Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care

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.

Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry

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.

Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis

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.

Tissue microarrays in diffuse large B-cell lymphomas: are they really able to identify distinct prognostic groups in lymphomas of both nodal and extranodal origin?

AIMS

Diffuse large B-cell lymphomas (DLBCL) can be divided into different subgroups (germinal center B-cell-like [GCB] and non-GCB) according to their gene expression profiles. Immunohistochemistry has been proposed as a surrogate for identifying these subgroups, but data about its efficacy in providing prognostic information are conflicting.

METHODS AND RESULTS

This study retrospectively analyzed a series of 105 DLBCL, defined as GCB and non-GCB according to CD10, bcl-6, and MUM1 expression. All patients received a first-line anthracycline-based (CHOP-like) chemotherapy. A total of 50 patients (48%) were identified as GCB and 55 (52%) as non-GCB. The overall response rate was 89% (94/105), with 62 (59%) complete response. Disease progressions were equally distributed between the 2 subgroups and were not significantly different (P = .756) considering the primary site of involvement (nodal or extranodal). The median follow-up was 62 months (range 5-126 months). Overall survival at 5 years was not significantly different between the groups (P = .3468) and was 72.3% and 66.6% for GCB and non-GCB, respectively.

CONCLUSION

The results do not support the prognostic value of GCB and non-GCB immunohistochemical categories in DLBCL of both nodal and extranodal origin. Furthermore, a limited number of antigens may be not sufficient to identify the same patterns defined by cDNA microarray. Prospective studies are warranted to address this issue.

Induction of the SOS function sfiA in E. coli by systems which generate triplet ketones

Generation of triplet ketones, either chemically through thermal decomposition of 3-hydroxymethyl-3,4,4-trimethyl-1,2-dioxetane and 3-[N-(pyridino)carbamoyl]methyl-3,4,4-trimethyl-1,2-dioxetane++ + or enzymatically via the aerobic oxidation of isobutyraldehyde trimethylsilyl enol ether catalyzed by horse-radish peroxidase, triggers the SOS function sfiA in E. coli. Although the observed effects are relatively weak and the triplet ketone scavenger tryptophan was ineffective in this system, our results provide evidence for the involvement of triplet ketones in this type of DNA damage. Possible mechanisms are discussed.

Induction of morphological transformation and micronuclei in Syrian hamster embryo fibroblasts by 1,2-dioxetanes. Correlation with single-strand breaks in HL-60 cells

The photochemical genotoxic and cell-transforming potential of 4-hydroxymethyl-3,3,4-trimethyl-1,2-dioxetane (HTMD) and 3-(N-[4-pyridino]carbamoyl)methyl-3,4,4-trimethyl-1,2-dioxetane , (APD), in mammalian cell was studied. Both dioxetanes, which are efficient sources of triplet-excited ketones on thermal decomposition, induced morphological transformation in Syrian hamster embryo (SHE) fibroblasts. Unscheduled DNA synthesis in SHE and in HeLa cells could not be detected with these dioxetanes, but the number of micronuclei scored after the first mitosis was dose-dependently increased. Single-strand breaks but not Micrococcus luteus u.v.-endonuclease sensitive sites were observed by alkaline elution in HL-60 cells when treated with sub-lethal doses of HTMD and APD. A possible mechanism for the transformation mediated by DNA and chromosomal damage as well as the intermediacy of triplet carbonyls in these events are discussed.

Chlorophyll: an efficient detector of electronically excited species in biochemical systems

Micelle-solubilized chlorophyll efficiently detects electronically excited species generated in enzymatic systems. In most, if not all, systems the chemiexcited species is formed in the triplet state; chlorophyll fluorescence is observed as result of energy transfer. Red emission can also be elicited from chlorophyll in chloroplasts or bound to microsomes.

Excitation of micelle-solubilized chlorophyll during the peroxidase-catalyzed aerobic oxidation of isonicotinic acid hydrazide

Addition of micelle (hexadecyl-trimethylammoniumbromide)-solubilized chlorophyll alpha to the isoniazid/peroxidase/Mn2+/O2 system promotes light emission, identified as chlorophyll fluorescence. Based on O2 consumption, the quantum yield of chlorophyll excitation to the S1 state exceeds 6 X 10(-6). At least part of the excitation has its origin in the conversion of an intermediate--presumably a diazene--to pyridine-4-carboxaldehyde. On the basis of the present and earlier results [K. Zinner, C. C. C. Vidigal, N. Durán, and G. Cilento (1977) Arch. Biochem. Biophys. 180, 452-458], it is inferred that isoniazid, an important chemotherapeutic and also a carcinogenic agent, can lead to a substantial generation of electronically excited states.

[The "Meghetometro": an apparatus to measure the body volume in vivo]

Here above the author describes a new apparatus ("meghetometro") to measure the body volume "in vivo" of infants which will also be utilizable for children and adults, if made of larger size. The working principle of the "meghetometro" is the following. The subject under examination will be put into a container filler with air and his volume will be drawn from the pressure variations produced in the gaseous matter (air) as a consequence of the (known) volume variation of the container itself. The value of the volume is of course only a factor that enables us to go back to the specific weight of the subject taken into consideration. We believe the specific weight may have a considerable clinical importance, for example as a symptom of some cases of disendocrinopathy or as an evaluation element of dehydration and edema.

["Preparative" chromatographic fractionation of human carbonic anhydrase isoenzymes. Specific studies on their identification]

The AA. describe a technique for chromatographic fractionation of the isoenzymes of carbonic anhydrase. They utilized a hydroxylapatite column, soaking the isoenzymes suspension at its top. As eluting solutions they utilized a series of phosphate buffers, pH 6,8, at increasing ionic strength. The elution, allowed the separation of three fractions which the AA. identified by spectrophotometric, electrophoretic and immunologic analysis and by atomic absorption spectrophotometry. -- Electrophoretic analysis showed that the "first fraction" eluted from the chromatographic column corresponding to the first peak, contained 8,5% of total protein, the "second chromatographic fraction", corresponding to the second electrophoretic peak contained 82,5%, whereas the "third" contained 9%. -- Nitrogen contents in the three eluted fractions showed the following values: 6,6% in the first fraction, 85,5% in the second, 8% in the third. These values are very near the ones obtained from ferogram. -- Spectrophotometric analysis revealed similar structure for the three fraction, in the range 230-300 nm of spectrum and a second peak at 400 nm for the third eluted fraction. -- The atomic spectrophotometric absorption revealed the presence of zinc in the three fractions, the amount of the element resulted almost constantly related to the nitrogen concentration in each of them.

[Current state of the world's experiences with vaccination against rubella]

In order to avoid the severe consequences that may result from intrauterine infection, the prevention of maternal rubella is of most importance. It should be remarked that the damage induced in the infant by the rubella virus is not confined to the first trimester of pregnancy, but may occur also in the following months, and some lesions, especially the auditive ones, may become worse during the childhood. From an immunological point of view in the present paper it is emphasized the prominent importance of neutralizing antibodies; these should be more broadly assayed in epidemiological investigations and in studies concerning the effects of the different vaccines that are available nowadays. In this connection, the RA 27/3 vaccine (prepared with human diploid cells) appears to be more effective than other vaccines (e.g.: Cendehill and HPV-77) in stimulating the formation of circulating antibodies. Furthermore this vaccine, which may be administrated intranasally, can produce a local resistence due to the presence of specific IgA in the secretions. The following programs have been proposed for the prevention of rubella: a mass-vaccination (as in the United States) and a selective vaccination of female prepubere subjects who appear to be non protected against the infection. The Authors consider the second program as the more advantageous and suggest that the age range should be 10-11 years. It may be interesting to note that a new anti-rubella vaccine has been recently employed in Soviet Union with satisfactory results, while an alive attenuate non-teratogenic vaccine has been prepared in Japan. However, the opinion of the Authors is that further studies are needed in order to obtain a really non-teratogenic vaccine and administrable intranasally; this should be the most effective means against all problems correlated to rubella infection.