scholarly journals American College of Rheumatology Pediatric Core Set for Juvenile Arthritis

2020 ◽  
Author(s):  
Keyword(s):  
Juvenile Arthritis ◽  
American College Of Rheumatology ◽  
Core Set ◽  
Rheumatology Pediatric

scholarly journals P75 Relation between polymorphism of folic acid cycle genes and effectiveness of methotrexate in children with juvenile idiopathic arthritis

2019 ◽  
Vol 104 (6) ◽  
pp. e48.1-e48
Author(s):  
N Panko
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Folic Acid ◽  
Acid Cycle ◽  
American College Of Rheumatology ◽  
Group I ◽  
Polymerase Chain ◽  
Folate Cycle ◽  
Rheumatology Pediatric ◽  
Homocysteine Methyltransferase

BackgroundMethotrexate (MTX) is the basic treatment of patient with Juvenile Idiopathic Arthritis (JIA), but effectiveness of this therapy is different. We aimed to study effectiveness of MTX in children with JIA with different genotypes of folic acid cycle genes.MethodsThe study included 8 patients with JIA. For determination of MTX effectiveness the American College of Rheumatology pediatric criteria (ACR-pedi) was used. Patients were divided into 2 groups according the effectiveness of MTX treatment. Group I included 4 patients, who were non-responders because ACR-pedi was less than 10%. Second group contained 4 patients, who had ACR-pedi more than 10%. The megerment of genotypes of genes of folate cycle, such as 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR), 5-methyltetrahydrofolate-homocysteine methyltransferase reductase (MTRR), 5,10methylenetetrahydrofolate reductase C677T and A1298C variants (MTHFR-677 and MTHFR129) by polymerase chain reaction (PCR) was performed for all patients.ResultsIn II group effectiveness of therapy according ACR-pedi was from 30% to 70% in 75% of children and more then 70% - in 25% of patients. In general, MTR gene indicated AA-genotype in 50% of patients, AG and GG-genotypes - in 25%; MTRR gene was performed with AA-genotype in 25%, AC-genotype in 12.5% and CC-genotype in 62.5%. MTHFR1298 gene was presented in 50% of patients with AA-alleles, in 25% - with AC and CC-genotypes. 50% of children had CC-genotype of MTHFR677 gene and other 50% - AC-genotype of MTHFR677 gene. CC-genotype of MTHFR1298 gene more frequently was determined in II group (p< 0.01). In group of non-responders AA-genotype of MTR gene was found more frequent in comparison with patients from group II (p< 0.01).ConclusionResponse to standard therapy in patients with JIA depends on time of prescription of MTX and genotype of MTHFR1298 and MTR genes.Disclosure(s)Nothing to disclose

ABCB1andABCC3Gene Polymorphisms Are Associated with First-year Response to Methotrexate in Juvenile Idiopathic Arthritis

2012 ◽  
Vol 39 (10) ◽  
pp. 2032-2040 ◽  
Author(s):  
MAURITS C.F.J. de ROTTE ◽  
MAJA BULATOVIC ◽  
MARLOES W. HEIJSTEK ◽  
GERRIT JANSEN ◽  
SANDRA G. HEIL ◽  
...  
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Gene Polymorphism ◽  
Treatment Strategies ◽  
First Year ◽  
Nucleotide Polymorphisms ◽  
Genetic Determinants ◽  
Single Nucleotide ◽  
American College Of Rheumatology ◽  
Individualize Treatment ◽  
Rheumatology Pediatric

Objective.Although methotrexate (MTX) is the most widely prescribed drug in juvenile idiopathic arthritis (JIA), 30% of patients fail to respond to it. To individualize treatment strategies, the genetic determinants of response to MTX should be identified.Methods.A cohort of 287 patients with JIA treated with MTX was studied longitudinally over the first year of treatment. MTX response was defined as the American College of Rheumatology pediatric 70 criteria (ACRped70). We genotyped 21 single-nucleotide polymorphisms in 13 genes related to MTX polyglutamylation and to cellular MTX uptake and efflux. Potential associations between ACRped70 and genotypes were analyzed in a multivariate model and corrected for these 3 covariates: disease duration prior to MTX treatment, physician’s global assessment of disease activity at baseline, and MTX dose at all study visits.Results.MTX response was more often achieved by patients variant for the adenosine triphosphate-binding cassette transporter B1 (ABCB1) gene polymorphism rs1045642 (OR 3.80, 95% CI 1.70−8.47, p = 0.001) and patients variant for theABCC3gene polymorphism rs4793665 (OR 3.10, 95% CI 1.49−6.41, p = 0.002) than by patients with other genotypes. Patients variant for the solute carrier 19A1 (SLC19A1) gene polymorphism rs1051266 were less likely to respond to MTX (OR 0.25, 95% CI 0.09−0.72, p = 0.011).Conclusion.ABCB1rs1045642,ABCC3rs4793665, andSLC19A1rs1051266 polymorphisms were associated with response to MTX in 287 patients with JIA studied longitudinally. Upon validation of our results in other JIA cohorts, these genetic determinants may help to individualize treatment strategies by predicting clinical response to MTX.

Clinical Activity After 12 Weeks of Treatment with Nonbiologics in Early Rheumatoid Arthritis May Predict Articular Destruction 2 Years Later

2010 ◽  
Vol 37 (4) ◽  
pp. 723-729 ◽  
Author(s):  
YOICHI ICHIKAWA ◽  
TERUNOBU SAITO ◽  
HISASI YAMANAKA ◽  
MASASHI AKIZUKI ◽  
HIROBUMI KONDO ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Early Rheumatoid Arthritis ◽  
Response To Treatment ◽  
Clinical Activity ◽  
Double Blind ◽  
American College Of Rheumatology ◽  
Core Set ◽  
Slow Progression ◽  
Biologic Dmard

Objective.To investigate earlier prediction of future articular destruction in patients with early rheumatoid arthritis (RA).Methods.We randomly allocated patients with RA with disease duration < 2 years to different nonbiologic disease modifying antirheumatic drug (DMARD) therapies in a double-blind trial. Progression of articular destruction over the 96-week treatment period was assessed using the modified Sharp method.Results.Progression of articular destruction correlated more strongly with the American College of Rheumatology (ACR) core set measures after 12 weeks of treatment than with pretreatment values. Multiple regression analysis of data after 12 weeks yielded a correlation coefficient of 0.711. The sensitivity and specificity to predict articular destruction over the 75th percentile of the cohort were 78.6% and 84.6%, respectively. Patients who showed articular destruction over the 75th percentile of the cohort had low response to treatment at 12 weeks, and continued to have high clinical disease activity thereafter. Contrasting data were found in patients with slow progression of articular destruction.Conclusion.In patients with early RA, ACR core set measures after 12 weeks of nonbiologic DMARD treatment may predict articular destruction 2 years later. Low response to treatment at 12 weeks and continuing high disease activity thereafter were found in patients with rapid radiological progression. These data can be used to determine the appropriateness of treatment at 12 weeks and aid the decision to introduce biologic DMARD.

New composite endpoint in early diffuse cutaneous systemic sclerosis: revisiting the provisional American College of Rheumatology Composite Response Index in Systemic Sclerosis

2020 ◽  
pp. annrheumdis-2020-219100
Author(s):  
Dinesh Khanna ◽  
Suiyuan Huang ◽  
Celia J F Lin ◽  
Cathie Spino
Keyword(s):  
Systemic Sclerosis ◽  
Health Assessment ◽  
Composite Endpoint ◽  
Response Index ◽  
American College Of Rheumatology ◽  
Core Set ◽  
Weighted Score ◽  
Modified Rodnan Skin Score ◽  
Diffuse Cutaneous Systemic Sclerosis ◽  
Composite Response

ObjectivesAmerican College of Rheumatology Composite Response Index in Systemic Sclerosis (ACR-CRISS) is a composite endpoint to assess the likelihood of improvement in diffuse systemic sclerosis. ACR-CRISS is a weighted score and includes five core set measures: modified Rodnan skin score, FVC% predicted, health assessment questionnaire–disability index, and patient and clinician global assessments.MethodsWe analysed core set measures from 354 participants who participated in three placebo-controlled trials. We generated 10 development datasets, randomly selected from 2/3 of the participants, stratified by study and treatment group. The remaining participants (1/3 of the participants) formed the validation sets. Risk differences (RDs) between active and placebo treatments were calculated by averaging over the replicate datasets; bootstrap 95% CIs for the RDs to estimate the magnitude of treatment effects.ResultsIn the development sets (n=237), the proportion of participants in the active group had statistically higher improvement in >1 of 5 core set measures versus the placebo group. For example, the proportion who improved by ≥20% in ≥3 core set measures was 49.4% in the active versus338.9% in the placebo; RD: 10.5%, 95% CI4.9 % to 16.1%. In the validation sets (n=117), the proportion who improved by ≥20% in ≥3 core set measures was 50.3% in the active versus35.63% in the placebo (RD:114.8%, 95% CI 3.1% to225.7%). Similar trends were seen with larger percentage cut-offs.ConclusionRevised CRISS, as assessed by the proportion of participants who improved by a certain percentage in ≥3 of 5 core set measures, is a potential new composite outcome measure.

scholarly journals Efficacy of Subcutaneous Methotrexate in JIA Patients Who have Failed to Improve with Oral Methotrexate

2012 ◽  
Vol 35 (1) ◽  
pp. 16-19
Author(s):  
Manik Kumar Talukder ◽  
Suraiya Begum ◽  
Md Imnul Islam ◽  
Mahmuda Hossain ◽  
Eva Rani Nandi ◽  
...  
Keyword(s):  
Subcutaneous Route ◽  
Interventional Study ◽  
Oral Methotrexate ◽  
American College Of Rheumatology ◽  
Core Set ◽  
Active Arthritis ◽  
Methotrexate Dose ◽  
Medical University ◽  
Study Setting

Objective: To determine the efficacy of subcutaneous methotrexate in patients with juvenile idiopathic arthritis (JIA) who failed to improve with oral methotrexate according to American College of Rheumatology 30 (ACR 30) improvement criteria. Design: Interventional Study. Setting: Rheumatology follow up clinic, Department of paediatrics, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, during the period from July 2006 to December 2008 . Methods: Twenty five patients who failed to improve with oral methotrexate were switched to subcutaneous methotrexate. Dose of methotrexate were same in both oral and subcutaneous route, at a dose of 10 mg/m2/week as a single dose. Results: According to ACR 30 criteria 76% patients improved after switching over to subcutaneous route. Among the core set variables active arthritis had the highest percentage of improvement and laboratory criteria (ESR) showed lowest improvement. Conclusion: From this study it may be concluded that subcutaneous methotrexate could be effective in patients with JIA who failed to improve with oral methotrexate. DOI: http://dx.doi.org/10.3329/bjch.v35i1.10368 BJCH 2011; 35(1): 16-19

scholarly journals Clinical Juvenile Arthritis Disease Activity Score proves to be a useful tool in treat-to-target therapy in juvenile idiopathic arthritis

2017 ◽  
Vol 77 (3) ◽  
pp. 336-342 ◽  
Author(s):  
Joost F Swart ◽  
E H Pieter van Dijkhuizen ◽  
Nico M Wulffraat ◽  
Sytze de Roock
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Disease Activity ◽  
Disease Activity Score ◽  
Target Therapy ◽  
Critical Item ◽  
Juvenile Arthritis ◽  
Activity Score ◽  
Treat To Target ◽  
Physician Global Assessment ◽  
American College Of Rheumatology

ObjectivesTo assess if the Juvenile Arthritis Disease Activity Score (JADAS71) could be used to correctly identify patients with juvenile idiopathic arthritis (JIA) in need of antitumour necrosis factor therapy (anti-TNF) therapy 3 and 6 months after start of methotrexate (MTX).MethodsMonocentric retrospective cohort study from 2011 to 2015 analysing all patients with oligoarticular JIA (OJIA) (n=39) and polyarticular course JIA (PJIA) (n=74) first starting MTX. Three and 6 months after MTX start, clinical and laboratory features and the 2011 American College of Rheumatology (ACR) JIA treatment recommendations (ACR clinical practice guideline (ACR-CPG)) were compared between groups starting and not starting anti-TNF therapy. The sensitivity and specificity of the ACR-CPG, JADAS71 and the clinical JADAS to identify non-responders after 12 months were calculated.ResultsPhysicians escalated patients with significantly higher physician global assessment, clinical JADAS (cJADAS) and patient Visual Analogue Scale (VAS). The decision not to escalate was correct in 70%–75% as shown by MTX response. The implementation of the ACR-CPG would increase the current anti-TNF use from 12% to 65%. The use of (c)JADAS in identifying patients in need of anti-TNF therapy outperformed the ACR-CPG with a much higher sensitivity, specificity and accuracy. The cJADAS threshold for treatment escalation at month 3 and 6 was >5 and >3 for OJIA and >7 and >4 for PJIA, respectively. The performance of the cJADAS decreased when the patient VAS contribution to the total score was restricted and overall did not improve by adding the erythrocyte sedimentation rate.ConclusionsThe cJADAS identifies patients in need of anti-TNF and is a user-friendly tool ready to be used for treat to target in JIA. The patient VAS is a critical item in the cJADAS for the decision to escalate to anti-TNF.

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