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Boneparth A, Ilowite NT. Comparison of renal response parameters for juvenile membranous plus proliferative lupus nephritis versus isolated proliferative lupus nephritis: a cross-sectional analysis of the CARRA Registry. Lupus 2014; 23:898-904. [PMID: 24729278 DOI: 10.1177/0961203314531841] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 03/21/2014] [Indexed: 01/15/2023]
Abstract
Lupus nephritis (LN) affects many patients with juvenile systemic lupus erythematosus (SLE) and is a significant cause of disease morbidity. Membranous plus proliferative LN (M + PLN) may represent a more difficult to treat subtype of juvenile LN, compared to isolated proliferative LN (PLN). In this retrospective observational study, we utilized data from the Childhood Arthritis and Rheumatism Research Alliance (CARRA) registry to compare response rates for pediatric M + PLN versus PLN. Response was assessed at the most recent CARRA registry visit gathered ≥6 months after diagnostic kidney biopsy. Estimated glomerular filtration rate (GFR) less than 90 ml/min/1.73 m(2), indicating renal insufficiency, was found in 16.1% of patients with M + PLN and 6.1% of patients with PLN (P = 0.071). We found no significant difference in achievement of response in either hematuria or proteinuria between PLN and M + PLN groups or between subgroups determined by presence of class III vs. class IV proliferative disease. Exposure rates to mycophenolate, cyclophosphamide, and rituximab were similar between groups. Future studies will be necessary to correlate pediatric LN renal histology data with treatment response as well as other disease outcome measures.
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Affiliation(s)
- A Boneparth
- Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, NY, USA
| | - N T Ilowite
- Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, NY, USA
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Wahezi DM, Ilowite NT, Wu XX, Pelkmans L, Laat B, Schanberg LE, Rand JH. Annexin A5 anticoagulant activity in children with systemic lupus erythematosus and the association with antibodies to domain I of β2-glycoprotein I. Lupus 2013; 22:702-11. [PMID: 23690366 DOI: 10.1177/0961203313490241] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Children with systemic lupus erythematosus (SLE) have a high prevalence of antiphospholipid (aPL) antibodies and are at increased risk for aPL-related thrombosis. We investigated the association between annexin A5 anticoagulant activity and antibodies to the domain I portion of β2-glycoprotein I (anti-DI antibodies), and propose a potential mechanism for the pathogenesis of aPL-related thrombosis. Using samples from 183 children with SLE collected during the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) trial, we examined resistance to the anticoagulant effects of annexin A5, using the annexin A5 resistance (A5R) assay, and evaluated for anti-DI IgG antibodies. Children with SLE had higher frequency of anti-D1 antibodies (p = 0.014) and significantly reduced A5R compared to pediatric controls: mean A5R = 172 ± 30% versus 242 ± 32% (p < 0.0001). Children with SLE and positive anti-DI antibodies had significantly lower mean A5R levels compared to those with negative anti-DI antibodies: mean A5R = 155 ± 24% versus 177 ± 30% (p < 0.0001). In multivariate analysis, anti-DI antibodies (p = 0.013) and lupus anticoagulant (LA) (p = 0.036) were both independently associated with reduced A5R. Children with SLE have significantly reduced annexin A5 anticoagulant activity that is associated with the presence of LA and anti-DI antibodies.
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Affiliation(s)
- D M Wahezi
- Department of Pediatrics, Division of Pediatric Rheumatology, Children's Hospital at Montefiore, Bronx, NY 10467, USA
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3
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Schanberg LE, Sandborg C, Barnhart HX, Ardoin SP, Yow E, Evans GW, Mieszkalski KL, Ilowite NT, Eberhard A, Imundo LF, Kimura Y, von Scheven E, Silverman E, Bowyer SL, Punaro M, Singer NG, Sherry DD, McCurdy D, Klein-Gitelman M, Wallace C, Silver R, Wagner-Weiner L, Higgins GC, Brunner HI, Jung L, Soep JB, Reed AM, Provenzale J, Thompson SD. Use of atorvastatin in systemic lupus erythematosus in children and adolescents. Arthritis Rheum 2012; 64:285-96. [PMID: 22031171 PMCID: PMC4074430 DOI: 10.1002/art.30645] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Statins reduce atherosclerosis and cardiovascular morbidity in the general population, but their efficacy and safety in children and adolescents with systemic lupus erythematosus (SLE) are unknown. This study was undertaken to determine the 3-year efficacy and safety of atorvastatin in preventing subclinical atherosclerosis progression in pediatric-onset SLE. METHODS A total of 221 participants with pediatric SLE (ages 10-21 years) from 21 North American sites were enrolled in the Atherosclerosis Prevention in Pediatric Lupus Erythematosus study, a randomized double-blind, placebo-controlled clinical trial, between August 2003 and November 2006 with 36-month followup. Participants were randomized to receive atorvastatin (n=113) or placebo (n=108) at 10 or 20 mg/day depending on weight, in addition to usual care. The primary end point was progression of mean-mean common carotid intima-media thickening (CIMT) measured by ultrasound. Secondary end points included other segment/wall-specific CIMT measures, lipid profile, high-sensitivity C-reactive protein (hsCRP) level, and SLE disease activity and damage outcomes. RESULTS Progression of mean-mean common CIMT did not differ significantly between treatment groups (0.0010 mm/year for atorvastatin versus 0.0024 mm/year for placebo; P=0.24). The atorvastatin group achieved lower hsCRP (P=0.04), total cholesterol (P<0.001), and low-density lipoprotein (P<0.001) levels compared with placebo. In the placebo group, CIMT progressed significantly across all CIMT outcomes (0.0023-0.0144 mm/year; P<0.05). Serious adverse events and critical safety measures did not differ between groups. CONCLUSION Our results indicate that routine statin use over 3 years has no significant effect on subclinical atherosclerosis progression in young SLE patients; however, further analyses may suggest subgroups that would benefit from targeted statin therapy. Atorvastatin was well tolerated without safety concerns.
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Affiliation(s)
- L E Schanberg
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Ardoin SP, Schanberg LE, Sandborg C, Yow E, Barnhart HX, Mieszkalski KL, Ilowite NT, von Scheven E, Eberhard A, Levy DM, Kimura Y, Silverman E, Bowyer SL, Punaro L, Singer NG, Sherry DD, McCurdy D, Klein-Gitelman M, Wallace C, Silver R, Wagner-Weiner L, Higgins GC, Brunner HI, Jung LK, Imundo L, Soep JB, Reed AM. Laboratory markers of cardiovascular risk in pediatric SLE: the APPLE baseline cohort. Lupus 2011; 19:1315-25. [PMID: 20861207 DOI: 10.1177/0961203310373937] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
As part of the Atherosclerosis Prevention in Pediatric Lupus Erythematosus (APPLE) Trial, a prospective multicenter cohort of 221 children and adolescents with systemic lupus erythematosus (SLE) (mean age 15.7 years, 83% female) underwent baseline measurement of markers of cardiovascular risk, including fasting levels of high-density lipoprotein (HDL), low-density lipoprotein (LDL), triglycerides (TG), lipoprotein A (Lpa), homocysteine and high-sensitivity C-reactive protein (hs-CRP). A cross-sectional analysis of the baseline laboratory values and clinical characteristics of this cohort was performed. Univariable relationships between the cardiovascular markers of interest and clinical variables were assessed, followed by multivariable linear regression modeling. Mean levels of LDL, HDL, Lpa, TG, hs-CRP and homocysteine were in the normal or borderline ranges. In multivariable analysis, increased Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), prednisone dose, and hypertension (HTN) were independently associated with higher LDL levels. Higher hs-CRP and creatinine clearance were independently related to lower HDL levels. Higher body mass index (BMI), prednisone dose, and homocysteine levels were independently associated with higher TG levels. Only Hispanic or non-White status predicted higher Lpa levels. Proteinuria, higher TG and lower creatinine clearance were independently associated with higher homocysteine levels, while use of multivitamin with folate predicted lower homocysteine levels. Higher BMI, lower HDL, and longer SLE disease duration, but not SLEDAI, were independently associated with higher hs-CRP levels. The R(2) for these models ranged from 7% to 23%. SLE disease activity as measured by the SLEDAI was associated only with higher LDL levels and not with hs-CRP. Markers of renal injury (HTN, proteinuria, and creatinine clearance) were independently associated with levels of LDL, HDL, and homocysteine, highlighting the importance of renal status in the cardiovascular health of children and adolescents with SLE. Future longitudinal analysis of the APPLE cohort is needed to further examine these relationships.
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Affiliation(s)
- S P Ardoin
- Ohio State University Medical Center, Columbus, OH 43210,USA.
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5
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Giannini EH, Ilowite NT, Lovell DJ, Wallace CA, Rabinovich CE, Reiff A, Higgins G, Gottlieb B, Singer NG, Chon Y, Lin SL, Baumgartner SW. Long-term safety and effectiveness of etanercept in children with selected categories of juvenile idiopathic arthritis. ACTA ACUST UNITED AC 2009; 60:2794-804. [PMID: 19714630 DOI: 10.1002/art.24777] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study was undertaken to evaluate the long-term safety and effectiveness of etanercept alone or in combination with methotrexate (MTX) in children with selected categories of juvenile idiopathic arthritis (JIA). METHODS Patients ages 2-18 years with rheumatoid factor (RF)-positive or RF-negative polyarthritis, systemic JIA, or extended oligoarthritis were eligible for the study. Patients received MTX alone (> or =10 mg/m(2)/week [ approximately 0.3 mg/kg/week], maximum dosage 1 mg/kg/week), etanercept alone (0.8 mg/kg/week, maximum dose 50 mg), or etanercept plus MTX for 3 years in an open-label, nonrandomized study. Safety was assessed by measuring rates of adverse events, and effectiveness was assessed using the physician's global assessment of disease activity and the pediatric total joint assessment. RESULTS A total of 197, 103, and 294 patients were enrolled in the MTX, etanercept, and etanercept plus MTX groups, respectively. Exposure-adjusted rates of adverse events were similar among the 3 treatment groups (18.3, 18.7, and 21.6 per 100 patient-years in the MTX, etanercept, and etanercept plus MTX groups, respectively). Respective rates per 100 patient-years of serious adverse events (4.6, 7.1, and 6.0) and medically important infections (1.3, 1.8, and 2.1) were also similar among the 3 treatment groups. Scores for physician's global assessment and total active joints improved from baseline, and improvement was maintained for the duration of the study. CONCLUSION These data confirm the findings of other long-term studies and suggest that etanercept or etanercept plus MTX has an acceptable safety and effectiveness profile in children with selected categories of JIA. Improvement was maintained for 3 years in those continuing to receive medication.
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Affiliation(s)
- E H Giannini
- Pediatrics and Rheumatology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
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6
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Sood SK, Ilowite NT. Lyme arthritis in children: is chronic arthritis a common complication? J Rheumatol 2000; 27:1836-8. [PMID: 10955321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
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Ilowite NT. Premature atherosclerosis in systemic lupus erythematosus. J Rheumatol Suppl 2000; 58:15-9. [PMID: 10782851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Premature atherosclerosis is a recognized complication of systemic lupus erythematosus (SLE). Since life expectancy in SLE is improving, premature atherosclerosis is emerging as an ever more important clinical issue. Atherosclerosis begins in the pediatric age group, and interventions directed at prevention should begin in childhood as well. Possible etiologies include dyslipoproteinemia (DL) from the underlying chronic inflammatory disease or from corticosteroid therapy, hypercoagulation due to antiphospholipid antibodies or nephrotic syndrome, vasculitis, and hypertension. A relationship between DL and presence of anticardiolipin antibodies (aCL) has been reported. Dietary therapy is helpful, but many patients continue to have significant DL after both dietary modification and fish oil supplementation. Lipid lowering drugs may be indicated in this subgroup. Potential mechanisms of the DL are discussed. Other strategies to prevent atherosclerosis and its complications are reviewed.
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Affiliation(s)
- N T Ilowite
- Children's Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA
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Lovell DJ, Giannini EH, Reiff A, Cawkwell GD, Silverman ED, Nocton JJ, Stein LD, Gedalia A, Ilowite NT, Wallace CA, Whitmore J, Finck BK. Etanercept in children with polyarticular juvenile rheumatoid arthritis. Pediatric Rheumatology Collaborative Study Group. N Engl J Med 2000; 342:763-9. [PMID: 10717011 DOI: 10.1056/nejm200003163421103] [Citation(s) in RCA: 733] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND We evaluated the safety and efficacy of etanercept, a soluble tumor necrosis factor receptor (p75):Fc fusion protein, in children with polyarticular juvenile rheumatoid arthritis who did not tolerate or had an inadequate response to methotrexate. METHODS Patients 4 to 17 years old received 0.4 mg of etanercept per kilogram of body weight subcutaneously twice weekly for up to three months in the initial, open-label part of a multicenter trial. Those who responded to treatment then entered a double-blind study and were randomly assigned to receive either placebo or etanercept for four months or until a flare of the disease occurred. A response was defined as an improvement of 30 percent or more in at least three of six indicators of disease activity, with no more than one indicator worsening by more than 30 percent. RESULTS At the end of the open-label study, 51 of the 69 patients (74 percent) had had responses to etanercept treatment. In the double-blind study, 21 of the 26 patients who received placebo (81 percent) withdrew because of disease flare, as compared with 7 of the 25 patients who received etanercept (28 percent) (P=0.003). The median time to disease flare with placebo was 28 days, as compared with more than 116 days with etanercept (P<0.001). In the double-blind study, there were no significant differences between the two treatment groups in the frequency of adverse events. CONCLUSIONS Treatment with etanercept leads to significant improvement in patients with active polyarticular juvenile rheumatoid arthritis. Etanercept is well tolerated by pediatric patients.
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Affiliation(s)
- D J Lovell
- Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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9
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Abstract
OBJECTIVE To explore the viability of a quantitative family interview to describe family-level coping strategies used to deal with juvenile rheumatoid arthritis (JRA)-related stressors for early and late adolescents. METHOD A structured interview protocol with 30 adolescents with JRA and family members assessed ways JRA disrupts or changes family functioning. Emotional reactions, sequential phases of family response, and treatment adherence were discussed. Interviews were coded for family-level coping. To assess adjustment, family members completed the Youth Self Report and the Family Environment Scale. The pediatric rheumatologist provided medical information. RESULTS The family interview produced both quantitative and qualitative data. Families reported multiple JRA-related stressors (mean 6.6). For many adolescents, treatment adherence was problematic. Families used all 3 types of coping strategies (appraisal-, problem-, and emotion-focused) to varying degrees. Problem-focused approaches were most commonly used and included seeking support (used by 73% of families), self-reliance (70%), and family coordination (70%) for dealing with specific problems, and seeking information about JRA (67%). Emotion-focused approaches, such as impulsive outbursts and diminished awareness of others' feelings, were associated with problematic adjustment. Few differences were found between the families of early and late adolescents. CONCLUSION The quantitative family interview has the potential to be a useful tool in documenting JRA-related stressors, family-level coping processes, and how family-level coping is associated with treatment adherence and psychosocial adjustment.
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Hom C, Ilowite NT. Other rheumatic diseases in adolescence. Dermatomyositis, scleroderma, overlap syndromes, systemic vasculitis, and panniculitis. Adolesc Med 1998; 9:69-83, vi. [PMID: 10961253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
In addition to juvenile rheumatoid arthritis (JRA) and systemic lupus erythematosus (SLE), dermatomyosytis, scleroderma, overlap syndromes, systemic vasculitis, and panniculitis also present in adolescence. The authors discuss the complex epidemiology, diagnosis, clinical features, diagnostic testing, treatment, and prognosis of these diseases.
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Affiliation(s)
- C Hom
- Schneider Children's Hospital, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde, NY 11040, USA
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Abstract
OBJECTIVE Children with juvenile rheumatoid arthritis (JRA) treated with methotrexate (MTX) were examined for their course after the discontinuation of the drug to define the relapse and remission rates and to identify predictors of relapse. METHODOLOGY A retrospective chart review of all patients with JRA was conducted in two pediatric rheumatology centers. A total of 101 patients being treated with MTX were identified. Dose, response to the drug, and length of time until reaching a state of complete control were noted. The outcome of patients with a complete response in whom the drug was discontinued was examined with regards to length of time to relapse or continued remission. RESULTS In 25 patients, MTX was discontinued after reaching complete control of the disease. There were no statistically significant predictors of response to MTX identified. Of 25 whose MTX was discontinued, relapse occurred in 13 (52%) after a mean of 11 months after discontinuation. There was no significant difference among patients who relapsed or those who remained in remission as to sex, subtype of JRA, number of months to complete control, or number of months in complete control until discontinuing MTX. Patients younger than 41/2 years at diagnosis were found to be more likely to relapse than patients diagnosed at a later age. In 10 of the patients who relapsed, complete control was induced within a mean of 7 months after restarting MTX. CONCLUSION The optimal time for discontinuing MTX in children with JRA who have achieved complete control is unknown. Relapse occurred in approximately half of the patients in whom MTX was discontinued. Because response to reinstitution of the drug is good, it is reasonable to discontinue MTX after prolonged complete control. It remains to be seen whether the relapse rate can be improved by waiting for longer periods of time in complete control before its discontinuation.
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Affiliation(s)
- B S Gottlieb
- Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of Medicine, New Hyde Park, New York 11040, USA
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Abstract
Wegener granulomatosis traditionally has been treated with glucocorticoids and cyclophosphamide. Both the disease and its treatments are associated with significant morbidity and mortality rates. There has been an effort to find effective but less toxic alternative treatments. We describe three children with Wegener granulomatosis who responded well to treatment with glucocorticoids and methotrexate, similar to a regimen used in adults.
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Affiliation(s)
- B S Gottlieb
- Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York, USA
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13
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Abstract
Premature atherosclerosis is a recognized complication of systemic lupus erythematosus. Atherosclerosis begins in the pediatric age group, and interventions directed toward prevention should begin in childhood as well. A possible cause of premature atherosclerosis is dyslipoproteinemia from the underlying chronic inflammatory disease or from corticosteroid therapy. A relationship between dyslipoproteinemia and anticardiolipin antibodies has been demonstrated. Dietary therapy is helpful, but many patients continue to have significant dyslipoproteinemia after both dietary modification and fish oil supplementation. Lipid-lowering drugs may be indicated in this subgroup. Potential mechanisms of dyslipoproteinemia are discussed.
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Affiliation(s)
- N T Ilowite
- Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA
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Jain VK, Hilton E, Maytal J, Dorante G, Ilowite NT, Sood SK. Immunoglobulin M immunoblot for diagnosis of Borrelia burgdorferi infection in patients with acute facial palsy. J Clin Microbiol 1996; 34:2033-5. [PMID: 8818908 PMCID: PMC229180 DOI: 10.1128/jcm.34.8.2033-2035.1996] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We used immunoblotting to improve the specificity of the serologic diagnosis of Lyme borreliosis in cases of acute facial palsy. Twelve of 15 patients (80%) with suspected Lyme borreliosis, versus 0 of 10 controls, were positive by immunoglobulin M immunoblotting of acute-phase sera and 3 were negative, including 2 with borderline enzyme immunoassay results. Immunoglobulin M immunoblotting is a useful test to confirm Borrelia burgdorferi infection in patients with acute facial palsy and a positive enzyme immunoassay result.
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Affiliation(s)
- V K Jain
- Division of Infectious Diseases, Schneider Children's Hospital, New Hyde Park, New York 11040, USA
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Levine JJ, Ilowite NT, Pettei MJ, Trachtman H. Increased urinary NO3(-) + NO2- and neopterin excretion in children breast fed by mothers with silicone breast implants: evidence for macrophage activation. J Rheumatol 1996; 23:1083-7. [PMID: 8782144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether children breast fed by mothers with silicone implants (BFSI) have increased urinary excretion of nitric oxide (NO) metabolites and neopterin, whether these are associated with esophageal dysmotility, and whether in vitro incubation of macrophages with silicone increases NO synthesis. METHODS In a case-control study based on laboratory investigation, 38 BFSI children (17 male, 21 female, mean age 7.1 +/- 3.6 years, range 0.5-16.5) were compared with 30 controls (14 male, 16 female, mean age 8.4 +/- 3.5 years, range 2.5-17). Urinary NO was quantitated using the Griess reaction. Urinary neopterin was determined by radioimmunoassay. Murine macrophages were cultured with or without silicone and NO production assayed. RESULTS Urinary NO and neopterin were significantly increased in BFSI children compared with controls. There was a significant inverse relationship between urinary neopterin excretion and the severity of esophageal dysfunction. In vitro nitrite production was nearly 60% higher in macrophages grown on silicone compared to other growth conditions. CONCLUSION BFSI children have evidence of macrophage activation and this is associated with esophageal dysmotility. In vitro data support the proposal that silicone exposure causes macrophage activation.
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Affiliation(s)
- J J Levine
- Division of Gastroenterology and Nutrition, Schneider Children's Hospital. Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA
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16
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Levine JJ, Lin HC, Rowley M, Cook A, Teuber SS, Ilowite NT. Lack of autoantibody expression in children born to mothers with silicone breast implants. Pediatrics 1996; 97:243-5. [PMID: 8584385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE We determined systematically the prevalence of autoantibodies in children born to mothers with silicone breast implants and the relationships with clinical symptoms and methods of exposure. METHODS Autoantibody expression was determined in 80 children born to mothers with silicone implants and in 42 controls. A clinical assessment score was assigned to each patient. Antinuclear antibodies as well as antibodies to mitochondrial, smooth muscle, striational, myocardial, parietal cell, reticulin tissues, or subcellular compartments were measured by indirect fluorescent assay. Antibodies to nRNP (U1-RNP/snRNP); Sm; SS-A; SS-B; Scl-70; thyroid microsome; immunoglobulin (Ig)G, IgM, and IgA antibodies to cardiolipin; and antibodies to native and denatured human types I and II collagen were measured by enzyme-linked immunosorbent assay. Serum complement components C3 and C4 and IgM rheumatoid factor were measured by nephelometry. RESULTS Autoantibody prevalence was not significantly different between children born to mothers with silicone implants and controls. The presence of autoantibodies was not related to the children's clinical symptoms or to the method of exposure. CONCLUSIONS Determination of autoantibody production is of limited clinical utility in the evaluation of children born to mothers with silicone breast implants.
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Affiliation(s)
- J J Levine
- Division of Gastroenterology and Nutrition, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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Ilowite NT, Copperman N, Leicht T, Kwong T, Jacobson MS. Effects of dietary modification and fish oil supplementation on dyslipoproteinemia in pediatric systemic lupus erythematosus. J Rheumatol 1995; 22:1347-51. [PMID: 7562770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To determine if a program of dietary modification and fish oil supplementation is effective in treating the dyslipoproteinemia in pediatric systemic lupus erythematosus (SLE). METHODS Prospective clinical trial where each patient serves as his/her own control. Twenty-four consecutive adolescents fulfilling SLE classification criteria were screened with fasting lipid profiles. Patients were identified as having dyslipoproteinemia of active disease or of corticosteroid therapy. Patients were treated for 6 weeks with dietary modification and if dyslipoproteinemia did not normalize with another 6 weeks of dietary modification and fish oil supplementation. RESULTS Seventeen patients (71%) had dyslipoproteinemia; 10 of active disease, 4 of steroid therapy; 3 with a combined pattern. Eleven patients underwent dietary modification. There was a significant decrease in serum triglyceride concentrations (p < 0.05). Total cholesterol, low density lipoprotein cholesterol, and high density lipoprotein cholesterol did not change significantly. A further significant decline in serum triglycerides was achieved with fish oil supplementation (p < 0.05). Five of the 11 patients who underwent treatment continued to have dyslipoproteinemia. CONCLUSION Dyslipoproteinemia is common in pediatric SLE. Dietary modification and fish oil supplementation appear to be effective in improving serum lipid profiles, and blinded studies are warranted. a significant number of patients may require pharmacologic therapy for persistent dyslipoproteinemia to prevent complications of premature atherosclerosis.
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Affiliation(s)
- N T Ilowite
- Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY, USA
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Abstract
In addition to classic organ system involvement, Lyme disease may be characterized by myositis, liver and spleen involvement, and atypical cutaneous manifestations. Myositis is characteristically localized near an involved joint or localized neuropathy. Nuclear imaging with gallium-67 may be useful for detection. Myositis responds to treatment with intravenous or oral antibiotics. Patients with erythema migrans have been observed to have liver function test abnormalities in the absence of symptomatic hepatitis. Splenomegaly has been noted infrequently in patients with Lyme disease. Chronic cutaneous manifestations of Lyme disease--including erythema migrans, acrodermatitis chronica atrophicans, and lymphadenosis benigna cutis--have been observed more frequently in Europe than in the United States. It appears that they are caused primarily by the Borrelia afzelii genomic group of Borrelia burgdorferi, which has been found exclusively in Europe.
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Affiliation(s)
- N T Ilowite
- Division of Pediatric Rheumatology, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York 11040, USA
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Affiliation(s)
- M J Pettei
- Division of Pediatric Gastroenterology, Schneider Children's Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park 11042, USA
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Sood SK, Zemel LS, Ilowite NT. Interpretation of immunoblot in pediatric Lyme arthritis. J Rheumatol 1995; 22:758-61. [PMID: 7791177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To determine the pattern of bands present on an immunoblot (Western blot) in children with Lyme arthritis. METHODS Sera from 20 children with Lyme arthritis from an endemic area were assayed, and the results compared with those obtained in 162 control sera from the same area. The study was retrospective, serum bank based. RESULTS Eighty-seven percent of control sera revealed no bands on immunoblot, and all had < or = 4 bands. All Lyme arthritis sera revealed > or = 5 bands (mean 8.4, range 5-13 bands). Bands of molecular weight 25, 28, 39, 47, 50, and 93 kDa were seen in patients and not in controls. There was no correlation between duration of arthritis or activity of arthritis at presentation and number of bands present. CONCLUSION Criteria were derived for a positive immunoblot based on the number and molecular weights of bands seen in our laboratory. These are the presence of 5 or more bands, of which at least one is an apparently specific band (25, 28, 39, 47, 50, or 93 kDa). Results of immunoblot are useful to confirm clinically suspected Lyme arthritis.
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Affiliation(s)
- S K Sood
- Pediatric Lyme Disease Center, Schneider Children's Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA
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21
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Kwong T, Leonidas JC, Ilowite NT. Asymptomatic superior vena cava thrombosis and pulmonary embolism in an adolescent with SLE and antiphospholipid antibodies. Clin Exp Rheumatol 1994; 12:215-7. [PMID: 8039293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a 14-year-old boy with systemic lupus erythematosus and anticardiolipin antibodies. He developed asymptomatic superior vena cava thrombosis and silent pulmonary embolism. Computed tomographic scan of his chest and abdomen showed features of long standing obstruction secondary to superior vena cava thrombosis. Asymptomatic thrombosis of the major vessels and silent pulmonary emboli are part of the disease spectrum of pediatric antiphospholipid syndrome.
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Affiliation(s)
- T Kwong
- Division of Pediatric Rheumatology, Schneider Children's Hospital/Long Island Jewish Medical Center, New Hyde Park, NY 11042
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Abstract
OBJECTIVE To determine whether breast-fed children of mothers with silicone implants are at increased risk for the development of sclerodermalike esophageal involvement compared with children not exposed to silicone implants. DESIGN Case-series [corrected]. SETTING Referral-based pediatric gastroenterology clinic. PATIENTS Eleven children (mean age, 6.0 years; range, 1.5 to 13 years; six boys and five girls) referred for abdominal pain who were born to mothers who had silicone breast implants (eight breast-fed children and three bottle-fed) were compared with 17 patients (mean age, 10.7 years; range, 2 to 18 years; 11 boys and six girls) with abdominal pain who were not exposed to silicone implants. METHODS All children underwent esophageal manometry and upper intestinal endoscopy with esophageal biopsy and were tested for antinuclear antibody and autoantibodies to Scl-70, centromere, ribonucleoprotein, Sm, Ro, La, and phospholipid. RESULTS Six of the eight breast-fed children from mothers with silicone implants had significantly abnormal esophageal motility with nearly absent peristalsis in the distal two thirds of the esophagus and decreased lower sphincter pressure. Upper esophageal pressures and motility were normal. Compared with controls, the breast-fed children had significantly decreased lower sphincter pressure and abnormal esophageal wave propagation. These manometric abnormalities were not seen in the three bottle-fed children. There was no difference in the expression of autoantibodies in the breast-fed children compared with the bottle-fed children or controls. CONCLUSIONS A relationship appears to exist between breast-feeding by mothers with silicone implants and abnormal esophageal motility. Studies evaluating larger numbers of children are needed to determine the extent of the risk.
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Affiliation(s)
- J J Levine
- Division of Pediatric Gastroenterology, Schneider Children's Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY 11042
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23
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Schuval SJ, Bonagura VR, Ilowite NT. Rheumatologic manifestations of pediatric human immunodeficiency virus infection. J Rheumatol 1993; 20:1578-82. [PMID: 8164219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Multiple rheumatologic signs and symptoms have been described in adult human immunodeficiency virus (HIV) infection. Our goals were to determine the incidence and characteristics of rheumatologic manifestations in HIV infected children, and to examine their relationship to laboratory evidence of autoimmunity. METHODS Forty HIV infected children were studied by means of a questionnaire, history, examination, and serologic testing including determination of concentrations of immunoglobulin, C3, C4, and of presence of antinuclear antibodies (ANA), rheumatoid factor (RF), and circulating immune complexes (CIC). RESULTS Rheumatologic manifestations included arthralgia (15%), myalgia (8%), erythema multiforme (3%), and parotitis (20%). Hypergammaglobulinemia (98%), hypocomplementemia (25%), RF (10%), ANA (3%), and CIC (82% of patients studied) were also found. Patients with or without rheumatologic manifestations did not differ significantly in any laboratory variable measured. CONCLUSIONS In contrast to HIV infected adults, HIV infected children, do not display serious rheumatologic manifestations. Mild rheumatologic symptoms are common, but there is little evidence that these are immune mediated. Parotid enlargement occurs and must be differentiated from Sjögren's syndrome. Differences between rheumatologic manifestations of HIV infection in children and adults may reflect host factors such as the immaturity of the pediatric immune system, or environmental factors such as modes of acquisition of HIV, duration of HIV infection, or exposure to other sexually transmitted organisms.
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Affiliation(s)
- S J Schuval
- Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11042
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24
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Abstract
Recent developments in the identification of prognostic features, measures of disease activity, and responses to therapy in the childhood rheumatic diseases are summarized. Progress in understanding the immunopathogenesis of neonatal lupus erythematosus phenomenon and Kawasaki disease is reviewed.
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Affiliation(s)
- N T Ilowite
- Division of Pediatric Rheumatology, Schneider Children's Hospital, New Hyde Park, NY 11042
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Abstract
In juvenile rheumatoid arthritis (JRA), it is likely that the release of proteolytic enzymes from activated synovial fluid neutrophils overwhelms the major protease inhibitor, alpha 2-macroglobulin (alpha 2-MG), and leads to cartilage destruction. Due to the unique nature of the alpha 2-MG-protease complex, proteolytic function is maintained until the complex is cleared. In this study, we sought to determine the concentration of alpha 2-MG-protease complexes in synovial fluid of patients with JRA, the proteolytic activity found in their synovial fluid, and whether the alpha 2-MG complexes are associated with increased proteolytic activity. The JRA patients' synovial fluids had complex levels of 217.0 +/- 192.2 nmol/L--significantly elevated compared with plasma values (p < 0.001) and with control synovial fluid (p < 0.05). Elastase activity (almost entirely neutrophil elastase) was detected in all JRA synovial fluid samples (mean 2.9 +/- 2.6 mg/L) and significantly correlated with alpha 2-MG-complex values (r = 0.67, p < 0.01). Synovial fluid tryptic activity was detectable in all JRA patients but did not significantly correlate with alpha 2-MG complexes (r = 0.53, p > 0.05). Seventy-four percent of total elastase activity and 41% of total tryptic activity were contained in the alpha 2-MG-complex fractions. We suggest that the increased concentration of synovial fluid alpha 2-MG complexes with retained elastase activity contributes to continued proteolysis and joint destruction and may affect the subsequent disease course through its role as a modulator of IL-6.
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Affiliation(s)
- J J Levine
- Division of Pediatric Gastroenterology and Nutrition, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York 11042
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26
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Ilowite NT, Wedgwood JF, Ramakrishnan T, Bonagura VR. The rheumatoid factor cross-reactive idiotype in juvenile rheumatoid arthritis: role of the CD5-positive B cell. Clin Immunol Immunopathol 1993; 67:S74-82. [PMID: 7684662 DOI: 10.1006/clin.1993.1086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The major rheumatoid factor cross-reactive idiotype (RCRI), which was defined by prototypic monoclonal IgM rheumatoid factors (RF) from Waldenstrom's macroglobulinemia patient Wa, is present on 60% of all monoclonal IgM RF paraproteins. The RCRI is expressed in high frequency by pokeweed mitogen-derived plasma cells (PWM-PCs) and in high concentration in the sera from adults with rheumatoid arthritis (RA) who express RF in their sera. Unlike adults with RA, most children with juvenile rheumatoid arthritis (JRA) are seronegative for RF as detected by classic IgG binding assays. In the experiments summarized herein, we demonstrated that approximately 2/3 of JRA patients who are seronegative for RF, express the RCRI in high concentration in their sera and in high frequency among their PWM-PCs. Expression of this idiotype could not be attributed to expression of hidden IgM RF, or IgA RF, and may be expressed on a parallel set of immunoglobulin molecules, related to RFs, but lacking the ability to bind to IgG. There is an increased number of circulating CD5+ B cells in patients with JRA but there was no significant relationship between CD5+ B cell numbers and serum RCRI concentration, suggesting that in this disease, RCRI bearing immunoglobulins may also be produced by non-CD5+ B cells or by a small subset of CD5+ B cells.
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Affiliation(s)
- N T Ilowite
- Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York
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Sood SK, Rubin LG, Blader ME, Ilowite NT. Positive serology for Lyme borreliosis in patients with juvenile rheumatoid arthritis in a Lyme borreliosis endemic area: analysis by immunoblot. J Rheumatol Suppl 1993; 20:739-41. [PMID: 8496876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Juvenile rheumatoid arthritis (JRA) and the arthritis of Lyme borreliosis in children can mimic each other. As false positive reactions are frequent in ELISA for Lyme borreliosis, they cannot be used reliably to make the distinction. Ninety-nine children diagnosed as having JRA at a children's hospital in an endemic area were evaluated by ELISA and immunoblot for antibodies to Borrelia burgdorferi. Sera from 9% were positive by ELISA, 5 of which showed bands on immunoblot. None met criteria for positive immunoblot. The antigenic basis of false positive ELISA was most frequently a reactivity to both 21 and 41 kDa. Analysis by immunoblot can help to definitively exclude Lyme borreliosis in children presenting with JRA in an endemic area.
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Affiliation(s)
- S K Sood
- Department of Pediatrics, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY 11042
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28
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Abstract
We describe three children with panniculitis and associated systemic manifestations including fever. Histopathologic features, such as the presence of lobular or septal inflammation, presence of vasculitis, character of the cellular infiltrate, and presence of erythrophagocytosis, were useful in classifying this group of panniculitides. In one patient with subcutaneous polyarteritis nodosa, corticosteroid therapy was effective; in two other patients with histiocytic cytophagic panniculitis, there were poor responses to steroids, intravenously administered immune globulin, dapsone, or antimalarial drugs; cyclosporine was very effective and appeared to be the drug of choice.
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Affiliation(s)
- S J Schuval
- Department of Pediatrics, Schneider Children's Hospital, New Hyde Park, NY 11042
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29
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Walco GA, Ilowite NT. Cognitive-behavioral intervention for juvenile primary fibromyalgia syndrome. J Rheumatol 1992; 19:1617-9. [PMID: 1464878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Seven girls between 8.6 and 17.7 years of age were treated for symptoms of juvenile primary fibromyalgia syndrome (JPFS) using cognitive-behavioral techniques (progressive muscle relaxation, guided imagery) aimed at reducing pain and facilitating sleep, as well as strategies aimed at increasing mastery over the pain and improving mood. Patients satisfying diagnostic criteria for JPFS based on the presence of chronic diffuse musculoskeletal pain lasting at least 3 months (mean = 9.4, SD = 8.28) and a minimum of 5 characteristic soft tissue trigger and/or tender points with absence of synovitis, were referred for intervention. Results indicated that in the majority of patients, such techniques were effective in reducing pain and facilitating improved functioning.
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Affiliation(s)
- G A Walco
- Department of Pediatrics, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY
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30
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Walco GA, Varni JW, Ilowite NT. Cognitive-behavioral pain management in children with juvenile rheumatoid arthritis. Pediatrics 1992; 89:1075-9. [PMID: 1594351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Decreasing chronic joint pain is a major goal in the management of juvenile rheumatoid arthritis. Cognitive-behavioral self-regulatory techniques were taught to children with juvenile rheumatoid arthritis to reduce musculoskeletal pain intensity and to facilitate better adaptive functioning. Subjects were 13 children between the ages of 4.5 and 16.9 years who had pauciarticular or systemic onset juvenile rheumatoid arthritis. Baseline data included an initial comprehensive assessment of pain, disease activity, and level of functional disability, as well as pain intensity ratings gathered over a 4-week period. Subjects were seen for eight individual sessions in which self-regulatory techniques (progressive muscle relaxation, guided imagery, meditative breathing) were taught, and parents were seen for two sessions in which key aspects of behavioral pain management techniques were reviewed. Results indicated that these techniques led to substantial reduction of pain intensity, which generalized to outside the clinic setting. Six- and 12-month follow-up data showed consistent decreases in pain as well as improved adaptive functioning. The data suggest that cognitive-behavioral interventions for pain are an effective adjunct to standard pharmacologic interventions for pain in patients with juvenile rheumatoid arthritis.
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Affiliation(s)
- G A Walco
- Schneider Children's Hospital of Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY
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31
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Ilowite NT, Walco GA, Pochaczevsky R. Assessment of pain in patients with juvenile rheumatoid arthritis: relation between pain intensity and degree of joint inflammation. Ann Rheum Dis 1992; 51:343-6. [PMID: 1575578 PMCID: PMC1004657 DOI: 10.1136/ard.51.3.343] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The relation between pain and joint inflammation in patients with juvenile rheumatoid arthritis has not previously been systematically evaluated. Eighteen patients with juvenile rheumatoid arthritis completed paediatric pain questionnaires and the joints affected were examined by thermography. Although significant correlations were shown between parent and doctor pain intensity ratings and joint temperature, correlations of patient pain intensity ratings and joint temperature were only significant in younger children. The degree of joint inflammation is only one factor of several contributing to the amount of subjective pain experienced by children with juvenile rheumatoid arthritis, indicating the need for a comprehensive assessment of the relatively independent variables of inflammation and pain in children with juvenile rheumatoid arthritis.
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Affiliation(s)
- N T Ilowite
- Division of Pediatric Rheumatology, Schneider Children's Hospital, New Hyde Park, NY 11042
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32
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Ilowite NT, O'Reilly ME, Hatam L, Wedgwood JF, Bonagura VR. Expression of the rheumatoid factor cross-reactive idiotype in JRA: association with disease onset subtype, disease activity and disease severity. Scand J Rheumatol 1992; 21:51-4. [PMID: 1570490 DOI: 10.3109/03009749209095067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We previously reported that approximately one-third of patients with juvenile rheumatoid arthritis (JRA) express high concentrations of antibodies marked by the rheumatoid factor cross reactive idiotype (RCRI) in their sera (6). In order to determine if an expression of RCRI is associated with certain clinical features of the disease, we prospectively studied 49 patients with JRA over a six month period, and determined serum RCRI concentrations by inhibition ELISA. RCRI concentrations correlated significantly with the duration of morning stiffness (r = .3866, p less than .01), and the functional class (p less than .001), but not with the number of active joints. Expression of RCRI was higher in patients with systemic onset disease (p less than .03), compared to patients with pauciarticular or polyarticular disease. In patients studied on more than one occasion, the RCRI expression was relatively constant despite changes in disease activity. A subset of JRA patients with systemic onset disease, higher serum concentrations of the RCRI.
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Affiliation(s)
- N T Ilowite
- Division of Pediatric Rheumatology, Schneider Children's Hospital, New Hyde Park, NY 11042
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33
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Abstract
The major rheumatoid factor cross-reactive idiotype, which was defined by prototypic monoclonal IgM rheumatoid factors from Waldenstrom's macroglobulinaemia patient Wa, is present on 60% of all monoclonal IgM RF paraproteins. One-third of patients with juvenile rheumatoid arthritis (JRA), who are seronegative for classic IgM rheumatoid factor (RF), express the Wa idiotype in high titre in their sera. To determine if the Wa idiotype is present on hidden rheumatoid factors in JRA patient sera, we studied hidden RF expression by both ELISA and haemolytic assay techniques. The majority of JRA sera with increased concentrations of the Wa idiotype did not have increased RF activity nor hidden RF activity. In some JRA patients, the Wa idiotype may be expressed on a parallel set of immunoglobulin molecules, related to RFs, but lacking the ability to bind to IgG.
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Affiliation(s)
- N T Ilowite
- Department of Pediatrics, Schneider Childrens Hospital, New Hyde Park, NY 11042
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34
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Valacer DJ, O'Reilly ME, Ilowite NT, Bonagura VR. Identification of anti-idiotypic antibodies in the sera of ryegrass-allergic and nonallergic individuals. J Allergy Clin Immunol 1991; 88:349-55. [PMID: 1890262 DOI: 10.1016/0091-6749(91)90096-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Anti-idiotypic (Id) antibodies (Abs) are generated in the humoral response to antigen (Ag). Some of these anti-Id Abs are capable of binding to the combining site or paratope of Abs that bind Ag. These Ab2 can competitively inhibit the binding of Ab1 to Ag may trigger an Ab1 response similar to the response induced by Ag. To determine if specific Ab2 that inhibit the binding of IgE Abs to ryegrass (RG)-pollen allergens are present in the sera of RG-allergic (RGA) individuals before the initiation of allergen-specific hyposensitization with RG-pollen extract, we studied sera from five RGA and four nonallergic (NA) subjects in an IgE anti-RG RAST-inhibition assay. Ab2-enriched serum fractions were prepared from these study subjects by exhaustive mixed grass-pollen affinity chromatography to remove IgE and IgG anti-RG Ab1 from whole serum aliquots containing Ab1. Unabsorbed, twice-concentrated sera were diluted to one-time concentrated sera with equal volumes of either Ab2-enriched sera without Ab1 or borate-buffered saline absorbed by mixed grass-pollen affinity chromatography. IgE anti-RG Ab1 was determined by a standard RG RAST assay. We have detected Ab2 in the sera of the RGA patients, which inhibit the binding of autologous and allogeneic IgE anti-RG to RG Ags in solid phase. Parallel RG RAST assays with sera from NA subjects demonstrated no significant inhibition. Ab2-enriched sera from some grass-allergic and some NA subjects inhibited IgE anti-RG binding found in some RGA patients' sera. We conclude that anti-Id Abs, Ab2, specific for IgE anti-RG, Ab1, are present in some RGA patients and NA individuals.
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Affiliation(s)
- D J Valacer
- Division of Pediatric Allergy and Immunology, Schneider Children's Hospital, Long Island Jewish Medical Center, Hyde Park, NY 11042
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35
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Bonagura VR, Ilowite NT, Hatam L, Valacer DJ, Wedgwood JF. Expression of the major rheumatoid factor cross-reactive idiotype in pediatric patients with systemic lupus erythematosus. Clin Immunol Immunopathol 1991; 60:232-43. [PMID: 2070569 DOI: 10.1016/0090-1229(91)90066-j] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Rheumatoid factor cross-reactive idiotype (RF-CRI) is expressed in high concentrations in the sera of some patients with rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA). To determine if RF-CRI is specifically expressed in rheumatic disease or if it is secondary to polyclonal B-cell activation, we examined sera of 23 children with SLE, 16 adolescents with infectious mononucleosis (IM), and age-matched pediatric controls for RF-CRI expression. Concentrations of RF-CRI in serum, determined by an inhibition ELISA, were 24 +/- 17 micrograms/ml (mean +/- SD) in 25 normal children, 31 +/- 17 in 16 young adults with IM, and were significantly increased, 70 +/- 80 micrograms/ml, in the 23 children with SLE (p less than 0.036). Eleven of 23 SLE patients had serum RF-CRI greater than the mean +/- 2 SD for normal children. Ten of 23 SLE sera contained IgM rheumatoid factor (RF) activity. One patient with IM had a borderline elevated RF-CRI level, and 5 IM patients had RF in their sera. The serum IgM concentrations in sera were: SLE (192 +/- 93 mg/dl) and IM (234 +/- 77 mg/dl) sera. These levels were significantly elevated compared to controls (132 +/- 44 mg/dl), p less than 0.031 for SLE and p less than 0.001 for IM, suggesting that polyclonal activation of B cells was present in SLE and IM patient groups. Increased expression of RF-CRI in the SLE patients correlated directly with high titer anti-DNA antibody values (r = 0.3965, p less than 0.05) and RF activity when human IgG (r = 0.5026, p less than 0.05) was used as the RF binding substrate and inversely with serum C3 levels (r = 0.3925, p less than 0.05). RF-CRI expression did not correlate with RF that bound rabbit (r = 0.3123, p greater than 0.05). Increased serum RF-CRI expression is not a result of polyclonal B-cell activation. RF-CRI may be selectively up-regulated in patients with SLE.
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Affiliation(s)
- V R Bonagura
- Division of Allergy/Immunology, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York 11042
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36
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Ramakrishnan TP, Ilowite NT, Wedgwood JF, Hatam L, Valacer DJ, Bonagura VR. The major rheumatoid factor crossreactive idiotype and IgA rheumatoid factor in juvenile rheumatoid arthritis. J Rheumatol 1991; 18:1068-72. [PMID: 1920311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
One third of patients with juvenile rheumatoid arthritis (JRA) are seronegative for classic or hidden IgM rheumatoid factor (RF) yet express the major RF crossreactive idiotype (RCRI). We studied 60 children with JRA and 57 pediatric controls for IgA RF and RCRI expression to determine whether RCRI is associated with IgA RF in JRA. Twenty-one patients had IgA RF using rabbit or human IgG as substrate. Twenty-seven patients with JRA expressed high concentrations of RCRI in their sera. Only 9 of these had IgA RF. Eleven of the RCRI+ sera contained neither IgA RF nor classic or hidden IgM RF, and IgA RF was found in patients with all JRA onset subtypes. In JRA, RCRI may be expressed on either IgG RF or on parallel set antibodies without RF activity.
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Affiliation(s)
- T P Ramakrishnan
- Department of Pediatrics, Schneider Children's Hospital, New Hyde Park, NY 11042
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37
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Posner MA, Gloster ES, Bonagura VR, Valacer DJ, Ilowite NT. Burkitt's lymphoma in a patient with systemic lupus erythematosus. J Rheumatol 1990; 17:380-2. [PMID: 2332862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Patients with systemic lupus erythematosus (SLE) appear to be at increased risk for development of neoplastic disease. We describe the case of a male teenager with SLE and Burkitt's lymphoma. His presentation was similar to that of an exacerbation of his underlying SLE. We believe this to be the first case of Burkitt's lymphoma in a patient with SLE. The association of SLE and malignancy, with emphasis on lymphoproliferative states, is discussed.
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Affiliation(s)
- M A Posner
- Department of Pediatrics, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY 11042
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38
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Abstract
Dyslipoproteinemia, a feature of systemic lupus erythematosus may contribute to premature atherosclerosis. In order to develop an experimental model for this dyslipoproteinemia we measured plasma concentrations of lipoproteins in juvenile NZB/W (lupus) and NZB/B (control) mice. Additionally to evaluate the effects of a diet rich in n - 3 fatty acids we measured lipoprotein concentrations in mice on normal or menhaden oil-enriched diets. The lupus mice had elevated triglycerides compared to the controls, similar to that seen in human SLE patients (161 +/- 31 vs 113 +/- 13 mg/dl, P less than 0.003). In contrast, the menhaden oil diet fed NZB/W mice had triglycerides similar to the NZB/B control fed group. In the NZB/W murine SLE model, dyslipoproteinemia is an early sign of disease as has been shown in man, therefore this model will be useful in elucidating the mechanism of dyslipoproteinemia in SLE.
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Affiliation(s)
- M S Jacobson
- Department of Pediatrics, State University of New York Stony Brook
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39
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Israel DM, Olson AD, Ilowite NT, Davidson M. Arthritis as the initial manifestation of inflammatory bowel disease in early infancy. J Pediatr Gastroenterol Nutr 1989; 9:123-5. [PMID: 2778561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
We report a 10-month-old infant who had arthritis as the initial clinical manifestation of ulcerative colitis. Arthritis is considered to be the most common extraintestinal manifestation of IBD in adults and children. This case emphasizes that arthritis may be the earliest manifestation of IBD even in the very young infant.
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Affiliation(s)
- D M Israel
- Division of Pediatric Gastroenterology and Nutrition, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, New York 11042
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40
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Bonagura VR, Cunningham-Rundles S, Edwards BL, Ilowite NT, Wedgwood JF, Valacer DJ. Common variable hypogammaglobulinemia, recurrent Pneumocystis carinii pneumonia on intravenous gamma-globulin therapy, and natural killer deficiency. Clin Immunol Immunopathol 1989; 51:216-31. [PMID: 2784754 DOI: 10.1016/0090-1229(89)90021-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
A toddler with common variable hypoimmunoglobulinemia (CVH), inflammatory bowel disease, and recurrent Pneumocystis carinii pneumonia (PCP) on intravenous gammaglobulin (IVIG) replacement was evaluated for a combined cellular immunodeficiency. He had a normal number of circulating T-cells, natural killer (NK) cells, T-cell subset percentages, and his peripheral blood mononuclear (PBM)-derived B-cell number was low. PBM mitogen blastogenesis and mixed lymphocyte reaction (MLR) were normal. MLR activated T-cells expressed class I and II MHC antigens, interleukin 2 (IL-2), and B-cell growth factor (IL-5)-related receptors. The patient's T-cells induced control B-cell maturation with pokeweed mitogen (PWM-PC), and did not suppress PWM-PC production by allogeneic PBM. Bone marrow (BM) CD19+ B-cell number varied between 10 and 44% of all PBM, and the BM B-cell-enriched fraction failed to differentiate to PWM-PC with autologous or allogeneic T-cell help. The NK activity assayed using K562 target cells was deficient, 9.2 x 7.7% (6.9-9.2%) pt, control 35.9 x 35.8% (16.3-67.2% +/- 12.8). In the presence of interferon-alpha, 800 U/ml, the patient's NK activity increased to 17.2 x 14.9% (12.6-17.2%), control 35.9 x 51.0% (36.5-72.3% +/- 12.0). The patient's cell-mediated lympholysis of HLA nonidentical, allogeneic stimulators was normal. Maintaining trough serum IgG levels above 500 mg/dl was required to suppress recurrent PCP. This functional NK deficiency may be relevant to the development of recurrent PCP in IVIG-treated CVH patients.
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Affiliation(s)
- V R Bonagura
- Department of Pediatrics, Schneider Children's Hospital, New Hyde Park, New York 11042
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Affiliation(s)
- N T Ilowite
- Division of Allergy/Immunology, Schneider Children's Hospital, New Hyde Park, NY 11042
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Ramakrishnan T, Gloster E, Bonagura VR, Valacer DJ, Ilowite NT. Eosinophilic lymphadenitis in Lyme disease. Pediatr Infect Dis J 1989; 8:180-1. [PMID: 2710589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- T Ramakrishnan
- Division of Allergy/Immunology, Rheumatology, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY 11042
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Ilowite NT, Wedgwood JF, Bonagura VR. Expression of the major rheumatoid factor cross-reactive idiotype in juvenile rheumatoid arthritis. Arthritis Rheum 1989; 32:265-70. [PMID: 2930601 DOI: 10.1002/anr.1780320306] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The major rheumatoid factor cross-reactive idiotype (RF-CRI), defined by prototypic monoclonal IgM rheumatoid factors, is expressed in high frequency by pokeweed mitogen-derived plasma cells from patients with rheumatoid arthritis who express RF in their sera. Unlike adults with rheumatoid arthritis, most patients with juvenile rheumatoid arthritis are seronegative for RF, as detected by classic IgG binding assays. We report that approximately 50% of seronegative patients with juvenile rheumatoid arthritis express the RF-CRI in high frequency among their pokeweed mitogen-derived plasma cells, and that approximately 33% of patients express the RF-CRI in high titer in their sera. The possible mechanisms for expression of an idiotypic marker of RF without expression of IgG binding activity by classic assays are discussed.
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Affiliation(s)
- N T Ilowite
- Division of Allergy/Immunology, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park 11042
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Edwards BL, Bonagura VR, Valacer DJ, Ilowite NT. Mucha-Habermann's disease and arthritis: possible association with reactivated Epstein-Barr virus infection. J Rheumatol 1989; 16:387-9. [PMID: 2542544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
We present a 12-year-old girl with skin lesions, arthritis and clinical response to tetracycline consistent with Mucha-Habermann's disease. She also showed serological evidence of reactivated Epstein-Barr virus (EBV) infection. We believe this represents the first such association of Mucha-Habermann's disease with EBV infection.
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Affiliation(s)
- B L Edwards
- Department of Pediatrics, Schneider Children's Hospital of Long Island Jewish Medical Center, Hyde Park, NY 11042
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Abstract
The major rheumatoid factor cross-reactive idiotype (RCRI), a tertiary structure formed by both light and heavy chains, is found on 60% of all monoclonal IgM kappa RFs. To determine if the RCRI is expressed in patients with rheumatic disease, we used polyclonal rabbit anti-idiotypic antibodies to detect RCRI in sera and in pokeweed mitogen cultures of blood mononuclear cells (PBM) from patients with rheumatoid arthritis (RA) and juvenile rheumatoid arthritis (JRA). We detected increased expression of RCRI+, plasma cells in PWM cultures, and in sera from these patients. We have determined that some 7S IgM molecules from RF+RA patients are RCRI+, and can bind IgG in a sensitive RF ELISA. We have also observed that the CD5+ B cell subset, which is responsible for autoantibody production, generates RCRI+ antibodies. We review these data and discuss the relationship of the idiotypic network of interacting antibodies with rheumatic disease.
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Affiliation(s)
- V R Bonagura
- Division of Allergy/Immunology, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, N.Y., USA
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Ilowite NT, Wedgwood JF, Valacer D, Hatam L, Ramakrishnan T, Bonagura VR. Detection of the major rheumatoid factor cross-reactive idiotype precedes human IgG binding activity in a patient with polyarticular juvenile rheumatoid arthritis. J Rheumatol Suppl 1988; 15:1789-92. [PMID: 3230564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
A patient with polyarthritis and subcutaneous nodules was studied for expression of rheumatoid factors (RF) by numerous techniques for 5 months after presentation. Assays for RF binding human or rabbit IgG in whole sera, assays for hidden RF binding human or rabbit IgG, and assays for expression of the major RF cross-reactive idiotype (RCRI) in whole sera or by pokeweed mitogen induced plasma cells were performed (PWM-PC). In this patient, increased expression of RCRI in sera and among PWM-PC preceded detectable RF binding human IgG, and paralleled hidden RF and RF binding rabbit IgG expression.
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Affiliation(s)
- N T Ilowite
- Department of Pediatrics, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY 11042
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Abstract
Patients with systemic lupus erythematosus are at increased risk for premature atherosclerosis. We examined one possible etiologic factor, dyslipoproteinemia, both before and after corticosteroid therapy. We identified 2 distinct patterns of dyslipoproteinemia. One is attributable to active disease; the other is attributable, in part, to corticosteroid therapy. The dyslipoproteinemia of active disease consists of depressed high density lipoprotein cholesterol and apoprotein A-I with elevated very low density lipoprotein cholesterol and triglyceride, while the dyslipoproteinemia after corticosteroid therapy consists of increased total cholesterol, very low density lipoprotein cholesterol, and triglyceride. The possible pathophysiologic mechanisms responsible for these patterns, as well as the possible roles in premature atherosclerosis seen in systemic lupus erythematosus patients, are discussed.
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Lightman HI, Valderrama E, Ilowite NT. Cutaneous polyarteritis nodosa and thromboses of the superior and inferior venae cavae. J Rheumatol Suppl 1988; 15:113-6. [PMID: 2895184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The case of an adolescent female with cutaneous polyarteritis nodosa and thromboses of the superior and inferior venae cavae is presented. Although thromboses of major vessels have been well described in systemic lupus erythematosus and Behçet's disease, this is only the second case of thromboses of major vessels in association with cutaneous polyarteritis nodosa. Possible pathophysiologic mechanisms are discussed.
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Affiliation(s)
- H I Lightman
- Division of Pediatric Allergy/Immunology and Rheumatology, Schneider Children's Hospital of Long Island Jewish Medical Center, New Hyde Park, NY 11042
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Ilowite NT, Wedgwood RJ, Rose LM, Clark EA, Lindgren CG, Ochs HD. Impaired in vivo and in vitro antibody responses to bacteriophage phi X 174 in juvenile rheumatoid arthritis. J Rheumatol 1987; 14:957-63. [PMID: 2963130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Immunologic abnormalities described in juvenile rheumatoid arthritis (JRA) have been largely confined to mitogen or antigen driven proliferation assays. We studied antigen specific antibody production using the neoantigen bacteriophage phi X 174 in vivo and in vitro; defective responses were found in all 8 patients with JRA studied. These could not be attributed to circulating anti-T cell antibodies, but may relate to lymphocyte subset abnormalities found by 2 color analyses. These immunologic aberrations may play a direct role in the pathogenesis of JRA or, alternatively, may be a secondary event.
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Affiliation(s)
- N T Ilowite
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
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Affiliation(s)
- H I Lightman
- Department of Pediatrics, State University of New York, Health Sciences Center at Stony Brook
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