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Rostron H, Wright JM, Gilbert AW, Dillon B, Pini S, Redmond AC, Livermore P. Adoption of technology enabled care to support the management of children and teenagers in rheumatology services: a protocol for a mixed-methods systematic review. BMJ Open 2024; 14:e082515. [PMID: 38387983 PMCID: PMC10882409 DOI: 10.1136/bmjopen-2023-082515] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION COVID-19 catalysed a rapid move to provide care away from the hospital using online communication platforms. Technology enabled care (TEC) continues to be an important driver in progressing future healthcare services. Due to the complex and chronic nature of conditions seen within paediatric rheumatology, TEC may lead to better outcomes. Despite some growth in published literature into the adoption of TEC in paediatric rheumatology, there is limited synthesis. The aim of this review is to provide a comprehensive understanding and evaluation of the adoption of TEC by patients in paediatric rheumatology services, to establish best practices. METHODS AND ANALYSIS This proposed mixed-methods systematic review will be conducted by searching a wide variety of healthcare databases, grey literature resources and associated charities and societies, for articles reported in English language. Data extraction will include population demographics, technology intervention, factors affecting adoption of intervention and consequent study outcomes. A parallel-results convergent synthesis design is planned, with independent syntheses of quantitative and qualitative data, followed by comparison of the findings of each synthesis using a narrative approach. Normalisation process theory will be used to identify, characterise and explain implementation factors. The quality of included articles will be assessed using the Mixed Methods Appraisal Tool for research papers and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature. Overall confidence in quality and strength of evidence will be assessed using the Confidence in the Evidence from Reviews of Qualitative Research tool. ETHICS AND DISSEMINATION Ethical approval is not required due to the nature of this mixed-methods systematic review. The findings will be disseminated via a peer-reviewed journal, relevant conferences and any other methods (eg, via NHS Trust or NIHR YouTube channels) as advised by paediatric rheumatology patients. PROSPERO REGISTRATION NUMBER CRD42023443058.
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Affiliation(s)
- Heather Rostron
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Children's Research Team, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Judy M Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Anthony W Gilbert
- Therapies Department, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Simon Pini
- Psychological and Social Medicine, University of Leeds, Leeds, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Polly Livermore
- Infection, Immunity & Inflammation Department, University College London, London, UK
- NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Zhang M, Li J, Su Y, Guo G, Chen N. Effects of a home-based exercise combined yoga and resistance training in enthesitis-related arthritis in China: study protocol for a randomised controlled trial. BMJ Open 2024; 14:e078549. [PMID: 38382959 PMCID: PMC10882405 DOI: 10.1136/bmjopen-2023-078549] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Enthesitis-related arthritis (ERA) is a category of juvenile idiopathic arthritis (JIA). The complications of JIA include pain, muscle weakness, limited movement and worsening quality of life. Yoga is an effective exercise therapy for rheumatoid arthritis and may have similar benefits for JIA. Considering the limitation of yoga for strengthening muscles, combined yoga and resistance training (CYRT) may compensate for the shortcomings and provide more benefits for JIA patients. Despite this, there is currently a lack of studies investigating the effectiveness of CYRT for JIA patients. Due to the inaccessibility of traditional exercise therapy, home-based exercise is needed. The study aims to assess the effectiveness of home-based CYRT on JIA. METHODS AND ANALYSIS This is a 12-week randomised single-blind controlled trial study. 60 patients with ERA will be randomised into two groups: the home-based exercise group (HBE) and the health education (HE) group. The HBE group (n=30) will perform the CYRT programme 3 times a week at home for 12 weeks and receive HE. The HE group (n=30) will only receive HE. The outcomes include primary outcome (pain levels) and secondary outcomes (lower limb muscle strength, motion range of joint, aerobic fitness, function ability, fatigue levels, mental health, quality of life and blood biomarkers). The assessments will be conducted at baseline, postintervention (12 weeks) and follow-up (24 weeks). Data will be analysed by intention to treat. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine in December 2023 (approval no. XHEC-C-2023-059-3). This study will require informed consent from all subjects and guardians of children under 18 years of age. The findings will be published in a peer-reviewed journal and international conferences. TRIAL REGISTRATION NUMBER ChiCTR2300073446.
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Affiliation(s)
- Mei Zhang
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Jiaoyu Li
- Department of Pediatric Nephrology and Rheumatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yue Su
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Guimei Guo
- Department of Pediatric Nephrology and Rheumatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Nan Chen
- Department of Rehabilitation, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
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Lee RR, McDonagh JE, Rapley T, Farre A, Connelly M, Palermo TM, Toupin-April K, Wakefield E, Peters S, Cordingley L. "My gut feeling is…": An Ethnographic Study Exploring Interprofessional Communication About Children and Adolescents With Chronic Musculoskeletal Pain in Paediatric Rheumatology. J Pain 2023; 24:2257-2267. [PMID: 37454883 DOI: 10.1016/j.jpain.2023.07.010] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/18/2023]
Abstract
Interprofessional communication about inflammatory and non-inflammatory musculoskeletal conditions is an important component of assessment and management in paediatric rheumatology. Chronic pain is a feature of some of these conditions which likely influences the extent and type of communication about pain. Research investigating interprofessional communication about paediatric pain is limited but has found that communication is inclusive of the biopsychosocial context of children/adolescents as well as their families. The aim of this ethnographic study was to explore interprofessional communication about children and adolescents with chronic musculoskeletal pain in paediatric rheumatology. We observed forty-five healthcare professionals recruited from 3 UK paediatric rheumatology teams during thirty multi-disciplinary team meetings. Contemporaneous field notes created during observations were analysed using grounded theory procedures. Core processes identified in interprofessional communication involved describing, making sense of, and managing children/adolescents with pain and their families. Topic areas discussed within these core processes included healthcare professional perceptions about children's and parents' personality characteristics, as well as healthcare professionals' familiarity with families. Underlying diagnoses and possible attributions of pain aetiology were also discussed. Interprofessional narratives included consideration of the potential anxieties and uncertainties about pain within families. Healthcare professionals communicated about strategies for managing expectations about pain. These findings characterise the nuances in interprofessional communication about pain and can be used to inform future work aimed at understanding and optimising the impact of interprofessional communication on clinical decisions and pain outcomes. PERSPECTIVE: This study characterises the processes (series of actions), the function (purpose) and the content (topic areas) of interprofessional communication about paediatric pain in rheumatology settings. These findings should be used to inform interventions targeting both the appropriateness and effectiveness of this communication.
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Affiliation(s)
- Rebecca R Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK; Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK
| | - Tim Rapley
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Northumbria, UK
| | - Albert Farre
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Mark Connelly
- Division of Developmental and Behavioral Health, Children's Mercy Kansas City, Kansas City
| | - Tonya M Palermo
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington
| | - Karine Toupin-April
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada; Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada; Institut du savoir Montfort, Ottawa, ON, Canada
| | - Emily Wakefield
- Division of Pain and Palliative Medicine, Connecticut Children's Medical Center, Hartford, Connecticut; Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Sarah Peters
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK; National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Manchester, UK; Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Livermore P, Ainsworth S, Beesley R, Douglas S, Earle E, Wilson D, Woolley L, Clinch J. 'The current mental health status of children and young people with JIA, and their wider family': a charity partner collaboration survey. Pediatr Rheumatol Online J 2023; 21:111. [PMID: 37798784 PMCID: PMC10557198 DOI: 10.1186/s12969-023-00898-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/15/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND This paper presents insight into the scale of mental health concerns for families who have a child or young person with a diagnosis of Juvenile Idiopathic Arthritis (JIA) living in any of the four nations of the United Kingdom (UK). The study's objective is to share the current experiences of those that responded to a charity survey and consider future work to improve mental health support. METHODS This work was initiated and led by five UK charity partner organisations working with families affected by JIA. Parents/carers of a child or young person with JIA, and young people with JIA, submitted self-completion online questionnaires. The questionnaire asked 19 core questions, with a focus on the mental health impact of having and living with a JIA diagnosis. Questionnaires were delivered via charity partner UK-wide mailing lists and social media. RESULTS Questionnaire were completed by 291 participants over a 3-week period in February 2022. The majority of respondents were parents (229, 79%), 103 children had been diagnosed for over six years (35%), and 131 (45%) received shared care between paediatric rheumatology centres. In total, 168 (59%) children and young people with JIA had received, were currently receiving or were waiting for mental health support. Parents reported that their child's diagnosis impacted their own mental health (218, 82%). Children and young people reported never being offered mental health support during appointments for JIA (157, 54%), and 71 (50%) of these had never received support. CONCLUSION Children and young people with JIA have significant mental health sequelae from their diagnosis. Our findings found that nearly 60% of our respondents have had or are requiring mental health support, with significant numbers of parents/carers reporting difficulties in accessing care for their child's mental health or their own mental health, due to their child's diagnosis. This unique collaborative charity-led study, illustrates the importance of timely and accessible mental health support. Further work is needed to understand why best practice guidance for mental health support is not being met consistently and to identify how to embed it into standard rheumatology care.
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Affiliation(s)
- Polly Livermore
- NIHR Advanced Clinical Academic Nursing Fellow, Infection, Immunity and Inflammation, Institute of Child Health, University College London Great Ormond Street Institute of Child Health, 6th Floor, 30 Guilford Street, WC1N 1EH, London, UK.
| | | | - R Beesley
- Juvenile Arthritis Research (JAR), Tonbridge, UK
| | - S Douglas
- Scottish Network for Arthritis in Children (SNAC), Edinburgh, Scotland
| | - E Earle
- Children's Chronic Arthritis Association (CCAA), Nuneaton, UK
| | - D Wilson
- National Rheumatoid Arthritis Society (NRAS), Berkshire, UK
| | - L Woolley
- Young People and Families, Versus Arthritis (VA), London, UK
| | - J Clinch
- Bristol Royal Hospital for Children, Bristol, UK
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Thomas KN, Aggarwal A. Childhood rheumatic diseases: bites not only the joint, but also the heart. Clin Rheumatol 2023; 42:2703-2715. [PMID: 37160484 PMCID: PMC10169151 DOI: 10.1007/s10067-023-06621-9] [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: 12/27/2022] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/11/2023]
Abstract
Cardiovascular involvement in juvenile rheumatic diseases is the primary manifestation in paediatric vasculitis and a major organ manifestation in paediatric connective tissue diseases. Though coronary vasculitis is the prototypical manifestation of Kawasaki disease, it can also be seen in patients with polyarteritis nodosa. Pericarditis is the most common manifestation seen in juvenile rheumatic diseases like systemic onset JIA, and lupus. Cardiac tamponade, valvular insufficiency, aortic root dilatation and arrhythmias are seen rarely. Cardiac involvement is often recognized late in children. The development of cardiac disease in juvenile systemic sclerosis is associated with a poor outcome. In long term, childhood onset of rheumatic diseases predisposes to diastolic dysfunction and premature atherosclerosis during adulthood. Key Points • Pericarditis is the most common cardiac manifestation in SLE and can lead to tamponade. • Conduction defects are common in juvenile mixed connective tissue disease and systemic sclerosis. • Pulmonary hypertension is a significant contributor to mortality in juvenile systemic sclerosis. • In Kawasaki disease, early treatment can reduce risk of coronary artery aneurysms.
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Affiliation(s)
- Koshy Nithin Thomas
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India
| | - Amita Aggarwal
- Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India.
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O'Leary D, Al Julandani DA, Zia M, Klotsche J, Minden K, Roderick M, Ramanan AV, Killeen OG, Wilson AG. HLA-B*27 is associated with CNO in a European cohort. Pediatr Rheumatol Online J 2023; 21:52. [PMID: 37277844 DOI: 10.1186/s12969-023-00826-7] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 05/06/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVES To determine the influence of HLA-B27 positivity on risk of developing chronic nonbacterial osteomyelitis (CNO). METHODS HLA-B*27 genotype was assessed in 3 European CNO populations and compared with local control populations (572 cases, 33,256 controls). Regional or whole-body MRI was performed at diagnosis and follow-up in all cases which reduces the risk of disease misclassification. Genotyping was performed using either next generation DNA sequencing or PCR based molecular typing. Statistical analysis used Fisher's exact test with Bonferroni correction and a fixed effects model for meta-analysis of odds ratios. RESULTS HLA-B*27 frequency was higher in all 3 populations compared with local controls (combined odds ratio (OR) = 2.2, p-value = 3 × 10-11). This association was much stronger in male compared with female cases (OR = 1.99, corrected p-value = 0.015). However, the HLA-B*27 status was not statistically significantly associated with co-occurrence of psoriasis, arthritis or inflammatory bowel disease. CONCLUSION Carriage of HLA-B*27 is associated with greater risk of developing CNO, particularly in male cases.
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Affiliation(s)
- Daire O'Leary
- Centre for Arthritis Research, Conway Institute, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland.
- National Centre for Paediatric Rheumatology, Children's Health Ireland, Dublin, Ireland.
| | | | - Muhammad Zia
- National Centre for Paediatric Rheumatology, Children's Health Ireland, Dublin, Ireland
| | - Jens Klotsche
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
| | - Kirsten Minden
- Deutsches Rheuma-Forschungszentrum Berlin, Leibniz Institute, Berlin, Germany
- Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Marion Roderick
- Department of Paediatric Immunology and Infectious Diseases, Bristol Royal Hospital for Children, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Athimalaipet V Ramanan
- Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, Bristol, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Orla G Killeen
- Centre for Arthritis Research, Conway Institute, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
- National Centre for Paediatric Rheumatology, Children's Health Ireland, Dublin, Ireland
| | - Anthony G Wilson
- Centre for Arthritis Research, Conway Institute, School of Medicine, University College Dublin, Belfield, Dublin 4, Ireland
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Weitzman ER, Gaultney A, von Scheven E, Ringold S, Mann CM, Magane KM, Lin L, Leverty R, Dennos A, Hernandez A, Lippmann SJ, Dedeoglu F, Marin AC, Cox R, Reeve BB, Schanberg LE. Construct validity of Patient-Reported Outcomes Measurement Information System Paediatric measures in juvenile idiopathic arthritis and systemic lupus erythematosus: cross-sectional evaluation. BMJ Open 2023; 13:e063675. [PMID: 36707118 PMCID: PMC9884859 DOI: 10.1136/bmjopen-2022-063675] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES Evaluate construct validity of Patient-Reported Outcomes Measurement Information System (PROMIS) Paediatric measures of symptoms and functioning against measures of disease activity among youth with juvenile idiopathic arthritis (JIA) or systemic lupus erythematosus (SLE). DESIGN Cross-sectional associations among PROMIS measures and clinical metrics of disease activity were estimated. SETTING Seven clinical sites of the Childhood Arthritis and Rheumatology Alliance (CARRA) in the USA. PARTICIPANTS Youth aged 8-17 years enrolled in the CARRA Registry. INTERVENTION PROMIS measures were collected and associations with clinical measures of disease activity estimated, by condition, in bivariate and multivariable analyses with adjustment for sociodemographics, insurance status, medications and disease duration. MAIN OUTCOME MEASURES PROMIS Paediatric measures of mobility, physical activity, fatigue, pain interference, family relationships, peer relationships, depressive symptoms, psychological stress, anxiety, and meaning and purpose, and clinical metrics of disease. RESULTS Among 451 youth (average age 13.8 years, 71% female), most (n=393, 87%) had a JIA diagnosis and the remainder (n=58, 13%) had SLE. Among participants with JIA, those with moderate/high compared with low/inactive disease had, on average, worse mobility (multivariable regression coefficient and 95% CIs) (-7.40; -9.30 to -5.50), fatigue (3.22; 1.02 to 5.42), pain interference (4.76; 3.04 to 6.48), peer relationships (-2.58; -4.52 to -1.64), depressive symptoms (3.00; 0.96 to 5.04), anxiety (2.48; 0.40 to 4.56) and psychological stress (2.52; 0.68 to 4.36). For SLE, youth with active versus inactive disease had on average worse mobility (-5.07; -10.15 to 0.01) but PROMIS Paediatric measures did not discriminate participants with active and inactive disease in adjusted analyses. CONCLUSIONS Seven PROMIS Paediatric measures discriminated between active and inactive disease in youth with JIA. Results advance the usefulness of PROMIS for understanding well-being and improving interventions for youth with JIA, but larger studies are needed to determine utility in SLE cohorts. TRIAL REGISTRATION NUMBER National Institute of Arthritis and Musculoskeletal and Skin Diseases (U19AR069522).
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Affiliation(s)
- Elissa R Weitzman
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Computational Health Informatics Program, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Amy Gaultney
- Pediatric Rheumatology, Children's Hospital of Orange County, Orange, California, USA
| | - Emily von Scheven
- Pediatric Rheumatology, University of California San Francisco, San Francisco, California, USA
| | - Sarah Ringold
- Pediatrics, Seattle Children's Hospital, Seattle, Washington, USA
| | - Courtney M Mann
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kara M Magane
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Li Lin
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Renee Leverty
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Anne Dennos
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Alexy Hernandez
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Steven J Lippmann
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Fatma Dedeoglu
- Division of Immunology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Alexandra C Marin
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Rachele Cox
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Bryce B Reeve
- Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Laura E Schanberg
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
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Migowa A, Bernatsky S, Ngugi A, Foster HE, Muriuki P, Lusambili A, Luchters S. An iceberg I can't handle: a qualitative inquiry on perceptions towards paediatric rheumatology among healthcare workers in Kenya. Pediatr Rheumatol Online J 2023; 21:6. [PMID: 36681840 PMCID: PMC9862847 DOI: 10.1186/s12969-023-00790-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 01/15/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Delay in diagnosis and access to specialist care is a major problem for many children and young people with rheumatic disease in sub-Saharan Africa. Most children with symptoms of rheumatic disease present to non-specialists for care. There is an urgent need to understand and scale-up paediatric rheumatology knowledge and skills amongst non-specialist healthcare workers to promote early diagnosis, prompt referral, and management. PURPOSE We evaluated the knowledge, attitudes and practices towards diagnosis and care of paediatric rheumatology patients among health care workers in Kenya. METHODS We conducted 12 focus group discussions with clinical officers (third-tier community health workers) nurses, general practitioners and paediatricians across 6 regions in Kenya. Interviews were conducted on zoom, audio-recorded, transcribed, and analysed using NVIVO software. RESULTS A total of 68 individuals participated; 11 clinical officers, 12 nurses, 10 general practitioners, 27 paediatricians and 7 others. Most (n = 53) were female, and the median age was 36 years (range 31-40 years). Fifty per cent of the participants (34 of 68) worked in public health facilities. Our study revealed gaps in knowledge of paediatric rheumatology amongst healthcare workers which contributes to delayed diagnosis and poor management. Healthcare workers reported both positive and negative attitudes towards diagnosis and care of paediatric rheumatology patients. Perceived complexity and lack of knowledge in diagnosis, management and lack of health system clinical pathways made all cadres of healthcare workers feel helpless, frustrated, inadequate and incompetent to manage paediatric rheumatology patients. Positive attitudes arose from a perceived feeling that paediatric rheumatology patients pose unique challenges and learning opportunities. CONCLUSION There is an urgent need to educate healthcare workers and improve health systems to optimize clinical care for paediatric rheumatology patients.
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Affiliation(s)
- Angela Migowa
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium. .,Department of Paediatrics and Child Health, Aga Khan University, Medical College East Africa, Nairobi, Kenya.
| | - Sasha Bernatsky
- grid.63984.300000 0000 9064 4811Department of Medicine (Division of Rheumatology and Epidemiology) McGill University Health Centre (MUCH), Montreal, Canada
| | - Anthony Ngugi
- grid.470490.eDepartment of Population Health, Aga Khan University East Africa, Nairobi, Kenya
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Population and Health Institute, Newcastle University, Newcastle, UK
| | - Peter Muriuki
- grid.413355.50000 0001 2221 4219African Population and Health Research Centre, Nairobi, Kenya
| | - Adelaide Lusambili
- grid.470490.eDepartment of Population Health, Aga Khan University East Africa, Nairobi, Kenya
| | - Stanley Luchters
- grid.5342.00000 0001 2069 7798International Centre for Reproductive Health, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium ,grid.463169.f0000 0004 9157 2417Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe ,grid.48004.380000 0004 1936 9764Liverpool School of Tropical Medicine (LSTM), Liverpool, UK
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Song H, Zhao C, Zhang Y, Li D, Qian Y, Gao F, Xiao J, Zhang M. Efficacy and safety of adalimumab for inflammatory flare prevention in paediatric non-infectious anterior uveitis with peripheral retinal vascular leakage: a study protocol for a single-centre, randomised controlled trial. BMJ Open 2022; 12:e062211. [PMID: 36600374 PMCID: PMC9730384 DOI: 10.1136/bmjopen-2022-062211] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Paediatric patients with chronic anterior uveitis are more prone to suffer from the chronic course of intraocular inflammation and adverse effects of long-term immunomodulatory therapy, either topical glucocorticosteroids or systemic immunomodulatory agents. The performance of adalimumab has been shown to be fairly favourable in treating refractory non-infectious uveitis, but the detailed indication is still under investigation. This study aims to assess the efficacy and safety of adalimumab for inflammatory flare prevention in non-infectious paediatric anterior uveitis with peripheral retinal vascular leakage, compared with methotrexate. METHODS AND ANALYSIS Children weighed ≥30 kg and aged between 4 and 16 years old with active non-infectious anterior uveitis with peripheral retinal vascular leakage on ultra-wildfield fluorescein fundus angiography will be included. They will be treated with a predesigned inflammatory control regimen to reach inflammatory quiescence in 1 month. After that they will be treated with either methotrexate 10 mg once a week or adalimumab once every 2 weeks and regularly followed up for 6 months. The primary endpoint is uveitis flare defined as defined as anterior chamber cell count grading increased from 0 to 1 within the observation period. ETHICS AND DISSEMINATION The study was approved by the Institutional Review Board of Peking Union Medical College Hospital, Beijing, China (Approved protocol V3, dated 27 July 2021. Approval number 25-ZS-3062) and has been registered on ClinicalTrials.gov. Written informed consent will be collected from every patient and their guardians prior to study participation. The results of this trial will be presented at local and international meetings and submitted to peer-reviewed journals for publication. TRIAL REGISTRATION NUMBER NCT05015335.
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Affiliation(s)
- Hang Song
- Department of Ophthalmology, Key laboratory of Ocular Fundus Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Chan Zhao
- Department of Ophthalmology, Key laboratory of Ocular Fundus Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Yuelun Zhang
- Medical Research Center, Peking Union Medical College Hospital, Beijing, China
| | - Donghui Li
- Department of Ophthalmology, Key laboratory of Ocular Fundus Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Yujing Qian
- Department of Ophthalmology, Key laboratory of Ocular Fundus Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Fei Gao
- Department of Ophthalmology, Key laboratory of Ocular Fundus Diseases, Peking Union Medical College Hospital, Beijing, China
| | - Junyan Xiao
- Department of Ophthalmology, Fudan University Eye Ear Nose and Throat Hospital Department of Ophthalmology, Shanghai, China
| | - Meifen Zhang
- Department of Ophthalmology, Key laboratory of Ocular Fundus Diseases, Peking Union Medical College Hospital, Beijing, China
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10
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Elliott RS, Taylor E, Ainsworth J, Preston J, Smith EMDS. Improving communication of the concept of 'treat-to target' in childhood lupus: a public and patient (PPI) engagement project involving children and young people. BMC Rheumatol 2022; 6:69. [PMID: 36242078 PMCID: PMC9578343 DOI: 10.1186/s41927-022-00300-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A treat-to-target (T2T) approach, where treatment is escalated until a specific target is achieved, and re-escalated if the target is lost, has been proposed as a strategy to improve Childhood Systemic Lupus Erythematosus (cSLE) outcomes. Previous studies involving children and young people (CYP) have identified that the concept of T2T can be difficult to understand by CYP and their families. We aimed to explore the views of CYP participating in existing public and patient involvement (PPI) groups in relation to a proposed animation that is being developed to explain the concept of T2T to CYP who will be eligible for a future cSLE T2T trial. METHODS An illustrated animation storyboard was developed on PowerPoint, to be used alongside a contemporaneous voiceover to simulate the animation for CYP participating in three existing CYP PPI groups (GenerationR, Lupus UK, and YOUR RHEUM). Mixed methods were used to generate CYP feedback on the resource, including on-line surveys and qualitative topic-guided discussion, noting CYP suggestions for improvement. Changes were made iteratively to the resources. Pre/post workshop questionnaires to assess the impact of the resource on their understanding of T2T were completed anonymously. RESULTS 40 CYP were consulted; 16/40 (40%) from GenerationR (median age 15-years [IQR 12-15]), 12/40 (30%) from Lupus UK (median age 27-years [IQR 22-30]), and 12/40 (30%) from YOUR RHEUM (median age 17-years [IQR 16-21]). 62% of respondents had an underlying rheumatic condition. Pre-workshop median participant understanding of T2T was 2/10 [IQR 1-4], on a 1-10 scale (1 = "no understanding at all", 10 = "completely confident in my understanding"). After viewing the resource, participant understanding improved to a median of 9/10 [IQR 8-10], p < 0.0001). Overall, participants felt that the animation greatly improved their understanding of the concept of T2T, making several suggestions for improvement. CONCLUSION Involvement of CYP in research is crucial to help improve the design/delivery of studies, ensuring relevance to CYP and their families. This manuscript demonstrates the involvement of CYP in the development of an animation that will be integral to a future clinical trial, helping to describe the T2T approach in a comprehensible way to eligible CYP and their families, supporting study recruitment.
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Affiliation(s)
- R S Elliott
- School of Medicine, University of Liverpool, Liverpool, UK
| | - E Taylor
- School of Medicine, University of Liverpool, Liverpool, UK
| | - J Ainsworth
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - J Preston
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - E M D S Smith
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK. .,Department of Paediatric Rheumatology, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.
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11
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Levinsky Y, Butbul Aviel Y, Ahmad SA, Broide M, Gendler Y, Dagan N, Gafner M, Gavra H, Kagan S, Kedar K, Natour HM, Tal R, Veres T, Amarilyo G, Harel L. PFAPA flares observed during COVID outbreak: can emotional stress trigger PFAPA attacks? A multicenter cohort study. Pediatr Rheumatol Online J 2022; 20:46. [PMID: 35804374 PMCID: PMC9264301 DOI: 10.1186/s12969-022-00705-7] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/19/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE It is common knowledge among clinicians who treat PFAPA (Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis) patients that emotional stress can trigger PFAPA attacks similarly to other autoinflammatory diseases. However, it has never been proved scientifically. Our aim was to examine whether emotional stress serves as a trigger for PFAPA attacks. METHODS Patients aged 3-12 years, with active PFAPA, from two Israeli medical centers were enrolled to this study. Patient's parents were reached via phone calls in two occasions: a stressful period related to the COVID-19 pandemic restrictions and a less stressful period. In both times they were asked to report occurrence of PFAPA attacks in the preceding 2 weeks. The relative stress levels of the two periods were validated by an emotional distress scale questionnaire. The significance level was set at 0.05. RESULTS Mean age was 7.28 ± 2.7 for the 99 paediatric patients enrolled in the study. Scores for the mean emotional distress questionnaire were statistically significant higher in the stressful period compared to the less stressful period (35.6 ± 8.1 vs. 32.1 ±7.7, respectively, P = 0.047). In the stressful period, 41 (38.7%) reported at least one attack during the preceding 2 weeks, compared to 24 (22.6%) in the less stressful period (p = 0.017). CONCLUSION PFAPA flares during COVID-19 outbreak are described. This study is the first to suggest that emotional stress is associated with PFAPA attacks.
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Affiliation(s)
- Yoel Levinsky
- Department of Pediatrics B, Schneider Children's Medical Center of Israel, Pediatric Rheumatology Unit, Petach Tikva, Israel. .,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yonatan Butbul Aviel
- grid.413731.30000 0000 9950 8111Pediatric Rheumatology Service, Ruth Rappaport Children’s Hospital, Rambam Health Care Campus, Haifa, Israel ,grid.6451.60000000121102151The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sabreen Abu Ahmad
- grid.413731.30000 0000 9950 8111Department of Pediatrics B, Ruth Rappaport Children’s Hospital, Rambam Medical Center, Haifa, Israel
| | - Mor Broide
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.414231.10000 0004 0575 3167Department of Pediatrics A, Schneider Children’s Medical Center, Petah Tikva, Israel
| | - Yulia Gendler
- grid.411434.70000 0000 9824 6981Department of Nursing, Ariel University, Ariel, Israel
| | - Neta Dagan
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.414231.10000 0004 0575 3167Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Michal Gafner
- grid.414231.10000 0004 0575 3167Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Pediatric Rheumatology Unit, Petach Tikva, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Gavra
- grid.413731.30000 0000 9950 8111Department of Pediatrics B, Ruth Rappaport Children’s Hospital, Rambam Medical Center, Haifa, Israel
| | - Shelly Kagan
- grid.414231.10000 0004 0575 3167Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Pediatric Rheumatology Unit, Petach Tikva, Israel ,grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kfir Kedar
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.414231.10000 0004 0575 3167Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Hamada Mohammad Natour
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.414231.10000 0004 0575 3167Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Rotem Tal
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.414231.10000 0004 0575 3167Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Tamar Veres
- grid.413731.30000 0000 9950 8111Department of Pediatrics B, Ruth Rappaport Children’s Hospital, Rambam Medical Center, Haifa, Israel
| | - Gil Amarilyo
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.414231.10000 0004 0575 3167Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
| | - Liora Harel
- grid.12136.370000 0004 1937 0546Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel ,grid.414231.10000 0004 0575 3167Pediatric Rheumatology Unit, Schneider Children’s Medical Center of Israel, Petach Tikva, Israel
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12
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McErlane F, Anderson C, Lawson-Tovey S, Lee B, Lee C, Lunt L, McDonagh JE, Smith AD, Smith N, Cleary G. Quality improvement in juvenile idiopathic arthritis: a mixed-methods implementation pilot of the CAPTURE-JIA dataset. Pediatr Rheumatol Online J 2022; 20:43. [PMID: 35717328 PMCID: PMC9206126 DOI: 10.1186/s12969-022-00697-4] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A significant proportion of children and young people with juvenile idiopathic arthritis (JIA) do not achieve inactive disease during the first two years following diagnosis. Refinements to clinical care pathways have the potential to improve clinical outcomes but a lack of consistent and contemporaneous clinical data presently precludes standard setting and implementation of meaningful quality improvement programmes. This study was the first to pilot clinical data collection and analysis using the CAPTURE-JIA dataset, and to explore patient and clinician-reported feasibility and acceptability data. METHODS A multiphase mixed-methods approach enabled prospective collection of quantitative data to examine the feasibility and efficacy of dataset collection and of qualitative data informing the context and processes of implementation. An initial paper pilot informed the design of a bespoke electronic data collection system (the Agileware system), with a subsequent electronic pilot informing the final CAPTURE-JIA data collection tool. RESULTS Paper collection of patient data was feasible but time-consuming in the clinical setting. Phase 1 paper pilot data (121 patients) identified three themes: problematic data items (14/62 data items received >40% missing data), formatting of data collection forms and a clinician-highlighted need for digital data collection, informing Phase 2 electronic data collection tool development. Patients and families were universally supportive of the collection and analysis of anonymised patient data to inform clinical care. No apparent preference for paper / electronic data collection was reported by families. Phase 3 electronic pilot data (38 patients) appeared complete and the system reported to be easy to use. Analysis of the study dataset and a dummy longitudinal dataset confirmed that all eleven JIA national audit questions can be answered using the electronic system. CONCLUSIONS Multicentre CAPTURE-JIA data collection is feasible and acceptable, with a bespoke data collection system highlighted as the most satisfactory solution. The study is informing ongoing work towards a streamlined and flexible national paediatric data collection system to drive quality improvement in clinical care.
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Affiliation(s)
- Flora McErlane
- Paediatric Rheumatology, Great North Children's Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK. .,Institute of Population and Health Sciences, Medical School, Newcastle University, Newcastle upon Tyne, UK.
| | | | - Saskia Lawson-Tovey
- grid.5379.80000000121662407Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK ,grid.498924.a0000 0004 0430 9101National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Chris Lee
- Appligo Ltd, https://www.agileware.io/about
| | - Laura Lunt
- grid.498924.a0000 0004 0430 9101National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Janet E. McDonagh
- grid.498924.a0000 0004 0430 9101National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK ,grid.415910.80000 0001 0235 2382Department of Paediatric and Adolescent Rheumatology, Royal Manchester Children’s Hospital, Manchester University Hospitals NHS Trust, Manchester, UK
| | - Andrew D. Smith
- grid.498924.a0000 0004 0430 9101National Institute of Health Research Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK ,grid.5379.80000000121662407Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research, The University of Manchester, Manchester, UK
| | - Nicola Smith
- grid.1006.70000 0001 0462 7212Musculoskeletal Research Group, Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Gavin Cleary
- grid.413582.90000 0001 0503 2798Department of Rheumatology, Alder Hey Children’s Hospital, Liverpool, UK
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13
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Abstract
OBJECTIVE The James Lind Alliance (JLA) offers a method for better aligning health and care agenda's with the needs of patients, carers and clinicians by bringing them together in a Priority Setting Partnership (PSP). In this paper, we draw attention to crucial lessons learnt when establishing such a shared research agenda. KEY ARGUMENTS Having specific strategies and plans in place for maximising dialogic processes in a PSP can help facilitate and maintain trust, innovation and equal inclusion. CONCLUSION Eight lessons learnt have been formulated, based on our observations and reflections on the JLA PSP and our expertise on patient participation and participatory research.
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Affiliation(s)
- Karin Rolanda Jongsma
- Medical Humanities, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Megan M Milota
- Medical Humanities, University Medical Center, Utrecht University, Utrecht, The Netherlands
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14
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Gargh K, Al-Abadi E, Low S, Harrison K, Coles W, Davis P, Johnson K. Juvenile Dermatomyositis Magnetic Resonance Imaging Score (JIS) does not correlate with criteria for clinically inactive disease: a single-centre retrospective evaluation. Rheumatol Int 2021; 42:1221-1226. [PMID: 34796407 PMCID: PMC9203389 DOI: 10.1007/s00296-021-05049-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022]
Abstract
The Paediatric Rheumatology International Trials Organisation (PRINTO) criteria for clinically inactive disease (CID) and their proposal for glucocorticoid tapering do not consider MRI findings, despite the growing use of MRI and development of reliable MRI scoring tools. We aim to evaluate how CID correlates with MRI scores and physician decision making. We retrospectively used the Juvenile Dermatomyositis Imaging Score (JIS) to score MRIs of all children with JDM over a 10-year period. Demographic, diagnosis, treatment and core set measures data were collected. Correlation between CID and JIS was assessed as well as correlation with the physician treatment decision. There were 25 patients with 59 follow-up episodes to analyse correlation between physician treatment decision and JIS; and 50 episodes for the CID category and JIS correlation. JIS was not significantly associated with the CID category but did correlate with the physician decision. No significant association was found between clinical decision and CID category. The JIS area under the ROC curve (AUC) was 0.80 (95% CI 0.62-0.99) with a score ≥ 8 to predict an escalation. JIS sensitivity and specificity were both 78% with accuracy of 78%, compared to only 67%, 46% and 49%, respectively, for the CID criteria. Clinical criteria alone are not sufficient to assess disease activity status. Clinical decision trends correlated to MRI findings but not PRINTO CID criteria. Multi centre prospective studies are needed to replicate our findings and establish how to best use MRI as a biomarker of disease activity.
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Affiliation(s)
- Kapil Gargh
- Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, West Midlands, UK
| | - Eslam Al-Abadi
- Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, West Midlands, UK.
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, West Midlands, UK.
| | - Samantha Low
- Radiology Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
| | - Kathryn Harrison
- Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, West Midlands, UK
| | - William Coles
- Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, West Midlands, UK
| | - Penny Davis
- Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's Hospital NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, West Midlands, UK
| | - Karl Johnson
- Radiology Department, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, West Midlands, UK
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15
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Walters HM, Mian Z, Thomas L, Cerise J, Eberhard BA, Pagano E, Gottlieb BS, Steigerwald K, Hui-Yuen JS. Seroprevalence and Clinical Outcomes of SARS-CoV-2 in Paediatric Patients with Rheumatic Disease. Rheumatology (Oxford) 2021; 61:SI112-SI119. [PMID: 34599820 DOI: 10.1093/rheumatology/keab730] [Citation(s) in RCA: 4] [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] [Received: 06/09/2021] [Revised: 09/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Immunosuppressed paediatric patients with rheumatic disease (RD) may be at risk for severe or critical disease related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Data remain scarce on COVID-19 outcomes in paediatric RD patients. The aim of this study is to determine the seroprevalence of SARS-CoV-2 IgG and to describe COVID-19 outcomes in immunosuppressed paediatric RD patients. METHODS Patients diagnosed with RD before age 18 and treated with at least one immunosuppressive medication for at least three months were enrolled from a tertiary paediatric rheumatology practice in New York, and also underwent routine SARS-CoV-2 IgG testing from May to November 2020. Five hundred and seventy-one patients were screened and 262 were enrolled. SARS-CoV-2 IgG+ subjects were assessed for symptoms of COVID-19 infection. SARS-CoV-2 PCR results were recorded where available. Demographic, diagnostic, medication, and outcome data were collected. RESULTS Of 262 subjects (186 female), 35 (13%) were SARS-CoV-2 IgG+; 17 (49%) had symptoms suggestive of COVID-19. Of 17 patients who had SARS-CoV-2 PCR testing, 11 (65%) were PCR+; seven of whom were IgG+. Most SARS-CoV-2 IgG+ subjects were not PCR tested. The most common symptoms in IgG+ and/or PCR+ subjects were fever, fatigue, and cough. No SARS-CoV-2 IgG+ or PCR+ subject developed severe or critical COVID-19 or required hospitalisation. CONCLUSIONS This is the first report of clinical outcomes of SARS-CoV-2 infection and seroprevalence of SARS-CoV-2 IgG in a large cohort of paediatric RD patients. Most SARS-CoV-2 IgG+ subjects had no symptoms of COVID-19 infection. Symptomatic subjects all had mild COVID-19 symptoms, suggesting that risk of severe or critical COVID-19 in immunosuppressed paediatric RD patients is minimal.
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Affiliation(s)
- Heather M Walters
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Zanab Mian
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Lydia Thomas
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jane Cerise
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Biostatistics Unit, Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | - B Anne Eberhard
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Eileen Pagano
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Beth S Gottlieb
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Katherine Steigerwald
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joyce S Hui-Yuen
- Division of Pediatric Rheumatology, Cohen Children's Medical Center, New Hyde Park, NY, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.,Center for Autoimmune, Musculoskeletal, and Hematopoietic Diseases Research, Feinstein Institutes for Medical Research, Manhasset, NY, USA
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16
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Lee RR, McDonagh JE, Connelly M, Peters S, Cordingley L. Identifying the content and context of pain within paediatric rheumatology healthcare professional curricula in the UK: a summative content analysis. Pediatr Rheumatol Online J 2021; 19:129. [PMID: 34419095 PMCID: PMC8379855 DOI: 10.1186/s12969-021-00614-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The curriculum for professionals working in paediatric rheumatology should include pain but it is unclear to what extent this currently occurs. The aim of this study was to identify pain-related curriculum content and the context in which pain is presented in educational and training documentation for healthcare professionals in this clinical speciality. METHODS Core curricula documents from UK based professional organisations were identified in partnership with healthcare professionals. Documents were analysed using a summative content analysis approach. Key pain terms were quantified and weighted frequencies were used to explore narrative pain themes. Latent content was interpreted qualitatively to explore the context within which pain terms were positioned. RESULTS Nine curriculum documents were identified and analysed from doctors, nurses, physiotherapists and occupational therapists specialising in paediatric rheumatology. Pain themes represented a mean percentage of 1.51% of text across all documents. Pain was rarely presented in the context of both inflammatory and non-inflammatory condition types despite being a common feature of each. Musculoskeletal pain was portrayed simply as a 'somatic' symptom, rather than as a complex phenomenon involving biological and psychosocial processes. Content around the assessment and management of pain was vague and inexplicit. CONCLUSION Current educational and training documentation in paediatric rheumatology do not include core pain topics. Curricula for these healthcare professionals would benefit from updates in contemporary pain theories and examples of in-context, evidence-based pain practices. This should be a priority starting point for optimising patient pain care in paediatric musculoskeletal healthcare.
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Affiliation(s)
- Rebecca Rachael Lee
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK.
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Stopford Building, Oxford Road, Manchester, M13 9PT, UK.
| | - Janet E McDonagh
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
- Royal Manchester Children's Hospital, Manchester University Foundation Hospitals Trust, Manchester, UK
| | - Mark Connelly
- Children's Mercy Kansas City, 2401 Gillham Road, Kansas City, USA
| | - Sarah Peters
- Manchester Centre for Health Psychology, Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Lis Cordingley
- Centre for Epidemiology Versus Arthritis, Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Biomedical Research Centre, Manchester University Hospital NHS Trust, Stopford Building, Oxford Road, Manchester, M13 9PT, UK
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Beukelman T, Lougee A, Matsouaka RA, Collier D, Rumsey DG, Schenfeld J, Stryker S, Twilt M, Kimura Y. Patterns of etanercept use in juvenile idiopathic arthritis in the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2021; 19:131. [PMID: 34419107 PMCID: PMC8380401 DOI: 10.1186/s12969-021-00625-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/31/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND We aimed to characterize etanercept (ETN) use in juvenile idiopathic arthritis (JIA) patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry. METHODS The CARRA Registry is a convenience cohort of patients with paediatric onset rheumatic diseases, including JIA. JIA patients treated with ETN for whom the month and year of ETN initiation were available were included. Patterns of ETN and methotrexate (MTX) use were categorized as follows: combination therapy (ETN and MTX started concurrently), step-up therapy (MTX started first and ETN added later), switchers (MTX started and then stopped when or before ETN started), MTX add-on (ETN started first and MTX added later), and ETN only (no MTX use). Data were described using parametric and non-parametric statistics as appropriate. RESULTS Two thousand thirty-two of the five thousand six hundred forty-one patients with JIA met inclusion criteria (74% female, median age at diagnosis 6.0 years [interquartile range 2.0, 11.0]. Most patients (66.9%) were treated with a non-biologic disease modifying anti-rheumatic drug (DMARD), primarily MTX, prior to ETN. There was significant variability in patterns of MTX use prior to starting ETN. Step-up therapy was the most common approach. Only 34.0% of persistent oligoarticular JIA patients continued treatment with a non-biologic DMARD 3 months or more after ETN initiation. ETN persistence overall was 66.3, 49.4, and 37.3% at 24, 36 and 48 months respectively. ETN persistence among spondyloarthritis patients (enthesitis related arthritis and psoriatic JIA) varied by MTX initiation pattern, with higher ETN persistence rates in those who initiated combination therapy (68.9%) and switchers/ETN only (73.3%) patients compared to step-up (65.4%) and MTX add-on (51.1%) therapy. CONCLUSION This study characterizes contemporary patterns of ETN use in the CARRA Registry. Treatment was largely in keeping with American College of Rheumatology guidelines.
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Affiliation(s)
- Timothy Beukelman
- Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL, 35233, USA.
| | - Aimee Lougee
- grid.26009.3d0000 0004 1936 7961Duke University, Duke Clinical Research Institute, 200 Morris Street, Durham, NC 27701 USA
| | - Roland A. Matsouaka
- grid.26009.3d0000 0004 1936 7961Department of Biostatistics and Bioinformatics, Duke University, Duke Clinical Research Institute, 200 Morris Street, Durham, NC 27701 USA
| | - David Collier
- grid.417886.40000 0001 0657 5612Global Medical Affairs, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320-1799 USA
| | - Dax G. Rumsey
- grid.17089.37Department of Pediatrics, University of Alberta, 3-502 ECHA; 11405 87 Ave NW, Edmonton, Alberta T6G 1C9 Canada
| | - Jennifer Schenfeld
- grid.417886.40000 0001 0657 5612Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320-1799 USA
| | - Scott Stryker
- grid.417886.40000 0001 0657 5612Center for Observational Research, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320-1799 USA
| | - Marinka Twilt
- grid.22072.350000 0004 1936 7697Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, Alberta T3B 6A8 Canada
| | - Yukiko Kimura
- grid.239835.60000 0004 0407 6328Joseph M. Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ USA
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Welzel T, Winskill C, Zhang N, Woerner A, Pfister M. Biologic disease modifying antirheumatic drugs and Janus kinase inhibitors in paediatric rheumatology - what we know and what we do not know from randomized controlled trials. Pediatr Rheumatol Online J 2021; 19:46. [PMID: 33766063 DOI: 10.1186/s12969-021-00514-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 03/04/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Biologic disease modifying antirheumatic drugs (bDMARDs) and Janus Kinase (JAK) inhibitors are prescribed in adult and paediatric rheumatology. Due to age-dependent changes, disease course, and pharmacokinetic processes paediatric patients with inflammatory rheumatic diseases (PiRD) differ from adult rheumatology patients. METHODS A systematic literature search for randomized clinical trials (RCTs) in PiRD treated with bDMARDs/JAK inhibitors was conducted on Medline, clinicaltrials.gov , clinicaltrialsregister.eu and conference abstracts as of July 2020. RCTs were included if (i) patients were aged ≤20 years, (ii) patients had a predefined rheumatic diagnosis and (iii) RCT reported predefined outcomes. Selected studies were excluded in case of (i) observational or single arm study or (ii) sample size ≤5 patients. Study characteristics were extracted. RESULTS Out of 608 screened references, 65 references were selected, reporting 35 unique RCTs. All 35 RCTs reported efficacy while 34/3 provided safety outcomes and 16/35 provided pharmacokinetic data. The most common investigated treatments were TNF inhibitors (60%), IL-1 inhibitors (17%) and IL-6 inhibitors (9%). No RCTs with published results were identified for baricitinib, brodalumab, certolizumab pegol, guselkumab, risankizumab, rituximab, sarilumab, secukinumab, tildrakizumab, or upadacitinib. In patients with juvenile idiopathic arthritis (JIA) 25/35 RCTs were conducted. The remaining 10 RCTs were performed in non-JIA patients including plaque psoriasis, Kawasaki Disease, systemic lupus erythematosus and non-infectious uveitis. In JIA-RCTs, the control arm was mainly placebo and the concomitant treatments were either methotrexate, non-steroidal anti-inflammatory drugs (NSAID) or corticosteroids. Non-JIA patients mostly received NSAID. There are ongoing trials investigating abatacept, adalimumab, baricitinib, brodalumab, certolizumab pegol, etanercept, guselkumab, infliximab, risankizumab, secukinumab, tofacitinib and tildrakizumab. CONCLUSION Despite the FDA Modernization Act and support of major paediatric rheumatology networks, such as the Pediatric Rheumatology Collaborative Study Group (PRCSG) and the Paediatric Rheumatology International Trials Organization (PRINTO), which resulted in drug approval for PiRD indications, there are limited RCTs in PiRD patients. As therapy response is influenced by age-dependent changes, pharmacokinetic processes and disease course it is important to consider developmental changes in bDMARDs/JAK inhibitor use in PiRD patients. As such it is critical to collaborate and conduct international RCTs to appropriately investigate and characterize efficacy, safety and pharmacokinetics of bDMARDs/JAK inhibitors in paediatric rheumatology.
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Tangcheewinsirikul S, Tang SP, Smith N, Sukharomana M, Charuvanij S, Vilaiyuk S, Arkachaisri T, Scott C, Foster HE. Delivery of paediatric rheumatology care: a survey of current clinical practice in Southeast Asia and Asia-Pacific regions. Pediatr Rheumatol Online J 2021; 19:11. [PMID: 33485337 PMCID: PMC7824936 DOI: 10.1186/s12969-021-00498-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Paediatric rheumatic diseases are a leading cause of acquired disability in Southeast Asia and Asia-Pacific Countries (SE ASIA/ASIAPAC). The aims of this study were to identify and describe the challenges to the delivery of patient care and identify solutions to raise awareness about paediatric rheumatic diseases. METHODS The anonymised online survey included 27 items about paediatric rheumatology (PR) clinical care and training programmes. The survey was piloted and then distributed via Survey-Monkey™ between March and July 2019. It was sent to existing group lists of physicians and allied health professionals (AHPs), who were involved in the care pathways and management of children with rheumatic diseases in SE ASIA/ASIAPAC. RESULTS Of 340 participants from 14 countries, 261 participants had been involved in PR care. The majority of the participants were general paediatricians. The main reported barriers to providing specialised multidisciplinary service were the absence or inadequacy of the provision of specialists and AHPs in addition to financial issues. Access to medicines was variable and financial constraints cited as the major obstacle to accessing biological drugs within clinical settings. The lack of a critical mass of specialist paediatric rheumatologists was the main perceived barrier to PR training. CONCLUSIONS There are multiple challenges to PR services in SE ASIA/ASIAPAC countries. There is need for more specialist multidisciplinary services and greater access to medicines and biological therapies. The lack of specialist paediatric rheumatologists is the main barrier for greater access to PR training.
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Affiliation(s)
- Sirikarn Tangcheewinsirikul
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Swee-Ping Tang
- grid.413442.40000 0004 1802 4561Paediatric Rheumatology Unit, Selayang Hospital, Selangor, Malaysia
| | - Nicola Smith
- grid.1006.70000 0001 0462 7212Paediatric Rheumatology, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Maynart Sukharomana
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirirat Charuvanij
- Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Soamarat Vilaiyuk
- grid.10223.320000 0004 1937 0490Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thaschawee Arkachaisri
- grid.414963.d0000 0000 8958 3388Department of Paediatric Subspecialties, Rheumatology and Immunology Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Christiaan Scott
- grid.415742.10000 0001 2296 3850Division of Paediatric Rheumatology, Department of Paediatrics, University of Cape Town, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
| | - Helen E. Foster
- grid.1006.70000 0001 0462 7212Paediatric Rheumatology, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK ,grid.472342.40000 0004 0367 3753Newcastle University Medicine Malaysia, Johor, Malaysia
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Gezgin Yıldırım D, Bakkaloğlu SA, Soysal Acar AŞ, Çelik B, Buyan N. Evaluation of caregiver burden and coping strategies in parents of paediatric familial Mediterranean fever patients in relation to illness severity, therapy and health-related quality of life. Qual Life Res 2021; 30:1347-1354. [PMID: 33447957 DOI: 10.1007/s11136-020-02739-4] [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] [Accepted: 12/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The study aimed to determine the caregiver burden and coping strategies in caregivers of familial Mediterranean fever (FMF) patients in relation to illness severity, therapy and health-related quality of life (HRQoL). METHODS The study included 171 paediatric FMF patients and their caregivers (parents). The caregivers were asked to complete a socio-demographic form, the Zarit caregiver burden interview (ZCBI) and the Brief COPE. The patients and their caregivers were asked to complete the KINDer Lebensqualitätsfragebogen questionnaire (self-report and proxy report, respectively) for assessing HRQoL. The patients were categorised according to their disease activity (mild, moderate or severe) and the presence or absence of anti-IL-1 therapy. RESULTS The mean ZCBI score of the caregivers was 44.7 ± 13.5. ZCBI and COPE scores did not differ significantly between the caregivers of FMF patients receiving and not receiving anti-IL-1 therapy. However, dysfunctional COPE (p = 0.039) and ZCBI (p = 0.021) scores showed a significant difference between the caregivers in relation to patient's disease severity. ZCBI scores were positively correlated with dysfunctional coping (p = 0.01). Self-reported HRQoL disease module scores were lower for the patients who received anti-IL-1 therapy than for those did not (p = 0.009). Proxy-reported (p < 0.001) and self-reported (p = 0.043) HRQoL disease module scores were lower for the patients with severe disease activity. CONCLUSIONS As the caregiver burden increases, parents tend to use a dysfunctional coping strategy. Good control of disease activity with administration of medical therapy can reduce the disease severity, thereby decrease the caregiver burden, and secondly help to reduce the usage of dysfunctional coping in caregivers.
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Affiliation(s)
- Deniz Gezgin Yıldırım
- Department of Paediatric Rheumatology, Gazi University Faculty of Medicine, 06560, Ankara, Turkey.
| | - Sevcan A Bakkaloğlu
- Department of Paediatric Rheumatology, Gazi University Faculty of Medicine, 06560, Ankara, Turkey
| | | | - Bülent Çelik
- Department of Biostatistics, Gazi University Faculty of Science, Ankara, Turkey
| | - Necla Buyan
- Department of Paediatric Rheumatology, Gazi University Faculty of Medicine, 06560, Ankara, Turkey
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21
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McCann LJ, Hedrich CM. Is it time to re-think juvenile-onset Rheumatic and Musculoskeletal Diseases? - First steps towards individualised treatments to meet agreed targets. Clin Immunol 2020; 223:108647. [PMID: 33310069 DOI: 10.1016/j.clim.2020.108647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Liza J McCann
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK
| | - Christian M Hedrich
- Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust Hospital, UK; Department of Women's & Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, UK.
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Koker O, Demirkan FG, Kayaalp G, Cakmak F, Tanatar A, Karadag SG, Sonmez HE, Omeroglu R, Aktay Ayaz N. Does immunosuppressive treatment entail an additional risk for children with rheumatic diseases? A survey-based study in the era of COVID-19. Rheumatol Int 2020; 40:1613-1623. [PMID: 32743705 PMCID: PMC7395897 DOI: 10.1007/s00296-020-04663-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 06/08/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Abstract
The aim of the research was to further extend current knowledge of whether severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease 2019 (COVID-19) entails a risk for children with various rheumatic diseases under immunosuppressive treatment. Telephone survey was administered by conducting interviews with the parents from May 1, 2020 to May 20, 2020. A message containing a link to the actual questionnaire was sent to their phones simultaneously. The medical records of the patients were reviewed for gathering information about demographic data, clinical follow-up, and treatments. Patients who were followed-up under immunosuppressive treatment (n = 439) were attempted to be contacted. The diagnostic distribution of patients (n = 414) eligible for the study was as follows: juvenile idiopathic arthritis (JIA) (n = 243, 58.7%), autoinflammatory diseases (n = 109, 26.3%), connective tissue diseases (n = 51, 12.3%), and vasculitis (n = 11, 2.7%). In the entire cohort, the mean age was 12 ± 4.7 years, and 54.1% (n = 224) were female. Nine patients have attended the hospital for COVID-19 evaluation, 6 of whom were in close contact with confirmed cases. One patient with seronegative polyarticular JIA, previously prescribed methotrexate and receiving leflunomide during pandemic was identified to be diagnosed with COVID-19. None, including the confirmed case, had any severe symptoms. More than half of the patients with household exposure did not require hospitalization as they were asymptomatic. Although circumstances such as compliance in social distancing policy, transmission patterns, attitude following contact may have influenced the results, immunosuppressive treatment does not seem to pose an additional risk in terms of COVID-19.
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Affiliation(s)
- Oya Koker
- Department of Paediatric Rheumatology, Istanbul Faculty of Medical School, Istanbul University, Istanbul, Turkey
| | - Fatma Gul Demirkan
- Department of Paediatric Rheumatology, Istanbul Faculty of Medical School, Istanbul University, Istanbul, Turkey
| | - Gulsah Kayaalp
- Department of Paediatric Rheumatology, Istanbul Faculty of Medical School, Istanbul University, Istanbul, Turkey
| | - Figen Cakmak
- Department of Paediatric Rheumatology, Istanbul Faculty of Medical School, Istanbul University, Istanbul, Turkey
| | - Ayse Tanatar
- Department of Paediatric Rheumatology, Istanbul Faculty of Medical School, Istanbul University, Istanbul, Turkey
| | - Serife Gul Karadag
- Department of Paediatric Rheumatology, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Hafize Emine Sonmez
- Department of Paediatric Rheumatology, Kanuni Sultan Süleyman Research and Training Hospital, Istanbul, Turkey
| | - Rukiye Omeroglu
- Department of Paediatric Rheumatology, Istanbul Faculty of Medical School, Istanbul University, Istanbul, Turkey
| | - Nuray Aktay Ayaz
- Department of Paediatric Rheumatology, Istanbul Faculty of Medical School, Istanbul University, Istanbul, Turkey.
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23
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Renton WD, Leveret H, Guly C, Smee H, Leveret J, Ramanan AV. Same but different? A thematic analysis on adalimumab biosimilar switching among patients with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2019; 17:67. [PMID: 31585539 PMCID: PMC6778384 DOI: 10.1186/s12969-019-0366-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/05/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Biologic medications have dramatically enhanced the treatment of many chronic paediatric inflammatory conditions. Their high cost is a factor that prohibits their broader use. Cheaper generic versions, or biosimilars, are increasingly being used. Healthcare services are switching some patients over to biosimilars for economic reasons, known as 'non-medical switching'. Some patients unsuccessfully switch due to perceived decreases in efficacy or non-specific drug effects. The implications of failed switching include exhaustion of therapeutic options, unnecessary exposure to other medications, increased healthcare utilisation, worse patient outcomes and higher overall healthcare costs. Patient perceptions almost certainly play a role in these 'failed switches'. METHODS A thematic analysis was performed to better understand patient and parent perceptions on non-medical biosimilar switching. The study was conducted in accordance with the Consolidated Criteria for Reporting Qualitative Research recommendations. Patients with juvenile idiopathic arthritis currently taking adalimumab were included. RESULTS Nine families were interviewed just prior to a hospital trust-wide non-medical switch to an adalimumab biosimilar. Several common themes were identified. The most frequent concerns were regarding practical aspects of the switch including the medication administration device type; the colour of the medication and administration device; and whether the injections would sting more. The relative safety and efficacy of the biosimilar was raised although most families felt that there would be no significant difference. Anxieties about the switch were largely placated by reassurances from the medical team. CONCLUSIONS We derived recommendations based on existing adult literature and the observations from our study to optimise the benefits from non-medical biosimilar switching.
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Affiliation(s)
- William D. Renton
- 0000 0004 0399 4960grid.415172.4Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Helen Leveret
- 0000 0004 0399 4960grid.415172.4Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Catherine Guly
- 0000 0004 0399 4581grid.415175.3Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Heather Smee
- 0000 0004 0399 4960grid.415172.4Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Jamie Leveret
- 0000 0004 0399 4960grid.415172.4Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Athimalaipet V. Ramanan
- 0000 0004 0399 4960grid.415172.4Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, Bristol, UK ,0000 0004 1936 7603grid.5337.2Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Trauzeddel R, Lehman H, Trauzeddel RF, Haller M, Palm-Beden K, Ganser G, Berendes R, Nirschl C, Nimtz-Talaska A, Krumrey-Langkammerer M, Schoof P, Windschall D. Age dependent ultrasound B-mode findings of the elbow joint in healthy children and adolescents. Rheumatol Int 2019; 39:1007-1018. [PMID: 31006048 DOI: 10.1007/s00296-018-4233-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 12/18/2018] [Indexed: 11/25/2022]
Abstract
Due to maturation of joints, various changes take place, not only in the field of paediatric rheumatology but also in paediatric orthopaedics musculoskeletal ultrasound plays an important role in both the diagnosis and the follow-up of diseases in this field. To differentiate between physiological and pathological findings, the knowledge of reference values of joint structures is indispensable. The objective was to define B-mode ultrasound age- and sex-related reference values for the elbow joint in healthy children and adolescents during maturation. In a cross-sectional, multicentre ultrasound study we examined both sides of the elbow joints of 437 healthy children and adolescents (194 boys/243 girls) being between one and less than 18 years old. The children were classified into six equal age groups and divided according to their gender. We measured the distance between the outer margin of the joint capsule and the bone surface to define the bone-capsule distance (BCD), the thickness of the joint cartilage as well as the thickness of the joint capsule. The bone-capsule junction zone and the shape of the joint capsule were analysed qualitatively. The bone capsule distance and the capsule thickness increased with age. In contrast, the joint cartilage thickness decreased. In most cases the junction zone was peaked. The joint capsule showed mostly a concave shape. Intra- and interobserver reliabilities were good. We propose B-mode ultrasound age- and sex-related reference values for the elbow joint in a large number of healthy children and adolescents for the first time. By applying these standard values to the ultrasound examination of the elbow joint, it may be possible to achieve greater certainty in the diagnosis of pathological processes.
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Affiliation(s)
- Ralf Trauzeddel
- Department of Pediatric and Adolescent Medicine, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany.
| | - Hartwig Lehman
- Department of Pediatrics, University Medicine Gießen, Feulgenstrasse 10-12, 35392, Giessen, Germany
| | - Ralf Felix Trauzeddel
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charite Platz 1, 10117, Berlin, Germany
| | | | - Katharina Palm-Beden
- Department of Paediatric and Adolescent Rheumatology, North-Western German Centre for Rheumatology, St. Josef-Stift Sendenhorst, Westtor 7, 48324, Sendenhorst, Germany
| | - Gerd Ganser
- Department of Paediatric and Adolescent Rheumatology, North-Western German Centre for Rheumatology, St. Josef-Stift Sendenhorst, Westtor 7, 48324, Sendenhorst, Germany
| | - Rainer Berendes
- St. Marien Children's Hospital, Grillparzerstrasse 9, 84036, Landshut, Germany
| | - Christine Nirschl
- Klinikum Burgenlandkreis GmbH Naumburg, Humboldtstrasse 33, 06618, Naumburg, Germany
| | | | - Manuela Krumrey-Langkammerer
- German Center for Pediatric and Adolescent Rheumatology, Gehfeldstrasse 24, 82467, Garmisch-Partenkirchen, Germany
| | | | - Daniel Windschall
- Department of Pediatrics, Asklepios Hospital Weißenfels, Naumburger Strasse 76, 06667, Weissenfels, Germany
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Foster HE, Vojinovic J, Constantin T, Martini A, Dolezalova P, Uziel Y, Smith E, Lamot L, Wouters C, Avcin T, Wulffraat N. Educational initiatives and training for paediatric rheumatology in Europe. Pediatr Rheumatol Online J 2018; 16:77. [PMID: 30526605 PMCID: PMC6286498 DOI: 10.1186/s12969-018-0289-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/30/2018] [Indexed: 01/08/2023] Open
Abstract
The Paediatric Rheumatology European Society (PReS) has over many years, developed a portfolio of educational activities to address increasing educational needs of workforce and support young clinicians to acquire skills to develop new knowledge and deliver clinical care in the future. These educational activities aim to facilitate growth of paediatric rheumatology and ultimately improve the clinical care for children and families. This article describes the current portfolio of PReS educational activities and their relevance to the international paediatric rheumatology community.
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Affiliation(s)
- Helen E. Foster
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Paediatric Rheumatology, Great North Children’s Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jelena Vojinovic
- Faculty of Medicine, Department Pediatric Rheumatology, University of Nis, Nis, Serbia
| | - Tamas Constantin
- 2nd Department of Paediatrics, Semmelweis University, Budapest, Hungary
| | | | - Pavla Dolezalova
- Paediatric Rheumatology and Autoinflammatory Diseases Centre, Department of Paediatrics and Adolescent Medicine, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Yosef Uziel
- Department of Pediatrics, Meir medical center, Tel Aviv University Sackler School of Medicine, Kfar-Saba, Israel
| | - E.M.D Smith
- Department of Women’s & Children’s Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK
- Department of Paediatric Rheumatology, Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
| | - Lovro Lamot
- Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
- Division of Clinical Immunology and Rheumatology, Department of Pediatrics, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Carine Wouters
- University of Leuven, Department of Microbiology and Immunology, Laboratory Immunobiology, Leuven, Belgium
- University Hospitals Leuven, Pediatric Rheumatology, Leuven, Belgium
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children’s Hospital, University Medical Center Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nico Wulffraat
- Department of Paediatrics, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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Tansley SL, Simou S, Shaddick G, Betteridge ZE, Almeida B, Gunawardena H, Thomson W, Beresford MW, Midgley A, Muntoni F, Wedderburn LR, McHugh NJ. Autoantibodies in juvenile-onset myositis: Their diagnostic value and associated clinical phenotype in a large UK cohort. J Autoimmun 2017; 84:55-64. [PMID: 28663002 PMCID: PMC5656106 DOI: 10.1016/j.jaut.2017.06.007] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [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: 03/07/2017] [Revised: 06/16/2017] [Accepted: 06/18/2017] [Indexed: 01/07/2023]
Abstract
Objectives Juvenile myositis is a rare and heterogeneous disease. Diagnosis is often difficult but early treatment is important in reducing the risk of associated morbidity and poor outcomes. Myositis specific autoantibodies have been described in both juvenile and adult patients with myositis and can be helpful in dividing patients into clinically homogenous groups. We aimed to explore the utility of myositis specific autoantibodies as diagnostic and prognostic biomarkers in patients with juvenile-onset disease. Methods Using radio-labelled immunoprecipitation and previously validated ELISAs we examined the presence of myositis specific autoantibodies in 380 patients with juvenile-onset myositis in addition to, 318 patients with juvenile idiopathic arthritis, 21 patients with juvenile-onset SLE, 27 patients with muscular dystrophies, and 48 healthy children. Results An autoantibody was identified in 60% of juvenile-onset myositis patients. Myositis specific autoantibodies (49% patients) were exclusively found in patients with myositis and with the exception of one case were mutually exclusive and not found in conjunction with another autoantibody. Autoantibody subtypes were associated with age at disease onset, key clinical disease features and treatment received. Conclusions In juvenile patients the identification of a myositis specific autoantibody is highly suggestive of myositis. Autoantibodies can be identified in the majority of affected children and provide useful prognostic information. There is evidence of a differential treatment approach and patients with anti-TIF1γ autoantibodies are significantly more likely to receive aggressive treatment with IV cyclophosphamide and/or biologic drugs, clear trends are also visible in other autoantibody subgroups. Using immunoprecipitation, an autoantibody is identifiable in most children with juvenile-onset myositis. Myositis specific autoantibodies are highly specific and were not identified in control groups. Autoantibodies identify patient subgroups associated with clinically important disease features. Evidence of an existing differential treatment approach between autoantibody subgroups is presented.
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Affiliation(s)
- Sarah L Tansley
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Upper Borough Walls, Bath, BA1 1RL, UK; Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK.
| | - Stefania Simou
- Inflammation and Rheumatology Section, UCL Institute of Child Health and Arthritis Research UK Centre for Adolescent Rheumatology at UCL, UCLH and GOSH, London, UK
| | - Gavin Shaddick
- Department of Mathematics, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Zoe E Betteridge
- Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
| | - Beverley Almeida
- Inflammation and Rheumatology Section, UCL Institute of Child Health and Arthritis Research UK Centre for Adolescent Rheumatology at UCL, UCLH and GOSH, London, UK; Department of Rheumatology, Great Ormond Street Children's Hospital, London, UK
| | - Harsha Gunawardena
- Clinical and Academic Rheumatology, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Wendy Thomson
- Arthritis Research UK Centre Genetics and Genomics, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, UK
| | - Michael W Beresford
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Department of Paediatric Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK; Arthritis Research UK Experimental Arthritis Treatment Centre for Children, Liverpool, UK
| | - Angela Midgley
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK; Arthritis Research UK Experimental Arthritis Treatment Centre for Children, Liverpool, UK
| | - Francesco Muntoni
- Developmental Neuroscience Programme, UCL Great Ormond Street Institute of Child Health, MRC Centre for Neuromuscular Diseases, UCL, London, UK
| | - Lucy R Wedderburn
- Inflammation and Rheumatology Section, UCL Institute of Child Health and Arthritis Research UK Centre for Adolescent Rheumatology at UCL, UCLH and GOSH, London, UK; Department of Rheumatology, Great Ormond Street Children's Hospital, London, UK; Arthritis Research UK Centre for Adolescent Rheumatology at UCL, UCLH and GOSH, London, UK
| | - Neil J McHugh
- Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Upper Borough Walls, Bath, BA1 1RL, UK; Department of Pharmacy and Pharmacology, University of Bath, Claverton Down, Bath, BA2 7AY, UK
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Abstract
Objectives The ideal goal of treatment for juvenile idiopathic arthritis (JIA) is disease remission. However, many sets of remission criteria have been developed and no systematic review of remission in JIA exists. The current systematic review investigated (1) how remission has been defined across JIA clinical cohorts and (2) the frequency of remission overall and within disease categories. Methods Studies using prospective inception cohorts published after 1972 were selected if they estimated remission in cohorts of ≥50 patients. Articles focusing on specific medical interventions, not defining remission clearly or not reporting disease duration at remission assessment were excluded. Studies were selected from Medline, Embase, PubMed and bibliographies of selected articles. Risks of selection, missing outcome data and outcome reporting biases were assessed. Results Within 17 studies reviewed, 88% had majority female participants and patient disease duration ranged from 0.5 to 17 years. Thirteen sets of criteria for clinically inactive disease and remission were identified. Uptake of Wallace’s preliminary criteria was good in studies recruiting or following patients after their publication (78%). Remission frequencies increased with longer disease duration from 7% within 1.5 years to 47% by 10 years following diagnosis. Patients with persistent oligoarticular and rheumatoid-factor positive polyarticular JIA were most and least likely to achieve remission, respectively. Conclusions Achievement of remission increased with longer disease duration, but many patients remain in active disease, even in contemporary cohorts. Multiple sets of outcome criteria limited comparability between studies.
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Affiliation(s)
- Stephanie J W Shoop-Worrall
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Lianne Kearsley-Fleet
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Wendy Thomson
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK; Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Arthritis Research UK Centre for Genetics and Genomics, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK
| | - Suzanne M M Verstappen
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK
| | - Kimme L Hyrich
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, University of Manchester, Manchester, UK; NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust and University of Manchester Partnership, Manchester, UK.
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28
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Howland S, Fisher K. Looking through the patient lens - Improving best practice for young people with juvenile idiopathic arthritis transitioning into adult care. Springerplus 2015; 4:111. [PMID: 25774337 PMCID: PMC4353820 DOI: 10.1186/s40064-015-0888-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/13/2015] [Indexed: 11/10/2022]
Abstract
We describe a qualitative study to establish the emerging needs of young people with juvenile idiopathic arthritis (JIA) as they go through the transition process, identifying which elements are valued and where support gaps exist. Qualitative interviews with healthcare professionals, young people with JIA and their parents explored the lived experience of transition to care in an adult rheumatology clinic. Perspectives of the experience and reflections of the process of transitioning were captured along with the young people's views of optimal support. Service provision in the clinical environment varied. Service design for this particular patient group has an impact on how young people optimise management of, and engagement with, their condition during young adulthood. Two specific themes emerged that had the greatest impact on defining a positive user experience of transitioning care: tailored service provision within the clinical environment and support for those living with JIA beyond the clinic doors (we have termed these the lived experience). Factors of importance to young people with JIA were grouped into key domains, namely: day-to-day life with JIA, emotional and developmental factors and a desire for independence. The young people and healthcare professionals interviewed in this small qualitative study highlighted some common themes considered critical in the development and organisation of an excellent care pathway from paediatric to adult healthcare. Aligning the clinical process with young people's individual needs and lifestyle creates stronger beginnings in adult care.
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Affiliation(s)
- Samantha Howland
- Pfizer Ltd, Walton Oaks, Dorking Road, Tadworth, Surrey KT20 7NS UK
| | - Kay Fisher
- Experience Engineers, Chalfont St Peter, Bucks, UK
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