 scores were achieved in 47.6%, 38.1%, 21.9%, and 15.2% of biologic-switcher patients, respectively. Forty-eight patients experienced 222 adverse events (50.9 per 100 patient-years). Eleven were reported as serious (2.5 per 100 patient-years). No malignancies were observed during adalimumab exposure. There were 16 uveitis flares in 11 patients. Treatment was discontinued in 58 patients for the following reasons: inefficacy 11.1%, adverse events 5.2%, remission 4.5%, patient request 11.8%, and other reasons 7.9%. CONCLUSION Adalimumab appears to be highly effective in children and adolescents with JIA who have been previously treated with biologic agents and in children and adolescents who switched biologic agents. The treatment is safe and its efficacy is similar to that of other biologic agents used to treat JIA. Few patients discontinued therapy due to intolerance or inefficacy.
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Affiliation(s)
- Heinrike Schmeling
- Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada
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Horneff G, Foeldvari I, Ganser G, Thon A, Schmeling H. Methotrexate in oligoarticular persistent juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2014. [PMCID: PMC4190976 DOI: 10.1186/1546-0096-12-s1-p139] [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: 11/16/2022] Open
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Guzman J, Oen K, Tucker LB, Huber AM, Shiff N, Boire G, Scuccimarri R, Berard R, Tse SML, Morishita K, Stringer E, Johnson N, Levy DM, Duffy KW, Cabral DA, Rosenberg AM, Larché M, Dancey P, Petty RE, Laxer RM, Silverman E, Miettunen P, Chetaille AL, Haddad E, Houghton K, Spiegel L, Turvey SE, Schmeling H, Lang B, Ellsworth J, Ramsey S, Bruns A, Campillo S, Benseler S, Chédeville G, Schneider R, Yeung R, Duffy CM. The outcomes of juvenile idiopathic arthritis in children managed with contemporary treatments: results from the ReACCh-Out cohort. Ann Rheum Dis 2014; 74:1854-60. [PMID: 24842571 DOI: 10.1136/annrheumdis-2014-205372] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 05/03/2014] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To describe clinical outcomes of juvenile idiopathic arthritis (JIA) in a prospective inception cohort of children managed with contemporary treatments. METHODS Children newly diagnosed with JIA at 16 Canadian paediatric rheumatology centres from 2005 to 2010 were included. Kaplan-Meier survival curves for each JIA category were used to estimate probability of ever attaining an active joint count of 0, inactive disease (no active joints, no extraarticular manifestations and a physician global assessment of disease activity <10 mm), disease remission (inactive disease >12 months after discontinuing treatment) and of receiving specific treatments. RESULTS In a cohort of 1104 children, the probabilities of attaining an active joint count of 0 exceeded 78% within 2 years in all JIA categories. The probability of attaining inactive disease exceeded 70% within 2 years in all categories, except for RF-positive polyarthritis (48%). The probability of discontinuing treatment at least once was 67% within 5 years. The probability of attaining remission within 5 years was 46-57% across JIA categories except for polyarthritis (0% RF-positive, 14% RF-negative). Initial treatment included joint injections and non-steroidal anti-inflammatory drugs for oligoarthritis, disease-modifying antirheumatic drugs (DMARDs) for polyarthritis and systemic corticosteroids for systemic JIA. CONCLUSIONS Most children with JIA managed with contemporary treatments attain inactive disease within 2 years of diagnosis and many are able to discontinue treatment. The probability of attaining remission within 5 years of diagnosis is about 50%, except for children with polyarthritis.
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Affiliation(s)
- Jaime Guzman
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Kiem Oen
- Winnipeg Children's Hospital and University of Manitoba, Winnipeg, Canada
| | - Lori B Tucker
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Adam M Huber
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Natalie Shiff
- Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | - Gilles Boire
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Rosie Scuccimarri
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Roberta Berard
- London Health Sciences Centre and Western University, London, Canada
| | - Shirley M L Tse
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Kimberly Morishita
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | | | - Nicole Johnson
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Deborah M Levy
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | | | - David A Cabral
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Alan M Rosenberg
- Royal University Hospital and University of Saskatchewan, Saskatoon, Canada
| | | | - Paul Dancey
- Janeway Children's Health and Rehabilitation Centre and Memorial University, Saint John's, Canada
| | - Ross E Petty
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Ronald M Laxer
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Earl Silverman
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Paivi Miettunen
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | | | - Elie Haddad
- CHU Ste. Justine and Université de Montréal, Montréal, Canada
| | - Kristin Houghton
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Lynn Spiegel
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Stuart E Turvey
- British Columbia Children's Hospital and the University of British Columbia, Vancouver, Canada
| | - Heinrike Schmeling
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Bianca Lang
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Janet Ellsworth
- The Stollery Children's Hospital and University of Alberta, Edmonton, Canada
| | - Suzanne Ramsey
- IWK Health Centre and Dalhousie University, Halifax, Canada
| | - Alessandra Bruns
- Centre Hospitalier Universitaire de Sherbrooke and Université de Sherbrooke, Sherbrooke, Canada
| | - Sarah Campillo
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Susanne Benseler
- The Alberta Children's Hospital and University of Calgary, Calgary, Canada
| | - Gaëlle Chédeville
- McGill University Health Centre and McGill University, Montreal, Canada
| | - Rayfel Schneider
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Rae Yeung
- Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Ciarán M Duffy
- Children's Hospital of Eastern Ontario and University of Ottawa, Ottawa, Canada
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Robinson AB, Hoeltzel MF, Wahezi DM, Becker ML, Kessler EA, Schmeling H, Carrasco R, Huber AM, Feldman BM, Reed AM. Clinical characteristics of children with juvenile dermatomyositis: the Childhood Arthritis and Rheumatology Research Alliance Registry. Arthritis Care Res (Hoboken) 2014; 66:404-10. [PMID: 23983017 DOI: 10.1002/acr.22142] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 08/13/2013] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To investigate aspects of juvenile dermatomyositis (DM), including disease characteristics and treatment, through a national multicenter registry. METHODS Subjects meeting the modified Bohan and Peter criteria for definite juvenile DM were analyzed from the cross-sectional Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry between 2010 and 2012 from 55 US pediatric rheumatology centers. Demographics, disease characteristics, diagnostic assessments, and medication exposure data were collected at enrollment. RESULTS A total of 384 subjects met the criteria for analysis. At enrollment, the median Childhood Myositis Assessment Scale score was 51 (interquartile range [IQR] 46-52), the median Childhood Health Assessment Questionnaire score was 0 (IQR 0-0.5), and the median physician and subject global assessment scores were 1 (IQR 0-2) and 1 (IQR 0-3), respectively, out of a maximum of 10. Of the diagnostic assessments, magnetic resonance imaging was more likely than electromyography or muscle biopsy to show abnormalities. A total of 329 subjects had ≥2 diagnostic studies performed, and >34% of these subjects reported ≥1 negative study. Ninety-five percent had been treated with corticosteroids and 92% with methotrexate, suggesting that these medications were almost universally prescribed for juvenile DM in the US. CONCLUSION In 2 years, the ongoing CARRA Registry has collected clinical data on 384 children with juvenile DM and has the potential to become one of the largest juvenile DM cohorts in the world. More research is needed about prognostic factors in juvenile DM, and differences in therapy based on manifestations of disease need to be explored by practitioners. This registry provides the infrastructure needed to advance clinical and translational research and represents a major step toward improving outcomes of children with juvenile DM.
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Ravelli A, Ruperto N, Pederzoli S, Burgos-Vargas R, Kobusinska K, Schmeling H, Sztajnbok F, Weller-Heinemann F, Zholobova E, Zulian F, Allen R, Chaitow J, Keane C, Wells C, Martini A, Lovell DJ, De Benedetti F. A11: Assessment of Radiographic Progression in Patients With Polyarticular-Course Juvenile Idiopathic Arthritis Treated With Tocilizumab: 2-Year Data From CHERISH. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38422] [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)
| | | | | | | | | | - Heinrike Schmeling
- University of Calgary/Alberta Childrens Hospital Research Institute; Calgary AB
| | | | | | | | | | | | | | | | - Chris Wells
- Roche Products Ltd.; Welwyn Garden City United Kingdom
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Schmeling H, Foeldvari I, Horneff G. A39: Efficacy and Safety of Methotrexate in Oligoarticular Persistent Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2014. [DOI: 10.1002/art.38455] [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: 11/06/2022]
Affiliation(s)
- Heinrike Schmeling
- University of Calgary/Alberta Childrens Hospital Research Institute; Calgary AB
| | - Ivan Foeldvari
- Hamburger Zentrum für Kinder- und Jugendrheumatologie; Klinikum Eilbek, Hamburg Germany
| | - Gerd Horneff
- Asklepios Klinik Sankt Augustin; Sankt Augustin Germany
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