Pediatric Rheumatology Research Highlights Successful Approaches to Manage Juvenile Rheumatic Diseases

Using data from the Research Registry for Neonatal Lupus, the researchers analyzed questionnaire data and DNA mapping of 346 children exposed to anti-Ro in utero, including 134 with cardiac NL and 74 with cutaneous NL, and 138 of their unaffected siblings. Sixty-three percent of the subjects’ mothers had either Sjögren’s syndrome or systemic lupus erythematosus, said Dr. Garza.

They found that 15 of the cardiac NL and two of the cutaneous NL patients developed autoimmune diseases later, with psoriasis most prevalent. Five out of 138 siblings unaffected by NL developed other autoimmune diseases later, he said. Psoriasis gene regions were significant in cardiac NL patients.

Geographic Disparities

JIA patients exhibit different disease outcomes depending on where they live, possibly due to availability of biologics in wealthier countries, according to a new study of 8,779 patients conducted by Prof. Angelo Ravelli and his research group at Istituto Giannina Gaslini in Genova, Italy.⁶

“We wanted to define and compare epidemiology of different JIA categories in different geographic areas, and to compare treatments used in different pediatric rheumatology centers, including the availability of biologics, and to compare outcomes across the world,” said Alessandro Consolaro, MD, PhD, a lead author of the study.

[In focus groups,] adolescents identified activity & participation, & the psychosocial impact of disease as important domains. Young adults most frequently cited psychosocial impact.

The researchers analyzed questionnaires from JIA patients and parents in the Epidemiology, Treatment and Outcome of Childhood Arthritis (EPOCA) study, including data from 53 countries and 130 pediatric rheumatology centers from the Pediatric Rheumatology International Trials Organization (PRINTO).

Fifty percent of JIA patients in North America received one or more biologics, and patients in Southeast Asia reported the lowest frequency of biologic use, said Dr. Consolaro. Biologics were less frequently used in regions with lower GDPs, he said.

JIA patients in North Africa/Middle East and Eastern Europe reported higher disease activity scores based on cJADAS-10, and patients in Western Europe, North America and Southeast Asia had low scores. The study’s results showed a modest negative correlation between disease outcome and regions’ GDPs, he said.

Susan Bernstein is a freelance medical journalist based in Atlanta.

References

1. Walter M, Kamphuis SSM, van Pelt PA, et al. Evaluation of a clinical transition pathway for adolescents with autoimmune diseases (abstract). Arthritis Rheumatol. 2016;68 (suppl 10).
2. Risum K, Edvardsen E, Selvaag AM, et al. Cardiorespiratory fitness in children with juvenile idiopathic arthritis treated in the biological era is comparable with controls: A cross-sectional study (abstract). Arthritis Rheumatol. 2016;68 (suppl 10).
3. Horonjeff JR, Thornhill S, Horton DB, et al. Reconsidering the juvenile idiopathic arthritis core set: How patients and caregivers define disease activity (abstract). Arthritis Rheumatol. 2016;68 (suppl 10).
4. Giancane G, Swart J, Bovis F. Risk of infections in juvenile idiopathic arthritis patients treated with biologic agents and/or methotrexate: Results from pharmachild registry (abstract). Arthritis Rheumatol. 2016;68 (suppl 10).
5. Garza Romero A, Izmirly PM, Ainsworth HC, et al. Development of autoimmune diseases and genetic predisposition in children with neonatal lupus and their unaffected siblings (abstract). Arthritis Rheumatol. 2016;68 (suppl 10).
6. Consolaro A, Ruperto N, van Dijkhuizen P, et al. Differences in disease phenotype, management and outcomes of children with juvenile idiopathic arthritis throughout the world—Analysis of 8,325 patients enrolled in the EPOCA study (abstract). Arthritis Rheumatol. 2016;68 (suppl 10).