Reema H. Syed

Consensus treatment plans for induction therapy of newly diagnosed proliferative lupus nephritis in juvenile systemic lupus erythematosus

To formulate consensus treatment plans (CTPs) for induction therapy of newly diagnosed proliferative lupus nephritis (LN) in juvenile systemic lupus erythematosus (SLE).

Methylphenidate and Dextroamphetamine-induced Peripheral Vasculopathy

Methylphenidate and dextroamphetamine are central nervous system stimulants used in the treatment of attention deficit hyperactivity disorders in children. These medications have been associated with cerebral arteritis, renal necrotizing vasculitis, and systemic and pulmonary hypertension. We report 4 patients, 2 on methylphenidate and 2 on dextroamphetamine who presented with acral cyanosis, livedo reticularis, or Raynaud phenomenon. Two patients were found to have a positive ANA at low titers, 1 of whom had histopathologic evidence of stratum malgiphian necrosis with perivascular lymphocytic infiltration on skin biopsy. Two had positive antihistone antibodies. One patient improved after withdrawal of dextroamphetamine; others had worsening of their symptoms on higher doses of medications. These cases indicate the potential for development of acral cyanosis, livedo reticularis, or Raynaud symptoms with these medications and their potential contribution to a vasculopathy.

Race, Income, and Disease Outcomes in Juvenile Dermatomyositis

Objective To determine the relationships among race, income, and disease outcomes in children with juvenile dermatomyositis (JDM). Study design Data from 438 subjects with JDM enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Legacy Registry were analyzed. Demographic data included age, sex, race, annual family income, and insurance status. Clinical outcomes included muscle strength, presence of rash, calcinosis, weakness, physical function, and quality of life measures. Disease outcomes were compared based on race and income. Results Minority subjects were significantly more likely to have low annual family income and significantly worse scores on measures of physical function, disease activity, and quality of life measures. Subjects with lower annual family income had worse scores on measures of physical function, disease activity, and quality of life scores, as well as weakness. Black subjects were more likely to have calcinosis. Despite these differences in outcome measures, there were no significant differences among the racial groups in time to diagnosis or duration of disease. Using calcinosis as a marker of disease morbidity, black race, annual family income <

Novel Method to Collect Medication Adverse Events in Juvenile Arthritis: Results From the Childhood Arthritis and Rheumatology Research Alliance Enhanced Drug Safety Surveillance Project

50 000 per year, negative antinuclear antibody, and delay in diagnosis >12 months were associated with calcinosis. Conclusion Minority race and lower family income are associated with worse morbidity and outcomes in subjects with JDM. Calcinosis was more common in black subjects. Further studies are needed to examine these associations in more detail, to support efforts to address health disparities in subjects with JDM and improve disease outcomes.

Rheumatic manifestations of parvovirus B19 in children

Few data are available regarding the rates of serious adverse events (SAEs) and important medical events (IMEs) outside of product‐based registries and clinical trials for juvenile idiopathic arthritis (JIA). The Enhanced Drug Safety Surveillance Project (EDSSP) was developed to pilot a novel system to collect SAEs/IMEs in children with JIA. This analysis reports the results from this 4‐year (2008–2012) EDSSP.

Rheumatic manifestations of Epstein-Barr virus in children

It is well known that parvovirus B19 causes erythema infectiosum, a common febrile exanthema of childhood. Studies have also shown that parvovirus B19 can cause chronic arthropathy in children, and some children may meet classification criteria for juvenile idiopathic arthritis. A childs anti-B19 antibodies may cross-react with other antigens leading to autoantibody formation and immune complex deposition. This process can cause a similar clinical picture to systemic lupus erythematosus, and in some cases has been implicated in initiation of disease. Parvovirus B19 has also been linked to the presence of antiphospholipid antibodies, juvenile dermatomyositis, vasculitides, immune thrombocytopenic purpura, and hemophagocytic lymphohistiocytosis. This review provides an extensive evaluation of the literature on parvovirus B19 and its role in rheumatic diseases in children.

Novel Method to Collect Medication Adverse Events in Juvenile Arthritis: Results From the Childhood Arthritis and Rheumatology Research Alliance Enhanced Drug Safety Surveillance Project: Enhanced Drug Safety Surveillance Project

Epstein-Barr virus (EBV) is known to cause infectious mononucleosis; in addition, it is strongly associated with malignancies. Studies have also demonstrated that EBV infection may trigger the development of systemic lupus erythematosus. EBV infection has been implicated in complicating treatment of juvenile idiopathic arthritis, in addition to triggering cytokine production. Awareness of a past or present EBV infection has been highlighted as an important factor in determining treatment options in several diseases. Repeated associations have been described between EBV infection and various rheumatic diseases and complications of rheumatic disease, including Kawasaki disease, immune thrombocytopenic purpura, and hemophagocytic lymphohistiocytosis. We present a review of recent literature demonstrating the significance of EBV infection in rheumatic diseases, and complications of rheumatic disease, in children.

Novel method to collect medication adverse events in juvenile arthritis

Few data are available regarding the rates of serious adverse events (SAEs) and important medical events (IMEs) outside of product‐based registries and clinical trials for juvenile idiopathic arthritis (JIA). The Enhanced Drug Safety Surveillance Project (EDSSP) was developed to pilot a novel system to collect SAEs/IMEs in children with JIA. This analysis reports the results from this 4‐year (2008–2012) EDSSP.

Presence of anti-cyclic citrullinated peptide antibody isotypes in juvenile idiopathic arthritis synovial fluid indicates autoantibody production at the site of inflammation

Few data are available regarding the rates of serious adverse events (SAEs) and important medical events (IMEs) outside of product‐based registries and clinical trials for juvenile idiopathic arthritis (JIA). The Enhanced Drug Safety Surveillance Project (EDSSP) was developed to pilot a novel system to collect SAEs/IMEs in children with JIA. This analysis reports the results from this 4‐year (2008–2012) EDSSP.

Measurement of autoantibodies in pediatric- and adolescent-onset systemic lupus erythematosus and their significant relationship with disease-associated manifestations

Results Eleven of 47 (23%) JIA SF samples were positive for the different anti-CCP antibody isotypes. IgM anti-CCP antibodies were positive in 9 JIA patients, including 5 oligoarthritis, 3 IgM RF+ and 1 IgM RFpolyarthritis. IgG antiCCP antibodies were positive in 8 JIA patients, including 4 oligoarthritis, 2 IgM RF+, 1 IgM RFpolyarthritis, and 1 enthesitis-related. Two IgM RF+ polyarthritis patients were positive for IgA anti-CCP antibodies, and also positive for all 3 isotypes. Four JIA patients were positive for 2 anti-CCP antibody isotypes, including 1 IgM RFpolyarthritis patient (IgG and IgM) and 3 oligoarthritis patients (2 IgG and IgM, 1 IgA and IgM). Five JIA patients were positive for 1 anti-CCP antibody isotype, including 3 oligoarthritis (2 IgM, 1 IgG), 1 enthesitis-related (IgG), and 1 IgM RF+ polyarthritis patient (IgM). Three JIA patients were positive for the combined IgA/IgG anti-CCP antibody ELISA, including 2 with IgM RF+ polyarthritis and 1 enthesitis-related. Polyarthritis patients demonstrated significantly higher levels of all anti-CCP antibody isotypes compared to the other JIA subtypes (p<0.05). When only evaluating the IgM RF+ polyarthritis patients against the other subtypes, the levels were even more significantly increased (p<0.05). Serum-matched IgG anti-CCP antibody data was available in 27 JIA patients and 5 healthy controls. All 3 IgM RF+ polyarthritis patients were positive for the IgG anti-CCP antibodies in serum and SF. Two JIA patients who were positive for IgG anti-CCP antibodies in SF had a negative result in serum. Date-matched SF and serum IgM and IgA data was available on 12 JIA patients. More JIA patients were positive for IgA anti-CCP antibodies in serum compared to SF, while SF showed increased positivity for IgM anti-CCP antibodies compared to serum.