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Wang CS, Sadun RE, Zhou W, Miller KR, Pyle L, Ardoin SP, Bacha C, Hause E, Hui-Yuen J, Ling N, Pereira M, Riebschleger M, Rouster-Stevens K, Sarkissian A, Shalen J, Soulsby W, Twilt M, Wu EY, Lewandowski LB, Wenderfer SE, Cooper JC. Renal Response Outcomes of the EuroLupus and National Institutes of Health Cyclophosphamide Dosing Regimens in Childhood-Onset Proliferative Lupus Nephritis. Arthritis Rheumatol 2024; 76:469-478. [PMID: 37800549 DOI: 10.1002/art.42725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 09/07/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE We compared clinical characteristics and renal response in patients with childhood-onset proliferative lupus nephritis (LN) treated with the EuroLupus versus National Institutes of Health (NIH) cyclophosphamide (CYC) regimen. METHODS A retrospective cohort study was conducted at 11 pediatric centers in North America that reported using both CYC regimens. Data were extracted from the electronic medical record at baseline and 3, 6, and 12 months after treatment initiation with CYC. To evaluate the adjusted association between CYC regimen (EuroLupus vs NIH) and renal response over time, generalized estimating equations with a logit link were used. An interaction between time and CYC regimen was included, and a contrast between CYC regimens at 12 months was used to evaluate the primary outcome. RESULTS One hundred forty-five patients (58 EuroLupus, 87 NIH) were included. EuroLupus patients were on average older at the start of current CYC therapy, had longer disease duration, and more commonly had relapsed or refractory LN compared with the NIH group. After multivariable adjustment, there was no significant association between CYC regimen and achieving complete renal response at 12 months (odds ratio [OR] of response for the EuroLupus regimen, reference NIH regimen: 0.76; 95% confidence interval [CI] 0.29-1.98). There was also no significant association between CYC regimen and achieving at least a partial renal response at 12 months (OR 1.35, 95% CI 0.57-3.19). CONCLUSION Our study failed to demonstrate a benefit of the NIH regimen over the EuroLupus CYC regimen in childhood-onset proliferative LN. However, future prospective outcome studies are needed.
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Affiliation(s)
| | | | - Wenru Zhou
- University of Colorado Anschutz Medical Campus, Aurora
| | | | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Aurora
| | | | | | - Emily Hause
- University of Minnesota Masonic Children's Hospital, Minneapolis
| | - Joyce Hui-Yuen
- Cohen Children's Medical Center, New Hyde Park, New York
| | | | - Maria Pereira
- Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | | | - Kelly Rouster-Stevens
- Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia
| | | | - Julia Shalen
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Marinka Twilt
- Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Laura B Lewandowski
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, NIH, Bethesda, Maryland
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Ikram N, Lewandowski LB, Watt MH, Scott C. Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study. Res Sq 2024:rs.3.rs-3919073. [PMID: 38464004 PMCID: PMC10925452 DOI: 10.21203/rs.3.rs-3919073/v1] [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] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background: Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members). Methods: Caregivers (n=22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth ( < 19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria. Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis. Results: Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient. Conclusion: These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to attrition. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings.
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Woo JM, Simmonds F, Dennos A, Son MBF, Lewandowski LB, Rubinstein TB. Health Equity Implications of Missing Data Among Youths With Childhood-Onset Systemic Lupus Erythematosus: A Proof-of-Concept Study in the Childhood Arthritis and Rheumatology Research Alliance Registry. Arthritis Care Res (Hoboken) 2023; 75:2285-2294. [PMID: 37093036 PMCID: PMC10593908 DOI: 10.1002/acr.25136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 03/15/2023] [Accepted: 04/18/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE Health disparities in childhood-onset systemic lupus erythematosus (SLE) disproportionately impact marginalized populations. Socioeconomically patterned missing data can magnify existing health inequities by supporting inferences that may misrepresent populations of interest. Our objective was to assess missing data and subsequent health equity implications among participants with childhood-onset SLE enrolled in a large pediatric rheumatology registry. METHODS We evaluated co-missingness of 12 variables representing demographics, socioeconomic position, and clinical factors (e.g., disease-related indices) using Childhood Arthritis and Rheumatology Research Alliance Registry childhood-onset SLE enrollment data (2015-2022; n = 766). We performed logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for missing disease-related indices at enrollment (Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI-2K] and/or Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]) associated with data missingness. We used linear regression to assess the association between socioeconomic factors and SLEDAI-2K at enrollment using 3 analytic methods for missing data: complete case analysis, multiple imputation, and nonprobabilistic bias analyses, with missing values imputed to represent extreme low or high disadvantage. RESULTS On average, participants were missing 6.2% of data, with over 50% of participants missing at least 1 variable. Missing data correlated most closely with variables within data categories (i.e., demographic). Government-assisted health insurance was associated with missing SLEDAI-2K and/or SDI scores compared to private health insurance (OR 2.04 [95% CI 1.22, 3.41]). The different analytic approaches resulted in varying analytic sample sizes and fundamentally conflicting estimated associations. CONCLUSION Our results support intentional evaluation of missing data to inform effect estimate interpretation and critical assessment of causal statements that might otherwise misrepresent health inequities.
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Affiliation(s)
- Jennifer M.P. Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (NIH), Department of Health and Human Services (DHHS), Research Triangle Park, NC, USA
| | - Faith Simmonds
- Lupus Genomics and Global Health Disparities Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, DHHS, Bethesda, MD, USA
| | - Anne Dennos
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
| | - Mary Beth F. Son
- Division of Immunology, Boston Children’s Hospital, Boston MA, USA
| | - Laura B. Lewandowski
- Lupus Genomics and Global Health Disparities Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), NIH, DHHS, Bethesda, MD, USA
| | - Tamar B. Rubinstein
- Division of Pediatric Rheumatology, Children’s Hospital at Montefiore, Bronx, NY, USA
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
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4
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Vazzana KM, Musolf AM, Bailey-Wilson JE, Hiraki LT, Silverman ED, Scott C, Dalgard CL, Hasni S, Deng Z, Kaplan MJ, Lewandowski LB. Transmission disequilibrium analysis of whole genome data in childhood-onset systemic lupus erythematosus. Genes Immun 2023; 24:200-206. [PMID: 37488248 PMCID: PMC10529982 DOI: 10.1038/s41435-023-00214-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 06/23/2023] [Accepted: 07/06/2023] [Indexed: 07/26/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) patients are unique, with hallmarks of Mendelian disorders (early-onset and severe disease) and thus are an ideal population for genetic investigation of SLE. In this study, we use the transmission disequilibrium test (TDT), a family-based genetic association analysis that employs robust methodology, to analyze whole genome sequencing data. We aim to identify novel genetic associations in an ancestrally diverse, international cSLE cohort. Forty-two cSLE patients and 84 unaffected parents from 3 countries underwent whole genome sequencing. First, we performed TDT with single nucleotide variant (SNV)-based (common variants) using PLINK 1.9, and gene-based (rare variants) analyses using Efficient and Parallelizable Association Container Toolbox (EPACTS) and rare variant TDT (rvTDT), which applies multiple gene-based burden tests adapted for TDT, including the burden of rare variants test. Applying the GWAS standard threshold (5.0 × 10-8) to common variants, our SNV-based analysis did not return any genome-wide significant SNVs. The rare variant gene-based TDT analysis identified many novel genes significantly enriched in cSLE patients, including HNRNPUL2, a DNA repair protein, and DNAH11, a ciliary movement protein, among others. Our approach identifies several novel SLE susceptibility genes in an ancestrally diverse childhood-onset lupus cohort.
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Affiliation(s)
- Kathleen M Vazzana
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
- Arnold Palmer Hospital for Children, Orlando, FL, USA
| | - Anthony M Musolf
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Baltimore, MD, 22124, USA
| | - Joan E Bailey-Wilson
- Computational and Statistical Genomics Branch, National Human Genome Research Institute, National Institutes of Health, Baltimore, MD, 22124, USA
| | - Linda T Hiraki
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Earl D Silverman
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Christiaan Scott
- Paediatric Rheumatology, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - Clifton L Dalgard
- The American Genome Center, Department of Anatomy, Physiology & Genetics, Uniformed Services University, Bethesda, MD, USA
| | - Sarfaraz Hasni
- Clinical Program, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Zuoming Deng
- Biodata Mining and Discovery Section, Office of Science and Technology, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Laura B Lewandowski
- Lupus Genomics and Global Health Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA.
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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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Smith EMD, Aggarwal A, Ainsworth J, Al-Abadi E, Avcin T, Bortey L, Burnham J, Ciurtin C, Hedrich CM, Kamphuis S, Levy DM, Lewandowski LB, Maxwell N, Morand EF, Ozen S, Pain CE, Ravelli A, Saad Magalhaes C, Pilkington CA, Schonenberg-Meinema D, Scott C, Tullus K, Beresford MW. Towards development of treat to target (T2T) in childhood-onset systemic lupus erythematosus: PReS-endorsed overarching principles and points-to-consider from an international task force. Ann Rheum Dis 2023; 82:788-798. [PMID: 36627168 PMCID: PMC10314055 DOI: 10.1136/ard-2022-223328] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/09/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Application of 'treat-to-target' (T2T) in childhood-onset systemic lupus erythematosus (cSLE) may improve care and health outcomes. This initiative aimed to harmonise existing evidence and expert opinion regarding T2T for cSLE. METHODS An international T2T Task Force was formed of specialists in paediatric rheumatology, paediatric nephrology, adult rheumatology, patient and parent representatives. A steering committee formulated a set of draft overarching principles and points-to-consider, based on evidence from systematic literature review. Two on-line preconsensus meeting Delphi surveys explored healthcare professionals' views on these provisional overarching principles and points-to-consider. A virtual consensus meeting employed a modified nominal group technique to discuss, modify and vote on each overarching principle/point-to-consider. Agreement of >80% of Task Force members was considered consensus. RESULTS The Task Force agreed on four overarching principles and fourteen points-to-consider. It was agreed that both treatment targets and therapeutic strategies should be subject to shared decision making with the patient/caregivers, with full remission the preferred target, and low disease activity acceptable where remission cannot be achieved. Important elements of the points-to-consider included: aiming for prevention of flare and organ damage; glucocorticoid sparing; proactively addressing factors that impact health-related quality of life (fatigue, pain, mental health, educational challenges, medication side effects); and aiming for maintenance of the target over the long-term. An extensive research agenda was also formulated. CONCLUSIONS These international, consensus agreed overarching principles and points-to-consider for T2T in cSLE lay the foundation for future T2T approaches in cSLE, endorsed by the Paediatric Rheumatology European Society.
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Affiliation(s)
- Eve Mary Dorothy Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Amita Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jenny Ainsworth
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Eslam Al-Abadi
- Department of Paediatric Rheumatology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Tadej Avcin
- Department of Pediatric Rheumatology and Clinical Immunology, University Medical Centre Ljubljana Division of Paediatrics, Ljubljana, Slovenia
| | - Lynette Bortey
- TARGET Lupus Public Patient Involvement and Engagement Group, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Jon Burnham
- Department of Pediatric Rheumatology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Coziana Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, London, UK
| | - Christian M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Deborah M Levy
- Department of Pediatric Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatric Rheumatology, University of Toronto, Toronto, Ontario, Canada
| | - Laura B Lewandowski
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases Systemic Autoimmunity Branch, Bethesda, Maryland, USA
| | - Naomi Maxwell
- TARGET Lupus Public Patient Involvement and Engagement Group, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
| | - Eric F Morand
- Department of Rheumatology, Monash University, Clayton, Victoria, Australia
| | - Seza Ozen
- Department of Pediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Clare E Pain
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Angelo Ravelli
- Direzione Scientifica, Istituto Giannina Gaslini Istituto Pediatrico di Ricovero e Cura a Carattere Scientifico, Genova, Liguria, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINIGMI), Università degli Studi di Genova, Genova, Italy
| | - Claudia Saad Magalhaes
- Department of Pediatric Rheumatology, Botucatu Medical School, Sao Paulo University Faculty of Medicine, Sao Paulo, Brazil
| | - Clarissa A Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, University of Amsterdam, Amsterdam, The Netherlands
- Emma Children's Hospital, Amsterdam University Medical Centres, Duivendrecht, The Netherlands
| | - Christiaan Scott
- Department of Paediatric Rheumatology, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Kjell Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, London, UK
| | - Michael William Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool Faculty of Health and Life Sciences, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Cannon LA, Wenderfer SE, Lewandowski LB, Cooper JC, Goilav B, Knight AM, Hersh AO, Ardoin SP, Sadun RE. Use of EuroLupus Cyclophosphamide Dosing for the Treatment of Lupus Nephritis in Childhood-onset Systemic Lupus Erythematosus in North America. J Rheumatol 2022; 49:607-614. [PMID: 35169053 PMCID: PMC10464387 DOI: 10.3899/jrheum.210428] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Childhood-onset systemic lupus erythematosus (cSLE) has higher rates of lupus nephritis (LN) than adult-onset SLE, often requiring intensive immunosuppression. This study examined North American practices and preferences for the low-dose EuroLupus cyclophosphamide (CYC) protocol, as compared to the high-dose National Institutes of Health (NIH) CYC protocol, to treat LN in cSLE. METHODS A 35-item Web-based survey was distributed to Childhood Arthritis and Rheumatology Research Alliance (CARRA) and Pediatric Nephrology Research Consortium (PNRC) providers. The survey assessed participant demographics, CYC prescribing practices, perceptions of EuroLupus protocol, and LN vignette treatment decisions; 1 vignette was taken from a 2009 CARRA survey and responses were compared. Multivariable logistic regression analyzed provider factors associated with use of low- vs high-dose CYC. RESULTS Responses were provided by 185/421 (44%) pediatric rheumatologists (CARRA) and 40/354 (11%) pediatric nephrologists (PNRC). Among respondents who prescribed CYC for pediatric LN over the past year (n = 135), half reported using EuroLupus. When presented with the same vignette about an adolescent with class IV LN, 32% of pediatric rheumatologists chose EuroLupus dosing in 2020, vs 6% in 2009. Provider factors associated with choosing the low-dose regimen were familiarity with the protocol (OR 4.2, P = 0.006) and greater perceived benefit (OR 1.6, P < 0.0001). Pediatric nephrologists had similar responses to the pediatric rheumatology providers. Overall, 78% of respondents perceived EuroLupus protocol efficacy to be equivalent to the high-dose protocol in cSLE LN. CONCLUSION Pediatric specialists are currently more likely to use low-dose CYC to treat cSLE LN than they were a decade ago. Nevertheless, familiarity with EuroLupus dosing remains low.
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Affiliation(s)
- Laura A Cannon
- L.A. Cannon, MD, Division of Pediatric Rheumatology, Department of Pediatrics, Duke University, Durham, and Division of Pediatric Rheumatology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA;
| | - Scott E Wenderfer
- S.E. Wenderfer, MD, Department of Pediatrics, Baylor College of Medicine; Renal Section, Texas Children's Hospital, Houston, Texas, USA
| | - Laura B Lewandowski
- L.B. Lewandowski, MD, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer C Cooper
- J.C. Cooper, MD, Division of Pediatric Rheumatology, Department of Pediatrics, University of Colorado, Denver, Colorado, USA
| | - Beatrice Goilav
- B. Goilav, MD, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrea M Knight
- A.M. Knight, MD, Division of Pediatric Rheumatology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aimee O Hersh
- A.O. Hersh, MD, Division of Pediatric Rheumatology, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Stacy P Ardoin
- S.P. Ardoin, MD, Division of Pediatric Rheumatology, Department of Pediatrics, and Division of Rheumatology, Department of Medicine, The Ohio State University, Columbus, Ohio, USA
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8
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Bilsborrow JB, Peláez-Ballestas I, Pons-Estel B, Scott C, Tian X, Alarcon GS, Bucala R, Lewandowski LB, Hsieh E. Global Rheumatology Research: Frontiers, Challenges, and Opportunities. Arthritis Rheumatol 2022; 74:1-4. [PMID: 34535973 PMCID: PMC8712358 DOI: 10.1002/art.41980] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/27/2021] [Accepted: 09/14/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Joshua B. Bilsborrow
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States,Veterans Affairs Connecticut Healthcare System, West Haven VA Medical Center, West Haven, Connecticut, United States
| | - Ingris Peláez-Ballestas
- Rheumatology Department, Hospital General de México “Dr. Eduardo Liceaga,” Mexico City, Mexico
| | - Bernardo Pons-Estel
- Centro Regional de Enfermedades Autoinmunes y Reumáticas (GO-CREAR), Rosario, Santa Fe, Argentina
| | - Christiaan Scott
- Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Xinping Tian
- Department of Rheumatology, Peking Union Medical College Hospital, Beijing, China
| | - Graciela S. Alarcon
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States and School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Richard Bucala
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Laura B. Lewandowski
- National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland, United States
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, United States,Veterans Affairs Connecticut Healthcare System, West Haven VA Medical Center, West Haven, Connecticut, United States
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9
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Vazzana KM, Daga A, Goilav B, Ogbu EA, Okamura DM, Park C, Sadun RE, Smitherman EA, Stotter BR, Dasgupta A, Knight AM, Hersh AO, Wenderfer SE, Lewandowski LB. Principles of pediatric lupus nephritis in a prospective contemporary multi-center cohort. Lupus 2021; 30:1660-1670. [PMID: 34219529 PMCID: PMC10461610 DOI: 10.1177/09612033211028658] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lupus nephritis (LN) is a life-threatening manifestation of systemic lupus erythematosus (SLE) and is more common in children than adults. The epidemiology and management of childhood-onset SLE (cSLE) have changed over time, prompting the need to reassess expected outcomes. The purpose of this study is to use the Childhood Arthritis and Rheumatology Research Alliance (CARRA) prospective registry to validate historical principles of LN in a contemporary, real-world cohort. After an extensive literature review, six principles of LN in cSLE were identified. The CARRA registry was queried to evaluate these principles in determining the rate of LN in cSLE, median time from cSLE diagnosis to LN, short-term renal outcomes, and frequency of rituximab as an induction therapy. Of the 677 cSLE patients in the CARRA registry, 32% had documented LN. Decline in kidney function was more common in Black cSLE patients than non-Black patients (p = 0.04). Black race was associated with worse short-term renal outcomes. In short-term follow up, most children with LN had unchanged or improved kidney function, and end stage kidney disease (ESKD) was rare. Ongoing follow-up of cSLE patients in the CARRA registry will be necessary to evaluate long-term outcomes to inform risk, management, and prognosis of LN in cSLE.
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Affiliation(s)
- Kathleen M Vazzana
- Lupus Genomics and Global Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Ankana Daga
- Division of Nephrology, Boston Children's Hospital, Boston, MA, USA
| | - Beatrice Goilav
- Division of Nephrology, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ekemini A Ogbu
- Department of Pediatrics, 1466Johns Hopkins University, Division of Pediatric Allergy, Immunology and Rheumatology, Johns Hopkins University, Baltimore, MD, USA
| | - Daryl M Okamura
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - Catherine Park
- Division of Nephrology, Children's National Hospital, Washington, DC, USA
| | | | - Emily A Smitherman
- Division of Rheumatology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Brian R Stotter
- Division of Pediatric Nephrology, Hypertension & Pheresis, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | | | - Andrea M Knight
- Division of Pediatric Rheumatology, 7979Hospital for Sick Children, Hospital for Sick Children, Toronto, Canada
| | - Aimee O Hersh
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Scott E Wenderfer
- Division of Pediatric Nephrology, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Laura B Lewandowski
- Lupus Genomics and Global Disparities Unit, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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10
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Affiliation(s)
- Laura B Lewandowski
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892-1102, USA
| | - Evelyn Hsieh
- Section of Rheumatology, Allergy, and Immunology, Yale School of Medicine, New Haven, CT, USA.,Section of Rheumatology, Veteran Affairs Connecticut Healthcare System, West Haven, CT, USA
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11
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Lewandowski LB, Schiffenbauer A, Mican JM, Moses SJ, Fallah MP, Plotz P, Katz JD. Rheumatology capacity building: implementing a rheumatology curriculum for Liberian health-care providers in 2016. Clin Rheumatol 2020; 39:689-696. [PMID: 31960207 PMCID: PMC10461609 DOI: 10.1007/s10067-019-04817-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/03/2019] [Accepted: 10/10/2019] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Liberia has no rheumatology providers for the nation's 4.7 million people. We proposed a short course format rheumatology curriculum to educate Liberian providers as an initial step in providing graduate medical education in musculoskeletal health. METHOD A 1-week training curriculum in rheumatology encompassing introduction to musculoskeletal exam and approach to rheumatology diagnosis and management was designed. The curriculum used multiple education methods including interactive lectures, bedside training, and hands-on learning. RESULTS A 1-week rheumatology training curriculum for 24 local physicians was feasible. The execution of the designed rheumatology curriculum in Liberia relied upon a mixed method format that was both didactic and case-based. A survey of the Liberian trainees revealed that the curriculum was salient to care of patients and barriers to optimal learning such as time and space limitations were identified. CONCLUSIONS A 1-week rheumatology training education program is possible and relevant to local providers, but training length and setting may need to be optimized. Future training will aim to minimize barriers to education and expand the cohort of providers with rheumatologic knowledge in Liberia.Key Points• Liberia, like many nations in sub-Saharan Africa, has no trained rheumatologists to serve the nation's population.• Education and capacity building for rheumatologic care in short course format are relevant and feasible to local health-care providers.• Further efforts are needed to develop and evaluate continuing rheumatology education in Liberia.
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Affiliation(s)
| | - Adam Schiffenbauer
- Environmental Autoimmunity Group, National Institute of Environmental Health Sciences, National Institutes of Health, Bethesda, MD, USA
| | - JoAnn M Mican
- NIAID, National Institutes of Health, Bethesda, MD, USA
| | - Soka J Moses
- John F. Kennedy Medical Center, Monrovia, Liberia
| | | | - Paul Plotz
- NIAMS, National Institutes of Health, Bethesda, MD, USA
| | - James D Katz
- NIAMS, National Institutes of Health, Bethesda, MD, USA
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12
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Harrison MJ, Zühlke LJ, Lewandowski LB, Scott C. Pediatric systemic lupus erythematosus patients in South Africa have high prevalence and severity of cardiac and vascular manifestations. Pediatr Rheumatol Online J 2019; 17:76. [PMID: 31771606 PMCID: PMC6878620 DOI: 10.1186/s12969-019-0382-x] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/13/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Pediatric onset of systemic lupus erythematosus (SLE) is associated with major organ involvement, and African patients tend to develop more aggressive disease than patients of European descent. Although cardiovascular involvement is common in pediatric SLE, there are few published reports on the subject. This study describes the frequency and characteristics of cardiac and vascular manifestations of pediatric SLE in a multi-ethnic South African cohort. METHODS Demographic, clinical, and echocardiographic data were collected from pediatric SLE patients at two centers in Cape Town, South Africa. At the time of investigation, this cohort consisted of 93 participants diagnosed with SLE according to international classification criteria prior to the age of 19. Individuals with cardiac and/or vascular involvement were identified by retrospective chart review. Cardiac manifestations were defined as presence of pericardial effusion, myocarditis, cardiomyopathy, cardiac failure, Libman-Sacks endocarditis, myocardial infarction, and arrhythmia. Vascular manifestations included deep vein thrombosis, pulmonary embolism, sinus thrombosis, stroke, critical limb ischemia, cerebral vasculitis and systemic vasculitis. Statistical analysis was performed using R (v3.4.1). RESULTS Cardiac and vascular involvement was present in 47% of the cohort. Previous studies have reported prevalence of 5%-50%. Demographic features of those with cardiac/vascular involvement did not differ from the overall cohort. Echocardiographic data were available for 23 participants. The most common cardiac manifestations were pericardial effusion (n = 24) and cardiac failure (n = 8), while the most common vascular manifestations were cerebral vasculitis (n = 9), stroke (n = 7), and pulmonary embolism (n = 7). Cardiovascular manifestations were frequently severe; one third of pericardial effusion cases required intervention, including three cases of cardiac tamponade. Cardiac and vascular involvement conferred an increased risk of mortality (31.1% versus 10.4%). CONCLUSIONS Cardiac and vascular involvement were highly prevalent in this South African cohort. The mortality rate was high, and severe manifestations were frequent. Prospective research is needed to improve knowledge of pediatric SLE in Africa and to improve outcomes for this high-risk population.
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Affiliation(s)
- Michael J. Harrison
- Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Liesl J. Zühlke
- Division of Pediatric Cardiology, Department of Pediatrics, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Laura B. Lewandowski
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, DHHS, 9000 Rockville Pike, Building 10, 12N248 Room 28, Bethesda, MD 20892-1102 USA
| | - Christiaan Scott
- Division of Pediatric Rheumatology, Department of Pediatrics, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
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13
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Smith EMD, Lewandowski LB, Jorgensen AL, Phuti A, Nourse P, Scott C, Beresford MW. Growing international evidence for urinary biomarker panels identifying lupus nephritis in children - verification within the South African Paediatric Lupus Cohort. Lupus 2018; 27:2190-2199. [PMID: 30348048 DOI: 10.1177/0961203318808376] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A urinary biomarker panel including alpha-1-acid-glycoprotein (AGP), lipocalin-like-prostaglandin-D-synthase (LPGDS), transferrin and ceruloplasmin demonstrates an 'excellent' ability for identifying active lupus nephritis in UK/US children. This study aimed to assess whether this panel identifies active lupus nephritis within the South African Paediatric Lupus Cohort. METHODS Juvenile-onset-systemic lupus erythematosus (JSLE) patients aged < 19 years at diagnosis and healthy controls were recruited. Patients were categorized as having active lupus nephritis (renal BILAG score; A/B and previous histological confirmation) or inactive lupus nephritis (renal BILAG score: D/E). Urinary biomarkers were quantified by ELISA. Mann-Whitney U-test compared biomarker levels between groups. Binary logistic regression and receiver operating curve analysis assessed biomarker combinations. RESULTS Twenty-three juvenile-onset-systemic lupus erythematosus patients were recruited with a median age of 13.5 years (interquartile range (IQR) 12.7-14.9) and disease duration of 2.6 years (IQR 1.8-4.0). Eighteen healthy controls had a median age of 11.0 years (IQR 10.0-12.0). AGP, LPGDS, transferrin, ceruloplasmin and VCAM-1 were significantly higher in active than in inactive lupus nephritis patients (corrected p-values, all pc < 0.05), with no difference between inactive lupus nephritis patients and healthy controls (all pc = 1.0). The optimal biomarker combination included AGP, ceruloplasmin, LPGDS and transferrin (area under the curve = 1.0). CONCLUSIONS A urinary biomarker panel comprising AGP, ceruloplasmin, LPGDS and transferrin previously validated within UK/US cohorts also performed excellently within a racially distinct South African cohort which displayed more severe lupus nephritis.
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Affiliation(s)
- E M D Smith
- 1 Department of Women's & Children's Health, University of Liverpool, UK.,2 Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - L B Lewandowski
- 3 Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, USA
| | - A L Jorgensen
- 4 Department of Biostatistics, University of Liverpool, UK
| | - A Phuti
- 5 Paediatric Rheumatology, University of Cape Town, South Africa
| | - P Nourse
- 6 Paediatric Nephrology, University of Cape Town, South Africa
| | - C Scott
- 5 Paediatric Rheumatology, University of Cape Town, South Africa
| | - M W Beresford
- 1 Department of Women's & Children's Health, University of Liverpool, UK.,2 Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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14
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Tektonidou MG, Lewandowski LB, Hu J, Dasgupta A, Ward MM. Survival in adults and children with systemic lupus erythematosus: a systematic review and Bayesian meta-analysis of studies from 1950 to 2016. Ann Rheum Dis 2017; 76:2009-2016. [PMID: 28794077 DOI: 10.1136/annrheumdis-2017-211663] [Citation(s) in RCA: 123] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 07/05/2017] [Accepted: 07/18/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine trends in survival among adult and paediatric patients with systemic lupus erythematosus (SLE) from 1950 to the present. METHODS We performed a systematic literature review to identify all published cohort studies on survival in patients with SLE. We used Bayesian methods to derive pooled survival estimates separately for adult and paediatric patients, as well as for studies from high-income countries and low/middle-income countries. We pooled contemporaneous studies to obtain trends in survival over time. We also examined trends in major causes of death. RESULTS We identified 125 studies of adult patients and 51 studies of paediatric patients. Among adults, survival improved gradually from the 1950s to the mid-1990s in both high-income and low/middle-income countries, after which survival plateaued. In 2008-2016, the 5-year, 10-year and 15-year pooled survival estimates in adults from high-income countries were 0.95, 0.89 and 0.82, and in low/middle-income countries were 0.92, 0.85 and 0.79, respectively. Among children, in 2008-2016, the 5-year and 10-year pooled survival estimates from high-income countries were 0.99 and 0.97, while in low/middle-income countries were 0.85 and 0.79, respectively. The proportion of deaths due to SLE decreased over time in studies of adults and among children from high-income countries. CONCLUSIONS After a period of major improvement, survival in SLE has plateaued since the mid-1990s. In high-income countries, 5-year survival exceeds 0.95 in both adults and children. In low/middle-income countries, 5-year and 10-year survival was lower among children than adults.
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Affiliation(s)
- Maria G Tektonidou
- Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, Medical School, Athens, Greece
| | - Laura B Lewandowski
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Intramural Research Program, Bethesda, Maryland, USA
| | - Jinxiang Hu
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Intramural Research Program, Bethesda, Maryland, USA
| | - Abhijit Dasgupta
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Intramural Research Program, Bethesda, Maryland, USA
| | - Michael M Ward
- National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, Intramural Research Program, Bethesda, Maryland, USA
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15
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Lewandowski LB, Watt MH, Schanberg LE, Thielman NM, Scott C. Missed opportunities for timely diagnosis of pediatric lupus in South Africa: a qualitative study. Pediatr Rheumatol Online J 2017; 15:14. [PMID: 28231857 PMCID: PMC5322669 DOI: 10.1186/s12969-017-0144-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/24/2016] [Accepted: 01/29/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Systemic Lupus Erythematosus (SLE) is a serious multisystem autoimmune disease, which is more aggressive in children and people of African descent. In South Africa, pediatric SLE (pSLE) patients are at high risk for severe disease. Similar to pSLE worldwide, South African children and adolescents with SLE require subspecialized medical care. The aim of this study is to describe the care-seeking experiences of families and examine factors that contribute to delays in the diagnosis of pSLE. Specifically, we sought to identify factors to inform interventions that support the timely referral and diagnosis of pediatric SLE patients in South Africa. METHODS In-depth, semi-structured interviews were conducted with 22 caregivers of pSLE patients recruited from two government hospitals in Cape Town, South Africa in 2014. Interviews were audio-recorded, transcribed, and analyzed for themes related to barriers to diagnosis. RESULTS Six themes were identified and classified as either caregiver or health system barriers to diagnosis. Caregiver barriers included lack of knowledge regarding SLE, financial difficulties, and the social stigma of SLE. Health system barriers were lack of trained staff, a complex medical system, and misdiagnosis. CONCLUSION Caregivers reported missed opportunities for diagnosing pSLE in their children. Raising public awareness may improve caregiver awareness and reduce stigma of pSLE. Improving family education at diagnosis holds potential to increase patient-physician trust and mitigate fear. Education modules for primary care providers at initial point of contact with the health care system may improve recognition of early pSLE and facilitate expedited referral to a specialist.
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Affiliation(s)
- Laura B. Lewandowski
- National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, DHHS, 9000 Rockville Pike, Building 10, 12 N248 Room 28, Bethesda, MD 20892-1102 USA ,0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA ,0000000100241216grid.189509.cPediatric Rheumatology, Duke University Medical Center, 2301 Erwin Road, Durham, NC USA ,0000 0004 1937 1151grid.7836.aRed Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape South Africa
| | - Melissa H. Watt
- 0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Laura E. Schanberg
- 0000000100241216grid.189509.cPediatric Rheumatology, Duke University Medical Center, 2301 Erwin Road, Durham, NC USA
| | - Nathan M. Thielman
- 0000 0004 1936 7961grid.26009.3dDuke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710 USA
| | - Christiaan Scott
- 0000 0004 1937 1151grid.7836.aRed Cross War Memorial Children’s Hospital, University of Cape Town, Klipfontein Road, Rondebosch, Cape Town, Western Cape South Africa
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Abstract
PURPOSE OF REVIEW Atherosclerotic cardiovascular disease confers significant morbidity and mortality in patients with systemic lupus erythematosus (SLE) and cannot be fully explained by traditional cardiovascular risk factors. Recent immunologic discoveries have outlined putative pathways in SLE that may also accelerate the development of atherosclerosis. RECENT FINDINGS Aberrant innate and adaptive immune responses implicated in lupus pathogenesis may also contribute to the development of accelerated atherosclerosis in these patients. Defective apoptosis, abnormal lipoprotein function, autoantibodies, aberrant neutrophil responses, and a dysregulated type I interferon pathway likely contribute to endothelial dysfunction. SLE macrophages have an inflammatory phenotype that may drive progression of plaque. SUMMARY Recent discoveries have placed increased emphasis on the immunology of atherosclerotic cardiovascular disease. Understanding the factors that drive the increased risk for cardiovascular disease in SLE patients may provide selective therapeutic targets for reducing inflammation and improving outcomes in atherosclerosis.
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Affiliation(s)
- Laura B. Lewandowski
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892
| | - Mariana J. Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD 20892
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17
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Lewandowski LB, Schanberg LE, Thielman N, Phuti A, Kalla AA, Okpechi I, Nourse P, Gajjar P, Faller G, Ambaram P, Reuter H, Spittal G, Scott C. Severe disease presentation and poor outcomes among pediatric systemic lupus erythematosus patients in South Africa. Lupus 2016; 26:186-194. [PMID: 27488473 DOI: 10.1177/0961203316660625] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Systemic lupus erythematosus (SLE) is a life-threatening multisystem autoimmune disease that is more severe in patients of African ancestry and children, yet pediatric SLE on the African continent has been understudied. This study describes a cohort of pediatric SLE (PULSE) patients in South Africa. Methods Patients with a diagnosis of SLE (1997 American College of Rheumatology criteria) diagnosed prior to age 19 years in Cape Town, South Africa, were enrolled in this cross-sectional study from September 2013 to December 2014. Information on clinical and serological characteristics was extracted from medical records. Results were compared to a well-described North American pediatric SLE cohort. Results Seventy-two South African patients were enrolled in the study; mean age 11.5 years; 82% were girls. The racial distribution was 68% Coloured, 24% Black, 5% White and 3% Asian/Indian. Most patients presented with severe lupus nephritis documented by renal biopsy (61%). Of patients with lupus nephritis, 63% presented with International Society of Nephrology/Renal Pathology Society class III or IV. Patients in the PULSE cohort were more likely to be treated with cyclophosphamide, methotrexate and azathioprine. The PULSE cohort had high disease activity at diagnosis (mean Systemic Lupus Erythematosus Disease Activity Index-2K (SLEDAI-2K) 20.6). The SLEDAI-2K at enrolment in the PULSE cohort (5.0) did not differ from the North American pediatric SLE cohort (4.8). Sixty-three per cent of the PULSE cohort had end organ damage with Systemic Lupus International Collaborating Clinics Damage Index (SLICC-DI) score >0 (mean SLICC-DI 1.9), compared to 23% in a previously reported US cohort. Within the PULSE cohort, nine (13%) developed end-stage renal disease with six (8%) requiring transplant, strikingly higher than North American peers (transplant rate <1%). Conclusions The PULSE cohort had highly active multiorgan disease at diagnosis and significant disease damage at enrolment in the South African registry. South African patients have severe lupus nephritis and poor renal outcomes compared to North American peers. Our study revealed a severe disease phenotype in the PULSE cohort resulting in poor outcomes in this high-risk population.
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Affiliation(s)
- L B Lewandowski
- 1 Pediatric Rheumatology, Duke University Medical Center, USA.,2 Duke Hubert Yeargan Global Health, Duke University Medical Center, USA.,3 Paediatric Rheumatology, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa.,9 National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, USA
| | - L E Schanberg
- 1 Pediatric Rheumatology, Duke University Medical Center, USA
| | - N Thielman
- 2 Duke Hubert Yeargan Global Health, Duke University Medical Center, USA
| | - A Phuti
- 3 Paediatric Rheumatology, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - A A Kalla
- 4 Rheumatology, Groote Schuur and University of Cape Town, Cape Town, South Africa
| | - I Okpechi
- 5 Division of Nephrology and Hypertension, Groote Schuur Hospital and University of Cape Town, South Africa
| | - P Nourse
- 6 Paediatric Nephrology, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - P Gajjar
- 6 Paediatric Nephrology, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - G Faller
- 7 Paediatric Rheumatology, Chris Hani Baragwanath Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - P Ambaram
- 7 Paediatric Rheumatology, Chris Hani Baragwanath Academic Hospital and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa
| | - H Reuter
- 8 Winelands Rheumatology Centre, Stellenbosch and Department of Medicine, Stellenbosch University, South Africa
| | - G Spittal
- 3 Paediatric Rheumatology, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
| | - C Scott
- 3 Paediatric Rheumatology, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
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18
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Fotis L, Shaikh N, Baszis K, French A, Tarr P, Grevich S, Lee P, Ringold S, Leroux B, Leahey H, Yuasa M, Foster J, Sokolove J, Lahey L, Robinson W, Newsom J, Stevens A, Karasawa R, Tamaki M, Tanaka M, Sato T, Yudoh K, Jarvis JN, Moncrieffe H, Bennett MF, Tsoras M, Luyrink L, Xu H, Prahalad S, Morris P, Dare J, Nigrovic PA, Rosenkranz M, Becker M, O’Neil KM, Griffin T, Lovell DJ, Grom AA, Medvedovic M, Thompson SD, Zhu L, Jiang K, Wong L, Buck MJ, Chen Y, Moncrieffe H, Brungs L, Liu T, Wang T, Jarvis JN, Alsaeid K, Alfailakawi J, Alenezi H, Alsaeed H, Beukelman T, Natter M, Ilowite N, Mieszkalski K, Burrell G, Best B, Bristow H, Carr S, Dennos A, Kaufmann R, Kimura Y, Schanberg L, Blier PR, Boneparth A, Wenderfer SE, Moorthy LN, Radhakrishna SM, Sagcal-Gironella ACP, von Scheven E, Gedik KC, Siddique S, Aguiar CL, Erkan D, Cohen E, Lee Y, Dossett M, Mehta D, Davis R, Gilbert M, Goilav B, Meidan E, Hsu J, Boneparth A, Chua A, Ardoin S, Wenderfer SE, Von Scheven E, Ruth NM, Hui-Yuen J, Gedik KC, Bermudez L, Cook A, Imundo L, Starr A, Eichenfield A, Askanase A, Janow G, Schanberg LE, Setoguchi S, Hasselblad V, Mellins ED, Schneider R, Kimura Y, Kimura Y, Grevich S, Beukelman T, Morgan E, Graham TB, Ibarra M, Ruas YS, Klein-Gitelman M, Onel K, Prahalad S, Punaro M, Ringold S, Toib D, Van Mater H, Weiss JE, Weiss PF, Mieszkalski K, Schanberg LE, Kwok TSH, Bisaillon J, Smith C, Brosseau L, Stinson J, Huber AM, Duffy CM, April KT, Lewandowski LB, Scott C, Li SC, Torok KS, Rabinovich CE, Hong SD, Becker ML, Dedeoglu F, Ibarra MF, Ferguson PJ, Fuhbrigge RC, Stewart KG, Pope E, Laxer RM, Mason TG, Higgins GC, Li X, Punaro MG, Tomlinson G, Pullenayegum E, Matelski J, Schanberg L, Feldman BM, Manthiram K, Correa H, Edwards K, Oberle EJ, Bayer M, Co DO, Baris HE, Chiu Y, Huber A, Kim S, Oberle EJ, Beukelman T, Orandi AB, Baszis KW, Dharnidharka V, Hoeltzel MF, Reed A, Huber A, Tomlinson G, Pullenayegum E, Matelski J, Goh YI, Schanberg L, Feldman BM, Schnabel A, Range U, Hahn G, Siepmann T, Berner R, Hedrich CM, Stevens B, Torok KS, Li S, Hershey N, Curran M, Higgins G, Moore K, Rabinovich E, Stevens AM, Stinson J, Connelly M, Huber A, Luca N, Spiegel L, Tsimicalis A, Luca S, Tajuddin N, Berard R, Barsalou J, Campillo S, Dancey P, Duffy C, Feldman B, Johnson N, McGrath P, Shiff N, Tse S, Tucker L, Victor C, Stinson J, Lalloo C, Harris L, Cafazzo J, Spiegel L, Feldman B, Luca N, Laxer R, Bullock DR, Vehe RK, Zhang L, Correll CK, Ganguli S, Shenberger M, Korumilli R, Gottlieb B, Rodriguez M, de Ranieri D, Onel K, Wagner-Weiner L, Tesher M, Wojcicki ER, Maletta KL, Co DO, Malloy M, Thomson S, Olson JC, Wenderfer SE, Gilbert M, Hsu J, Sule S, Rubinstein TB, Goilav B, Okamura DM, Chua A, Greenbaum LA, Lane JC, von Scheven E, Ardoin SP, Ruth NM, Woo JMP, Malloy MM, Jegers JA, Hahn DJ, Hintermeyer MK, Martinetti SM, Heckel GR, Roth-Wojcicki EL, Co DO. Proceedings of the 2016 Childhood Arthritis and Rheumatology Research Alliance (CARRA) Scientific Meeting : Toronto, Canada. 14-17 April 2016. Pediatr Rheumatol Online J 2016; 14 Suppl 1:41. [PMID: 27409414 PMCID: PMC4943514 DOI: 10.1186/s12969-016-0098-0] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
P1 Serologic evidence of gut-driven systemic inflammation in juvenile idiopathic arthritis Lampros Fotis, Nur Shaikh, Kevin Baszis, Anthony French, Phillip Tarr P2 Oral health and anti-citrullinated peptide antibodies (ACPA) in juvenile idiopathic arthritis Sriharsha Grevich, Peggy Lee, Sarah Ringold, Brian Leroux, Hannah Leahey, Megan Yuasa, Jessica Foster, Jeremy Sokolove, Lauren Lahey, William Robinson, Joshua Newsom, Anne Stevens P3 Novel autoantigens for endothelial cell antibodies in pediatric rheumatic diseases identified by proteomics Rie Karasawa, Mayumi Tamaki, Megumi Tanaka, Toshiko Sato, Kazuo Yudoh, James N. Jarvis P4 Transcriptional profiling reveals monocyte signature associated with JIA patient poor response to methotrexate Halima Moncrieffe, Mark F. Bennett, Monica Tsoras, Lorie Luyrink, Huan Xu, Sampath Prahalad, Paula Morris, Jason Dare, Peter A. Nigrovic, Margalit Rosenkranz, Mara Becker, Kathleen M. O’Neil, Thomas Griffin, Daniel J. Lovell, Alexei A. Grom, Mario Medvedovic, Susan D. Thompson P5 A multi-dimensional genomic map for polyarticular juvenile idiopathic arthritis Lisha Zhu, Kaiyu Jiang, Laiping Wong, Michael J Buck, Yanmin Chen, Halima Moncrieffe, Laura Brungs, Tao Liu, Ting Wang, James N Jarvis P6 Tocilizumab for treatment of children with refractory JIA Khaled Alsaeid, Jasim Alfailakawi, Hamid Alenezi, Hazim Alsaeed P7 Clinical characteristics of the initial patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry Tim Beukelman, Marc Natter, Norm Ilowite, Kelly Mieszkalski, Grendel Burrell, Brian Best, Helen Bristow, Shannon Carr, Anne Dennos, Rachel Kaufmann, Yukiko Kimura, Laura Schanberg P8 Comparative performance of small and large clinical centers in a comprehensive pediatric rheumatology disease registry Peter R Blier P9 Clinical characteristics of children with membranous lupus nephritis: The Childhood Arthritis and Rheumatology Research Alliance Legacy Registry Alexis Boneparth, Scott E. Wenderfer, L. Nandini Moorthy, Suhas M. Radhakrishna, Anna Carmela P. Sagcal-Gironella, Emily von Scheven P10 Rituximab use in pediatric lupus anticoagulant hypoprothrombinemia syndrome - a two center experience Kader Cetin Gedik, Salma Siddique, Cassyanne L. Aguiar, Doruk Erkan P11 Predictors of complementary and alternative medicine use and response in children with musculoskeletal conditions Ezra Cohen, Yvonne Lee, Michelle Dossett, Darshan Mehta, Roger Davis P12 Comparison of pediatric rheumatology and nephrology survey results for the treatment of refractory proliferative lupus nephritis and renal flare in juvenile SLE Mileka Gilbert, Beatrice Goilav, Esra Meidan, Joyce Hsu, Alexis Boneparth, Anabelle Chua, Stacy Ardoin, Scott E. Wenderfer, Emily Von Scheven, Natasha M. Ruth P13 Transitioning lupus patients from pediatric to adult rheumatology Joyce Hui-Yuen, Kader Cetin Gedik, Liza Bermudez, Ashlea Cook, Lisa Imundo, Amy Starr, Andrew Eichenfield, Anca Askanase P14 The systemic juvenile idiopathic arthritis cohort of the Childhood Arthritis & Rheumatology Research Alliance Registry Ginger Janow, Laura E. Schanberg, Soko Setoguchi, Victor Hasselblad, Elizabeth D. Mellins, Rayfel Schneider, Yukiko Kimura, The CARRA Legacy Registry Investigators P15 Results of the pilot study of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) consensus treatment plans for new-onset systemic juvenile idiopathic arthritis Yukiko Kimura, Sriharsha Grevich, Timothy Beukelman, Esi Morgan, T Brent Graham, Maria Ibarra, Yonit Sterba Ruas, Marisa Klein-Gitelman, Karen Onel, Sampath Prahalad, Marilynn Punaro, Sarah Ringold, Dana Toib, Heather Van Mater, Jennifer E. Weiss, Pamela F. Weiss, Kelly Mieszkalski, Laura E. Schanberg P16 A systemic review of pain relief modalities in juvenile idiopathic arthritis: First step in developing a novel decision support intervention Timothy S. H. Kwok, Jacinthe Bisaillon, Christine Smith, Lucie Brosseau, Jennifer Stinson, Adam M. Huber, Ciaran M. Duffy, Karine Toupin April P17 Barriers and facilitators to care retention for pediatric systemic lupus erythematous patients in South Africa: A qualitative study Laura B Lewandowski, Christiaan Scott P18 Evaluating the feasibility of conducting comparative effectiveness studies in juvenile Localized Scleroderma (jLS) Suzanne C. Li, Kathryn S. Torok, C. Egla Rabinovich, Sandy D. Hong, Mara L Becker, Fatma Dedeoglu, Maria F. Ibarra, Polly J Ferguson, Rob C. Fuhbrigge, Katie G. Stewart, Elena Pope, Ronald M. Laxer, Thomas G. Mason, Gloria C. Higgins, Xiaohu Li, Marilynn G. Punaro, George Tomlinson, Eleanor Pullenayegum, John Matelski, Laura Schanberg, Brian M. Feldman P19 Tonsillar histology in patients with periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome Kalpana Manthiram, Hernan Correa, Kathryn Edwards P20 Clinical course of juvenile dermatomyositis presenting as skin predominant disease Edward J. Oberle, Michelle Bayer, Dominic O. Co, Hatice Ezgi Baris, Yvonne Chiu, Adam Huber, Susan Kim P21 A Survey of musculoskeletal ultrasound practices of pediatric rheumatologists in North America Edward J Oberle, Timothy Beukelman P22 Assessment, classification and treatment of calcinosis as a complication of juvenile dermatomyositis: A survey of pediatric rheumatologists by the Childhood Arthritis and Rheumatology Research Alliance Amir B. Orandi, Kevin W. Baszis, Vikas Dharnidharka, Mark F. Hoeltzel, for the CARRA JDM Committee P23 CARRA dermatomyositis CTP pilot study Ann Reed, Adam Huber, George Tomlinson, Eleanor Pullenayegum, John Matelski, Y. Ingrid Goh, Laura Schanberg, Brian M. Feldman P24 Unexpectedly high incidences and prolonged disease activity in children with chronic non-bacterial osteomyelitis (CNO) as compared to bacterial osteomyelitis Anja Schnabel, Ursula Range, Gabriele Hahn, Timo Siepmann, Reinhard Berner, Christian Michael Hedrich P25 Juvenile systemic sclerosis cohort within the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry: Follow up characteristics Brandi Stevens, Kathryn S. Torok, Suzanne Li, Nicole Hershey, Megan Curran, Gloria Higgins, Katharine Moore, Egla Rabinovich, Anne M. Stevens, for the CARRA Registry Investigators P26 Development and usability testing of an iPad and desktop psycho-educational game for children with Juvenile Idiopathic Arthritis and their parents Jennifer Stinson, Mark Connelly, Adam Huber, Nadia Luca, Lynn Spiegel, Argerie Tsimicalis, Stephanie Luca, Naweed Tajuddin, Roberta Berard, Julia Barsalou, Sarah Campillo, Paul Dancey, Ciaran Duffy, Brian Feldman, Nicole Johnson, Patrick McGrath, Natalie Shiff, Shirley Tse, Lori Tucker, Charles Victor P27 iCanCopeTM: User-centred design and development of a smartphone app to support self-management for youth with arthritis pain Jennifer Stinson, Chitra Lalloo, Lauren Harris, Joseph Cafazzo, Lynn Spiegel, Brian Feldman, Nadia Luca, Ronald Laxer P28 Accessing pediatric rheumatology care: Despite barriers, few parents prefer telemedicine Danielle R. Bullock, Richard K. Vehe, Lei Zhang, Colleen K. Correll1 P29 Exploration of factors contributing to time to achieve clinically inactive disease (CID) in juvenile idiopathic arthritis (JIA): A preliminary report Suhas Ganguli, Max Shenberger, Ritesh Korumilli, Beth Gottlieb P30 Pediatric rheumatology referral patterns: Presenting complaints of new patients at a large, urban academic center Martha Rodriguez, Deirdre de Ranieri, Karen Onel, Linda Wagner-Weiner, Melissa Tesher P31 Quality improvement (QI) initiatives in childhood systemic lupus erythematosus (cSLE) Elizabeth Roth Wojcicki, Kristyn L. Maletta, Dominic O. Co, Marsha Malloy, Sarah Thomson, Judyann C. Olson P32 Proliferative lupus nephritis in juvenile SLE: Support from the pediatric nephrology community for the definitions of responsiveness and flare in the 2012 consensus treatment plans Scott E. Wenderfer, Mileka Gilbert, Joyce Hsu, Sangeeta Sule, Tamar B. Rubinstein, Beatrice Goilav, Daryl M. Okamura, Annabelle Chua, Laurence A. Greenbaum, Jerome C. Lane, Emily von Scheven, Stacy P. Ardoin, Natasha M. Ruth P33 The steroid taper app: Making of a mobile app Jennifer M. P. Woo, Marsha M. Malloy, James A. Jegers, Dustin J. Hahn, Mary K. Hintermeyer, Stacey M. Martinetti, Gretchen R. Heckel, Elizabeth L. Roth-Wojcicki, Dominic O. Co
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Affiliation(s)
- Lampros Fotis
- Washington University School of Medicine, St Louis, Missouri USA
| | - Nur Shaikh
- Washington University School of Medicine, St Louis, Missouri USA
| | - Kevin Baszis
- Washington University School of Medicine, St Louis, Missouri USA
| | - Anthony French
- Washington University School of Medicine, St Louis, Missouri USA
| | - Phillip Tarr
- Washington University School of Medicine, St Louis, Missouri USA
| | - Sriharsha Grevich
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA USA
| | - Peggy Lee
- Department of Oral Medicine, University of Washington, Seattle, WA USA
| | - Sarah Ringold
- Department of Rheumatology, Seattle Children’s Hospital, Seattle, WA USA
| | - Brian Leroux
- Department of Oral Health Sciences, University of Washington, Seattle, WA USA
| | | | | | | | - Jeremy Sokolove
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University, Stanford, CA USA
| | - Lauren Lahey
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University, Stanford, CA USA
| | - William Robinson
- Department of Medicine, Division of Immunology and Rheumatology, Stanford University, Stanford, CA USA
| | | | - Anne Stevens
- Department of Pediatrics, Division of Rheumatology, University of Washington, Seattle, WA USA ,Seattle Children’s Research Institute, Seattle, WA USA
| | - Rie Karasawa
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Mayumi Tamaki
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Megumi Tanaka
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshiko Sato
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - Kazuo Yudoh
- St. Marianna University School of Medicine, Kawasaki, Japan
| | - James N. Jarvis
- University at Buffalo, State University of New York, Buffalo, NY USA
| | - Halima Moncrieffe
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,University of Cincinnati, Cincinnati, OH USA
| | | | - Monica Tsoras
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Lorie Luyrink
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Huan Xu
- University of Cincinnati, Cincinnati, OH USA
| | | | - Paula Morris
- Arkansas Children’s Hospital Research Institute, Little Rock, AR USA
| | - Jason Dare
- Arkansas Children’s Hospital Research Institute, Little Rock, AR USA
| | | | | | - Mara Becker
- Children’s Mercy Hospital, Kansas City, MO USA
| | | | | | - Daniel J. Lovell
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | - Alexei A. Grom
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | | | - Susan D. Thompson
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA ,University of Cincinnati, Cincinnati, OH USA
| | - Lisha Zhu
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Kaiyu Jiang
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Laiping Wong
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Michael J Buck
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Yanmin Chen
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | | | | | - Tao Liu
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Ting Wang
- Washington University, St. Louis, MO USA
| | - James N Jarvis
- University at Buffalo, The State University of New York, Buffalo, NY USA
| | - Khaled Alsaeid
- Department of Pediatrics, Kuwait University, Kuwait City, Kuwait ,Mubarak Hospital, Jabriya, Kuwait
| | | | | | | | - Tim Beukelman
- University of Alabama at Birmingham, Birmingham, AL USA
| | - Marc Natter
- Tufts University, Medford, MA USA ,Harvard University, Boston, MA USA
| | - Norm Ilowite
- The Children’s Hospital at Montefiore, Bronx, NY USA
| | | | | | | | | | | | | | | | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ USA
| | | | - Peter R. Blier
- Baystate Children’s Hospital, Springfield, MA USA ,Tufts University School of Medicine, Boston, MA USA
| | - Alexis Boneparth
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ USA
| | | | | | | | | | | | | | - Salma Siddique
- Hospital for Special Surgery-Weill Cornell Medical Center, New York, NY USA
| | | | - Doruk Erkan
- Hospital for Special Surgery-Weill Cornell Medical Center, New York, NY USA
| | - Ezra Cohen
- Boston Children’s Hospital, Boston, MA USA
| | - Yvonne Lee
- Brigham and Women’s Hospital, Boston, MA USA
| | | | | | | | - Mileka Gilbert
- Medical University of South Carolina, Charleston, SC USA
| | | | | | - Joyce Hsu
- Stanford University, Stanford, CA USA
| | | | | | - Stacy Ardoin
- Nationwide Children’s Hospital, Columbus, OH USA
| | | | | | | | - Joyce Hui-Yuen
- Division of Pediatric Rheumatology, Cohen Children’s Medical Center, New Hyde Park, NY USA
| | - Kader Cetin Gedik
- Division of Pediatric Rheumatology, Cohen Children’s Medical Center, New Hyde Park, NY USA
| | - Liza Bermudez
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Ashlea Cook
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Lisa Imundo
- Division of Adult Rheumatology, Columbia University Medical Center, New York, NY USA
| | - Amy Starr
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Andrew Eichenfield
- Division of Pediatric Rheumatology, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY USA
| | - Anca Askanase
- Division of Adult Rheumatology, Columbia University Medical Center, New York, NY USA
| | - Ginger Janow
- Pediatrics, Joseph M Sanzari Children’s Hospital, Hackensack, NJ USA
| | - Laura E. Schanberg
- Pediatrics, Duke University, Durham, NC USA ,Duke Clinical Research Institute, Durham, NC USA
| | | | | | | | - Rayfel Schneider
- Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - Yukiko Kimura
- Pediatrics, Joseph M Sanzari Children’s Hospital, Hackensack, NJ USA
| | | | - Yukiko Kimura
- Hackensack University Medical Center, Hackensack, NJ USA
| | | | | | - Esi Morgan
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
| | | | | | | | | | - Karen Onel
- Comer Children’s Hospital of Chicago, Chicago, IL USA
| | | | | | | | - Dana Toib
- St. Christopher’s Hospital for Children, Philadelphia, PA USA
| | | | | | | | | | | | - Timothy S. H. Kwok
- Undergraduate Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Jacinthe Bisaillon
- School of Nursing Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Christine Smith
- School of Epidemiology, Public Health and Preventive Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Jennifer Stinson
- Hospital for Sick Children, Lawrence S. Bloomberg Faculty of Nursing University of Toronto, Toronto, Ontario Canada
| | - Adam M. Huber
- Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia Canada
| | - Ciaran M. Duffy
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario Canada
| | - Karine Toupin April
- Department of Pediatrics, Children’s Hospital of Eastern Ontario Research Institute, Faculty of Medicine, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario Canada
| | - Laura B. Lewandowski
- Pediatric Rheumatology, Duke University Medical Center, Durham, NC USA ,Duke Global Health Institute, Duke University, Durham, NC USA ,Paediatric Rheumatology, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa ,National Institute of Arthritis, Musculoskeletal, and Skin Diseases, NIH, Bethesda, MD USA
| | - Christiaan Scott
- Paediatric Rheumatology, Red Cross War Memorial Children’s Hospital and University of Cape Town, Cape Town, South Africa
| | - Suzanne C. Li
- Hackensack University Medical Center, Hackensack, NJ USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Xiaohu Li
- Stevens Institute of Technology, Hoboken, NJ USA
| | | | | | | | | | | | | | - Kalpana Manthiram
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Hernan Correa
- Department of Pathology, Immunology, and Microbiology, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Kathryn Edwards
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, TN USA
| | - Edward J. Oberle
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH USA
| | - Michelle Bayer
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | - Dominic O. Co
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | | | - Yvonne Chiu
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI USA
| | - Adam Huber
- IWK Health Centre, Dalhousie University, Halifax, NS Canada
| | - Susan Kim
- Boston Children’s Hospital, Boston, MA USA ,Harvard Medical School, Boston, MA USA
| | - Edward J. Oberle
- Nationwide Children’s Hospital, Columbus, OH USA ,The Ohio State University, Columbus, OH USA
| | | | - Amir B. Orandi
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Kevin W. Baszis
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Vikas Dharnidharka
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Mark F. Hoeltzel
- Mott Children’s Hospital, University of Michigan Medical School, Ann Arbor, MI USA
| | | | | | - Adam Huber
- Dalhousie University, Halifax, NS Canada
| | | | | | | | | | | | | | - Anja Schnabel
- Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ursula Range
- Institute for Medical Informatics and Biometry, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Gabriele Hahn
- Department of Radiology, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Timo Siepmann
- Division of Health Care Sciences, Center for Clinical Research and Management Education, Dresden International University, Dresden, Germany
| | - Reinhard Berner
- Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Michael Hedrich
- Pediatric Rheumatology and Immunology, Children’s Hospital Dresden, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Brandi Stevens
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA USA
| | | | - Suzanne Li
- Hackensack University Medical Center, Hackensack, NJ USA
| | - Nicole Hershey
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA USA
| | - Megan Curran
- Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | | | | | | | - Anne M. Stevens
- Seattle Children’s Research Institute, University of Washington, Seattle, WA USA
| | | | - Jennifer Stinson
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Mark Connelly
- University of Kansas Medical Center, Kansas City, MO USA
| | - Adam Huber
- IWK Health Centre, Halifax, Nova Scotia Canada
| | - Nadia Luca
- Alberta Children’s Hospital, Calgary, Alberta Canada
| | - Lynn Spiegel
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Stephanie Luca
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Naweed Tajuddin
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | | | | | - Paul Dancey
- Memorial University of Newfoundland, Newfoundland, Canada
| | - Ciaran Duffy
- Children’s Hospital of Eastern Ontario, Ottawa, Canada
| | - Brian Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | | | | | - Shirley Tse
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Lori Tucker
- British Columbia Children’s Hospital, Vancouver, British Columbia Canada
| | | | | | | | - Lauren Harris
- The Hospital for Sick Children, Toronto, Canada ,University of Toronto, Toronto, Canada ,Centre for Global eHealth Innovation, Toronto, Canada
| | | | | | | | - Nadia Luca
- Alberta Children’s Hospital, Calgary, Alberta Canada
| | | | - Danielle R. Bullock
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Richard K. Vehe
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Lei Zhang
- Clinical and Translational Sciences Institute, University of Minnesota, Minneapolis, MN USA
| | - Colleen K. Correll
- Division of Pediatric Rheumatology, Department of Pediatrics, University of Minnesota Masonic Children’s Hospital, Minneapolis, MN USA
| | - Suhas Ganguli
- Pediatric Rheumatology, Cohen Children’s Medical Center, New York, NY 11040 USA
| | - Max Shenberger
- Pediatric Rheumatology, Cohen Children’s Medical Center, New York, NY 11040 USA
| | - Ritesh Korumilli
- Pediatrics, Flushing Hospital Medical Center, New York, NY 11355 USA
| | - Beth Gottlieb
- Pediatric Rheumatology, Cohen Children’s Medical Center, New York, NY 11040 USA
| | - Martha Rodriguez
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | - Deirdre de Ranieri
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | - Karen Onel
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | | | - Melissa Tesher
- University of Chicago Medicine Comer Children’s Hospital, Chicago, IL USA
| | | | | | | | | | | | | | | | - Mileka Gilbert
- Medical University of South Carolina, Charleston, SC USA
| | - Joyce Hsu
- Stanford University, Stanford, CA USA
| | - Sangeeta Sule
- Johns Hopkins Children’s Hospital, Baltimore, MD USA
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19
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Lewandowski LB, Sanghavi D. Lack of association between folate receptor autoantibodies and conotruncal congenital heart defects. Pediatr Cardiol 2013; 34:512-7. [PMID: 22915140 DOI: 10.1007/s00246-012-0485-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 08/06/2012] [Indexed: 11/26/2022]
Abstract
Conotruncal cardiac defects are partially prevented by maternal folic acid supplementation. However, the biochemical mechanism is unknown. Maternal autoantibodies to folate receptors, previously associated with increased risk for neural tube defects, also may account for this effect. This study aimed to examine the titers of folate receptor-blocking autoantibodies in mothers of children with conotruncal congenital heart defects and to compare them with those in the general population. Serum samples were obtained from 22 women whose pregnancies were complicated by conotruncal congenital heart malformations. Groups of samples were analyzed for autoantibodies against [(3)H] folic acid-labeled folate receptors, quantitative amounts of immunoglobulin G (IgG) and IgM autoantibodies to the folate receptor, and for ability to block-bind folic acid to receptors. No elevated levels of antibodies binding to [(3)H] folic acid-labeled folate receptors were found. No difference was found in antifolate receptor alpha-IgG or IgM median levels between cases (261 vs. 240 μg/mL) and control subjects (773 vs. 924 μg/mL). There was no increased blocking of folic acid binding between cases [0.69 ng/mL; 95 % confidence interval (CI), 0.006-0.01] and control subjects (0.69 ng/mL; 95 % CI, 0.003-0.013). Although epidemiologic evidence suggests that periconceptual folic acid may prevent many conotruncal congenital heart defects, the current study suggests that this effect is unlikely to be explained by the presence of maternal autoantibodies to folate receptor. These data suggest that a strategy of screening women for such autoantibodies will not identify a high-risk group of women to target for supplemental folic acid to prevent congenital heart defects.
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Affiliation(s)
- Laura B Lewandowski
- Division of Pediatric Rheumatology, Department of Pediatrics, Duke University Medical Center, 55 Lake Avenue, North, Worcester, MA 01655, USA
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Abstract
In mammalian cells the signal recognition particle (SRP) consists of a approximately 300 nucleotide RNA and six proteins. Although the molecular structure and functional cycle of the SRP are both very well understood, far less is known about how the SRP is first assembled in the cell. Recent work has suggested that SRP assembly begins in the nucleoli. When NRK (rat fibroblast) cells were treated with leptomycin B (LMB), a specific inhibitor of the CRM1 nuclear export receptor, the level of SRP RNA increased in the nucleoli, as did the level of nucleolar 28S ribosomal RNA. Moreover, when a hamster cell line carrying a temperature-sensitive mutation in the guanine nucleotide exchange factor of the GTPase Ran (Ran-GEF) was shifted to the non-permissive temperature, the nucleolar level of SRP RNA increased. These results indicate that the steady-state concentration of SRP RNA in the nucleolus is sensitive to perturbations in nuclear import/export pathways.
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Affiliation(s)
- Christina N Alavian
- Department of Biochemistry and Molecular Pharmacology and Program in Cell Dynamics, University of Massachusetts Medical School, Worcester, MA 01605, USA
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21
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Abstract
The nucleolus is the site of ribosome biosynthesis, but is now known to have other functions as well. In the present study we have investigated how the distribution of signal recognition particle (SRP) RNA within the nucleolus relates to the known sites of ribosomal RNA synthesis, processing, and nascent ribosome assembly (i.e., the fibrillar centers, the dense fibrillar component (DFC), and the granular component). Very little SRP RNA was detected in fibrillar centers or the DFC of the nucleolus, as defined by the RNA polymerase I-specific upstream binding factor and the protein fibrillarin, respectively. Some SRP RNA was present in the granular component, as marked by the protein B23, indicating a possible interaction with ribosomal subunits at a later stage of maturation. However, a substantial portion of SRP RNA was also detected in regions of the nucleolus where neither B23, UBF, or fibrillarin were concentrated. Dual probe in situ hybridization experiments confirmed that a significant fraction of nucleolar SRP RNA was not spatially coincident with 28S ribosomal RNA. These results demonstrate that SRP RNA concentrates in an intranucleolar location other than the classical stations of ribosome biosynthesis, suggesting that there may be nucleolar regions that are specialized for other functions.
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Affiliation(s)
- Joan C Politz
- Department of Biochemistry and Molecular Pharmacology, Program in Cell Dynamics, University of Massachusetts Medical School, 377 Plantation Street, Worcester, MA 01605, USA
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