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

OBJECTIVE

The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis.

METHODS

We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded.

RESULTS

We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers.

CONCLUSION

In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.

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

BACKGROUND

Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months.

METHODS

We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed.

RESULTS

We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05).

CONCLUSION

While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.

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

BACKGROUND

Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry.

METHODS

In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months.

RESULTS

One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability.

CONCLUSION

High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.

Social behavior and off-target verbosity in elderly people

This study investigated social behavior in older adults with varying levels of off-target verbosity (OTV). After screening 455 adults in Phase 1, 198 individuals were selected to participate in both a get-acquainted conversation and an experimental cues situation and to complete social and cognitive measures. Higher OTV participants had lower cognitive inhibitory scores, talked more, were less interested in their partners, and focused more on themselves. Their conversational partners were less satisfied. Age and cognitive functioning were not related to OTV scores or conversational style for low- and mid-range participants. Although high-OTV individuals talked less when exposed to social cues signalling boredom, they spoke more relative to other participants. Self-reported social behavior had little relation with OTV and conversational style, but higher OTV individuals were less accurate in judging videotaped social interactions. Gender differences in conversational behavior are also discussed.

Social behavior and off-target verbosity in elderly people

This study investigated social behavior in older adults with varying levels of off-target verbosity (OTV). After screening 455 adults in Phase 1, 198 individuals were selected to participate in both a get-acquainted conversation and an experimental cues situation and to complete social and cognitive measures. Higher OTV participants had lower cognitive inhibitory scores, talked more, were less interested in their partners, and focused more on themselves. Their conversational partners were less satisfied. Age and cognitive functioning were not related to OTV scores or conversational style for low- and mid-range participants. Although high-OTV individuals talked less when exposed to social cues signalling boredom, they spoke more relative to other participants. Self-reported social behavior had little relation with OTV and conversational style, but higher OTV individuals were less accurate in judging videotaped social interactions. Gender differences in conversational behavior are also discussed.

Measurement of lifetime alcohol consumption

The reliability and validity of a retrospective, self-report measure, the Concordia Lifetime Drinking Questionnaire (CLDQ), were assessed with a group of 72 elderly Canadian men. The CLDQ includes quantity and frequency questions on current beverage-specific alcohol use and a series of questions about the start of alcohol use. The innovative features of the CLDQ include requiring subjects to collaborate with the interviewer in drawing a graph that represents their lifetime drinking patterns and encouraging more accurate recall by the use of salient events in the subject's life history. Drinking was assessed on two occasions approximately 33 months apart. Forty-six wives responded to questions about their husband's drinking. The reliability coefficient for lifetime drinking was .78. A comparison of the two graphs every fifth year from 1945 to 1985 yielded significant correlations that ranged from .65 to .87. Validity was tested by comparing each wife's rating of her husband's drinking at present and at time of marriage with similar points on the husband's graphs; the correlations were .87 and .72, respectively. Moderate correlations were obtained between the MAST and the CLDQ. The CLDQ was judged to be a reliable and valid measure of lifetime drinking, appropriate for use with the elderly. The longitudinal lifetime drinking patterns appeared similar to those found in cross-sectional studies.

Adult age differences in memory in relation to availability and accessibility of knowledge-based schemas

Three experiments investigated whether, over adulthood, the use of schemas to process and remember new information increases (developmental shift hypothesis), decreases (production deficiency hypothesis) or remains constant (age-invariance hypothesis). Effects of schema access were studied by having young, middle-aged, and old music experts and nonexperts recall information that was relevant or irrelevant to music (Experiment 1) and by comparing young and old participants' memory for prose passages when they knew or did not know the subject of the passage (Experiments 2 and 3). In each case, schema access facilitated memory equally across age levels, supporting the age-invariance hypothesis and implying that the basic structures and operations of memory do not necessarily change with age. Possible limits on the independence of age and schema utilization were considered in relation to the conditions under which each of the two alternative hypotheses might hold.

Adult age differences in memory in relation to availability and accessibility of knowledge-based schemas

Three experiments investigated whether, over adulthood, the use of schemas to process and remember new information increases (developmental shift hypothesis), decreases (production deficiency hypothesis) or remains constant (age-invariance hypothesis). Effects of schema access were studied by having young, middle-aged, and old music experts and nonexperts recall information that was relevant or irrelevant to music (Experiment 1) and by comparing young and old participants' memory for prose passages when they knew or did not know the subject of the passage (Experiments 2 and 3). In each case, schema access facilitated memory equally across age levels, supporting the age-invariance hypothesis and implying that the basic structures and operations of memory do not necessarily change with age. Possible limits on the independence of age and schema utilization were considered in relation to the conditions under which each of the two alternative hypotheses might hold.

Hibernoma: report of two cases

Hibernomas are rare tumors of fat which are most often benign. Arteriographic fingings may be misleading with respect to the diagnosis of malignancy preoperatively. These uncommon tumors may be confused prior to surgery with lipomas, soft tissue sarcomas, and hemangiomas.