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Ciurtin C, Robinson G, Butt M, Peng J, Ardoin S, Schanberg L, Boteanu A, Bouchalova K, Demir S, Moraitis E, Migowa A, Glackin Y, Ainsworth J, Smith E, Jury E, Sahin S, Kamphuis S, Lewandowski L. Cardiovascular risk in young people with childhood onset systemic lupus erythematosus. Lancet Rheumatol 2024; 6:e258-e263. [PMID: 38658113 DOI: 10.1016/s2665-9913(24)00085-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/04/2024] [Accepted: 03/19/2024] [Indexed: 04/26/2024]
Affiliation(s)
- Coziana Ciurtin
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, London, UK.
| | - George Robinson
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, London, UK
| | - Maryam Butt
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, London, UK
| | - Junjie Peng
- Centre for Adolescent Rheumatology, Division of Medicine, University College London, London, UK
| | - Stacy Ardoin
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Laura Schanberg
- Duke Clinical Research Institute, Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA
| | - Alina Boteanu
- Department of Rheumatology, Ramon y Cajal University Hospital, Madrid, Spain
| | - Katerina Bouchalova
- Paediatric Rheumatology, Department of Paediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Selcan Demir
- Department of Paediatrics, Division of Rheumatology, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkey
| | - Elena Moraitis
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Angela Migowa
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
| | - Yvonne Glackin
- Department of Paediatric Rheumatology, Great Ormond Street Hospital, London, UK
| | - Jenny Ainsworth
- Department of Paediatric Rheumatology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Eve Smith
- Department of Paediatric Rheumatology, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Elizabeth Jury
- Centre for Rheumatology, Division of Medicine, University College London, London, UK
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University MC, Rotterdam, Netherlands
| | - Laura Lewandowski
- Lupus Genomics and Global Health Disparities Unit, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD, USA
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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, Lambert L, Levy DM, Lewandowski L, Maxwell N, Morand E, Özen S, Pain CE, Ravelli A, Saad Magalhaes C, Pilkington C, Schonenberg-Meinema D, Scott C, Tullus K, Beresford MW, Goilav B, Goss N, Oni L, Marks SD. Defining remission in childhood-onset lupus: PReS-endorsed consensus definitions by an international task force. Clin Immunol 2024:110214. [PMID: 38604255 DOI: 10.1016/j.clim.2024.110214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/30/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To derive childhood-onset SLE (cSLE) specific remission definitions for future treat-to-target (T2T) trials, observational studies, and clinical practice. METHODS The cSLE International T2T Task Force conducted Delphi surveys exploring paediatric perspectives on adult-onset SLE remission targets. A modified nominal group technique was used to discuss, refine, and agree on the cSLE remission target criteria. RESULTS The Task Force proposed two definitions of remission: 'cSLE clinical remission on steroids (cCR)' and 'cSLE clinical remission off steroids (cCR-0)'. The common criteria are: (1) Clinical-SLEDAI-2 K = 0; (2) PGA score < 0.5 (0-3 scale); (4) stable antimalarials, immunosuppressive, and biologic therapy (changes due to side-effects, adherence, weight, or when building up to target dose allowed). Criterion (3) in cCR is the prednisolone dose ≤0.1 mg/kg/day (maximum 5 mg/day), whereas in cCR-0 it is zero. CONCLUSIONS cSLE definitions of remission have been proposed, maintaining sufficient alignment with the adult-SLE definition to facilitate life-course research.
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Affiliation(s)
- E M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - A Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - J Ainsworth
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Al-Abadi
- Department of Paediatric Rheumatology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - T Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Slovenia
| | - L Bortey
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J Burnham
- Department of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - C Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - S Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - L Lambert
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - D M Levy
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - L 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
| | - N Maxwell
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Morand
- Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - S Özen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - C E Pain
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - C Saad Magalhaes
- Paediatric Rheumatology Division, Botucatu Medical School, Sao Paulo State, University (UNESP), Sao Paulo, Brazil
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious diseases, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - C Scott
- Department of Pediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - K Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - B Goilav
- Albert Einstein College of Medicine, New York, USA
| | - N Goss
- Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - L Oni
- Department of Paediatric Nephrology, Alder Hey children's NHS Foundation Trust, Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - S D Marks
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; NIHR Great Ormond Street Hospital Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, London, UK
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Verschoof MA, van Meenen LCC, Andriessen MVE, Brinkman DMC, Kamphuis S, Kuijpers TW, Leavis HL, Legger GE, Mulders-Manders CM, de Pagter APJ, Rutgers A, van Well GTJ, Coutinho JM, Hak AE, van Montfrans JM, Klouwer FCC. Neurological phenotype of adenosine deaminase 2 deficient patients: a cohort study. Eur J Neurol 2024; 31:e16043. [PMID: 37584090 DOI: 10.1111/ene.16043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/22/2023] [Accepted: 08/11/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND AND PURPOSE Patients with adenosine deaminase 2 (ADA2) deficiency can present with various neurological manifestations due to vasculopathies and autoinflammation. These include ischaemic and hemorrhagic stroke, but less clearly defined neurological symptoms have also been reported. METHODS In this cohort study, patients with confirmed ADA2 deficiency from seven university hospitals in the Netherlands were included. The frequency and recurrence rates of neurological manifestations before and after initiation of tumor necrosis factor α (TNF-α) inhibiting therapy were analyzed. RESULTS Twenty-nine patients were included with a median age at presentation of 5 years (interquartile range 1-17). Neurological manifestations occurred in 19/29 (66%) patients and were the presenting symptom in 9/29 (31%) patients. Transient ischaemic attack (TIA)/ischaemic stroke occurred in 12/29 (41%) patients and was the presenting symptom in 8/29 (28%) patients. In total, 25 TIAs/ischaemic strokes occurred in 12 patients, one after initiation of TNF-α inhibiting therapy and one whilst switching between TNF-α inhibitors. None was large-vessel occlusion stroke. Two hemorrhagic strokes occurred: one aneurysmatic subarachnoid hemorrhage and one spontaneous intracerebral hemorrhage. Most neurological symptoms, including cranial nerve deficits, vertigo, ataxia and seizures, were caused by TIAs/ischaemic strokes and seldom recurred after initiation of TNF-α inhibiting therapy. CONCLUSIONS Neurological manifestations, especially TIA/ischaemic stroke, are common in patients with ADA2 deficiency and frequently are the presenting symptom. Because it is a treatable cause of young stroke, for which antiplatelet and anticoagulant therapy are considered contraindicated, awareness amongst neurologists and pediatricians is important. Screening for ADA2 deficiency in young patients with small-vessel ischaemic stroke without an identified cause should be considered.
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Affiliation(s)
| | - Laura C C van Meenen
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Valérie E Andriessen
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniëlle M C Brinkman
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Sylvia Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology and Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Helen L Leavis
- Department of Rheumatology and Clinical Immunology, University Medical Center and Utrecht University, Utrecht, The Netherlands
| | - G Elizabeth Legger
- Department of Pediatric Rheumatology and Immunology, University Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Catharina M Mulders-Manders
- Department of Internal Medicine, Radboud Expertise Center for Immunodeficiency and Autoinflammation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anne P J de Pagter
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Gijs T J van Well
- Division of Pediatric Infectious Diseases, Immunology & Rheumatology, Department of Pediatrics, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jonathan M Coutinho
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - A Elisabeth Hak
- Departments of Internal Medicine and Rheumatology and Clinical Immunology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joris M van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Femke C C Klouwer
- Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatric Neurology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Andriessen MVE, Legger GE, Bredius RGM, van Gijn ME, Hak AE, Muller PCEH, Kamphuis S, Klouwer FCC, Kuijpers TW, Leavis HL, Nierkens S, Rutgers A, van der Veken LT, van Well GTJ, Mulders-Manders CM, van Montfrans JM. Clinical Symptoms, Laboratory Parameters and Long-Term Follow-up in a National DADA2 Cohort. J Clin Immunol 2023; 43:1581-1596. [PMID: 37277582 PMCID: PMC10499949 DOI: 10.1007/s10875-023-01521-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 05/13/2023] [Indexed: 06/07/2023]
Abstract
Deficiency of adenosine deaminase-2 (DADA2) is an autosomal recessive autoinflammatory disease with an extremely variable disease presentation. This paper provides a comprehensive overview of the Dutch DADA2 cohort. We performed a retrospective cohort study in 29 ADA2-deficient patients from 23 families with a median age at inclusion of 26 years. All patients had biallelic pathogenic variants in the ADA2 gene. The most common clinical findings included cutaneous involvement (79.3%), (hepato)splenomegaly (70.8%) and recurrent infections (58.6%). Stroke was observed in 41.4% of the patients. The main laboratory abnormalities were hypogammaglobulinemia and various cytopenias. Patients presented most often with a mixed phenotype involving vasculopathy, immunodeficiency and hematologic manifestations (62.1%). In this cohort, malignancies were reported in eight patients (27.6%), of whom five presented with a hematologic malignancy and two with a basal cell carcinoma. Four patients developed hemophagocytic lymphohistiocytosis (HLH) or an HLH-like episode, of whom three passed away during or shortly after the occurrence of HLH. TNF-inhibitors (TNFi) were effective in treating vasculopathy-associated symptoms and preventing stroke, but were hardly effective in the treatment of hematologic manifestations. Three patients underwent hematopoietic cell transplantation and two of them are doing well with complete resolution of DADA2-related symptoms. The overall mortality in this cohort was 17.2%. In conclusion, this cohort describes the clinical, genetic and laboratory findings of 29 Dutch DADA2 patients. We describe the occurrence of HLH as a life-threatening disease complication and report a relatively high incidence of malignancies and mortality.
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Affiliation(s)
- Marie Valérie E Andriessen
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht University, PO Box 85050, 3508 GA, Utrecht, the Netherlands
| | - G Elizabeth Legger
- Department of Pediatric Rheumatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Robbert G M Bredius
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Marielle E van Gijn
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A Elisabeth Hak
- Departments of Internal Medicine and Rheumatology and Clinical Immunology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Petra C E Hissink Muller
- Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Sylvia Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus MC University Centre, Rotterdam, the Netherlands
| | - Femke C C Klouwer
- Department of Neurology and Pediatric Neurology, Location AMC, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Taco W Kuijpers
- Department of Pediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Helen L Leavis
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Stefan Nierkens
- Center for Translational Immunology, University Medical Center Utrecht & Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Abraham Rutgers
- Department of Rheumatology and Clinical Immunology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Lars T van der Veken
- Department of Genetics, Division Laboratories, Pharmacy and Biomedical Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Gijs T J van Well
- Department of Pediatrics: Division of Pediatric Infectious Diseases, Immunology and Rheumatology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Catharina M Mulders-Manders
- Department of Internal Medicine, Radboud Expertise Center for Immunodeficiency and Autoinflammation, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Joris M van Montfrans
- Department of Pediatric Immunology and Infectious Diseases, University Medical Center Utrecht, Utrecht University, PO Box 85050, 3508 GA, Utrecht, the Netherlands.
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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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6
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Bergkamp SC, Wahadat MJ, Salah A, Kuijpers TW, Smith V, Tas SW, van den Berg JM, Kamphuis S, Schonenberg-Meinema D. Dysregulated endothelial cell markers in systemic lupus erythematosus: a systematic review and meta-analysis. J Inflamm (Lond) 2023; 20:18. [PMID: 37194071 DOI: 10.1186/s12950-023-00342-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/28/2023] [Indexed: 05/18/2023] Open
Abstract
OBJECTIVES To perform a systematic literature review and meta-analysis on endothelial cell (EC) markers that are involved and dysregulated in systemic lupus erythematosus (SLE) in relation to disease activity, as EC dysregulation plays a major role in the development of premature atherosclerosis in SLE. METHODS Search terms were entered into Embase, MEDLINE, Web of Science, Google Scholar and Cochrane. Inclusion criteria were 1) studies published after 2000 reporting measurements of EC markers in serum and/or plasma of SLE patients (diagnosed according to ACR/SLICC criteria), 2) English language peer reviewed articles, and 3) disease activity measurement. For meta-analysis calculations, the Meta-Essentials tool by Erasmus Research Institute and of Management (ERIM) was used. Only those EC markers, which were 1) reported in at least two articles and 2) reported a correlation coefficient (i.e. Spearman's rank or Pearson's) between the measured levels of the EC marker and disease activity were included. For meta-analyses, a fixed effect model was used. RESULTS From 2133 hits, 123 eligible articles were selected. The identified SLE-related endothelial markers were involved in EC activation, EC apoptosis, disturbed angiogenesis, defective vascular tone control, immune dysregulation and coagulopathy. Meta-analyses of primarily cross-sectional studies showed significant associations between marker levels and disease activity for the following endothelial markers: Pentraxin-3, Thrombomodulin, VEGF, VCAM-1, ICAM-1, IP-10 and MCP-1. Dysregulated EC markers without associations with disease activity were: Angiopoeitin-2, vWF, P-Selectin, TWEAK and E-Selectin. CONCLUSIONS We provide a complete literature overview for dysregulated EC markers in SLE comprising a wide range of different EC functions. SLE-induced EC marker dysregulation was seen with, but also without, association with disease activity. This study provides some clarity in the eminent complex field of EC markers as biomarkers for SLE. Longitudinal data on EC markers in SLE are now needed to guide us more in unravelling the pathophysiology of premature atherosclerosis and cardiovascular events in SLE patients.
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Affiliation(s)
- S C Bergkamp
- Department of Paediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centres (AUMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M J Wahadat
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - A Salah
- Department of Paediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centres (AUMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - T W Kuijpers
- Department of Paediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centres (AUMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - V Smith
- Department of Internal Medicine, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
- Unit for Molecular Immunology and Inflammation, VIB Inflammation Research Centre (IRC), Ghent, Belgium
| | - S W Tas
- Department of Rheumatology and Clinical Immunology, and Laboratory for Experimental Immunology, Amsterdam Rheumatology and Immunology Centre, Amsterdam University Medical Centres (AUMC), University of Amsterdam, Amsterdam, The Netherlands
| | - J M van den Berg
- Department of Paediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centres (AUMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - S Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - D Schonenberg-Meinema
- Department of Paediatric Immunology, Rheumatology and Infectious Diseases, Emma Children's Hospital, Amsterdam University Medical Centres (AUMC), University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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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, Lambert L, Levy DM, Lewandowski L, Maxwell N, Morand E, Ozen S, Pain CE, Ravelli A, Saad Magalhaes C, Pilkington C, Schonenberg-Meinema D, Scott C, Tullus K, Beresford MW. PReS-endorsed international childhood lupus T2T task force definition of childhood lupus low disease activity state (cLLDAS). Clin Immunol 2023; 250:109296. [PMID: 36934849 PMCID: PMC10500564 DOI: 10.1016/j.clim.2023.109296] [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: 01/10/2023] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To achieve a consensus-based definition of Low Disease Activity (LDA) for use in cSLE trials. METHODS The International cSLE T2T Task Force, comprising of paediatric rheumatologists/nephrologists, and adult rheumatologists undertook a series of Delphi surveys/consensus meetings to discuss, refine, and vote upon cSLE LDA criteria. RESULTS The Task Force agreed that LDA should be based upon the adult-SLE Lupus Low Disease Activity State definition (LLDAS), with modifications to make it applicable to cSLE (cLLDAS). They agreed upon five cLLDAS criteria: (1) SLE Disease Activity Index (SLEDAI)-2 K ≤4, with no activity in major organ systems; (2) no new features of lupus disease activity compared with the last assessment; (3) Physician Global Assessment score of ≤1 (0-3 scale); (4) prednisolone dose of ≤0.15 mg/kg/day, 7.5 mg/day/maximum; while on (5) stable antimalarials, immunosuppressives, and biologics. CONCLUSIONS A cSLE-appropriate definition of cLLDAS has been generated, maintaining alignment with the adult-SLE definition to promote life-course research.
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Affiliation(s)
- E M D Smith
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
| | - A Aggarwal
- Department of Clinical Immunology & Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - J Ainsworth
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - E Al-Abadi
- Department of Paediatric Rheumatology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - T Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, Children's Hospital, University Medical Center Ljubljana, Slovenia
| | - L Bortey
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J Burnham
- Department of Pediatric Rheumatology, Children's Hospital of Philadelphia, Philadelphia, USA
| | - C Ciurtin
- Centre for Adolescent Rheumatology Versus Arthritis, Division of Medicine, University College London, UK
| | - C M Hedrich
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - S Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, Netherlands
| | - L Lambert
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - D M Levy
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Canada
| | - L 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
| | - N Maxwell
- TARGET Lupus Public Patient Involvement and Engagement Group, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E Morand
- Centre for Inflammatory Diseases, Monash University, Melbourne, Australia
| | - S Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | - C E Pain
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - A Ravelli
- Direzione Scientifica, IRCCS Istituto Giannina Gaslini, Genoa, Italy; Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno Infantili (DINOGMI), Università degli Studi di Genova, Genoa, Italy
| | - C Saad Magalhaes
- Department of Pediatric Rheumatology, Botucatu Medical School, Sao Paulo State University, Sao Paulo, Brazil
| | - C Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - D Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious diseases, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands
| | - C Scott
- Clinical Research Centre, Department of Pediatric Rheumatology, University of Cape Town, Cape Town, South Africa
| | - K Tullus
- Department of Paediatric Nephrology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M W Beresford
- Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
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Wahadat MJ, van Tilburg SJ, Mueller YM, de Wit H, Van Helden-Meeuwsen CG, Langerak AW, Gruijters MJ, Mubarak A, Verkaaik M, Katsikis PD, Versnel MA, Kamphuis S. Targeted multiomics in childhood-onset SLE reveal distinct biological phenotypes associated with disease activity: results from an explorative study. Lupus Sci Med 2023; 10:10/1/e000799. [PMID: 37012057 PMCID: PMC10083882 DOI: 10.1136/lupus-2022-000799] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 02/10/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To combine targeted transcriptomic and proteomic data in an unsupervised hierarchical clustering method to stratify patients with childhood-onset SLE (cSLE) into similar biological phenotypes, and study the immunological cellular landscape that characterises the clusters. METHODS Targeted whole blood gene expression and serum cytokines were determined in patients with cSLE, preselected on disease activity state (at diagnosis, Low Lupus Disease Activity State (LLDAS), flare). Unsupervised hierarchical clustering, agnostic to disease characteristics, was used to identify clusters with distinct biological phenotypes. Disease activity was scored by clinical SELENA-SLEDAI (Safety of Estrogens in Systemic Lupus Erythematosus National Assessment-Systemic Lupus Erythematosus Disease Activity Index). High-dimensional 40-colour flow cytometry was used to identify immune cell subsets. RESULTS Three unique clusters were identified, each characterised by a set of differentially expressed genes and cytokines, and by disease activity state: cluster 1 contained primarily patients in LLDAS, cluster 2 contained mainly treatment-naïve patients at diagnosis and cluster 3 contained a mixed group of patients, namely in LLDAS, at diagnosis and disease flare. The biological phenotypes did not reflect previous organ system involvement and over time, patients could move from one cluster to another. Healthy controls clustered together in cluster 1. Specific immune cell subsets, including CD11c+ B cells, conventional dendritic cells, plasmablasts and early effector CD4+ T cells, differed between the clusters. CONCLUSION Using a targeted multiomic approach, we clustered patients into distinct biological phenotypes that are related to disease activity state but not to organ system involvement. This supports a new concept where choice of treatment and tapering strategies are not solely based on clinical phenotype but includes measuring novel biological parameters.
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Affiliation(s)
- Mohamed Javad Wahadat
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Yvonne M Mueller
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Harm de Wit
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Anton W Langerak
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Marike J Gruijters
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Amani Mubarak
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marleen Verkaaik
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Peter D Katsikis
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Marjan A Versnel
- Department of Immunology, Erasmus MC, Rotterdam, The Netherlands
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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9
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Wahadat MJ, Qi H, van Helden-Meeuwsen CG, Huijser E, van den Berg L, van Dijk-Hummelman A, Göpfert JC, Heine A, Verkaaik M, Schreurs MWJ, Dik WA, Kamphuis S, Versnel MA. Serum IFNα2 levels are associated with disease activity and outperform IFN-I gene signature in a longitudinal childhood-onset SLE cohort. Rheumatology (Oxford) 2022:6900960. [PMID: 36515466 PMCID: PMC10393436 DOI: 10.1093/rheumatology/keac698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/25/2022] [Accepted: 11/23/2022] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To study the association of serum IFNα2 levels measured by ultrasensitive single-molecule array (Simoa) and interferon type I gene signature (IGS) with disease activity and determine whether these assays can mark disease activity states in a longitudinal cohort of childhood-onset SLE patients. METHODS Serum IFNα2 levels were measured in 338 samples from 48 cSLE patients and 67 healthy controls using IFNα Simoa assay. Five gene IGS was measured by RT-PCR in paired whole blood samples. Disease activity was measured by clinical SELENA-SLEDAI and BILAG-2004. Low disease activity was defined by Low Lupus Disease Activity State (LLDAS) and flares were characterized by SELENA-SLEDAI flare index. Analysis was performed using linear mixed models. RESULTS A clear positive correlation was present between serum IFNα2 levels and the IGS (r = 0.78, p < 0.0001). Serum IFNα2 levels and IGS showed the same significant negative trend in the first three years after diagnosis. In this timeframe, mean baseline serum IFNα2 levels decreased with 55.1% (Δ 201 fg/mL, p < 0.001) to a mean value of 164 fg/mL, which was below the calculated threshold of 219.4 fg/mL, which discriminated between patients and healthy controls. In the linear mixed model, serum IFNα2 levels were significantly associated with both cSELENA-SLEDAI and BILAG-2004, while the IGS did not show this association. Both IFN-I assays were able to characterize LLDAS and disease flare in ROC analysis. CONCLUSIONS Serum IFNα2 levels measured by Simoa technology are associated with disease activity scores and characterize disease activity states in cSLE.
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Affiliation(s)
- M Javad Wahadat
- Dept. Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
- Dept. Paediatric Rheumatology, Sophia Children's hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hongchao Qi
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Erika Huijser
- Dept. Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Lotte van den Berg
- Dept. Paediatric Rheumatology, Sophia Children's hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annette van Dijk-Hummelman
- Dept. Paediatric Rheumatology, Sophia Children's hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jens C Göpfert
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Dep. of Applied, Biomarkers and Immunoassays, Reutlingen, Germany
| | - Anne Heine
- NMI Natural and Medical Sciences Institute at the University of Tübingen, Dep. of Applied, Biomarkers and Immunoassays, Reutlingen, Germany
| | - Marleen Verkaaik
- Dept. Paediatric Rheumatology, Sophia Children's hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marco W J Schreurs
- Laboratory Medical Immunology, dept. Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Willem A Dik
- Laboratory Medical Immunology, dept. Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sylvia Kamphuis
- Dept. Paediatric Rheumatology, Sophia Children's hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marjan A Versnel
- Dept. Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
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10
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Huijser E, van Helden-Meeuwsen CG, Grashof DGB, Tarn JR, Brkic Z, Huisman JMA, Wahadat MJ, van de Werken HJG, Lopes AP, van Roon JAG, van Daele PLA, Kamphuis S, Ng WF, Bekkering S, Joosten LAB, Dik WA, Versnel MA. Trained Immunity in Primary Sjögren’s Syndrome: Linking Type I Interferons to a Pro-Atherogenic Phenotype. Front Immunol 2022; 13:840751. [PMID: 35860283 PMCID: PMC9289449 DOI: 10.3389/fimmu.2022.840751] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Background Trained immunity – or innate immune memory – can be described as the long-term reprogramming of innate immune cells towards a hyperresponsive state which involves intracellular metabolic changes. Trained immunity has been linked to atherosclerosis. A subgroup of patients with primary Sjögren’s syndrome (pSS) exhibits systemic type I interferon (IFN) pathway activation, indicating innate immune hyperactivation. Here, we studied the link between type I IFNs and trained immunity in an in vitro monocytic cell model and peripheral blood mononuclear cells (PBMCs) from pSS patients. Methods The training stimuli heat killed Candida albicans, muramyl dipeptide, IFNβ, and patient serum were added to THP-1 cells for 24 hours, after which the cells were washed, rested for 48 hours and subsequently re-stimulated with LPS, Pam3Cys, poly I:C, IFNβ or oxLDL for 4-24 hours. PBMCs from pSS patients and healthy controls were stimulated with LPS, Pam3Cys, poly I:C or IFNβ for 0.5-24 hours. Results Training with IFNβ induced elevated production of pro-atherogenic cytokines IL-6, TNFα and CCL2, differential cholesterol- and glycolysis-related gene expression, and increased glucose consumption and oxLDL uptake upon re-stimulation. Type I IFN production was increased in Candida albicans- and IFNβ-trained cells after LPS re-stimulation, but was reduced after poly I:C re-stimulation. Training with muramyl dipeptide and IFNβ, but not Candida albicans, affected the IFN-stimulated gene expression response to IFNβ re-stimulation. PBMCs from pSS patients consumed more glucose compared with healthy control PBMCs and tended to produce more TNFα and type I IFNs upon LPS stimulation, but less type I IFNs upon poly I:C stimulation. Conclusions Type I IFN is a trainer inducing a trained immunity phenotype with pro-atherogenic properties in monocytes. Conversely, trained immunity also affects the production of type I IFNs and transcriptional response to type I IFN receptor re-stimulation. The phenotype of pSS PBMCs is consistent with trained immunity. This connection between type I IFN, trained immunity and cholesterol metabolism may have important implications for pSS and the pathogenesis of (subclinical) atherosclerosis in these patients.
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Affiliation(s)
- Erika Huijser
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Dwin G. B. Grashof
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jessica R. Tarn
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
| | - Zana Brkic
- Department of Internal Medicine, Division of Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Josje M. A. Huisman
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - M. Javad Wahadat
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Paediatric Rheumatology, Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Harmen J. G. van de Werken
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Cancer Computational Biology Center, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ana P. Lopes
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Joel A. G. van Roon
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Center for Translational Immunology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Paul L. A. van Daele
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Internal Medicine, Division of Clinical Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wan-Fai Ng
- Translational and Clinical Research Institute, Newcastle University, Newcastle, United Kingdom
- NIHR Newcastle Biomedical Research Centre, Newcastle, United Kingdom
- NIHR Newcastle Clinical Research Facility, Newcastle, United Kingdom
| | - Siroon Bekkering
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud UMC, Nijmegen, Netherlands
- Radboud Center for Molecular Life Sciences, Radboud UMC, Nijmegen, Netherlands
| | - Leo A. B. Joosten
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud UMC, Nijmegen, Netherlands
- Radboud Center for Molecular Life Sciences, Radboud UMC, Nijmegen, Netherlands
| | - Willem A. Dik
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marjan A. Versnel
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- *Correspondence: Marjan A. Versnel,
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11
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Giancane G, Papa R, Vastert S, Bagnasco F, Swart JF, Quartier P, Antón J, Kamphuis S, Sanner H, Glerup M, De Benedetti F, Tsitsami E, Remesal A, Moreno E, De Inocencio J, Myrup C, Pallotti C, Koné-Paut I, Franck-Larsson K, Malmström H, Cederholm S, Pistorio A, Wulffraat N, Ruperto N. Anakinra in Patients With Systemic Juvenile Idiopathic Arthritis: Long-term Safety From the Pharmachild Registry. J Rheumatol 2022; 49:398-407. [PMID: 35105709 DOI: 10.3899/jrheum.210563] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To evaluate the long-term safety profile of anakinra in patients with systemic juvenile idiopathic arthritis (sJIA). METHODS Data from patients with sJIA enrolled in the Pharmachild registry (ClinicalTrials.gov: NCT03932344) prior to September 30, 2018, and treated with anakinra were analyzed. The study endpoints were the occurrence of non-serious adverse events (SAEs) of at least moderate severity and SAEs, including macrophage activation syndrome (MAS), and the duration of anakinra treatment with reasons for discontinuation. All endpoints were analyzed overall by 6-month time windows, and in different treatment sets represented by those patients treated continuously with anakinra for at least 12, 18, and 24 months (set-12, -18, and -24, respectively). RESULTS Three hundred six patients were enrolled. Of these patients, 46%, 34%, and 28% had been treated for at least 12, 18, and 24 months, respectively. Two hundred and one AEs, mostly represented by infections, were reported for 509.3 patient-years (PY) with an overall incidence rate (IR) of 39.5 per 100 PY. Among 56 SAEs (IR 11.0/100 PY), 23.2% were infections and 19.6% MAS episodes. The IR of AEs was higher during the first 6 months of anakinra treatment, followed by decreasing IRs in the long-term treatment sets. Treatment discontinuation occurred in 76% of patients, most frequently in the first 6 months, because of inefficacy (43%), remission (31%), or AEs/intolerance (15%). No deaths or malignancies occurred during anakinra treatment. CONCLUSION The results of the present study confirm the long-term safety profile of anakinra in patients with sJIA and demonstrate an overall decreasing incidence of AEs over time. [ClinicalTrials.gov: NCT01399281 and NCT03932344].
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Affiliation(s)
- Gabriella Giancane
- G. Giancane, MD, PhD, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy;
| | - Riccardo Papa
- R. Papa, MD, C. Pallotti, MA, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sebastiaan Vastert
- S. Vastert, MD, Department of Pediatric Immunology and Rheumatology, Wilhelmina Kinderziekenhuis, Utrecht, the Netherlands
| | - Francesca Bagnasco
- F. Bagnasco, MSc, A. Pistorio, MD, Servizio di Epidemiologia e Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Joost F Swart
- J.F. Swart, MD, N. Wulffraat, Professor, Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
| | - Pierre Quartier
- P. Quartier, MD, Université de Paris, Institut IMAGINE, Centre de référence national pour les Rhumatismes inflammatoires et les maladies Auto-Immunes Systémiques rares de l'Enfant (RAISE), Unité d'Immunologie, Hématologie et Rhumatologie Pédiatrique, Hôpital Necker-Enfants Malades, AP-HP, Paris, France
| | - Jordi Antón
- J. Antón, MD, Division of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat (Barcelona), Spain
| | - Sylvia Kamphuis
- S. Kamphuis, MD, Department of Paediatric Rheumatology/Department of Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Helga Sanner
- H. Sanner, MD, Department of Rheumatology - Norwegian National Advisory Unit on Rheumatic Diseases in Children and Adolescents, Oslo University Hospital, Oslo, Norway
| | - Mia Glerup
- M. Glerup, MD, Pediatric rheumatology unit, Aarhus University Hospital, Aarhus, Denmark
| | - Fabrizio De Benedetti
- F. De Benedetti, MD, Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Elena Tsitsami
- E. Tsitsami, MD, First Department of Pediatrics, Aghia Sophia Children's Hospital, University of Athens Medical School, Athens, Greece
| | - Agustin Remesal
- A. Remesal, MD, Rheumatology Unit, University Hospital La Paz, Madrid, Spain
| | - Estefania Moreno
- E. Moreno, MD, Rheumatology Unit, University Hospital Valle de Hebron, Barcelona, Spain
| | - Jaime De Inocencio
- J. De Inocencio, MD, Department of Pediatric Rheumatology, 12 de Octubre University Hospital, Madrid, Spain
| | - Charlotte Myrup
- C. Myrup, MD, Pediatric rheumatology unit 4272, Rigshospitalet, Copenhagen, Denmark
| | - Chiara Pallotti
- R. Papa, MD, C. Pallotti, MA, Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Isabelle Koné-Paut
- I. Koné-Paut, MD, Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, AP-HP, University of Paris Sud Saclay, le Kremlin Bicêtre, France
| | - Karin Franck-Larsson
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Håkan Malmström
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Susanna Cederholm
- K. Franck-Larsson, MD, PhD, H. Malmström, PhD, S. Cederholm, MSc Pharm, Sobi, Stockholm, Sweden
| | - Angela Pistorio
- F. Bagnasco, MSc, A. Pistorio, MD, Servizio di Epidemiologia e Biostatistica, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Nico Wulffraat
- J.F. Swart, MD, N. Wulffraat, Professor, Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Utrecht, the Netherlands
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12
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Wahadat MJ, Schonenberg-Meinema D, van Helden-Meeuwsen CG, van Tilburg SJ, Groot N, Schatorjé EJH, Hoppenreijs EPAH, Hissink Muller PCE, Brinkman DMC, Dvorak D, Verkaaik M, van den Berg JM, Bouchalova K, Kamphuis S, Versnel MA. OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:4344-4354. [PMID: 35143620 PMCID: PMC9629374 DOI: 10.1093/rheumatology/keac083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/31/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives Clinical phenotyping and predicting treatment responses in SLE patients is challenging. Extensive blood transcriptional profiling has identified various gene modules that are promising for stratification of SLE patients. We aimed to translate existing transcriptomic data into simpler gene signatures suitable for daily clinical practice. Methods Real-time PCR of multiple genes from the IFN M1.2, IFN M5.12, neutrophil (NPh) and plasma cell (PLC) modules, followed by a principle component analysis, was used to identify indicator genes per gene signature. Gene signatures were measured in longitudinal samples from two childhood-onset SLE cohorts (n = 101 and n = 34, respectively), and associations with clinical features were assessed. Disease activity was measured using Safety of Estrogen in Lupus National Assessment (SELENA)-SLEDAI. Cluster analysis subdivided patients into three mutually exclusive fingerprint-groups termed (1) all-signatures-low, (2) only IFN high (M1.2 and/or M5.12) and (3) high NPh and/or PLC. Results All gene signatures were significantly associated with disease activity in cross-sectionally collected samples. The PLC-signature showed the highest association with disease activity. Interestingly, in longitudinally collected samples, the PLC-signature was associated with disease activity and showed a decrease over time. When patients were divided into fingerprints, the highest disease activity was observed in the high NPh and/or PLC group. The lowest disease activity was observed in the all-signatures-low group. The same distribution was reproduced in samples from an independent SLE cohort. Conclusions The identified gene signatures were associated with disease activity and were indicated to be suitable tools for stratifying SLE patients into groups with similar activated immune pathways that may guide future treatment choices.
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Affiliation(s)
- M Javad Wahadat
- Department of Immunology, Erasmus MC
- Department of Paediatric Rheumatology, Erasmus MC—Sophia Children’s hospital, University Medical Center Rotterdam, Rotterdam
| | - Dieneke Schonenberg-Meinema
- Department of Pediatric Immunology, Rheumatology and Infectious diseases, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam
| | | | | | - Noortje Groot
- Department of Paediatric Rheumatology, Erasmus MC—Sophia Children’s hospital, University Medical Center Rotterdam, Rotterdam
| | - Ellen J H Schatorjé
- Department of Paediatric Rheumatology, Amalia Children’s Hospital, Radboudumc
- Department of Paediatric Rheumatology, St. Maartenskliniek, Nijmegen
| | - Esther P A H Hoppenreijs
- Department of Paediatric Rheumatology, Amalia Children’s Hospital, Radboudumc
- Department of Paediatric Rheumatology, St. Maartenskliniek, Nijmegen
| | - Petra C E Hissink Muller
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Danielle M C Brinkman
- Department of Pediatrics, Division of Pediatric Rheumatology, Willem Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Denis Dvorak
- Paediatric Rheumatology, Department of Paediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | - Marleen Verkaaik
- Department of Paediatric Rheumatology, Erasmus MC—Sophia Children’s hospital, University Medical Center Rotterdam, Rotterdam
| | - J Merlijn van den Berg
- Department of Pediatric Immunology, Rheumatology and Infectious diseases, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam
| | - Kateřina Bouchalova
- Paediatric Rheumatology, Department of Paediatrics, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital, Olomouc, Czech Republic
| | | | - Marjan A Versnel
- Correspondence to: Marjan Versnel, Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Room: Nb-1141a, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. E-mail:
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Wahadat MJ, van den Berg L, Timmermans D, van Rijswijk K, van Dijk-Hummelman A, Bakx S, Verkaaik M, Versnel MA, Kamphuis S. LLDAS is an attainable treat-to-target goal in childhood-onset SLE. Lupus Sci Med 2021; 8:e000571. [PMID: 34969874 PMCID: PMC8719245 DOI: 10.1136/lupus-2021-000571] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/12/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To study whether clinical remission (CR) and Low Lupus Disease Activity State (LLDAS) are achievable goals in childhood-onset SLE. METHODS Data on medication use and disease activity were prospectively collected. LLDAS was defined as Safety of Estrogen in Lupus Erythematosus National Assesment-SLE disease Activity Index (SELENA-SLEDAI) ≤4 with zero scores for renal, Central Nervous System (CNS), serositis, vasculitis and constitutional components, no increase in any SLEDAI component since the previous visit, PGA ≤1, and prednisone dose ≤7.5 mg/day. CR on treatment (Tx) was defined as a Physician Global Assessment <0.5, SELENA-SLEDAI=0, with prednisone ≤5 mg/day and maintenance treatment with immunosuppressives. CR off Tx was the same but without prednisone or other immunosuppressive usage. RESULTS 51 patients (700 visits) were included. Within 3 months after diagnosis, 94.1% of children were treated with hydroxychloroquine and 60.8% with prednisone. Prednisone dosage decreased from a median of 0.74 mg/kg/day at diagnosis to 0.44 mg/kg/day at 3 months and 0.16 mg/kg/day at 6 months after diagnosis. Use of mycophenolate mofetil increased from 25.5% to 56.9% within 6 months after diagnosis. All children achieved LLDAS (median 186 days) and 72.5% remained in LLDAS >50% of time. 52.9% children achieved CR on Tx, and only 21.6% children achieved CR off Tx. CONCLUSIONS LLDAS is an attainable treat-to-target goal in contrast to CR on and off Tx. Even more, LLDAS can be reached with limited use of corticosteroids with early introduction of immunosuppressives.
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Affiliation(s)
- Mohamed Javad Wahadat
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Lotte van den Berg
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Demi Timmermans
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Kevin van Rijswijk
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Annette van Dijk-Hummelman
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Susan Bakx
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marleen Verkaaik
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marjan A Versnel
- Department of Immunology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
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Bergkamp S, Wahadat MJ, Smith V, Kamphuis S, Van den Berg JM, Schonenberg-Meinema D. AB0081 ENDOTHELIAL MARKERS WITH DYSREGULATION IN SYSTEMIC LUPUS ERYTHEMATOSUS: A SYSTEMATIC LITERATURE REVIEW. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic lupus erythematosus (SLE) is a severe, lifelong autoimmune disease known for its multisystem organ involvement. SLE patients are known to be at risk for premature atherosclerosis at a relatively young age (1). Endothelial dysregulation is one of the pathophysiologic mechanisms that can lead to the higher risk for cardiovascular disease in SLE (2). Multiple endothelial markers with dysregulation in SLE have been described so far, of which some are associated with disease activity.Objectives:To report a systematic literature review regarding endothelial markers that are dysregulated in SLE and search for associations with disease activity.Methods:The search was performed according to the Preferred Reporting Items for Systematic review and Meta-analysis Protocols (PRISMA-P) 2015 (3). In July 2020, the search terms were used in Embase, MEDLINE, Web of Science, Google Scholar and Cochrane. Inclusion criteria were 1) published studies after the year 2000 that reported measurements of endothelial cell markers in serum and/or plasma of SLE patients (diagnosed according to ACR/SLICC criteria), 2) English language peer reviewed articles and 3) disease activity measurement (i.e. SLEDAI, BILAG, SLAM, ECLAM or PGA). Exclusion criteria were 1) case reports or editorials, 2) studies performed in animals and 3) studies with microRNA/cytokine biomarkers. There was no minimum count for study population. The screening process is shown in figure 1.Results:From 1892 hits, we identified 110 eligible articles. Table 1 shows an overview of the most frequently studied endothelial markers. These identified endothelial markers are involved in endothelial cell (EC) activation, EC apoptosis, disturbed angiogenesis, defective vascular tone control, immune dysregulation and coagulopathy. In most studies, dysregulation of the endothelial marker was associated with disease activity. The majority of the studies had a cross-sectional design, longitudinal data on endothelial markers in SLE are scarce.Conclusion:We identified multiple endothelial markers that are dysregulated in SLE and this dysregulation was often associated with disease activity in cross-sectional studies. Our future plan is to test the identified endothelial markers in (longitudinally collected) samples of (childhood onset) SLE patients, disease- and healthy controls. This will be a next step in unravelling the pathophysiology of premature atherosclerosis and cardiovascular events in SLE-patients in young adulthood.Figure 1.References:[1]Vavlukis M, Pop-Gjorceva D, Poposka L, Sandevska E, Kedev S. Myocardial Infarction in Systemic Lupus Erythematosus - the Sex Specific Risk Profile. Curr Pharm Des. 2020 Dec 9.[2]Westerweel PE, Luyten RK, Koomans HA, Derksen RH, Verhaar MC. Premature atherosclerotic cardiovascular disease in systemic lupus erythematosus. Arthritis Rheum. 2007 May;56(5):1384-96.[3]Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, Shekelle P, Stewart LA; PRISMA-P Group. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015 Jan 2;350:g7647.Table 1.Endothelial markerArticles(no. of studies)Significant correlation with SLEDAI(no. of studies)Studies with control groups(no. of studies)Longitudinal data(no. of studies)YesNoUnknownHealthy controlsDiseased controlsVCAM-12620152338VEGF2213542022ICAM-11811521734Thrombomodulin1710521322E-Selectin136521021MCP-18620712P-Selectin6321611IP-106510501Pentraxin-35500512vWF5410502Neopterin3210202Fas3021201Angiopoeietin-2330021-Endothelin-1312030-PAI-1311120-Adrenomedullin320120-TWEAK311112-PECAM-1311130-Disclosure of Interests:None declared
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Giancane G, Papa R, Vastert S, Bagnasco F, Swart JF, Quartier P, Hofer M, Anton J, Kamphuis S, Sanner H, Glerup M, De Benedetti F, Tsitsami E, Remesal A, Moreno Ruzafa E, De Inocencio J, Myrup C, Pallotti C, Koné-Paut I, Franck-Larsson K, Malmstrom H, Cederholm S, Pistorio A, Wulffraat N, Ruperto N. OP0164 LONG-TERM SAFETY OF ANAKINRA IN PATIENTS WITH SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS FROM THE PHARMACHILD REGISTRY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.1731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic juvenile idiopathic arthritis (SJIA) is characterized by extra-articular manifestations, as fever and rash, and rarely associated by a potentially lethal complication as macrophage activation syndrome (MAS). Anakinra is a recombinant human interleukin (IL)-1 receptor antagonist whose efficacy and safety profile has been studied for patients with SJIA.Objectives:To evaluate the long-term safety profile of anakinra in patients with SJIA.Methods:Data from patients with SJIA enrolled in the Pharmachild registry before 30 September 2018 and treated with anakinra were analyzed. The study endpoints were the occurrence of non-serious adverse events (AEs) of at least moderate severity and serious AEs (SAEs), including macrophage activation syndrome (MAS), and the duration of anakinra treatment with reasons for discontinuation. All endpoints were analyzed overall, by 6 month-time windows and in different treatment sets represented by those patients continuously treated with anakinra for at least 12, 18 and 24 months (set-12, -18, -24, respectively).Results:306 patients were enrolled. 46%, 34% and 28% of them had been treated for at least 12, 18 and 24 months, respectively. 201 AEs, mostly represented by infections, were reported for 509.3 patient-years (py) with an overall incidence rate (IR) of 39.5/100 py. Among 56 SAEs (IR 11.0/100 py), (Table 1) 23.2% were infections and 19.6% MAS episodes. The IR of AEs was higher during the first 6 months of anakinra, followed by decreasing IR in the different long-term treatment sets. Treatment discontinuation occurred in 76% of patients, most in the first 6 months, due to inefficacy (43%), remission (31%) or AEs/intolerance (15%). No deaths or malignancies occurred during anakinra treatment.Table 1.Number of SAEs and incidence rates (95% CI) by overall PT decreasing order and time window in the complete set (events with a frequency >1 by overall SOC and >1 by overall PT were reported) Only time windows <13 months were reported in the present table.Time window1-6 months7-12 monthsOverallN306194306Patient-time (years)117.380.2509.3SOCPTnRate (95% CI)nRate (95% CI)nRate(95% CI)AllAll3328.1 (19.1-41.5)45.0 (1.9-13.2)5611.0 (7.9-15.2)Infections and infestationsAll76.0 (2.9- 12.4)11.2 (0.2- 8.8)132.6 (1.4- 4.8)Pneumonia21.7 (0.4- 6.8)11.2 (0.2- 8.8)40.8 (0.3- 2.1)Immune system disordersAll76.0 (2.8- 12.5)11.2 (0.2- 8.8)112.2 (1.1- 4.1)Haemophagocytic lymphohistiocytosis76.0 (2.8- 12.5)11.2 (0.2- 8.8)112.2 (1.1- 4.1)Injury, poisoning and procedural complicationsAll54.3 (1.8- 10.2)--91.8 (0.9- 3.4)Infusion related reaction10.9 (0.1- 6.0)--20.4 (0.1- 1.6)Injection related reaction43.4 (1.3- 9.1)--61.2 (0.5- 2.6)Metabolism and nutrition disordersAll32.6 (0.8- 7.9)--40.8 (0.3- 2.1)Skin and subcutaneous tissue disordersAll32.6 (0.8- 7.9)11.2 (0.2- 8.8)40.8 (0.3- 2.1)Blood and lymphatic system disordersAll10.9 (0.1- 6.1)--20.4 (0.1- 1.6)General disorders and administration site conditionsAll10.9 (0.1- 6.1)11.2 (0.2- 8.8)20.4 (0.1- 1.6)InvestigationsAll21.7 (0.4- 6.8)--20.4 (0.1- 1.6)Nervous system disordersAll10.9 (0.1- 6.0)--20.4 (0.1- 1.6)Surgical and medical proceduresAll10.9 (0.1- 6.0)--20.4 (0.1- 1.5)Abbreviations: SAE, serious adverse event; SOC, system organ class; PT, preferred term, MedDRA version 21.1; N, number of patients ever treated with anakinra during the time window irrespectively of the length of any unexposed periods; 95% CI, 95% Confidence Interval.Conclusion:The results of the present study confirm the long-term safety profile of anakinra in SJIA patients and show a decreasing overall incidence rate of AEs over time.Disclosure of Interests:Gabriella Giancane Grant/research support from: The study was funded by SOBI Swedish, Riccardo Papa Grant/research support from: The study was funded by SOBI Swedish, Sebastian Vastert Grant/research support from: The study was funded by SOBI Swedish, Francesca Bagnasco Grant/research support from: The study was funded by SOBI Swedish, Joost F. Swart Grant/research support from: The study was funded by SOBI Swedish, Pierre Quartier Grant/research support from: The study was funded by SOBI Swedish, michael hofer Grant/research support from: The study was funded by SOBI Swedish, Jordi Anton Grant/research support from: The study was funded by SOBI Swedish, Sylvia Kamphuis Grant/research support from: The study was funded by SOBI Swedish, Helga Sanner Grant/research support from: The study was funded by SOBI Swedish, Mia Glerup Grant/research support from: The study was funded by SOBI Swedish, Fabrizio De Benedetti Grant/research support from: The study was funded by SOBI Swedish, Elena Tsitsami Grant/research support from: The study was funded by SOBI Swedish, Agustin Remesal Grant/research support from: The study was funded by SOBI Swedish, Estefania Moreno Ruzafa Grant/research support from: The study was funded by SOBI Swedish, Jaime de Inocencio Grant/research support from: The study was funded by SOBI Swedish, Charlotte Myrup Grant/research support from: The study was funded by SOBI Swedish, Chiara Pallotti Grant/research support from: The study was funded by SOBI Swedish, Isabelle Koné-Paut Grant/research support from: The study was funded by SOBI Swedish, Karin Franck-Larsson Employee of: I am employee of SOBI pharmaceutical company, Hakan Malmstrom Employee of: I am employee of SOBI pharmaceutical company, Susanna Cederholm Employee of: I am employee of SOBI pharmaceutical company, Angela Pistorio Grant/research support from: The study was funded by SOBI Swedish, Nico Wulffraat Grant/research support from: The study was funded by SOBI Swedish, Nicolino Ruperto Speakers bureau: NR has received honoraria for consultancies or speaker bureaus (< 10.000 USD each) from the following pharmaceutical companies in the past 3 years: Ablynx, Astrazeneca-Medimmune, Bayer, Biogen, Boehringer, Bristol Myers and Squibb, Celgene, Eli-Lilly, EMD Serono, Glaxo Smith and Kline, Hoffmann-La Roche,Janssen, Merck, Novartis, Pfizer, R-Pharma, Sinergie, Sobi and UCB., Consultant of: NR has received honoraria for consultancies or speaker bureaus (< 10.000 USD each) from the following pharmaceutical companies in the past 3 years: Ablynx, Astrazeneca-Medimmune, Bayer, Biogen, Boehringer, Bristol Myers and Squibb, Celgene, Eli-Lilly, EMD Serono, Glaxo Smith and Kline, Hoffmann-La Roche,Janssen, Merck, Novartis, Pfizer, R-Pharma, Sinergie, Sobi and UCB., Grant/research support from: The IRCCS Istituto Giannina Gaslini (IGG), where NR works as full-time public employee has received contributions (> 10.000 USD each) from the following industries in the last 3 years: BMS, Eli-Lilly, GlaxoSmithKline, F Hoffmann-La Roche, Janssen, Novartis, Pfizer, Sobi. This funding has been reinvested for the research activities of the hospital in a fully independent manner, without any commitment with third parties.
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Wahadat MJ, Van Helden-Meeuwsen CG, Van Tilburg S, Schatorjé E, Hoppenreijs E, Hissink Muller PCE, Van den Berg JM, Schonenberg-Meinema D, Kamphuis S, Versnel M. POS0178 GENE SIGNATURE FINGERPRINTS DIVIDE SLE PATIENTS IN SUBGROUPS WITH COMPARABLE BIOLOGICAL DISEASE PROFILES: A MULTICENTRE LONGITUDINAL STUDY. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Even in the hands of experienced clinicians, clinical phenotyping and predicting treatment responses in Systemic Lupus Erythematosus (SLE) patients remains challenging. Therefore, the identification of biomarkers that can help physicians to divide patients into subgroups based upon aberrantly activated pathways is relevant and might guide future treatment strategies. Extensive blood transcriptional profiling has identified various gene modules that seem promising for stratification of SLE patients into subgroups (1). However, the feasibility to implement these complicated and expensive tests for use in the daily practice of routine clinical laboratories is challenging if not impossible.Objectives:The aim of this study was to develop gene signatures that stratify patients into groups with comparable disease profiles and are feasible to perform in routine clinical laboratories.Methods:To identify coordinated expression of a set of genes and reduce data complexity, genes from 4 previously described modules (Interferon M1.2, Interferon M5.12, Neutrophil- and Plasmablast (PB)(1)) were measured using real-time quantitative PCR expression on whole blood RNA samples. Subsequently, a principle component analysis was used to select 2-5 indicator genes, that represent a specific signature. Expression levels of these genes were measured in healthy donors (n=42) and samples from two independent childhood-onset SLE cohorts (n=51 and n=20). Scores higher than the mean + 2 S.D. score of healthy controls were defined as high gene signature scores. Based on their expression levels, gene signatures were divided over 14 clusters. Associated clusters were subsequently grouped into three gene fingerprints termed 1) all-signatures-low, 2) only high IFN (M1.2 and/or M5.12) and 3) high PB and/or Neutrophil. Disease activity was measured by the SELENA-SLEDAI score.Results:All four gene signatures were higher expressed in patients compared to healthy controls and showed a significant correlation with the SLEDAI. The PB signature showed the highest association with disease activity (r= 0.6512, P<0.0001). In longitudinally collected samples, the PB signature was reduced in patients who were on treatment and showed a significant trend with the SLEDAI. When patients were divided into the described gene fingerprints, the highest SLEDAI scores (median score=8) were observed in the high PB-Neutrophil group. The lowest disease activity (median score =2) was observed in the all-signatures-low group. The same distribution was seen when samples from a second time point were divided based on this stratification method and this was also reproduced in samples from an independent SLE cohort (figure 1).Conclusion:Various gene signatures are associated with disease activity, which underlines the involvement of different pathophysiological mechanisms in SLE. Combining these signatures into gene fingerprints can help to stratify patients into comparable groups and guide individualized treatment choices for patients in the future.References:[1]Banchereau R, Hong S, Cantarel B, Baldwin N, Baisch J, Edens M, et al. Personalized Immunomonitoring Uncovers Molecular Networks that Stratify Lupus Patients. Cell. 2016;165(6):1548-50.Figure 1.SELENA-SLEDAI scores based on gene fingerprint distribution. Blue indicates time point one of cohort 1 (n=51); pink indicates time point two of cohort 1 (n=45); red indicates time point one of the replication cohort (n=20)Disclosure of Interests:None declared
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Dominguez D, Kamphuis S, Beyene J, Wither J, Harley JB, Blanco I, Vila-Inda C, Brunner H, Klein-Gitleman M, McCurdy D, Wahezi DM, Lehman T, Jelusic M, Peschken CA, Pope JE, Gladman DD, Hanly JG, Clarke AE, Bernatsky S, Pineau C, Smith CD, Barr S, Boire G, Rich E, Silverman ED. Relationship Between Genetic Risk and Age of Diagnosis in Systemic Lupus Erythematosus. J Rheumatol 2020; 48:852-858. [PMID: 33060314 DOI: 10.3899/jrheum.200002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Specific risk alleles for childhood-onset systemic lupus erythematosus SLE (cSLE) vs adult-onset SLE (aSLE) patients have not been identified. The aims of this study were to determine if there is an association (1) between non-HLA-related genetic risk score (GRS) and age of SLE diagnosis, and (2) between HLA-related GRS and age of SLE diagnosis. METHODS Genomic DNA was obtained from 2001 multiethnic patients and genotyped using the Immunochip. Following quality control, genetic risk counting (GRCS), weighted (GRWS), standardized counting (GRSCS), and standardized weighted (GRSWS) scores were calculated based on independent single-nucleotide polymorphisms from validated SLE loci. Scores were analyzed in a regression model and adjusted by sex and ancestral population. RESULTS The analyzed cohort consisted of 1540 patients: 1351 females and 189 males (675 cSLE and 865 aSLE). There were significant negative associations between all non-HLA GRS and age of SLE diagnosis: P = 0.011 and r2 = 0.175 for GRWS; P = 0.008 and r2 = 0.178 for GRSCS; P = 0.002 and r2 = 0.176 for GRSWS (higher GRS correlated with lower age of diagnosis.) All HLA GRS showed significant positive associations with age of diagnosis: P = 0.049 and r2 = 0.176 for GRCS; P = 0.022 and r2 = 0.176 for GRWS; P = 0.022 and r2 = 0.176 for GRSCS; P = 0.011 and r2 = 0.177 for GRSWS (higher GRS correlated with higher age of diagnosis). CONCLUSION Our data suggest that there is a linear relationship between genetic risk and age of SLE diagnosis and that HLA and non-HLA GRS are associated with age of diagnosis in opposite directions.
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Affiliation(s)
- Daniela Dominguez
- D. Dominguez, MSc, Division of Rheumatology, Hospital for Sick Children, Hospital for Sick Children, Research Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sylvia Kamphuis
- S. Kamphuis, MD, PhD, Division of Rheumatology Department of Pediatrics, Sophia Children's Hospital, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joseph Beyene
- J. Beyene, PhD, Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton
| | - Joan Wither
- J. Wither, MD, PhD, Division of Genetics and Development, Krembil Research Institute, Arthritis Centre of Excellence, Division of Rheumatology, Toronto Western Hospital, University Health Network, Departments of Medicine and Immunology, University of Toronto, Toronto, Ontario, Canada
| | - John B Harley
- J.B. Harley, MD, PhD, Center for Autoimmune Genomics and Etiology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati, and US Department of Veterans Affairs Medical Center, Cincinnati, Ohio
| | - Irene Blanco
- I. Blanco, MD, C. Vila-Inda, MD, Albert Einstein College of Medicine, Division of Rheumatology, Bronx, New York
| | - Catarina Vila-Inda
- I. Blanco, MD, C. Vila-Inda, MD, Albert Einstein College of Medicine, Division of Rheumatology, Bronx, New York
| | - Hermine Brunner
- H. Brunner, MD, MSc, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Marissa Klein-Gitleman
- M. Klein-Gitleman, MD, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Deborah McCurdy
- D. McCurdy, MD, Division of Pediaitric Rheumatology, University of California Los Angeles, Los Angeles, California
| | - Dawn M Wahezi
- D.M. Wahezi, MD, Children's Hospital at Montefiore, Division of Pediatric Rheumatology, Albert Einstein College of Medicine, the Bronx, New York
| | - Thomas Lehman
- T. Lehman, MD, Division of Pediatric Rheumatology, Hospital for Special Surgery, New York, New York, USA
| | - Marija Jelusic
- M. Jelusic, MD, Department of Pediatric Rheumatology, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Christine A Peschken
- C.A. Peschken, MD, MSc, Departments of Medicine and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba
| | - Janet E Pope
- J.E. Pope, MD, MPH, Professor of Medicine, Department of Medicine, University of Western Ontario, London, Ontario
| | - Dafna D Gladman
- D.D. Gladman, MD, Department of Medicine, University of Toronto, Toronto, Ontario
| | - John G Hanly
- J.G. Hanly, MD, Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Center and Dalhousie University, Halifax, Nova Scotia
| | - Ann E Clarke
- A.E. Clarke, MD, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Sasha Bernatsky
- S. Bernatsky, MD, PhD, Department of Medicine, McGill University, Montreal, Quebec
| | - Christian Pineau
- C. Pineau, MD, Department of Medicine, McGill University Hospital, Montreal, Quebec
| | - C Douglas Smith
- C.D. Smith, MD, Department of Medicine, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario
| | - Susan Barr
- S. Barr, MD, Division of Rheumatology, Department of Medicine, University of Calgary, Calgary, Alberta
| | - Gilles Boire
- G. Boire, MD, Division of Rheumatology, Department of Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec
| | - Eric Rich
- E. Rich, MD, Division of Rheumatology, Centre Hospitalier de l'Université de Montreal, Department of Medicine, University of Montreal School of Medicine, Montreal, Quebec
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18
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Groot N, Kardolus A, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Burdorf A, Bultink IE, Kamphuis S. Effects of Childhood-onset Systemic Lupus Erythematosus on Academic Achievements and Employment in Adult Life. J Rheumatol 2020; 48:915-923. [PMID: 32739896 DOI: 10.3899/jrheum.191004] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Long-term outcome data in adults with childhood-onset systemic lupus erythematosus (cSLE) are limited. Here, we report the effects of cSLE on education, vocation, and employment in a large cohort of adults with cSLE. METHODS Patients were seen for a single study visit comprising a structured history and physical examination. Medical records were retrieved to supplement information obtained during the study visit. Education and employment status were assessed by questionnaires. Health-related quality of life (HRQOL) was measured with the 36-Item Short Form Health Survey (SF-36). RESULTS One hundred six patients with cSLE (93% female, 73% White), with a median disease duration of 20 years, completed the visit and questionnaires. Almost all patients stated that cSLE had influenced their education, but the level of completed education was similar to the general Dutch population. Half of the patients had adjusted their vocational choice due to the disease. Still, 44% of patients who had finished education did not have a paid job. Of the employed patients, 61% worked part time. Disease damage was equally prevalent in patients with and without paid employment. A high percentage of patients (51%) were declared work disabled, due to disease damage. Patients who did not have paid employment were often work disabled. Both had a negative effect on HRQOL. CONCLUSION The effect of cSLE on academic achievements and employment is substantial, despite patients adjusting their educational and vocational choices. To optimize participation in the community, ongoing support is necessary, not only to help patients find suitable education and vocations but also to offer guidance regarding potential adjustments during their career.
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Affiliation(s)
- Noortje Groot
- N. Groot, MD, PhD, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, and Department of Pediatric Immunology, Wilhemina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anne Kardolus
- A. Kardolus, MD, MSc, S. Kamphuis, MD, PhD, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marc Bijl
- M. Bijl, MD, PhD, Department of Internal Medicine and Rheumatology, Martini Hospital, Groningen, the Netherlands
| | - Radboud J E M Dolhain
- R.J.E.M. Dolhain, MD, PhD, Department of Rheumatology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Y K Onno Teng
- Y.K.O. Teng, MD, PhD, Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands
| | - Els Zirkzee
- E. Zirkzee, MD, PhD, Department of Rheumatology, Maasstad Hospital, Rotterdam, the Netherlands
| | - Karina de Leeuw
- K. de Leeuw, MD, PhD, Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruth Fritsch-Stork
- R. Fritsch-Stork, MD, PhD, Professor, Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands, and 1st Medical Department & Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Center, Meidling, Hanusch Hospital, and Sigmund Freud University, Vienna, Austria
| | - Alex Burdorf
- A. Burdorf, PhD, Professor, Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Irene E Bultink
- I.E. Bultink, MD, PhD, Amsterdam Rheumatology and Immunology Center, Location VUmc, Amsterdam, the Netherlands
| | - Sylvia Kamphuis
- A. Kardolus, MD, MSc, S. Kamphuis, MD, PhD, Sophia Children's Hospital, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands;
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Wahadat MJ, Lourens M, Huijser E, Van Helden-Meeuwsen CG, Kamphuis S, Versnel M. AB0145 EFFECTS OF IMMUNOSUPPRESSIVE MEDICATION ON TYPE I INTERFERON ACTIVATION: IN VITRO ANALYSIS SHOWS A DOWNREGULATING EFFECT ON IFN ACTIVATION OF HYDROXYCHLOROQUINE AND ASPIRIN. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Systemic Lupus Erythematosus (SLE) is prototypic Interferon (IFN) driven autoimmune disease characterized by an increased expression of type-I IFN stimulated genes, known as the IFN signature. The inhibitory effects of various drugs like Hydroxychloroquine and more recently Aspirin on IFN inducing pathways (1, 2) led to the idea that some standard of care drugs might decrease the IFN score in patients. Data on the in vitro effect of immunosuppressive medication on IFN activation are limited. Testing immunosuppressive agents for their effect on IFN activation in vitro will give insight into the mechanisms of IFN activation in vivo and the effect of immunosuppressive medication on this activation.Objectives:To study the effect of immunosuppressive medication on the type-I IFN signature in anin vitromodelMethods:Freshly isolated human PBMCs were stimulated for 24 hours with or without CpG-A or Imiquimod (IQ) or transfected with the cGAS agonist G3-YSD to induce IFN upregulation through the TLR7/9- and DNA Sensing Receptor-pathway respectively. To assess the direct role of the medication on the downstream pathway of the IFNAR PBMCs were stimulated with IFN-a2b. Aspirin, diclofenac, HCQ, Mycophenolate Mofetil (MMF) and prednisone were added separately to these cultures followed by analysis of MxA by qPCR as a readout for IFN type I activation. Cell viability in all culture conditions was above 85%.Results:The type I IFN activation induced by CpG-A, IQ, G3-YSD and IFN-a2b was significantly reduced after addition of Aspirin. Addition of diclofenac showed a trend towards reduced levels in all conditions. HCQ was able to significantly reduce the TLR7/9 induced IFN activation by CpG-A and IQ while MMF and prednisone did not show an effect in any of the culture conditions.Conclusion:The IFN activation induced by the stimulation of various IFN inducing pathways was significantly reduced by Aspirin and HCQ in an in vitro model. Combining both clinical andin vitrodata from our longitudinal cohort of childhood-onset SLE patients will elucidate the effect of different immunosuppressive drugs on the type-I IFN signature in these patients.References:[1]Kuznik A, Bencina M, Svajger U, Jeras M, Rozman B, Jerala R. Mechanism of endosomal TLR inhibition by antimalarial drugs and imidazoquinolines. J Immunol. 2011;186(8):4794-804.[2]Dai J, Huang YJ, He X, Zhao M, Wang X, Liu ZS, et al. Acetylation Blocks cGAS Activity and Inhibits Self-DNA-Induced Autoimmunity. Cell. 2019;176(6):1447-60 e14.Disclosure of Interests:None declared
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20
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de Graeff N, Groot N, Brogan P, Ozen S, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, Marks SD, McCann L, Pilkington C, Ravelli A, van Royen A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European consensus-based recommendations for the diagnosis and treatment of rare paediatric vasculitides – the SHARE initiative. Rheumatology (Oxford) 2020; 59:919. [DOI: 10.1093/rheumatology/keaa057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nienke de Graeff
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Noortje Groot
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Paul Brogan
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Seza Ozen
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Tadej Avcin
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | | | - Pavla Dolezalova
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Brian M Feldman
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Pekka Lahdenne
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Stephen D Marks
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Liza McCann
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Angelo Ravelli
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Annet van Royen
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Yosef Uziel
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Bas Vastert
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Nico Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
- Department of Paediatric Rheumatology, Wilhelmina Children’s Hospital, Utrecht
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21
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Huijser E, van Helden-Meeuwsen CG, Groot N, Bodewes ILA, Wahadat MJ, Schreurs MWJ, van Daele PLA, Dalm VASH, van Laar JAM, van Hagen PM, Waris M, Kamphuis S, Versnel MA. MxA is a clinically applicable biomarker for type I interferon activation in systemic lupus erythematosus and systemic sclerosis. Rheumatology (Oxford) 2020; 58:1302-1303. [PMID: 30879072 DOI: 10.1093/rheumatology/kez078] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2019] [Indexed: 01/07/2023] Open
Affiliation(s)
- Erika Huijser
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Noortje Groot
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Iris L A Bodewes
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Javad Wahadat
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marco W J Schreurs
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paul L A van Daele
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Virgil A S H Dalm
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jan A M van Laar
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - P Martin van Hagen
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Matti Waris
- Department of Virology, University of Turku, Turku, Finland
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marjan A Versnel
- Department of Immunology, Erasmus University Medical Center, Rotterdam, The Netherlands
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22
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de Graeff N, Groot N, Ozen S, Eleftheriou D, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, McCann L, Pilkington C, Ravelli A, van Royen-Kerkhof A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Brogan P, Beresford MW. European consensus-based recommendations for the diagnosis and treatment of Kawasaki disease - the SHARE initiative. Rheumatology (Oxford) 2020; 58:672-682. [PMID: 30535127 DOI: 10.1093/rheumatology/key344] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES The European Single Hub and Access point for paediatric Rheumatology in Europe initiative aimed to optimize care for children with rheumatic diseases. Kawasaki disease (KD) is the most common cause of acquired heart disease in children and an important cause of long-term cardiac disease into adulthood. Prompt diagnosis and treatment of KD is difficult due to the heterogeneity of the disease but is crucial for improving outcome. To date, there are no European internationally agreed, evidence-based guidelines concerning the diagnosis and treatment of KD in children. Accordingly, treatment regimens differ widely. The aim of this study is to provide consensus-based, European-wide evidence-informed recommendations for diagnosis and treatment of children with KD. METHODS Recommendations were developed using the EULAR's standard operating procedures. An extensive systematic literature search was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of international experts via online surveys and subsequently discussed in three consensus meetings, using nominal group technique. Recommendations were accepted when ⩾80% agreed. RESULTS In total, 17 recommendations for diagnosis and 14 for treatment of KD in children were accepted. Diagnostic recommendations included laboratory and imaging workup for complete as well as incomplete KD. Treatment recommendations included the importance of early treatment in both complete and incomplete KD, use of intravenous immunoglobulin, aspirin, corticosteroids for high-risk cases, and other treatment options for those with resistant disease. CONCLUSION The Single Hub and Access point for paediatric Rheumatology in Europe initiative provides international evidence-based recommendations for diagnosing and treating KD in children, facilitating improvement and uniformity of care.
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Affiliation(s)
- Nienke de Graeff
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Noortje Groot
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Seza Ozen
- Department of Paediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Despina Eleftheriou
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Tadej Avcin
- Department of Paediatric Rheumatology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Brigitte Bader-Meunier
- Department of Paediatric Rheumatology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pavla Dolezalova
- First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Brian M Feldman
- Department of Paediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Bicêtre Hospital, APHP, University of Paris SUD, Paris, France
| | - Pekka Lahdenne
- Department of Paediatric Rheumatology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Angelo Ravelli
- Department of Paediatric Rheumatology, Gaslini Children's Hospital, Genoa, Italy
| | - Annet van Royen-Kerkhof
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Yosef Uziel
- Meir Medical Centre, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bas Vastert
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Nico Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Paul Brogan
- Department of Paediatric Rheumatology, Great Ormond Street Hospital for Children, London, UK
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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23
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de Graeff N, Groot N, Brogan P, Ozen S, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, Marks SD, McCann L, Pilkington C, Ravelli A, van Royen A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European consensus-based recommendations for the diagnosis and treatment of rare paediatric vasculitides - the SHARE initiative. Rheumatology (Oxford) 2020; 58:656-671. [PMID: 30535249 DOI: 10.1093/rheumatology/key322] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/04/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The European initiative Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) aimed to optimize care for children with rheumatic diseases. Systemic vasculitides are very rare in children. Consequently, despite recent advances, paediatric-specific information is sparse. The lack of evidence-based recommendations is an important, unmet need. This study aimed to provide recommendations for diagnosing and treating children with rare forms of childhood systemic vasculitis. METHODS Recommendations were developed by a consensus process in accordance with the European League Against Rheumatism standard operating procedures. A systematic literature review informed the recommendations, which were devised and evaluated by a panel of experts via an online survey, and two consensus meetings using nominal group technique. Recommendations were accepted when ⩾ 80% of experts agreed. RESULTS Ninety-three relevant articles were found, and 78 recommendations were accepted in the two consensus meetings. General, cross-cutting recommendations and disease-specific statements regarding the diagnosis and treatment of childhood-onset PAN, granulomatosis with polyangiitis, microscopic polyangiitis, eosinophilic granulomatosis with polyangiitis, and Takayasu arteritis are provided. CONCLUSION These Single Hub and Access point for paediatric Rheumatology in Europe recommendations were formulated through an evidence-based consensus process to support uniform, high-quality standard of care for children with rare forms of paediatric systemic vasculitis.
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Affiliation(s)
- Nienke de Graeff
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Noortje Groot
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht.,Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands.,Department of Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool
| | - Paul Brogan
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, London, UK
| | - Seza Ozen
- Department of Paediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Tadej Avcin
- Department of Paediatric Rheumatology, University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | - Brigitte Bader-Meunier
- Department of Paediatric Rheumatology, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pavla Dolezalova
- 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Brian M Feldman
- Department of Paediatric Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Bicêtre University Hospital, APHP, University of Paris Sud, Paris, France
| | - Pekka Lahdenne
- Department of Paediatric Rheumatology, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Stephen D Marks
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, London, UK
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool
| | - Clarissa Pilkington
- Department of Paediatric Rheumatology, University College London Great Ormond Street Institute of Child Health and Great Ormond St Hospital for Children NHS Foundation Trust, London, UK
| | - Angelo Ravelli
- Department of Paediatric Rheumatology, Gaslini Children's Hospital, Genoa, Italy
| | - Annet van Royen
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Yosef Uziel
- Meir Medical Center, Kfar Saba, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Bas Vastert
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Nico Wulffraat
- Department of Paediatric Rheumatology, Wilhelmina Children's Hospital, Utrecht
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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24
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Groot N, Shaikhani D, Teng YKO, de Leeuw K, Bijl M, Dolhain RJEM, Zirkzee E, Fritsch-Stork R, Bultink IEM, Kamphuis S. Long-Term Clinical Outcomes in a Cohort of Adults With Childhood-Onset Systemic Lupus Erythematosus. Arthritis Rheumatol 2019; 71:290-301. [PMID: 30152151 PMCID: PMC6590133 DOI: 10.1002/art.40697] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 08/21/2018] [Indexed: 12/22/2022]
Abstract
Objective Childhood‐onset systemic lupus erythematosus (SLE) is a severe, lifelong, multisystem autoimmune disease. Long‐term outcome data are limited. This study was undertaken to identify clinical characteristics and health‐related quality of life (HRQoL) of adults with childhood‐onset SLE. Methods Patients participated in a single study visit comprising a structured history and physical examination. Disease activity (scored using the SLE Disease Activity Index 2000 [SLEDAI‐2K]), damage (scored using the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]), and HRQoL (scored using the Short Form 36 Health Survey) were assessed. Medical records were reviewed. Results In total, 111 childhood‐onset SLE patients were included; the median disease duration was 20 years, 91% of patients were female, and 72% were white. Disease activity was low (median SLEDAI‐2K score 4), and 71% of patients received prednisone, hydroxychloroquine (HCQ), and/or other disease‐modifying antirheumatic drugs. The vast majority of new childhood‐onset SLE–related manifestations developed within 2 years of diagnosis. Damage such as myocardial infarctions began occurring after 5 years. Most patients (62%) experienced damage, predominantly in the musculoskeletal, neuropsychiatric, and renal systems. Cerebrovascular accidents, renal transplants, replacement arthroplasties, and myocardial infarctions typically occurred at a young age (median age 20 years, 24 years, 34 years, and 39 years, respectively). Multivariate logistic regression analysis showed that damage accrual was associated with disease duration (odds ratio [OR] 1.15, P < 0.001), antiphospholipid antibody positivity (OR 3.56, P = 0.026), and hypertension (OR 3.21, P = 0.043). Current HCQ monotherapy was associated with an SDI score of 0 (OR 0.16, P = 0.009). In this cohort, HRQoL was impaired compared to the overall Dutch population. The presence of damage reduced HRQoL scores in 1 domain. High disease activity (SLEDAI‐2K score ≥8) and changes in physical appearance strongly reduced HRQoL scores (in 4 of 8 domains and 7 of 8 domains, respectively). Conclusion The majority of adults with childhood‐onset SLE in this large cohort developed significant damage at a young age and had impaired HRQoL without achieving drug‐free remission, illustrating the substantial impact of childhood‐onset SLE on future life.
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Affiliation(s)
- N Groot
- Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands, and Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - D Shaikhani
- Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Y K O Teng
- Leiden University Medical Center, Leiden, The Netherlands
| | - K de Leeuw
- University Medical Center, Groningen, The Netherlands
| | - M Bijl
- Martini Hospital, Groningen, The Netherlands
| | - R J E M Dolhain
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E Zirkzee
- Maasstad Hospital, Rotterdam, The Netherlands
| | - R Fritsch-Stork
- University Medical Center, Utrecht, The Netherlands, Hanusch Hospital of WGKK and AUVA Trauma Center, Vienna, Austria, and Sigmund Freud University, Vienna, Austria
| | - I E M Bultink
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S Kamphuis
- Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
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25
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Ozen S, Marks SD, Brogan P, Groot N, de Graeff N, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, McCann L, Pilkington C, Ravelli A, van Royen A, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European consensus-based recommendations for diagnosis and treatment of immunoglobulin A vasculitis—the SHARE initiative. Rheumatology (Oxford) 2019; 58:1607-1616. [DOI: 10.1093/rheumatology/kez041] [Citation(s) in RCA: 101] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/09/2019] [Indexed: 01/25/2023] Open
Abstract
Abstract
Objectives
IgA vasculitis (IgAV, formerly known as Henoch–Schönlein purpura) is the most common cause of systemic vasculitis in childhood. To date, there are no internationally agreed, evidence-based guidelines concerning the appropriate diagnosis and treatment of IgAV in children. Accordingly, treatment regimens differ widely. The European initiative SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) aims to optimize care for children with rheumatic diseases. The aim therefore was to provide internationally agreed consensus recommendations for diagnosis and treatment for children with IgAV.
Methods
Recommendations were developed by a consensus process in accordance with the EULAR standard operating procedures. An extensive systematic literature review was performed, and evidence-based recommendations were extrapolated from the included papers. These were evaluated by a panel of 16 international experts via online surveys and subsequent consensus meeting, using nominal group technique. Recommendations were accepted when ⩾80% of experts agreed.
Results
In total, 7 recommendations for diagnosis and 19 for treatment of paediatric IgAV were accepted. Diagnostic recommendations included: appropriate use of skin and renal biopsy, renal work-up and imaging. Treatment recommendations included: the importance of appropriate analgesia and angiotensin-converting enzyme inhibitor use and non-renal indications for CS use, as well as a structured approach to treating IgAV nephritis, including appropriate use of CS and second-line agents in mild, moderate and severe disease along with use of angiotensin-converting enzyme inhibitors and maintenance therapy.
Conclusion
The SHARE initiative provides international, evidence-based recommendations for the diagnosis and treatment of IgAV that will facilitate improvement and uniformity of care.
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Affiliation(s)
- Seza Ozen
- Department of Paediatrics, Hacettepe University, Ankara, Turkey
| | - Stephen D. Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Paul Brogan
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, UK
| | - Noortje Groot
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
- Sophia Children’s Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Nienke de Graeff
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
| | - Tadej Avcin
- Department of Paediatric Rheumatology, University Children’s Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Pavla Dolezalova
- General University Hospital and 1 Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Brian M. Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Isabelle Kone-Paut
- Department of Paediatric Rheumatology, Bicêtre University Hospital, Paris, France
| | - Pekka Lahdenne
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Clarissa Pilkington
- Great Ormond Street Hospital for Children NHS Foundation Trust, University College London Great Ormond Street Institute of Child Health, London, UK
| | | | - Annet van Royen
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
| | - Yosef Uziel
- Meir Medical Centre, Tel Aviv University, Tel Aviv, Israel
| | - Bas Vastert
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
| | - Nico Wulffraat
- Wilhelmina Children’s Hospital, University Medical Center, Utrecht
| | - Sylvia Kamphuis
- Sophia Children’s Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michael W. Beresford
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
- Institute of Translational Medicine, University of Liverpool and Alder Hey children's NHS Foundation Trust, Members of Liverpool Health Partners, Liverpool, UK
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26
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Swart J, Giancane G, Horneff G, Magnusson B, Hofer M, Alexeeva Е, Panaviene V, Bader-Meunier B, Anton J, Nielsen S, De Benedetti F, Kamphuis S, Staņēviča V, Tracahana M, Ailioaie LM, Tsitsami E, Klein A, Minden K, Foeldvari I, Haas JP, Klotsche J, Horne AC, Consolaro A, Bovis F, Bagnasco F, Pistorio A, Martini A, Wulffraat N, Ruperto N. Pharmacovigilance in juvenile idiopathic arthritis patients treated with biologic or synthetic drugs: combined data of more than 15,000 patients from Pharmachild and national registries. Arthritis Res Ther 2018; 20:285. [PMID: 30587248 PMCID: PMC6307151 DOI: 10.1186/s13075-018-1780-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 11/27/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The availability of methotrexate and the introduction of multiple biological agents have revolutionized the treatment of juvenile idiopathic arthritis (JIA). Several international and national drug registries have been implemented to accurately monitor the long-term safety/efficacy of these agents. This report aims to present the combined data coming from Pharmachild/PRINTO registry and the national registries from Germany (BiKeR) and Sweden. METHODS Descriptive statistics was used for demographic, clinical data, drug exposure, adverse events (AEs) and events of special interest (ESIs). For the Swedish register, AE data were not available. RESULTS Data from a total of 15,284 patients were reported: 8274 (54%) from the Pharmachild registry and 3990 (26%) and 3020 (20%) from the German and the Swedish registries, respectively. Pharmachild children showed a younger age (median of 5.4 versus 7.6 years) at JIA onset and shorter disease duration at last available visit (5.3 versus 6.1-6.8) when compared with the other registries. The most frequent JIA category was the rheumatoid factor-negative polyarthritis (range of 24.6-29.9%). Methotrexate (61-84%) and etanercept (24%-61.8%) were the most frequently used synthetic and biologic disease-modifying anti-rheumatic drugs (DMARDs), respectively. There was a wide variability in glucocorticoid use (16.7-42.1%). Serious AEs were present in 572 (6.9%) patients in Pharmachild versus 297 (7.4%) in BiKeR. Infection and infestations were the most frequent AEs (29.4-30.1%) followed by gastrointestinal disorders (11.5-19.6%). The most frequent ESIs were infections (75.3-89%). CONCLUSIONS This article is the first attempt to present a very large sample of data on JIA patients from different national and international registries and represents the first proposal for data merging as the most powerful tool for future analysis of safety and effectiveness of immunosuppressive therapies in JIA. REGISTRY REGISTRATION The Pharmachild registry is registered at ClinicalTrials.gov ( NCT01399281 ) and at the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) ( http://www.encepp.eu/encepp/viewResource.htm?id=19362 ). The BiKeR registry is registered at ENCePP ( http://www.encepp.eu/encepp/viewResource.htm?id=20591 ).
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Affiliation(s)
- Joost Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Lundlaan, 6 PO box 85090, Utrecht, The Netherlands
| | - Gabriella Giancane
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy
| | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, Arnold-Janssen strasse 29, Sankt Augustin, Germany.,Department of Pediatric and Adolescents medicine, Medical faculty, University Hospital of Cologne, Kerpener Str. 62, Cologne, Germany
| | - Bo Magnusson
- Karolinska University Hospital, Pediatric Rheumatology Unit, Stockholm, Sweden
| | - Michael Hofer
- Unité Romande d'Immuno-Rhumatologie Pediatrique/Centre Hospitalier Universitaire Vaudois (CHUV), Pediatrie, University of Lausanne, Av Bugnon 46, Lausanne, Switzerland.,University Hospital of Geneva, Geneva, Switzerland
| | - Еkaterina Alexeeva
- Federal State Autonomous Institution "National Medical Research Center of Children's Health" of the Ministry of Health of the Russian Federation, LOMONOSOVSKIJ PR-T,2/62, Moscow, Russia.,Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Violeta Panaviene
- Vilnius University, Clinic of Children's Diseases, Vilnius, Lithuania and Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos, Santariskiu, 4, Vilnius, Lithuania
| | - Brigitte Bader-Meunier
- Université Paris-Descartes, Institut IMAGINE, Centre de référence national pour les Rhumatismes inflammatoires et les maladies Auto-Immunes Systémiques rares de l'Enfant (RAISE), Unité d'Immunologie, Hématologie et Rhumatologie Pediatrique, Hôpital Necker-Enfants Malades, Assistance Publique Hôpitaux de Paris, 149 Rue De Sevres, Paris, France
| | - Jordi Anton
- Hospital Sant Joan de Déu, Universitat de Barcelona, Unidad de Reumatología Pediátrica, Esplugues de Llobregat, Passeig Sant Joan de Deu 2, Barcelona, Spain
| | - Susan Nielsen
- Juliane Marie Centret, Rigshospitalet, Paediatric Rheumatology Unit, Blegdamsvej 9, Copenhagen, Denmark
| | - Fabrizio De Benedetti
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Piazza S. Onofrio, 4, Rome, Italy
| | - Sylvia Kamphuis
- Sophia Children's Hospital, Department of Paediatric Rheumatology, Erasmus University Medical Centre, Dr Molewaterplein 60, Rotterdam, The Netherlands.,Department of Rheumatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Valda Staņēviča
- Riga Stradins University, Department of Pediatrics, Children University Hospital, Vienibas gatve 45, Riga, LV, Latvia
| | - Maria Tracahana
- Hippokration General Hospital, First Department of pediatrics, Thessaloniki University School of Medicine, Konstantinoupoleos 49, Thessaloniki, Greece
| | | | - Elena Tsitsami
- Aghia Sophia Childrens Hospital, First Department of Pediatrics, University of Athens Medical School, Thivon 1, Athens, Greece
| | - Ariane Klein
- Asklepios Clinic Sankt Augustin, Arnold-Janssen strasse 29, Sankt Augustin, Germany
| | - Kirsten Minden
- German Rheumatism Research Centre, Berlin, Germany.,Charité University Medicine, Charitéplatz 1, Berlin, Germany
| | - Ivan Foeldvari
- Hamburg Centre for Pediatric and Adolescent Rheumatology, Dehnhaide 120, Hamburg, Germany
| | - Johannes Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Deutsches Zentrum für Kinder- und Jugendrheumatologie, Zentrum für Schmerztherapie junger Menschen, Gehfeldstrasse 24, Garmisch-Partenkirchen, Germany
| | - Jens Klotsche
- German Rheumatism Research Centre, Berlin, Germany.,Charité University Medicine, Charitéplatz 1, Berlin, Germany
| | - Anna Carin Horne
- Karolinska University Hospital, Pediatric Rheumatology Unit, Stockholm, Sweden
| | - Alessandro Consolaro
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, via Gaslini 5, Genoa, Italy.,Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DiNOGMI), Università degli Studi di Genova, Genoa, Italy
| | - Francesca Bovis
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy
| | - Francesca Bagnasco
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy
| | - Angela Pistorio
- IRCCS Istituto Giannina Gaslini, Servizio di Epidemiologia e Biostatistica, via Gaslini 5, Genoa, Italy
| | - Alberto Martini
- IRCCS Istituto Giannina Gaslini, Direzione Scientifica, via Gaslini 5, Genoa, Italy
| | - Nico Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Lundlaan, 6 PO box 85090, Utrecht, The Netherlands
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, PRINTO, Via Gaslini, 5, 16147, Genoa, Italy.
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27
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Schoemaker CG, Armbrust W, Swart JF, Vastert SJ, van Loosdregt J, Verwoerd A, Whiting C, Cowan K, Olsder W, Versluis E, van Vliet R, Fernhout MJ, Bookelman SL, Cappon J, van den Berg JM, Schatorjé E, Muller PCEH, Kamphuis S, de Boer J, Lelieveld OTHM, van der Net J, Jongsma KR, van Rensen A, Dedding C, Wulffraat NM. Dutch juvenile idiopathic arthritis patients, carers and clinicians create a research agenda together following the James Lind Alliance method: a study protocol. Pediatr Rheumatol Online J 2018; 16:57. [PMID: 30219072 PMCID: PMC6139167 DOI: 10.1186/s12969-018-0276-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/10/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Research on Juvenile Idiopathic Arthritis (JIA) should support patients, caregivers/parents (carers) and clinicians to make important decisions in the consulting room and eventually to improve the lives of patients with JIA. Thus far these end-users of JIA-research have rarely been involved in the prioritisation of future research. MAIN BODY Dutch organisations of patients, carers and clinicians will collaboratively develop a research agenda for JIA, following the James Lind Alliance (JLA) methodology. In a 'Priority Setting Partnership' (PSP), they will gradually establish a top 10 list of the most important unanswered research questions for JIA. In this process the input from clinicians, patients and their carers will be equally valued. Additionally, focus groups will be organised to involve young people with JIA. The involvement of all contributors will be monitored and evaluated. In this manner, the project will contribute to the growing body of literature on how to involve young people in agenda setting in a meaningful way. CONCLUSION A JIA research agenda established through the JLA method and thus co-created by patients, carers and clinicians will inform researchers and research funders about the most important research questions for JIA. This will lead to research that really matters.
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Affiliation(s)
- Casper G. Schoemaker
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands ,0000 0001 2208 0118grid.31147.30National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands ,0000 0004 0620 3132grid.417100.3Department of Paediatric Rheumatology, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Room KC.03.063.0, P.O. box 85090, 3508 AB Utrecht, The Netherlands
| | - Wineke Armbrust
- 0000 0004 0407 1981grid.4830.fUniversity Medical Center Groningen (UMCG), Beatrix Childrens Hospital, Dept Pediatric Rheumatology and Immunology, University of Groningen, Groningen, The Netherlands ,Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands
| | - Joost F. Swart
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Sebastiaan J. Vastert
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Jorg van Loosdregt
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Anouk Verwoerd
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
| | - Caroline Whiting
- 0000 0004 1936 9297grid.5491.9James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre (NETSCC), based at the University of Southampton, Southampton, UK
| | - Katherine Cowan
- 0000 0004 1936 9297grid.5491.9James Lind Alliance, National Institute for Health Research Evaluation, Trials and Studies Coordinating Centre (NETSCC), based at the University of Southampton, Southampton, UK
| | - Wendy Olsder
- Youth-R-Well.com, Young Patient Organisation, The Netherlands, member of EULAR PARE, Amsterdam, The Netherlands
| | - Els Versluis
- Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands
| | - Rens van Vliet
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands
| | - Marlous J. Fernhout
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands
| | - Sanne L. Bookelman
- Netherlands JIA Patient and Parent Organisation, member of ENCA, Amsterdam, The Netherlands
| | - Jeannette Cappon
- 0000 0004 0624 3484grid.418029.6Reade, Centre for Rehabilitation and Rheumatology, Department Rehabilitation, Amsterdam, The Netherlands ,Dutch Health Professionals in Pediatric Rheumatology (DHPPR), Amsterdam, The Netherlands
| | - J. Merlijn van den Berg
- Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aPaediatric rheumatology, Emma Children’s Hospital, University Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Ellen Schatorjé
- Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,grid.461578.9Paediatric Rheumatology, Amalia Children’s Hospital, Radboudumc, Nijmegen, The Netherlands ,Paediatric Rheumatology, St. Maartenskliniek, Nijmegen, The Netherlands
| | - Petra C. E. Hissink Muller
- Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,0000000089452978grid.10419.3dPaediatric Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands ,000000040459992Xgrid.5645.2Paediatric Rheumatology, Sophia Children’s Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Sylvia Kamphuis
- Dutch Association for Pediatric Rheumatology, Amsterdam, The Netherlands ,000000040459992Xgrid.5645.2Paediatric Rheumatology, Sophia Children’s Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joke de Boer
- 0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands ,0000000090126352grid.7692.aDepartment of Ophthalmology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Otto T. H. M. Lelieveld
- Dutch Health Professionals in Pediatric Rheumatology (DHPPR), Amsterdam, The Netherlands ,0000 0004 0407 1981grid.4830.fUniversity Medical Center Groningen, Center for Rehabilitation, University of Groningen, Groningen, The Netherlands
| | - Janjaap van der Net
- 0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands ,Dutch Health Professionals in Pediatric Rheumatology (DHPPR), Amsterdam, The Netherlands ,0000000090126352grid.7692.aChild Development and Exercise Center, Division of Pediatrics. Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Karin R. Jongsma
- 0000000090126352grid.7692.aJulius Center for Health Sciences and Primary Care Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemiek van Rensen
- PGOsupport, Dutch Networking Organisation for Patient Organisations, Utrecht, The Netherlands
| | - Christine Dedding
- Department of Medical Humanities, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nico M. Wulffraat
- 0000000090126352grid.7692.aPediatric Rheumatology and Immunology, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, Netherlands ,0000000120346234grid.5477.1Faculty of Medicine, Utrecht University, Utrecht, The Netherlands
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28
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Haasnoot AMJW, Schilham MW, Kamphuis S, Hissink Muller PCE, Heiligenhaus A, Foell D, Minden K, Ophoff RA, Radstake TRDJ, Den Hollander AI, Reinards THCM, Hiddingh S, Schalij-Delfos NE, Hoppenreijs EPAH, van Rossum MAJ, Wouters C, Saurenmann RK, van den Berg JM, Wulffraat NM, ten Cate R, de Boer JH, Pulit SL, Kuiper JJW. Identification of an Amino Acid Motif in HLA-DRβ1 That Distinguishes Uveitis in Patients With Juvenile Idiopathic Arthritis. Arthritis Rheumatol 2018. [DOI: 10.1002/art.40484] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Sylvia Kamphuis
- Sophia Children's Hospital, Erasmus University Medical Center; Rotterdam The Netherlands
| | | | - Arnd Heiligenhaus
- St. Franziskus-Hospital, Muenster, Germany, and University of Duisburg; Essen Germany
| | - Dirk Foell
- University of Muenster; Muenster Germany
| | - Kirsten Minden
- German Rheumatism Research Center Berlin-Leibniz Institute and Charite University Medicine; Berlin Germany
| | - Roel A. Ophoff
- University Medical Center Utrecht, Utrecht, The Netherlands, and University of California; Los Angeles
| | | | | | | | - Sanne Hiddingh
- University Medical Center Utrecht, Utrecht University; Utrecht The Netherlands
| | | | | | - Marion A. J. van Rossum
- Emma Children's Hospital AMC and Amsterdam Rheumatology and Immunology Center Reade; Amsterdam The Netherlands
| | - Carine Wouters
- University of Leuven and University Hospitals Leuven; Leuven Belgium
| | | | | | - Nico M. Wulffraat
- University Medical Center Utrecht, Utrecht University; Utrecht The Netherlands
| | | | - Joke H. de Boer
- University Medical Center Utrecht, Utrecht University; Utrecht The Netherlands
| | - Sara L. Pulit
- University Medical Center Utrecht, Utrecht, The Netherlands, and Oxford University; Oxford UK
| | - Jonas J. W. Kuiper
- University Medical Center Utrecht, Utrecht University; Utrecht The Netherlands
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29
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Bodewes ILA, Huijser E, van Helden-Meeuwsen CG, Tas L, Huizinga R, Dalm VASH, van Hagen PM, Groot N, Kamphuis S, van Daele PLA, Versnel MA. TBK1: A key regulator and potential treatment target for interferon positive Sjögren's syndrome, systemic lupus erythematosus and systemic sclerosis. J Autoimmun 2018; 91:97-102. [PMID: 29673738 DOI: 10.1016/j.jaut.2018.02.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 02/02/2018] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Upregulation of type I interferons (IFN-I) is a hallmark of systemic autoimmune diseases like primary Sjögren's syndrome (pSS), systemic lupus erythematosus (SLE) and systemic sclerosis (SSc). Expression of IFN-I is induced by three different receptor families: Toll-like receptors (TLRs), RIG-like receptors (RLRs) and DNA-sensing receptors (DSRs). TANK-binding kinase (TBK1) is an important signaling hub downstream of RLRs and DSRs. TBK1 activates IRF3 and IRF7, leading to IFN-I production and subsequent induction of interferon stimulated genes (ISGs). The objective of this study was to explore the potential of BX795, an inhibitor of TBK1, to downregulate IFN-I activation in pSS, SLE and SSc. METHODS TBK1, IRF3, IRF7 and STAT1 were determined by RT-PCR in PAXgene samples and phosphorylated-TBK1 (pTBK1) was analyzed by flowcytometry in plasmacytoid dendritic cells (pDCs) from IFN-I positive (IFNpos) patients. Peripheral blood mononuclear cells (PBMCs) of pSS, SLE and SSc patients and TLR7 stimulated PBMCs of healthy controls (HCs) were cultured with the TBK1 inhibitor BX795, followed by analysis of ISGs. RESULTS Increased gene expression of TBK1, IRF3, IRF7 and STAT1 in whole blood and pTBK1 in pDCs was observed in IFNpos pSS, SLE and SSc patients compared to HCs. Upon treatment with BX795, PBMCs from IFNpos pSS, SLE, SSc and TLR7-stimulated HCs downregulated the expression of the ISGs MxA, IFI44, IFI44L, IFIT1 and IFIT3. CONCLUSIONS TBK1 inhibition reduced expression of ISGs in PBMCs from IFNpos patients with systemic autoimmune diseases indicating TBK1 as a potential treatment target.
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Affiliation(s)
- Iris L A Bodewes
- Department of Immunology, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands.
| | - Erika Huijser
- Department of Immunology, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands.
| | | | - Liselotte Tas
- Department of Immunology, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands.
| | - Ruth Huizinga
- Department of Immunology, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands.
| | - Virgil A S H Dalm
- Department of Immunology, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands; Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Centre, 3015 CE, Rotterdam, The Netherlands.
| | - P Martin van Hagen
- Department of Immunology, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands; Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Centre, 3015 CE, Rotterdam, The Netherlands.
| | - Noortje Groot
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands.
| | - Sylvia Kamphuis
- Department of Pediatric Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands.
| | - Paul L A van Daele
- Department of Immunology, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands; Department of Internal Medicine, Division of Clinical Immunology, Erasmus University Medical Centre, 3015 CE, Rotterdam, The Netherlands.
| | - Marjan A Versnel
- Department of Immunology, Erasmus University Medical Centre, 3015 CN, Rotterdam, The Netherlands.
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30
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Wulffraat N, Kamphuis S, Swart JF, Vastert S, Van Dijkhuizen P, van Pelt P, van Dijk-Hummelman A, Consolaro A, Bovis F, Ruperto N. The Dutch version of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR). Rheumatol Int 2018; 38:139-146. [PMID: 29637344 PMCID: PMC5893680 DOI: 10.1007/s00296-018-3971-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/11/2018] [Indexed: 11/30/2022]
Abstract
The Juvenile Arthritis Multidimensional Assessment Report (JAMAR) is a new parent/patient reported outcome measure that enables a thorough assessment of the disease status in children with juvenile idiopathic arthritis (JIA). We report the results of the cross-cultural adaptation and validation of the parent and patient versions of the JAMAR in the Dutch language. The reading comprehension of the questionnaire was tested in ten JIA parents and patients. Each participating centre was asked to collect demographic, clinical data and the JAMAR in 100 consecutive JIA patients or all consecutive patients seen in a 6-month period and to administer the JAMAR to 100 healthy children and their parents. The statistical validation phase explored descriptive statistics and the psychometric issues of the JAMAR: the three Likert assumptions, floor/ceiling effects, internal consistency, Cronbach’s alpha, interscale correlations, test–retest reliability, and construct validity (convergent and discriminant validity). A total of 209 JIA patients (14.3% systemic, 39.7% oligoarticular, 25.8% RF negative polyarthritis, 20.2% other categories) and 107 healthy children were enrolled in two centres. The JAMAR components discriminated well healthy subjects from JIA patients. All JAMAR components revealed good psychometric performances. In conclusion, the Dutch version of the JAMAR is a valid tool for the assessment of children with JIA and is suitable for use both in routine clinical practice and clinical research.
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Affiliation(s)
- Nico Wulffraat
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Room KC 03.063.0, Lundlaan, 6, 3584 EA, Utrecht, The Netherlands.
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology/Department of Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Joost F Swart
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Room KC 03.063.0, Lundlaan, 6, 3584 EA, Utrecht, The Netherlands
| | - Sebastiaan Vastert
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Room KC 03.063.0, Lundlaan, 6, 3584 EA, Utrecht, The Netherlands
| | - Pieter Van Dijkhuizen
- Department of Pediatric Immunology and Rheumatology, Wilhelmina Children's Hospital, Room KC 03.063.0, Lundlaan, 6, 3584 EA, Utrecht, The Netherlands
| | - Philomine van Pelt
- Department of Paediatric Rheumatology/Department of Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Annette van Dijk-Hummelman
- Department of Paediatric Rheumatology/Department of Rheumatology, Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Alessandro Consolaro
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy.,Dipartimento di Pediatria, Università di Genova, Genoa, Italy
| | - Francesca Bovis
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, Paediatric Rheumatology International Trials Organisation (PRINTO), Istituto Giannina Gaslini, Via Gaslini 5, 16147, Genoa, Italy.
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31
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Walter M, Hazes JM, Dolhain RJ, van Pelt P, van Dijk A, Kamphuis S. Development of a clinical transition pathway for adolescents in the Netherlands. Nurs Child Young People 2018; 29:37-43. [PMID: 29115764 DOI: 10.7748/ncyp.2017.e932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2017] [Indexed: 01/23/2023]
Abstract
AIMS To explore how young people with juvenile-onset rheumatic and musculoskeletal diseases (jRMDs) and their parent(s) experience care during preparation for the upcoming transfer to adult services, and to develop a clinical transition pathway. METHOD A survey was conducted with 32 young people aged between 14 and 20 years with jRMDs, and their parents ( n =33), treated at the department of paediatric rheumatology in a tertiary care children's hospital in the Netherlands. RESULTS More than 30% of young people would have liked to discuss topics such as educational and vocational choices in a clinic, but did not get the opportunity. Preparation for transition was poor as was training in self-management skills. One third of parents had feelings of anxiety about the upcoming transfer. Results from the survey and evidence-based principles of transitional care were used to develop the clinical transition pathway. The pathway focuses on starting transition early, developing self-management skills, joint consultations and supporting parents in giving young people control of their clinical care. CONCLUSION Care does not currently meet the needs of young people in the process of transition to adult rheumatology services. The clinical transition pathway developed as a result of the study is a tool that may improve this process.
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Affiliation(s)
- Margot Walter
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Johanna Mw Hazes
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Radboud Jem Dolhain
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Philomine van Pelt
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Annette van Dijk
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sylvia Kamphuis
- Department of Rheumatology, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, the Netherlands
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32
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Groot N, de Graeff N, Marks SD, Brogan P, Avcin T, Bader-Meunier B, Dolezalova P, Feldman BM, Kone-Paut I, Lahdenne P, McCann L, Özen S, Pilkington CA, Ravelli A, Royen-Kerkhof AV, Uziel Y, Vastert BJ, Wulffraat NM, Beresford MW, Kamphuis S. European evidence-based recommendations for the diagnosis and treatment of childhood-onset lupus nephritis: the SHARE initiative. Ann Rheum Dis 2017; 76:1965-1973. [PMID: 28877866 DOI: 10.1136/annrheumdis-2017-211898] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 07/18/2017] [Accepted: 08/13/2017] [Indexed: 12/13/2022]
Abstract
Lupus nephritis (LN) occurs in 50%-60% of patients with childhood-onset systemic lupus erythematosus (cSLE), leading to significant morbidity. Timely recognition of renal involvement and appropriate treatment are essential to prevent renal damage. The Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative aimed to generate diagnostic and management regimens for children and adolescents with rheumatic diseases including cSLE. Here, we provide evidence-based recommendations for diagnosis and treatment of childhood LN. Recommendations were developed using the European League Against Rheumatism standard operating procedures. A European-wide expert committee including paediatric nephrology representation formulated recommendations using a nominal group technique. Six recommendations regarding diagnosis and 20 recommendations covering treatment choices and goals were accepted, including each class of LN, described in the International Society of Nephrology/Renal Pathology Society 2003 classification system. Treatment goal should be complete renal response. Treatment of class I LN should mainly be guided by other symptoms. Class II LN should be treated initially with low-dose prednisone, only adding a disease-modifying antirheumatic drug after 3 months of persistent proteinuria or prednisone dependency. Induction treatment of class III/IV LN should be mycophenolate mofetil (MMF) or intravenous cyclophosphamide combined with corticosteroids; maintenance treatment should be MMF or azathioprine for at least 3 years. In pure class V LN, MMF with low-dose prednisone can be used as induction and MMF as maintenance treatment. The SHARE recommendations for diagnosis and treatment of LN have been generated to support uniform and high-quality care for all children with SLE.
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Affiliation(s)
- Noortje Groot
- Wilhelmina Children's Hospital, Utrecht, The Netherlands.,Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Stephen D Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Paul Brogan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Tadej Avcin
- University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Pavla Dolezalova
- 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Brian M Feldman
- Division of Rheumatology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Pekka Lahdenne
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Liza McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Seza Özen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | | | - Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
| | | | - Yosef Uziel
- Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bas J Vastert
- Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | | | - Michael W Beresford
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Sylvia Kamphuis
- Sophia Children's Hospital, Erasmus University Medical Center, Rotterdam, The Netherlands
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33
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Groot N, de Graeff N, Avcin T, Bader-Meunier B, Brogan P, Dolezalova P, Feldman B, Kone-Paut I, Lahdenne P, Marks SD, McCann L, Ozen S, Pilkington C, Ravelli A, Royen-Kerkhof AV, Uziel Y, Vastert B, Wulffraat N, Kamphuis S, Beresford MW. European evidence-based recommendations for diagnosis and treatment of childhood-onset systemic lupus erythematosus: the SHARE initiative. Ann Rheum Dis 2017. [PMID: 28630236 DOI: 10.1136/annrheumdis-2016-210960] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [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: 01/01/2023]
Abstract
Childhood-onset systemic lupus erythematosus (cSLE) is a rare, multisystem and potentially life-threatening autoimmune disorder with significant associated morbidity. Evidence-based guidelines are sparse and management is often based on clinical expertise. SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) was launched to optimise and disseminate management regimens for children and young adults with rheumatic diseases like cSLE. Here, we provide evidence-based recommendations for diagnosis and treatment of cSLE. In view of extent and complexity of cSLE and its various manifestations, recommendations for lupus nephritis and antiphospholipid syndrome will be published separately. Recommendations were generated using the EULAR (European League Against Rheumatism) standard operating procedure. An expert committee consisting of paediatric rheumatologists and representation of paediatric nephrology from across Europe discussed evidence-based recommendations during two consensus meetings. Recommendations were accepted if >80% agreement was reached. A total of 25 recommendations regarding key approaches to diagnosis and treatment of cSLE were made. The recommendations include 11 on diagnosis, 9 on disease monitoring and 5 on general treatment. Topics included: appropriate use of SLE classification criteria, disease activity and damage indices; adequate assessment of autoantibody profiles; secondary macrophage activation syndrome; use of hydroxychloroquine and corticosteroid-sparing regimens; and the importance of addressing poor adherence. Ten recommendations were accepted regarding general diagnostic strategies and treatment indications of neuropsychiatric cSLE. The SHARE recommendations for cSLE and neuropsychiatric manifestations of cSLE have been formulated by an evidence-based consensus process to support uniform, high-quality standards of care for children with cSLE.
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Affiliation(s)
- Noortje Groot
- Wilhelmina Children's Hospital, Utrecht, Netherlands.,Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Tadej Avcin
- University Children's Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Paul Brogan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Pavla Dolezalova
- General University Hospital, First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Brian Feldman
- The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | | | - Pekka Lahdenne
- Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Stephen D Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Liza McCann
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Seza Ozen
- Department of Pediatrics, Hacettepe University, Ankara, Turkey
| | | | - Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genoa, Italy
| | | | - Yosef Uziel
- Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Bas Vastert
- Wilhelmina Children's Hospital, Utrecht, Netherlands
| | | | - Sylvia Kamphuis
- Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Michael W Beresford
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,Institute of Translational Medicine, University of Liverpool, Liverpool, UK
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Lomakina O, Alekseeva E, Valieva S, Bzarova T, Nikishina I, Zholobova E, Rodionovskaya S, Kaleda M, Nakagishi Y, Shimizu M, Mizuta M, Yachie A, Sugita Y, Okamoto N, Shabana K, Murata T, Tamai H, Smith EM, Yin P, Jorgensen AL, Beresford MW, Smith EM, Eleuteri A, Goilav B, Lewandowski L, Phuti A, Wahezi D, Rubinstein T, Jones C, Newland P, Marks S, Corkhill R, Ekdawy D, Pilkington C, Tullus K, Putterman C, Scott C, Fisher AC, Beresford MW, Smith EM, Lewandowski L, Phuti A, Jorgensen A, Scott C, Beresford MW, Batu ED, Kosukcu C, Taskiran E, Akman S, Ozturk K, Sozeri B, Unsal E, Ekinci Z, Bilginer Y, Alikasifoglu M, Ozen S, Lythgoe H, Beresford MW, Brunner HI, Gulati G, Jones JT, Altaye M, Eaton J, Difrancesco M, Yeo JG, Leong J, Bathi LDT, Arkachaisri T, Albani S, Abdelrahman N, Beresford MW, Leone V, Groot N, Shaikhani D, Bultink IEM, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Wright RD, Smith EM, Beresford MW, Abdawani R, Al Shaqshi L, Al Zakwani I, Gormezano NW, Kern D, Pereira OL, Esteves GCC, Sallum AM, Aikawa NE, Pereira RM, Silva CA, Bonfa E, Beckmann J, Bartholomä N, Foeldvari I, Bohnsack J, Milojevic D, Rabinovich C, Kingsbury D, Marzan K, Quartier P, Minden K, Chalom E, Horneff G, Venhoff N, Kuester RM, Dare J, Heinrich M, Kupper H, Kalabic J, Martini A, Brunner HI, Consolaro A, Horneff G, Burgos-Vargas R, Henneke P, Constantin T, Foeldvari I, Vojinovic J, Dehoorne J, Panaviene V, Susic G, Stanevica V, Kobusinska K, Zuber Z, Mouy R, Salzer U, Rumba-Rozenfelde I, Dolezalova P, Job-Deslandre C, Wulffraat N, Pederson R, Bukowski J, Hinnershitz T, Vlahos B, Martini A, Ruperto N, Janda A, Keskitalo P, Kangas S, Vähäsalo P, Valencia RAC, Martino D, Munro J, Ponsonby AL, Chiaroni-Clarke R, Meyer B, Allen RC, Boteanu AL, Akikusa JD, Craig JM, Saffrey R, Ellis JA, Davì S, Minoia F, Horne A, Wulffraat N, Wouters C, Wallace C, Corral SG, Uziel Y, Sterba G, Schneider R, Russo R, Ramanan AV, Schmid JP, Ozen S, Nichols KE, Miettunen P, Lovell DJ, Giraldo AS, Lehmberg K, Kitoh T, Khubchandani R, Ilowite NT, Henter JI, Grom AA, De Benedetti F, Behrens EM, Avcin T, Aricò M, Gámir MG, Martini A, Ruperto N, Cron RQ, Ravelli A, Grevich S, Lee P, Ringold S, Leroux B, Leahey H, Yuasa M, Mendoza AZ, Foster J, Sokolove J, Lahey L, Robinson W, Newson J, Stevens A, Shoop SJW, Hyrich KL, Verstappen SMM, Thomson W, Adrovic A, McDonagh JE, Beukelman T, Kimura Y, Natter M, Ilowite N, Mieszkalski K, Burrell G, Best B, Bristow H, Carr S, Dedeoglu R, Dennos A, Kaufmann R, Schanberg L, Parissenti I, Insalaco A, Taddio A, Mauro A, Pardeo M, Ricci F, Simonini G, Sahin S, Cattalini M, Montesano P, Parissenti I, Ricci F, Bonafini B, Medeghini V, Lancini F, Cattalini M, Gerbaux M, Lê PQ, Barut K, Goffin L, Badot V, La C, Caspers L, Willermain F, Ferster A, Ceci M, Licciardi F, Turco M, Santarelli F, Koka A, Montin D, Toppino C, Maggio MC, Alizzi C, Papia B, Vergara B, Corpora U, Messina L, Corsello G, Tsinti M, Oztunc F, Dermentzoglou V, Tziavas P, Tsitsami E, Perica M, Vidović M, Lamot L, Harjaček M, Bukovac LT, Çakan M, Ayaz NA, Kasapcopur O, Keskindemirci G, Miettunen P, Lang M, Laing C, Benseler S, Gerschman T, Luca N, Schmeling H, Dropol A, Taiani J, Rodriguez-Lozano AL, Johnson N, Rusted B, Nalbanti P, Trachana M, Pratsidou P, Pardalos G, Tzimouli V, Taparkou A, Stavrakidou M, Papachristou F, Rivas-Larrauri F, Kanakoudi-Tsakalidou F, Bale P, Robinson E, Palman J, Pilkington C, Ralph E, Gilmour K, Heard C, Wedderburn LR, Carlomagno R, de la Puente SG, Barrense-Dias Y, Gregory A, Amira D, Paolo S, Sylviane H, Michaël H, Panko N, Shokry S, Rakovska L, Pino S, Alves AGF, Diaz-Maldonado A, Guarnizo P, Torreggiani S, Cressoni P, Garagiola U, Di Landro G, Farronato G, Corona F, Filocamo G, Shenoi S, Giacomin MFDA, Bell S, Bhatti P, Nelson L, Mueller BA, Simon TA, Baheti A, Ray N, Guo Z, Ruperto N, Brunner HI, Farhat J, Hazra A, Stock T, Wang R, Mebus C, Alvey C, Lamba M, Krishnaswami S, Conte U, Wang M, Tzaribachev N, Braga ALF, Foeldvari I, Horneff G, Kingsbury D, Koskova E, Smolewska E, Vehe RK, Zuber Z, Martini A, Lovell D, Kubota T, Sallum AME, Shimizu M, Yasumura J, Nakagishi Y, Kizawa T, Yashiro M, Wakiguchi H, Yamatou T, Yamasaki Y, Takei S, Kawano Y, Campos LMDA, Nykvist UJ, Magnusson B, Wicksell R, Palmblad K, Olsson GL, Ziaee V, Modaressi M, Moradinejad MH, Seraya V, Zholobova E, Pereira LAA, Vitebskaya A, Moshe V, Amarilyo G, Harel L, Hashkes PJ, Mendelson A, Rabinowicz N, Reis Y, Uziel Y, Dāvidsone Z, Lichtenfels AJDFC, Lazareva A, Šantere R, Bērziņa D, Staņēviča V, Varnier GC, Consolaro A, Pilkington C, Maillard S, Ferrari C, Zaffarano S, Silva CA, Martini A, Ravelli A, Wienke J, Enders FB, van den Hoogen LL, Mertens JS, Radstake TR, Hotten HG, Fritsch R, de Jager W, Farhat SCL, Wedderburn L, Nistala K, Pilkington C, Prakken B, van Royen-Kerkhof A, van Wijk F, Alhemairi M, Muzaffer M, Van Dijkhuizen P, Deakin CT, Acar B, Simou S, Wedderburn LR, De Iorio M, Wu Q, Amin T, Simou S, Dossetter L, Wedderburn LR, Pilkington C, Campanilho-Marques R, Ozcakar ZB, Deakin C, Simou S, Wedderburn LR, Pilkington CA, Rosina S, Consolaro A, van Dijkhuizen P, Nistala K, Ruperto N, Pilkington C, Çakar N, Ravelli A, Soponkanaporn S, Simou S, Deakin CT, Wedderburn LR, Arıcı ZS, Tuğcu GD, Batu ED, Sönmez HE, Doğru-Ersöz D, Uncu N, Bilginer Y, Talim B, Kiper N, Özen S, Solyom A, Hügle B, Makay B, Magnusson B, Batu E, Mitchell J, Gür G, Kariminejad A, Hadipour F, Hadipour Z, Torcoletti M, Agostoni C, Di Rocco M, Tanpaiboon P, Superti-Furga A, Bonafé L, Arslan N, Özdel S, Guelbert N, Kostik M, Ehlert K, Grigelioniene G, Puri R, Ozen S, Schuchman E, Malagon C, Gomez P, Mosquera AC, Yalçınkaya F, Gonzalez T, Yepez R, Vargas C, Fernanda F, Lepri G, Ferrari A, Rigante D, Matucci-Cerinic M, Meini A, Moneta GM, Scott C, Caiello I, Marasco E, Nicolai R, Pardeo M, Bracaglia C, Insalaco A, Bracci-Laudiero L, De Benedetti F, Kopchak O, Kostik M, Brice N, Mushkin A, Maletin A, Makay B, Batu ED, Hügle B, Arslan N, Solyom A, Mitchell J, Schuchman E, Ozen S, Nourse P, Magnusson B, Malagon C, Gomez P, Mosquera C, Gonzalez T, Yepez R, Vargas C, Amorim RA, Len CA, Molina J, Lewandowski L, Moreira G, Santos FH, Fraga M, Keppeke L, Silva VM, Hirotsu C, Tufik S, Terreri MT, Braga VL, Fonseca MB, Arango C, Len CA, Fraga M, Schinzel V, Terreri MTR, Molina J, Len CA, Jorge L, Guerra L, Santos FH, Terreri MT, Mosquera AC, Junior EA, Fonseca MB, Braga VL, Len CA, Fraga M, Schinzel V, Terreri MTR, Alizzi C, Maggio MC, Castiglione MC, Malagon C, Tricarico A, Corsello G, Boulter E, Schultz A, Murray K, Falcini F, Lepri G, Stagi S, Bellucci E, Matucci-Cerinic M, Sakamoto AP, Grein IHR, Groot N, Pileggi G, Pinto NBF, de Oliveira AL, Wulffraat N, Chyzheuskaya I, Belyaeva L, Filonovich R, Khrustaleva H, Silva CA, Zajtseva L, Ilisson J, Pruunsild C, Kostik M, Kopchak O, Mushkin A, Maletin A, Gilliaux O, Corazza F, Lelubre C, Silva MFCD, Ferster A, Suárez RG, Morel Z, Espada G, Malagon C, C CSM, Lira L, Ladino M, Eraso R, Arroyo I, Lopes AS, Sztajnbok F, Silva C, Rose C, Russo GCS, Sallum AEM, Kozu K, Bonfá E, Saad-Magalhães C, Pereira RMR, Len CA, Terreri MT, Suri D, Didel S, Rawat A, Singh S, Maritsi D, Onoufriou MA, Vougiouka O, Tsolia M, Bosak EP, Vidović M, Lamot M, Lamot L, Harjaček M, Van Nieuwenhove E, Liston A, Wouters C, Tahghighi F, Ziaee V, Raeeskarami SR, Aguiar F, Pereira S, Rodrigues M, Moura C, Rocha G, Guimarães H, Brito I, Aguiar F, Fonseca R, Rodrigues M, Brito I, Horneff G, Klein A, Minden K, Huppertz HI, Weller-Heinemann F, Kuemmerle-Deschner J, Haas JP, Hospach A, Menendez-Castro R, Huegle B, Haas JP, Swart J, Giancane G, Bovis F, Castagnola E, Groll A, Horneff G, Huppertz HI, Lovell DJ, Wolfs T, Hofer M, Alekseeva E, Panaviene V, Nielsen S, Anton J, Uettwiller F, Stanevicha V, Trachana M, Marafon DP, Ailioaie C, Tsitsami E, Kamphuis S, Herlin T, Doležalová P, Susic G, Flatø B, Sztajnbok F, Pistorio A, Martini A, Wulffraat N, Ruperto N, Gattorno M, Brucato A, Finetti M, Lazaros G, Maestroni S, Carraro M, Cumetti D, Carobbio A, Lorini M, Rimini A, Marcolongo R, Valenti A, Erre GL, Belli R, Gaita F, Sormani MP, Ruperto N, Imazio M, Martini A, Abinun M, Smith N, Rapley T, McErlane F, Kearsley-Fleet L, Hyrich KL, Foster H, Ruperto N, Lovell DJ, Tzaribachev N, Zeft A, Cimaz R, Stanevicha V, Horneff G, Bohnsack J, Griffin T, Carrasco R, Trachana M, Dare J, Foeldvari I, Vehe R, Bovis F, Simon T, Martini A, Brunner H, Verazza S, Davì S, Consolaro A, Insalaco A, Gerloni V, Cimaz R, Zulian F, Pastore S, Corona F, Conti G, Barone P, Cattalini M, Cortis E, Breda L, Olivieri AN, Civino A, Podda R, Rigante D, La Torre F, D’Angelo G, Jorini M, Gallizzi R, Maggio MC, Consolini R, De Fanti A, Alpigiani MG, Martini A, Ravelli A, Sozeri B, Kısaarslan AP, Gunduz Z, Dusunsel R, Dursun I, Poyrazoglu H, Kuchinskaya E, Abduragimova F, Kostik M, Sundberg E, Omarsdottir S, Klevenvall L, Erlandsson-Harris H, Basbozkurt G, Erdemli O, Simsek D, Yazici F, Karsioglu Y, Tezcaner A, Keskin D, Ozkan H, Acikel C, Ozen S, Demirkaya E, Orbán I, Sevcic K, Brodszky V, Kiss E, Tekko IA, Rooney M, McElnay J, Taggart C, McCarthy H, Donnelly RF, Abinun M, Slatter M, Nademi Z, Friswell M, Foster H, Jandial S, McErlane F, Flood T, Hambleton S, Gennery A, Cant A, Finetti M, Bovis F, Swart J, Doležalová P, Tsitsami E, Trachana M, Demirkaya E, Duong PN, Koné-Paut I, Vougiouka O, Marafon DP, Cimaz R, Filocamo G, Gamir ML, Stanevicha V, Sanner H, Carenini L, Wulffraat N, Martini A, Ruperto N, Topdemir M, Basbozkurt G, Karslioglu Y, Ozkan H, Acikel C, Demirkaya E, Gok F, Zholobova E, Tsurikova N, Ligostaeva E, Ramchurn NR, Friswell M, Kostareva O, Nikishina I, Arsenyeva S, Rodionovskaya S, Kaleda M, Alexeev D, Dursun ID, Sozeri B, Kısaarslan AP, Dusunsel R, Poyrazoglu H, Poyrazoglu H, Murias S, Barral E, Alcobendas R, Enriquez E, Remesal A, de Inocencio J, Castro TM, Lotufo SA, Freye T, Carlomagno R, Zumbrunn T, Bonhoeffer J, Schneider EC, Kaiser D, Hofer M, Hentgen V, Woerner A, Schwarz T, Klotsche J, Niewerth M, Horneff G, Haas JP, Hospach A, Huppertz HI, Ganser G, Minden K, Jeyaratnam J, ter Haar N, Kasapcopur O, Rigante D, Dedeoglu F, Baris E, Vastert S, Wulffraat N, Frenkel J, Hausmann JS, Lomax KG, Shapiro A, Durrant KL, Brogan PA, Hofer M, Kuemmerle-Deschner JB, Lauwerys B, Speziale A, Leon K, Wei X, Laxer RM, Signa S, Rusmini M, Campione E, Chiesa S, Grossi A, Omenetti A, Caorsi R, Viglizzo G, Martini A, Ceccherini I, Gattorno M, Federici S, Frenkel J, Ozen S, Lachmann H, Finetti M, Martini A, Ruperto N, Gattorno M, Federici S, Vanoni F, Ozen S, Hofer M, Frenkel J, Lachmann H, Martini A, Ruperto N, Gattorno M, Gomes SM, Omoyinmi E, Arostegui JI, Gonzalez-Roca E, Eleftheriou D, Klein N, Brogan P, Volpi S, Santori E, Picco P, Pastorino C, Caorsi R, Rice G, Tesser A, Martini A, Crow Y, Candotti F, Gattorno M, Barut K, Sahin S, Adrovic A, Sinoplu AB, Yucel G, Pamuk G, Kasapcopur O, Damian LO, Lazea C, Sparchez M, Vele P, Muntean L, Albu A, Rednic S, Lazar C, Mendonça LO, Pontillo A, Kalil J, Castro FM, Barros MT, Pardeo M, Messia V, De Benedetti F, Insalaco A, Malighetti G, Gorio C, Ricci F, Parissenti I, Montesano P, Bonafini B, Medeghini V, Cattalini M, Giordano L, Zani G, Ferraro R, Vairo D, Giliani S, Cattalini M, Maggio MC, Luppino G, Corsello G, Fernandez MIG, Montesinos BL, Vidal AR, Gorospe JIA, Penades IC, Rafiq NK, Wynne K, Hussain K, Brogan PA, Ang E, Ng N, Kacar A, Gucenmez OA, Makay B, Unsal SE, Sahin Y, Barut K, Kutlu T, Cullu-Cokugras F, Sahin S, Adrovic A, Ayyildiz-Civan H, Kasapcopur O, Erkan T, Abdawani R, Al Zuhbi S, Abdalla E, Russo RA, Katsicas MM, Caorsi R, Minoia F, Viglizzo G, Grossi A, Chiesa S, Picco P, Ravelli A, Gattorno M, Bhattad S, Rawat A, Gupta A, Suri D, Pandiarajan V, Nada R, Tiewsoh K, Hawkins P, Rowczenio D, Singh S, Fingerhutova S, Franova J, Prochazkova L, Hlavackova E, Dolezalova P, Evrengül H, Yüksel S, Doğan M, Gürses D, Evrengül H, De Pauli S, Pastore S, Bianco AM, Severini GM, Taddio A, Tommasini A, Salugina SO, Fedorov E, Kamenets E, Zaharova E, Kaleda M, Salugina SO, Fedorov E, Kamenets E, Zaharova E, Kaleda M, Sleptsova T, Alexeeva E, Savostyanov K, Pushkov A, Bzarova T, Valieva S, Denisova R, Isayeva K, Chistyakova E, Lomakina O, Soloshenko M, Kaschenko E, Kaneko U, Imai C, Saitoh A, Teixeira VA, Ramos FO, Costa M, Aviel YB, Fahoum S, Brik R, Özçakar ZB, Çakar N, Uncu N, Celikel BA, Yalcinkaya F, Schiappapietra B, Davi’ S, Mongini F, Giannone L, Bava C, Alpigiani MG, Martini A, Ravelli A, Consolaro A, Lazarevic DS, Vojinovic J, Susic G, Basic J, Giancane G, Muratore V, Marzetti V, Quilis N, Benavente BS, Alongi A, Civino A, Quartulli L, Consolaro A, Martini A, Ravelli A, Januskeviciute G, van Dijkhuizen P, Muratore V, Giancane G, Schiappapietra B, Martini A, Ravelli A, Consolaro A, Groot N, van Dijk W, Bultink IEM, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Groot N, Kardolus A, Bultink IEM, Bijl M, Dolhain RJEM, Teng YKO, Zirkzee E, de Leeuw K, Fritsch-Stork R, Kamphuis SSM, Suárez RG, Nordal EB, Rypdal VG, Berntson L, Ekelund M, Aalto K, Peltoniemi S, Zak M, Nielsen S, Glerup M, Herlin T, Arnstad ED, Fasth A, Rygg M, Duarte AC, Sousa S, Teixeira L, Cordeiro A, Santos MJ, Mourão AF, Santos MJ, Eusébio M, Lopes A, Oliveira-Ramos F, Salgado M, Estanqueiro P, Melo-Gomes J, Martins F, Costa J, Furtado C, Figueira R, Brito I, Branco JC, Fonseca JE, Canhão H, Mourão AF, Santos MJ, Eusébio M, Lopes A, Oliveira-Ramos F, Salgado M, Estanqueiro P, Melo-Gomes J, Martins F, Costa J, Furtado C, Figueira R, Brito I, Branco JC, Fonseca JE, Canhão H, Coda A, Cassidy S, West K, Hendry G, Grech D, Jones J, Hawke F, Grewal DS, Coda A, Jones J, Grech D, Grewal DS, Foley C, Killeen O, MacDermott E, Veale D, Fearon U, Konukbay D, Demirkaya E, Tarakci E, Arman N, Barut K, Şahin S, Adrovic A, Kasapcopur O, Munro J, Consolaro A, Morgan E, Riebschleger M, Horonjeff J, Strand V, Bingham C, Collante MTM, Ganeva M, Stefanov S, Telcharova A, Mihaylova D, Saraeva R, Tzveova R, Kaneva R, Tsakova A, Temelkova K, Picarelli MMC, Danzmann LC, Barbé-Tuana F, Grun LK, Jones MH, Frković M, Ištuk K, Birkić I, Sršen S, Jelušić M, Smith N, Jandial S, Easton A, Quarmby R, Khubchandani R, Chan M, Rapley T, Foster H, Srp R, Kobrova K, Franova J, Fingerhutova S, Nemcova D, Hoza J, Uher M, Saifridova M, Linkova L, Dolezalova P, Charuvanij S, Leelayuwattanakul I, Pacharapakornpong T, Vallipakorn SAO, Lerkvaleekul B, Vilaiyuk S, Muratore V, Giancane G, Lanni S, Alongi A, Alpigiani MG, Martini A, Ravelli A, Consolaro A, Alongi A, Bovis F, Minoia F, Davì S, Martini A, Ruperto N, Cron RQ, Ravelli A, Passarelli C, Pardeo M, Pisaneschi E, Novelli A, De Benedetti F, Bracaglia C, Bracaglia C, Marafon DP, Caiello I, de Graaf K, Guilhot F, Ferlin W, Davi’ S, Schulert G, Ravelli A, Grom AA, Nelson R, de Min C, De Benedetti F, Holzinger D, Kessel C, Fall N, Grom A, de Jager W, Vastert S, Strippoli R, Bracaglia C, Sundberg E, Horne A, Ehl S, Ammann S, Lehmberg K, De Benedetti F, Beutel K, Foell D, Minoia F, Horne A, Bovis F, Davì S, Pagani L, Espada G, Gao YJ, Insalaco A, Lehmberg K, Sanner H, Shenoi S, Weitzman S, Ruperto N, Martini A, Cron RQ, Ravelli A, Prencipe G, Caiello I, Pascarella A, Bracaglia C, Ferlin WG, Chatel L, Strippoli R, de Min C, De Benedetti F, Jacqmin P, De Graaf K, Ballabio M, Nelson R, Johnson Z, Ferlin W, Lapeyre G, de Benedetti F, Cristina DM, Wakiguchi H, Hasegawa S, Hirano R, Okazaki F, Nakamura T, Kaneyasu H, Ohga S, Yamazaki K, Nozawa T, Kanetaka T, Ito S, Yokota S, McLellan K, MacGregor I, Martin N, Davidson J, Kuemmerle-Deschner J, Hansmann S, Wulffraat N, Eikelberg A, Haug I, Schuller S, Benseler SM, Nazarova LS, Danilko KV, Malievsky VA, Viktorova TV, Mauro A, Omoyinmi E, Barnicoat A, Brogan P, Foley C, Killeen O, MacDermott E, Veale D, Foley C, Killeen O, MacDermott E, Veale D, Gomes SM, Omoyinmi E, Hurst J, Canham N, Eleftheriou D, Klein N, Lacassagne S, Brogan P, Wiener A, Hügle B, Denecke B, Costa-Filho I, Haas JP, Tenbrock K, Popp D, Boltjes A, Rühle F, Herresthal S, de Jager W, van Wijk F, Schultze J, Stoll M, Klotz L, Vogl T, Roth J, Quesada-Masachs E, de la Sierra DÁ, Prat MG, Sánchez AMM, Borrell RP, Barril SM, Gallo MM, Caballero CM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Chyzheuskaya I, Byelyaeva LM, Filonovich RM, Khrustaleva HK, Zajtseva LI, Yuraga TM, Giner T, Hackl L, Albrecht J, Würzner R, Brunner J, Pastore S, Minute M, Parentin F, Tesser A, Nocerino A, Taddio A, Tommasini A, Nørgaard M, Herlin T, Alberdi-Saugstrup M, Zak MS, Nielsen SM, Herlin T, Nordal E, Berntson L, Fasth A, Rygg M, Müller KG, Avramovič MZ, Dolžan V, Toplak N, Avčin T, Ruperto N, Lovell DJ, Wallace C, Toth M. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part two. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461533 DOI: 10.1186/s12969-017-0142-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Groot N, de Graeff N, Avcin T, Bader-Meunier B, Dolezalova P, Feldman B, Kenet G, Koné-Paut I, Lahdenne P, Marks SD, McCann L, Pilkington CA, Ravelli A, van Royen-Kerkhof A, Uziel Y, Vastert SJ, Wulffraat NM, Ozen S, Brogan P, Kamphuis S, Beresford MW. European evidence-based recommendations for diagnosis and treatment of paediatric antiphospholipid syndrome: the SHARE initiative. Ann Rheum Dis 2017; 76:1637-1641. [PMID: 28473426 DOI: 10.1136/annrheumdis-2016-211001] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/13/2017] [Accepted: 03/25/2017] [Indexed: 12/14/2022]
Abstract
Antiphospholipid syndrome (APS) is rare in children, and evidence-based guidelines are sparse. Consequently, management is mostly based on observational studies and physician's experience, and treatment regimens differ widely. The Single Hub and Access point for paediatric Rheumatology in Europe (SHARE) initiative was launched to develop diagnostic and management regimens for children and young adults with rheumatic diseases. Here, we developed evidence-based recommendations for diagnosis and treatment of paediatric APS. Evidence-based recommendations were developed using the European League Against Rheumatism standard operating procedure. Following a detailed systematic review of the literature, a committee of paediatric rheumatologists and representation of paediatric haematology with expertise in paediatric APS developed recommendations. The literature review yielded 1473 articles, of which 15 were valid and relevant. In total, four recommendations for diagnosis and eight for treatment of paediatric APS (including paediatric Catastrophic Antiphospholipid Syndrome) were accepted. Additionally, two recommendations for children born to mothers with APS were accepted. It was agreed that new classification criteria for paediatric APS are necessary, and APS in association with childhood-onset systemic lupus erythematosus should be identified by performing antiphospholipid antibody screening. Treatment recommendations included prevention of thrombotic events, and treatment recommendations for venous and/or arterial thrombotic events. Notably, due to the paucity of studies on paediatric APS, level of evidence and strength of the recommendations is relatively low. The SHARE initiative provides international, evidence-based recommendations for diagnosis and treatment for paediatric APS, facilitating improvement and uniformity of care.
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Affiliation(s)
- Noortje Groot
- Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands.,Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Nienke de Graeff
- Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Tadej Avcin
- University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | | | - Pavla Dolezalova
- General University Hospital, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Brian Feldman
- The Hospital for Sick Children, University of Toronto, Canada
| | - Gili Kenet
- The Israel National Hemophilia Centre, Sackler Medical School, Sheba Medical Centre, Tel-Hashomer, Tel Aviv, Israel
| | | | - Pekka Lahdenne
- Hospital for Children and Adolescents, University of Helsinki, Finland
| | - Stephen D Marks
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Liza McCann
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | | | - Angelo Ravelli
- Università degli Studi di Genova and Istituto Giannina Gaslini, Genova, Italy
| | | | - Yosef Uziel
- Meir Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Sebastiaan J Vastert
- Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Nico M Wulffraat
- Wilhelmina Children's Hospital, University Medical Centre, Utrecht, The Netherlands
| | - Seza Ozen
- Department of Pediatrics, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Paul Brogan
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Sylvia Kamphuis
- Sophia Children's Hospital, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Michael W Beresford
- Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
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De Benedetti F, Anton J, Gattorno M, Lachmann H, Kone-Paut I, Ozen S, Frenkel J, Simon A, Zeft A, Ben-Chetrit E, Hoffman HM, Joubert Y, Lheritier K, Speziale A, Guido J, Caorsi R, Penco F, Grossi A, Insalaco A, Alessio M, Conti G, Marchetti F, Tommasini A, Martino S, Gallizzi R, Salis A, Schena F, Caroli F, Martini A, Damonte G, Ceccherini I, Gattorno M, Frémond ML, Uggenti C, Van Eyck L, Melki I, Duffy D, Bondet V, Rose Y, Neven B, Crow Y, Rodero MP, Kusche Y, Roth J, Barczyk-Kahlert K, Ferrara G, Chiocchetti A, Polizzi S, Vuch J, Vozzi D, Mondino A, Valencic E, Pastore S, Taddio A, Faletra F, Dianzani U, Ramenghi U, Tommasini A, Zhou Q, Yu X, Demirkaya E, Deuitch N, Stone D, Tsai W, Ombrello A, Romeo T, Remmers EF, Chae J, Gadina M, Welch S, Ozen S, Topaloglu R, Abinun M, Kastner DL, Aksentijevich I, Vairo D, Ferraro RM, Zani G, Galli J, De Simone M, Cattalini M, Fazzi E, Giliani S, Omoyinmi E, Standing A, Rowczenio D, Keylock A, Gomes SM, Price-Kuehne F, Nanthapisal S, Murphy C, Cullup T, Jenkins L, Gilmour K, Eleftheriou D, Lachmann H, Hawkins P, Klein N, Brogan P, Nikolayenko VB, Şahin K, Karaaslan Y, Civino A, Alighieri G, Davì S, Rondelli R, Martino S, Filocamo G, Magnolato A, Dhanrajani A, Ricci F, Gallizzi R, Olivieri A, Gerloni V, Lattanzi B, Soscia F, De Fanti A, Manzoni SM, Citiso S, Quartulli L, Chan M, La Torre F, Rigante D, Maggio MC, Marsili M, Pelagatti MA, Conter V, Fagioli F, Lepore L, Pession A, Ravelli A, Pau S, Consolaro A, Ruperto N, Garrone M, Rinaldi M, De Inocencio J, Demirkaya E, Garay S, Foell D, Lovell DJ, Lazar C, Ellsworth J, Nielsen S, Flato B, Martini A, Ravelli A, Marasco E, Aquilani A, Cascioli S, Caiello I, Moneta GM, Pires-Marafón D, Guzman J, Magni-Manzoni S, Carsetti R, De Benedetti F, Robinson E, Albani S, Beresford MW, de Jager W, de Roock S, Duong T, Ellis J, Aeschlimann FA, Hyrich K, Jervis L, Lovell D, Marshall L, Mellins ED, Minden K, Munro J, Nigrovic PA, Palman J, Roth J, Twilt M, Ruperto N, Sampath S, Schanberg LE, Thompson SD, Thomson W, Vesely R, Wallace C, Williams C, Wu Q, Wulffraat N, Eng SW, Yeung RSM, Prakken B, Wedderburn LR, Horneff G, Seyger MB, Arikan D, Kalabic J, Anderson JK, Lazar A, Williams DA, Sheikh S, Wang C, Tarzynski-Potempa R, Hymans JS, Simonini G, Scoccimarro E, Pontikaki I, Ferrara G, Giani T, Ventura A, Meroni PL, Laxer RM, Cimaz R, Minnone G, Soligo M, Caiello I, Prencipe G, Marafon DP, Magni-Manzoni S, Manni L, De Benedetti F, Laudiero LB, Hebert D, Groot N, Grein I, Wulffraat NM, Schepp R, Berbers G, de Souza CCBS, Ferriani VPL, Pileggi G, de Roock S, Grein IHR, Noone D, Scala S, Patrone E, Schoemaker C, Costello W, Wulffraat N, Parsons S, McDonagh J, Thomson W, Cohen JD, Bentayou D, Pagnoux C, Brunel MAB, Trope S, Klotsche J, Listing M, Niewerth M, Horneff G, Thon A, Huppertz HI, Mönkemöller K, Foeldvari I, Benseler SM, Föll D, Minden K, Marino A, Stagi S, Carli N, Bertini F, Giani T, Simonini G, Cimaz R, Díaz-Maldonado AS, Yeung RS, Pino S, Guarnizo P, Torres-Jimenez AR, Sanchez-Jara B, Solis-Vallejo E, Cespedes-Cruz AI, Zeferino-Cruz M, Ramirez-Miramontes JV, Kumar A, Gupta A, Kessel C, Suri D, Rawat A, Kakkar N, Singh S, Makay B, Gücenmez ÖA, Ünsal E, Magnusson B, Mördrup K, Vermé A, Lippitz K, Peterson C, Freychet C, Stephan JL, Hofer M, Belot A, Harkness CE, Rooney M, Foster L, Henry E, Taggart P, Weinhage T, Simsek D, Ozkececi CF, Kurt E, Basbozkurt G, Gok F, Demirkaya E, Gorczyca D, Postępski J, Czajkowska A, Szponar B, Hinze C, Paściak M, Gruenpeter A, Lachór-Motyka I, Augustyniak D, Olesińska E, Asuka ES, Golovko T, Aliejim SU, Clemente EI, Jimenez EI, Wittkowski H, Hernandez JC, Fernandez SB, Roca CG, Romo DM, Nieva NR, Angarita JMM, Lopez JA, Nuñez-Cuadros E, Diaz-Cordovés G, Galindo-Zavala R, Holzinger D, Urda-Cardona A, Fernández-Nebro A, Quesada-Masachs E, de la Sierra DÁ, Prat MG, Gallo MM, Borrell RP, Barril SM, Sánchez AMM, Caballero CM, Grün N, Merlin E, Breton S, Fraitag S, Stephan JL, Wouters C, Bodemer C, Bader-Meunier B, Baldo F, Annoni F, Di Landro G, Föll D, Torreggiani S, Torcoletti M, Petaccia A, Corona F, Filocamo G, Tiller G, Buckle J, Munro J, Cox A, Gowdie P, Van Dijkhuizen P, Allen RC, Akikusa JD, Hernández-Huirache HG, Rodea-Montero ER, Cohen JD, Belot A, Fahy W, Quartier P, Sordet C, Trope S, Del Chierico F, Berggren KB, Kembe JT, Bos J, Armbrust W, Wulffraat N, van Brussel M, Cappon J, Dijkstra P, Geertzen J, Legger E, Malattia C, van Rossum M, Sauer P, Lelieveld O, Ozturk K, Buluc L, Akansel G, Muezzinoglu B, Ekinci Z, Rychkova L, Knyazeva T, Russo A, Pogodina A, Belova T, Mandzyak T, Kulesh E, Cafarotti A, Marsili M, Giannini C, Salvatore R, Lapergola G, Di Battista C, Marafon DP, Marcovecchio ML, Basilico R, Pelliccia P, Chiarelli F, Breda L, Almeida B, Tansley S, Simou S, Gunawardena H, McHugh N, ter Haar NM, Wedderburn L, Aouizerate J, Bader-Meunier B, De Antonio M, Bodemer C, Barnerias C, Bassez G, Desguerre I, Quartier P, Gherardi R, Magni-Manzoni S, Charuel JL, Authier FJ, Gitiaux C, Spencer CH, Aziz RA, Yu CY, Adler B, Bout-Tabaku S, Lintner K, Moore-Clingenpeel M, Vastert SJ, Boros C, McCann L, Ambrose N, Cortina-Borja M, Simou S, Pilkington C, Wedderburn L, Hinze C, Oommen PT, Speth F, Dallapiccola B, Haas JP, Hinze C, Oommen PT, Speth F, Haas JP, Speth F, Haas JP, Hinze C, Lavarello C, Giancane G, Prakken B, Pistorio A, Rider L, Aggarwal R, Oliveira SK, Cuttica R, Fischbach M, Sterba G, Brochard K, Dressler F, Barone P, Martini A, Burgos-Vargas R, Chalom EC, Desjonqueres M, Espada G, Fasth A, Garay SM, Herbigneaux RM, Hoyoux C, Deslandre CJ, Miller FW, De Benedetti F, Vencovsky J, Ravelli A, Martini A, Ruperto N, Sag E, Ozen S, Kale G, Topaloglu H, Talim B, Giancane G, Putignani L, Lavarello C, Pistorio A, Zulian F, Magnusson B, Avcin T, Corona F, Gerloni V, Pastore S, Marini R, Martino S, Fidanci BE, Pagnier A, Rodiere M, Soler C, Stanevicha V, Ten Cate R, Uziel Y, Vojinovic J, Ravelli A, Martini A, Ruperto N, Barut K, Villarreal AV, 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N, Belot A, Jeziorski E, Duffy D, Bessis D, Cros G, Rice GI, Charbit B, Hulin A, Khoudour N, Caballero CM, Bodemer C, Fabre M, Berteloot L, Le Bourgeois M, Reix P, Walzer T, Moshous D, Blanche S, Fischer A, Bader-Meunier B, Rieux-Laucat F, Crow Y, Neven B, Annink K, ter Haar N, Al-Mayouf S, Amaryan G, Anton J, Barron K, Benseler S, Brogan P, Cantarini L, Cattalini M, Cochino A, De Benedetti F, Dedeoglu F, De Jesus A, Dellacasa O, Demirkaya E, Dolezalova P, Durrant K, Fabio G, Gallizzi R, Goldbach-Mansky R, Hachulla E, Hentgen V, Herlin T, Hofer M, Hoffman H, Insalaco A, Jansson A, Kallinich T, Koné-Paut I, Kozlova A, Kuemmerle-Deschner J, Lachmann H, Laxer R, Martini A, Nielsen S, Nikishina I, Ombrello A, Ozen S, Papadopoulou-Alataki E, Quartier P, Ravelli A, Rigante D, Russo R, Simon A, Trachana M, Uziel Y, Gattorno M, Frenkel J, ter Haar N, Jeyaratnam J, Lachmann H, Simon A, Brogan P, Doglio M, Cattalini M, Anton J, Modesto C, Quartier P, Hoppenreijs E, Martino S, Insalaco A, 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C, Doglio M, Malattia C, Ravelli A, Martini A, Garaventa A, Gattorno M, Bertoni A, Carta S, Balza E, Castellani P, Pellecchia C, Penco F, Schena F, Borghini S, Trotta ML, Pastorino C, Ceccherini I, Martini A, Gattorno M, Rubartelli A, Chiesa S, Guzman J, Henrey A, Loughin T, Berard R, Shiff N, Jurencak R, Benseler S, Tucker L, Papadopoulou C, Hong Y, Krol P, Ioannou Y, Pilkington C, Chaplin H, Simou S, Charakida M, Wedderburn L, Brogan P, Eleftheriou D, Spiegel LR, Kohut SA, Stinson J, Forgeron P, Kaufman M, Luca N, Amaria K, Bell M, Swart J, Boris F, Castagnola E, Groll A, Giancane G, Horneff G, Huppertz HI, Lovell D, Wolfs T, Hofer M, Alekseeva E, Panaviene V, Nielsen S, Anton J, Uettwiller F, Stanevicha V, Trachana M, De Benedetti F, Ailioaie LM, Tsitami E, Kamphuis S, Herlin T, Dolezalova P, Susic G, Sztajnbok F, Flato B, Pistorio A, Martini A, Wulffraat N, Ruperto N, Shoop SJW, Verstappen SMM, McDonagh JE, Thomson W, Hyrich KL, Tarkiainen M, Tynjala P, Lahdenne P, Martikainen J, Wilkinson M, Piper C, Otto G, Deakin CT, Dowle S, Simou S, Kelberman D, Ioannou Y, Mauri C, Jury E, Isenberg D, Wedderburn LR, Nistala K, Foeldvari I, Ruperto N, Lovell DJ, Horneff G, Huppertz HI, Quartier P, Simonini G, Bereswill M, Kalabic J, Martini A, Brunner HI, Oen K, Guzman J, Feldman BM, Dufault B, Lee J, Shiff N, Duffy KW, Tucker L, Duffy C, Ruperto N, Lovell DJ, Tzaribachev N, Vega-Cornejo G, Louw I, Berman A, Calvo I, Cuttica R, Horneff G, Avila-Zapata F, Anton J, Cimaz R, Solau-Gervais E, Joos R, Espada G, Li X, Nys M, Wong R, Banerjee S, Martini A, Brunner HI, Nicolai R, Marafon DP, Verardo M, D’Amico A, Bracci-Laudiero L, De Benedetti F, Moneta GM, Belot A, Rice G, Mathieu AL, Omarjee SO, Bader-Meunier B, Walzer T, Briggs TA, O’Sullivan J, Williams S, Cimaz R, Smith E, Beresford MW, Crow YJ, Rooney M, Bishop N, davidson J, pilkington C, Beresford M, Clinch J, Satyapal R, Foster H, Medwin JG, McDonagh J, Wyatt S, Modignani VL, Baldo F, Lanni S, Consolaro A, Ravelli A, Filocamo G, Omenetti A, Frenkel J, Lachmann HJ, Ozen S, Ruperto N, Gattorno M, Insalaco A, Moneta G, Pardeo M, Passarelli C, Celani C, Messia V, De Benedetti F, Cherqaoui B, Rossi-Semerano L, Dusser P, Hentgen V, Koné-Paut I, Grimwood C, Dusser P, Rossi L, Paut IK, Hentgen V, Lasigliè D, Ferrera D, Amico G, Di Duca M, Caorsi R, Lepore L, Insalaco A, Cattalini M, Obici L, Consolini R, Ravazzolo R, Martini A, Ceccherini I, Nishikomori R, Arostegui J, Gattorno M, Borghini S, Penco F, Petretto A, Lavarello C, Inglese E, Omenetti A, Finetti M, Pastorino C, Bertoni A, Gattorno M, Vanoni F, Federici S, Ozen S, Frenkel J, Lachmann H, Martini A, Ruperto N, Gattorno M, Hofer M, Kuemmerle-Deschner JB, Hoffman HM, Hawkins PN, van der Poll T, Walker UA, Speziale A, Joubert Y, Tilson HH, Kuemmerle-Deschner J, Ozen S, Tyrrell PN, Koné-Paut I, Goldbach-Mansky R, Lachmann H, Blank N, Hoffman HM, Weissbarth-Riedel E, Huegle B, Kallinich T, Gattorno M, Gul A, ter Haar NM, Oswald M, Dedeoglu F, Benseler SM, Hanaya A, Miyamae T, Kawamoto M, Tani Y, Hara T, Kawaguchi Y, Nagata S, Yamanaka H, Ćosićkić A, Skokić F, Čolić B, Suljendić S, Kozlova A, Mersiyanova I, Panina M, Hachtryan L, Burlakov V, Raikina E, Maschan A, Shcherbina A, Acar B, Albayrak M, Sozeri B, Sahin S, Barut K, Adrovic A, Inan N, Sevgi S, Kasapcopur O, Andreasen CM, Jurik AG, Glerup MB, Høst C, Mahler BT, Hauge EM, Herlin T, Lazea C, Damian L, Lazar C, Manasia R, Stephenson CM, Prajapati V, Miettunen PM, Yılmaz D, Tokgöz Y, Bulut Y, Çakmak H, Sönmez F, Comak E, Aksoy GK, Koyun M, Akman S, Arıkan Y, Terzioğlu E, Özdeş ON, Keser İ, Koçak H, Bingöl A, Yılmaz A, Artan R, De Benedetti F, Anton J, Gattorno M, Lachmann H, Kone-Paut I, Ozen S, Frenkel J, Simon A, Zeft A, Ben-Chetrit E, Hoffman HM, Joubert Y, Lheritier K, Speziale A, Guido J, Xu X, Mehregan FF, Ziaee V, Moradinejad MH, Ferrara G, Pastore S, Insalaco A, Pardeo M, Tommasini A, La Torre F, Alizzi C, Cimaz R, Finetti M, Gattorno M, D’Adamo P, Taddio A, Lachmann H, Simon A, Anton J, Gattorno M, Kone-Paut I, Ozen S, Frenkel J, Ben-Chetrit E, Hoffman H, Zeft A, Joubert Y, Lheritier K, Speziale A, Junge G, Gregson J, De Benedetti F, Sargsyan H, Sargsyan H, Zengin H, Fidanci BE, Kaymakamgil C, Konukbay D, Simsek D, Batu ED, Yildiz D, Gok F, Ozen S, Demirkaya E, Stoler I, Freytag J, Orak B, Seib C, Esmann L, Seipelt E, Gohar F, Foell D, Wittkowski H, Kallinich T, Dursun I, Tulpar S, Yel S, Kartal D, Borlu M, Bastug F, Poyrazoglu H, Gunduz Z, Kose K, Yuksel ME, Calıskan A, Cekgeloglu AB, Dusunsel R, Bouchalova K, Franova J, Schuller M, Macku M, Theodoropoulou K, Carlomagno R, von Scheven-Gête A, Poloni C, Hofer M, Damian LO, Cosma D, Radulescu A, Vasilescu D, Rogojan L, Lazar C, Rednic S, Lupse M, De Somer L, Moens P, Wouters C, Zavala RG, Pedraz LM, Cuadros EN, Rego GDC, Cardona ALU, Zavala RG, Pedraz LM, Cuadros EN, Rego GDC, Cardona ALU, Forno ID, Pieropan S, Viapiana O, Gatti D, Dallagiacoma G, Caramaschi P, Biasi D, Windschall D, Trauzeddel R, Lehmann H, Ganser G, Berendes R, Haller M, Krumrey-Langkammerer M, Nimtz-Talaska A, Schoof P, Trauzeddel RF, Nirschl C, Quesada-Masachs E, Blancafort CA, Barril SM, Caballero CM, Aguiar F, Fonseca R, Alves D, Vieira A, Vieira A, Dias JA, Brito I, Susic G, Milic V, Radunovic G, Boricic I, Marteau P, Adamsbaum C, Rossi-Semerano L, De Bandt M, Lemelle I, Deslandre C, Tran TA, Lohse A, Solau-Gervais E, Pillet P, Bader-Meunier B, Wipff J, Gaujoux-Viala C, Breton S, Devauchelle-Pensec V, Gran S, Fehler O, Zenker S, Schäfers M, Roth J, Vogl T, Czitrom SG, Foell D, Holzinger D, Lanni S, Van Dijkhuizen EHP, Manzoni SM, Marafon DP, Magnaguagno F, de Horatio LT, Ter Haar NM, Littooij AS, Vastert SJ, De Benedetti F, Ravelli A, Martini A, Malattia C, Teixeira VA, Campanilho-Marques R, Mourão AF, Ramos FO, Costa M, Madan WA, Killeen OG, Vidal AR, Delgado DS, Fernandez MIG, Montesinos BL, Penades IC, Kozhevnikov A, Pozdeeva N, Konev M, Melchenko E, Kenis V, Novik G, Sozeri B, Kısaarslan AP, Gunduz Z, Poyrazoglu H, Dusunsel R, Lerkvaleekul B, Jaovisidha S, Sungkarat W, Chitrapazt N, Fuangfa P, Ruangchaijatuporn T, Vilaiyuk S, Pradsgaard DØ, Hørlyck A, Spannow AH, Heuck CW, Herlin T, Diaz T, Garcia F, De La Cruz L, Rubio N, Świdrowska-Jaros J, Smolewska E, Lamot M, Lamot L, Vidovic M, Bosak EP, Rados I, Harjacek M, Tzaribachev N, Louka P, Hagoug R, Trentin C, Kubassova O, Hinton M, Boesen M, Oshlianska OA, Chaikovsky IA, Mjasnikov G, Kazmirchyk A, Garagiola U, Borzani I, Cressoni P, Corona F, Dzsida E, Farronato G, Garagiola U, Cressoni P, Corona F, Petaccia A, Dzsida E, Farronato G, Gagro A, Pasini AM, Roic G, Vrdoljak O, Lujic L, Zutelija-Fattorini M, Esser MM, Abraham DR, Kinnear C, Durrheim G, Urban M, Hoal E, Crow Y, Oshlianska OA. Proceedings of the 23rd Paediatric Rheumatology European Society Congress: part one. Pediatr Rheumatol Online J 2017. [PMCID: PMC5461530 DOI: 10.1186/s12969-017-0141-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Foster HE, Minden K, Clemente D, Leon L, McDonagh JE, Kamphuis S, Berggren K, van Pelt P, Wouters C, Waite-Jones J, Tattersall R, Wyllie R, Stones SR, Martini A, Constantin T, Schalm S, Fidanci B, Erer B, Demirkaya E, Ozen S, Carmona L. EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases. Ann Rheum Dis 2016; 76:639-646. [PMID: 27802961 DOI: 10.1136/annrheumdis-2016-210112] [Citation(s) in RCA: 125] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/11/2016] [Accepted: 10/16/2016] [Indexed: 02/06/2023]
Abstract
To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks.
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Affiliation(s)
- Helen E Foster
- Newcastle University, Institute of Cellular Medicine (Rheumatology), Newcastle, UK
| | - Kirsten Minden
- Children's University hospital Charité, Campus Virchow, SPZ, Berlin, Germany.,Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Daniel Clemente
- Paediatric Rheumatology Unit, Hospital Infantil Universitario "Niño Jesús", Madrid, Spain
| | - Leticia Leon
- Hospital Cí-nico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IDISSC), Madrid, Madrid, Spain.,Health Sciences, Universidad Camilo José Cela, Madrid, Madrid, Spain
| | - Janet E McDonagh
- University of Manchester, Centre for Musculoskeletal Research, Manchester, Manchester, UK
| | - Sylvia Kamphuis
- Immunology and Infectiology, Erasmus MC-Sophia, Rotterdam, The Netherlands
| | | | - Philomine van Pelt
- Department of Paediatrics/Paediatric Rheumatology, Erasmus MC Sophia Children's Hospital Rotterdam, Rotterdam, The Netherlands
| | - Carine Wouters
- Pediatric Immunology, University Hospital Gasthuisberg, Leuven, Belgium
| | | | - Rachel Tattersall
- University of Sheffield, School of Health and Related Research, Sheffield, Sheffield, UK
| | - Ruth Wyllie
- Paediatric Rheumatology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Newcastle upon Tyne, UK
| | | | - Alberto Martini
- Pediatria II, Universita degli Studi di Genova Scuola di Scienze Mediche e Farmaceutiche, Genova, Liguria, Italy
| | | | - Susanne Schalm
- Transitionssprechstunde am Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität München, Munchen, Germany
| | - Berna Fidanci
- Gulhane Military Medical Academy, School of Nursing, Ankara, Turkey, Ankara, Turkey
| | - Burak Erer
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erkan Demirkaya
- Gulhane Military Medical Faculty, Pediatric Rheumatology Unit, FMF Arthritis Vasculitis and Orphan Disease Research in Pediatric Rheumatology (FAVOR), Etlik, Ankara 06018, Turkey, Ankara, Turkey
| | - Seza Ozen
- Pediatric Rheumatology, Hacettepe University Medical Faculty, Ankara, Turkey
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Swart J, Giancane G, Bovis F, Castagnola E, Groll A, Horneff G, Huppertz HI, Lovell D, Wolfs T, Hofer M, Alekseeva E, Panaviene V, Nielsen S, Anton J, Uettwiller F, Stanevicha V, Trachana M, De Benedetti F, Ailioaie L, Tsitsami E, Kamphuis S, Herlin T, Dolezalova P, Susic G, Flato B, Sztajnbok F, Pistorio A, Martini A, Wulffraat N, Ruperto N. OP0217 Adjudication of Infections in The Pharmacovigilance in Juvenile Idiopathic Arthritis Patients (Pharmachild) Treated with Biologic Agents and/or Methotrexate. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Swart J, Pistorio A, Bovis F, Alekseeva E, Hofer M, Nielsen S, Anton J, Consolaro A, Panaviene V, Stanevicha V, Trachana M, Ailioaie C, Quartier P, De Benedetti F, Tsitsami E, Flato B, Dolezalova P, Constantin T, Herlin T, Kamphuis S, Sawhney S, Maritsi D, Vargova V, Villa L, Pallotti C, Ravelli A, Martini A, Wulffraat N, Ruperto N. OP0062 The Addition of One or More Biologics to Methotrexate in Children with Juvenile Idiopathic Arthritis Increases the Incidence of Infections and Serious Adverse Events. The 5882 Pharmachild Cohort. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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De Graeff N, Groot N, Kamphuis S, Avcin T, Bader-Meunier B, Dolezalova P, Kone-Paut I, Lahdenne P, McCann L, Pilkington C, Ravelli A, Van Royen A, Vastert B, Wulffraat N, Ozen S, Brogan P, Beresford M. FRI0271 Final Evidence-Based Recommendations for Diagnosis and Treatment of Paediatric Vasculitides. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.6334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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van Dijkhuizen EHP, Bulatović Ćalasan M, Pluijm SMF, de Rotte MCFJ, Vastert SJ, Kamphuis S, de Jonge R, Wulffraat NM. Prediction of methotrexate intolerance in juvenile idiopathic arthritis: a prospective, observational cohort study. Pediatr Rheumatol Online J 2015; 13:5. [PMID: 25745368 PMCID: PMC4349799 DOI: 10.1186/s12969-015-0002-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/01/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Methotrexate (MTX) is an effective and safe drug in the treatment of juvenile idiopathic arthritis (JIA). Despite its safety, MTX-related gastrointestinal adverse effects before and after MTX administration, termed MTX intolerance, occur frequently, leading to non-compliance and potentially premature MTX termination. The aim of this study was to construct a risk model to predict MTX intolerance. METHODS In a prospective JIA cohort, clinical variables and single nucleotide polymorphisms were determined at MTX start. The Methotrexate Intolerance Severity Score was employed to measure MTX intolerance in the first year of treatment. MTX intolerance was most prevalent at 6 or 12 months after MTX start, which was defined as the outcome for the prediction model. The model was developed in 152 patients using multivariable logistic regression analysis and subsequently internally validated using bootstrapping. RESULTS The prediction model included the following predictors: JIA category, antinuclear antibody, parent/patient assessment of pain, Juvenile Arthritis Disease Activity Score-27, thrombocytes, alanine aminotransferase and creatinine. The model classified 77.5% of patients correctly, and 66.7% of patients after internal validation by bootstrapping. The lowest predicted risk of MTX intolerance was 18.9% and the highest predicted risk was 85.9%. The prediction model was transformed into a risk score (range 0-17). At a cut-off of ≥6, sensitivity was 82.0%, specificity 56.1%, positive predictive value was 58.7% and negative predictive value 80.4%. CONCLUSIONS This clinical prediction model showed moderate predictive power to detect MTX intolerance. To develop into a clinically usable tool, it should be validated in an independent cohort and updated with new predictors. Such an easy-to-use tool could then assist clinicians in identifying patients at risk to develop MTX intolerance, and in turn to monitor them closely and intervene timely in order to prevent the development of MTX intolerance. TRIAL REGISTRATION ISRCTN register, www.isrctn.com, ISRCTN13524271.
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Affiliation(s)
- Evert Hendrik Pieter van Dijkhuizen
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands ,Pediatria II, Reumatologia, IRCCS G. Gaslini, Largo Gaslini 5, 16147 Genova, Italy
| | - Maja Bulatović Ćalasan
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Saskia MF Pluijm
- Department of Paediatric Haemato-Oncology, Erasmus University Medical Centre Rotterdam, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Maurits CFJ de Rotte
- Department of Clinical Chemistry, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sebastiaan J Vastert
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Erasmus University Medical Centre Rotterdam, Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Erasmus University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children’s Hospital, Utrecht, The Netherlands
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Groot N, de Graeff N, Avcin T, Bader-Meunier B, Brogan P, Dolezalova P, Feldman B, Kone-Paut I, Lahdenne P, Martini A, McCann L, Ozen S, Pilkington C, Ravelli A, van Royen A, Vastert B, Wulffraat N, Kamphuis S, Beresford M. SHARE – workpackage 5: evidence based recommendations for diagnosis and treatment of the antiphospholipid syndrome. Pediatr Rheumatol Online J 2014. [PMCID: PMC4190844 DOI: 10.1186/1546-0096-12-s1-p111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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43
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Vastert S, Dolezalova P, Feldman B, Ravelli A, Wulffraat N, Martini A, Foster H, Enders FB, van Royen A, McCann L, Groot N, Kamphuis S, Avcin T, Beresford M, Culpo R, Foeldvari I, Zulian F. SHARE – workpackage 5: development of best practices of diagnosis and treatment for paediatric rheumatic diseases throughout Europe. Pediatr Rheumatol Online J 2014. [PMCID: PMC4184158 DOI: 10.1186/1546-0096-12-s1-o7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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de Graeff N, Groot N, Kamphuis S, Dolezalova P, Eleftheriou D, van Royen A, Twilt M, Ozen S, Brogan P, Beresford M. SHARE – workpackage 5: evidence-based recommendations for diagnosis and treatment of rare paediatric vasculitides. Pediatr Rheumatol Online J 2014. [PMCID: PMC4190918 DOI: 10.1186/1546-0096-12-s1-p121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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45
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Groot N, de Graeff N, Avcin T, Bader-Meunier B, Brogan P, Dolezalova P, Feldman B, Kone-Paut I, Lahdenne P, Martini A, McCann L, Ozen S, Pilkington C, Ravelli A, van Royen A, Vastert B, Wulffraat N, Kamphuis S, Beresford M. SHARE – workpackage 5 : evidence based recommendations for diagnosis and treatment of childhood-onset systemic lupus erythematosus. Pediatr Rheumatol Online J 2014. [PMCID: PMC4184180 DOI: 10.1186/1546-0096-12-s1-p109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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46
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Groot N, Kamphuis S. Long-term outcomes in childhood-onset systemic lupus erythematosus: preliminary results of the CHILL-NL study. Pediatr Rheumatol Online J 2014. [PMCID: PMC4191609 DOI: 10.1186/1546-0096-12-s1-p311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Van Dijkhuizen P, Bulatovic-Calasan M, Pluijm S, De Rotte M, Vastert B, Kamphuis S, De Jonge R, Wulffraat N. PReS-FINAL-2162: Development of a risk model to predict methotrexate intolerance in juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044067 DOI: 10.1186/1546-0096-11-s2-p174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Reinards TH, Albers H, Brinkman D, Kamphuis S, Van Rossum M, Hoppenreijs E, Girschick H, Wouters C, Saurenmann R, Toes R, Huizinga T, Houwing-Duistermaat J, Schilham M, Ten Cate R. PReS-FINAL-2109: Genetic variations in patients with juvenile idiopathic arthritis and uveitis. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044289 DOI: 10.1186/1546-0096-11-s2-p121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ćalasan MB, den Boer E, de Rotte MCFJ, Vastert SJ, Kamphuis S, de Jonge R, Wulffraat NM. Methotrexate polyglutamates in erythrocytes are associated with lower disease activity in juvenile idiopathic arthritis patients. Ann Rheum Dis 2013; 74:402-7. [PMID: 24288013 DOI: 10.1136/annrheumdis-2013-203723] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine association of erythrocyte methotrexate polyglutamates (MTX-PG) with disease activity and adverse effects in a prospective juvenile idiopathic arthritis (JIA) cohort. METHODS One hundred and thirteen JIA patients were followed from MTX start until 12 months. Erythrocyte MTX-PGs with 1-5 glutamate residues were measured at 3 months with tandem mass spectrometry. The outcomes were Juvenile Arthritis Disease Activity Score (JADAS)-27 and adverse effects. To determine associations of MTX-PGs with JADAS-27 at 3 months and during 1 year of MTX treatment, linear regression and linear mixed-model analyses were used. To determine associations of MTX-PGs with adverse effects during 1 year of MTX treatment, logistic regression was used. Analyses were corrected for JADAS-27 at baseline and co-medication. RESULTS Median JADAS-27 decreased from 12.7 (IQR: 7.8-18.2) at baseline to 2.9 (IQR: 0.1-6.5) at 12 months. Higher concentrations of MTX-PG3 (β: -0.006, p=0.005), MTX-PG4 (β: -0.015, p=0.004), MTX-PG5 (β: -0.051, p=0.011) and MTX-PG3-5 (β: -0.004, p=0.003) were associated with lower disease activity at 3 months. Higher concentrations of MTX-PG3 (β: -0.005, p=0.028), MTX-PG4 (β: -0.014, p=0.014), MTX-PG5 (β: -0.049, p=0.023) and MTX-PG3-5 (β: -0.004, p=0.018) were associated with lower disease activity over 1 year. None of the MTX-PGs was associated with adverse effects. CONCLUSIONS In the first prospective study in JIA, long-chain MTX-PGs were associated with lower JADAS-27 at 3 months and during 1 year of MTX treatment. Erythrocyte MTX-PG could be a plausible candidate for therapeutic drug monitoring of MTX in JIA.
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Affiliation(s)
- Maja Bulatović Ćalasan
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Ethan den Boer
- Department of Clinical Chemistry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maurits C F J de Rotte
- Department of Clinical Chemistry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sebastiaan J Vastert
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Sylvia Kamphuis
- Department of Paediatric Rheumatology, Erasmus University Medical Centre Rotterdam, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Robert de Jonge
- Department of Clinical Chemistry, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nico M Wulffraat
- Department of Paediatric Immunology, University Medical Centre Utrecht, Wilhelmina Children's Hospital, Utrecht, The Netherlands
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Stoffels M, Szperl A, Simon A, Netea MG, Plantinga TS, van Deuren M, Kamphuis S, Lachmann H, Cuppen E, Kloosterman WP, Frenkel J, van Diemen CC, Wijmenga C, van Gijn M, van der Meer JW. OR7-002 – Pyrin 577 mutations in dominant autoinflammation. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952651 DOI: 10.1186/1546-0096-11-s1-a103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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