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  • 1
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    Online Resource
    Inflammatory arthritis in pediatric patients with morphea
    Elsevier BV ; 2018
    In:  Journal of the American Academy of Dermatology Vol. 79, No. 1 ( 2018-07), p. 47-51.e2
    Details
    In: Journal of the American Academy of Dermatology, Elsevier BV, Vol. 79, No. 1 ( 2018-07), p. 47-51.e2
    Type of Medium: Online Resource
    ISSN: 0190-9622
    URL: Article
    DOI: 10.1016/j.jaad.2018.03.005
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2018
    detail.hit.zdb_id: 603641-7
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  • 2
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    Non-criteria antiphospholipid antibodies and pediatric rheumatic disease: a case series
    Springer Science and Business Media LLC ; 2022
    In:  Pediatric Rheumatology Vol. 20, No. 1 ( 2022-08-20)
    Details
    In: Pediatric Rheumatology, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2022-08-20)
    Abstract: Non-criteria antiphospholipid antibodies (NC-aPL) are a relatively undefined subgroup of antiphospholipid antibodies (aPL). Knowledge about NC-aPL in adults is limited and even less is known in pediatric patients. Routine tests for antiphospholipid syndrome (APS)—a clinical state marked by the presence of aPL in association with vascular thrombosis—usually include lupus anticoagulant (LAC), anti-cardiolipin (aCL) and -beta-2 glycoprotein I (aβ2GPI). LAC is a functional screen for prothrombotic aPL, while the latter tests identify specific autoantibodies. Specific targets of NC-aPL include, but are not limited to, phosphatidylethanolamine, phosphatidylserine, and prothrombin. Presentation of cases We present single-center data from eight pediatric patients with NC-aPL identified during a three-year period. All patients had presenting features raising suspicion for APS. Most patients were female with a primary rheumatic disease. One patient had a stroke. Another patient had alveolar hemorrhage and pulmonary hypertension. Raynaud’s phenomenon, rashes involving distal extremities, and headaches were common. Most patients had a positive LAC, yet their routine aPL tests were negative, prompting testing for NC-aPL. Conclusions Our findings suggest NC-aPL are associated with typical signs and symptoms of APS in pediatric patients. Pediatricians and pediatric subspecialists should consider NC-aPL when clinical suspicion is high and routine aPL tests are negative, particularly when LAC is positive. While guidelines for NC-aPL do not yet exist for children or adults, these autoantibodies have pathogenic potential. Actionable items could include evaluation for the presence of other (primary) rheumatic diseases, and consultation with hematologists and/or obstetricians regarding anticoagulation/platelet inhibition and thrombosis education. Future guidelines regarding NC-aPL will only be generated by gathering more data, ideally prospectively.
    Type of Medium: Online Resource
    ISSN: 1546-0096
    URL: Article
    DOI: 10.1186/s12969-022-00732-4
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2279468-2
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  • 3
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    A143: Barriers to Referral to Pediatric Rheumatology among General Pediatricians in the Upper Midwest
    Wiley ; 2014
    In:  Arthritis & Rheumatology Vol. 66, No. S3 ( 2014-03)
    Details
    In: Arthritis & Rheumatology, Wiley, Vol. 66, No. S3 ( 2014-03)
    Abstract: Access to pediatric rheumatology (PR) care is limited. An average of 28 fellows graduate from PR training programs annually, and there are 224 board‐certified pediatric rheumatologists in the United States. Eleven states have no pediatric rheumatologist and 24 states have two or fewer. Furthermore, the mean distance to a certified pediatric rheumatologist is 60 miles. The impact that limited access to PR has on general pediatricians has not been studied. Methods: A web‐based survey was emailed to general pediatricians practicing in Minnesota (MN), North Dakota (ND), and South Dakota (SD). The email databases were obtained from the MN and ND state medical licensing boards and from the SD chapter of the American Academy of Pediatrics. The goal of the survey was to define barriers to access to PR care and the consequences of limited access. Basic descriptive analysis was performed and responses were summarized. Results: The overall response rate was 15.3% (93/609). Responders were younger than non‐responders (mean age 48 yo versus 53 yo, p = 0.0006) and had been in practice a shorter period of time (mean 22 y versus 27 y, p = 0.0051). Forty percent (37/92) of the clinics were urban, 40% (37/92) suburban, and 20% (18/92) rural. Twenty‐nine percent (27/92) of respondents' clinics were at least two hours by car from a pediatric rheumatologist, and 9% (8/92) were more than 6 hours away. Ninety‐two percent (85/92) had referred a patient to PR at least once, but 89% (83/93) had experienced a situation at least once in which they considered a referral to PR but ultimately did not. Reasons for not referring varied. When asked, “In cases in which you considered a PR referral but did not refer a patient to a pediatric rheumatologist, please indicate your reasons for doing so. (Select all that apply),” many had referred to other subspecialists instead: 29% (24/83) to pediatric infectious disease, 20% (17/83) to adult rheumatology, and 12% (10/83) to pediatric orthopedics, while 34% (28/83) managed the patient themselves. Although not a pre‐specified choice in the survey, 9% (3/32) of pediatricians added wait‐time as the reason for not referring to PR. Thirty‐five percent (32/60) had referred a pediatric patient to an adult rheumatologist, most commonly for distance (47%), while physician preference was never selected as a reason. Conclusion: Pediatricians often refer children with possible rheumatic disease to specialists other than PR due to reasons of distance and wait‐time. Referral to adult rheumatologists occurs, but not based on pediatrician preference. These findings suggest that the PR workforce is inadequate to meet demand, at least in the Upper Midwest. Interventions are needed to improve access to care in PR.
    Type of Medium: Online Resource
    ISSN: 2326-5191 , 2326-5205
    URL: Issue
    URL: Article
    DOI: 10.1002/art.v66.S3
    DOI: 10.1002/art.38564
    RVK:
    XA 10000
    RVK:
    XA 30325
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 127294-9
    detail.hit.zdb_id: 2754614-7
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  • 4
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    Use of Rheumatology Laboratory Studies Among Primary Pediatricians
    SAGE Publications ; 2016
    In:  Clinical Pediatrics Vol. 55, No. 14 ( 2016-12), p. 1279-1288
    Details
    In: Clinical Pediatrics, SAGE Publications, Vol. 55, No. 14 ( 2016-12), p. 1279-1288
    Type of Medium: Online Resource
    ISSN: 0009-9228 , 1938-2707
    URL: Article
    DOI: 10.1177/0009922815624902
    Language: English
    Publisher: SAGE Publications
    Publication Date: 2016
    detail.hit.zdb_id: 207678-0
    detail.hit.zdb_id: 2066146-0
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  • 5
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    Barriers and alternatives to pediatric rheumatology referrals: survey of general pediatricians in the United States
    Springer Science and Business Media LLC ; 2015
    In:  Pediatric Rheumatology Vol. 13, No. 1 ( 2015-12)
    Details
    In: Pediatric Rheumatology, Springer Science and Business Media LLC, Vol. 13, No. 1 ( 2015-12)
    Type of Medium: Online Resource
    ISSN: 1546-0096
    URL: Article
    DOI: 10.1186/s12969-015-0028-6
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2015
    detail.hit.zdb_id: 2279468-2
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  • 6
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    Capturing critical data elements in Juvenile Idiopathic Arthritis: initiatives to improve data capture
    Springer Science and Business Media LLC ; 2022
    In:  Pediatric Rheumatology Vol. 20, No. 1 ( 2022-09-29)
    Details
    In: Pediatric Rheumatology, Springer Science and Business Media LLC, Vol. 20, No. 1 ( 2022-09-29)
    Abstract: Documentation of critical data elements is a focus of the Pediatric Rheumatology Care and Outcomes Improvement Network to aid in clinical care and research for patients with juvenile idiopathic arthritis. We aimed to increase data capture for critical data elements and hypothesized that quality improvement methodology would improve data capture. We also hypothesized that data capture for all critical data elements would be lower for virtual visits compared to in-person visits. Methods All visits for patients with JIA between 9/14/2020 and 12/31/2021 at the University of Minnesota were included. We assessed completeness of critical data element capture. Sixteen interventions with providers were conducted, including email reminders, individual discussions, group meetings, and feedback reports. We used statistical process control charts to evaluate change over time. Results Baseline included 355 patient-visits: 221 (62%) in-person and 134 (38%) virtual with critical data elements entry ranging between 50 and 60%. Post-intervention included 1,596 patient-visits: 1,350 (85%) in-person and 246 (15%) virtual, with critical data elements entry reaching 91%. All providers improved data entry during this study. In-person visits had significantly higher data capture rates than virtual visits for all 4 critical data elements. Conclusion We achieved our aim to increase critical data element documentation by focusing on provider buy-in, frequent reminders, and individualized feedback. We also found that collection of critical data elements occurred significantly less often with virtual visits than with in-person visits. Now that we improved capture of critical data elements, we can shift the focus to efforts aimed at improving outcomes for patients with juvenile arthritis.
    Type of Medium: Online Resource
    ISSN: 1546-0096
    URL: Article
    DOI: 10.1186/s12969-022-00745-z
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2022
    detail.hit.zdb_id: 2279468-2
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  • 7
    Online Resource
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    A137: Appropriateness of Rheumatology Lab Studies and Referrals among General Pediatricians
    Wiley ; 2014
    In:  Arthritis & Rheumatology Vol. 66, No. S3 ( 2014-03)
    Details
    In: Arthritis & Rheumatology, Wiley, Vol. 66, No. S3 ( 2014-03)
    Abstract: Rheumatology lab tests are often of low diagnostic utility when ordered by primary care physicians, and may lead to erroneous referrals. No prior studies have investigated pediatricians' reasons for ordering these tests. We surveyed pediatricians in three states of the Upper Midwest regarding their ordering of rheumatology lab tests and reasons for referral to pediatric rheumatology (PR). Methods: A web‐based survey was emailed to general pediatricians practicing in Minnesota, North Dakota, and South Dakota. The rheumatology tests queried included antinuclear antibody (ANA), anti‐double‐stranded DNA antibody (anti‐dsDNA), rheumatoid factor (RF), anti‐citrullinated peptide antibodies (anti‐CCP), and HLA‐B27. Basic descriptive analysis was performed. Subgroup analysis was performed to assess the relationship between the pediatrician's experience with PR (defined as years since completion of residency training, whether or not the training program had a PR division, time spent in a PR clinic during training and completion of continued medical education focused on PR in the last three years) and the appropriateness of lab tests and PR referrals. Results: The response rate was 15.3% (93/609). Eighty‐nine percent (83/93) of the respondents had ordered ANA, for reasons including abnormal joint exam (72%), musculoskeletal (MSK) pain with a normal exam (52%), concern for juvenile idiopathic arthritis (JIA) (47%), rash (41%), concern for systemic lupus erythematosus (39%), fatigue (35%), and fever (35%). Fifty‐nine percent (54/92) had ordered anti‐dsDNA, and the distribution of reasons paralleled that of ANA. Seventy‐three percent (67/92) had ever ordered RF, most commonly for abnormal joint exam (67%), joint pain with a normal exam (60%), concern for JIA (42%), and fever (30%). Only 8% (7/92) had ordered anti‐CCP. Forty‐two percent (39/92) had ordered HLA‐B27, primarily for back pain (59%). Of those who had ever referred a patient to a pediatric rheumatologist, 44% (37/85) did so for a positive ANA of unclear significance, 14% (12/85) for positive RF of unclear significance, and 9% (8/85) for anti‐dsDNA of unclear significance. Positive HLA‐B27 and anti‐CCP were less common referral reasons. Subgroup analysis did not show significant differences between experience level and appropriateness of lab tests and referrals to PR. Conclusion: Inappropriate ordering of rheumatology lab tests with subsequent referral to PR is common among pediatricians in the Upper Midwest and likely elsewhere. The correctness of lab test utilization and referral to PR did not obviously improve with increased experience in PR. New educational interventions are needed to improve general pediatricians' understanding and utilization of rheumatology lab tests and to decrease unnecessary referrals to PR.
    Type of Medium: Online Resource
    ISSN: 2326-5191 , 2326-5205
    URL: Issue
    URL: Article
    DOI: 10.1002/art.v66.S3
    DOI: 10.1002/art.38558
    RVK:
    XA 10000
    RVK:
    XA 30325
    Language: English
    Publisher: Wiley
    Publication Date: 2014
    detail.hit.zdb_id: 127294-9
    detail.hit.zdb_id: 2754614-7
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  • 8
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    Rapid Infliximab Infusion in the Pediatric Population
    Pediatric Pharmacy Advocacy Group ; 2020
    In:  The Journal of Pediatric Pharmacology and Therapeutics Vol. 25, No. 8 ( 2020-11-01), p. 705-708
    Details
    In: The Journal of Pediatric Pharmacology and Therapeutics, Pediatric Pharmacy Advocacy Group, Vol. 25, No. 8 ( 2020-11-01), p. 705-708
    Abstract: To compare infusion reaction rates between rapid infliximab (REMICADE, Janssen Biotech Inc) infusions and previous standard 2- to 3-hour infusions; additionally, to assess patient satisfaction and reduction in chair time associated with rapid infliximab infusions. METHODS Pediatric rheumatology and gastroenterology patients receiving maintenance infliximab therapy using a standard 2- to 3-hour titrated infusion had the opportunity to enroll in the non-titrated rapid 1-hour infusion protocol following tolerance of induction dosing at 0, 2, and 6 weeks. Patients were included from December 1, 2017, to March 31, 2018, via retrospective chart review and patient satisfaction surveys. RESULTS Data were collected on 55 patients receiving a total of 160 rapid infliximab infusions. There were 2 infusion reactions during the enrollment and data collection period, resulting in an overall infusion reaction rate of 1.3%. The patient satisfaction survey results showed all patients were at minimum satisfied with the information provided regarding rapid infliximab, decreased time spent in clinic, ease of scheduling, and overall process. CONCLUSIONS Our data suggest rapid infliximab infusions are safe in pediatric rheumatology and gastroenterology patients receiving maintenance infliximab infusion therapy. The overall infusion reaction rate of 1.3% in this study is well below the accepted infusion reaction rate of standard-length infliximab infusions of 2% to 3%.
    Type of Medium: Online Resource
    ISSN: 1551-6776
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.5863/1551-6776-25.8.705
    DOI: 10.5863/1551-6776-25.8.705.S1
    DOI: 10.5863/1551-6776-25.8.705.S2
    DOI: 10.5863/1551-6776-25.8.705.S3
    DOI: 10.5863/1551-6776-25.8.705.S4
    Language: English
    Publisher: Pediatric Pharmacy Advocacy Group
    Publication Date: 2020
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  • 9
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    T cell-intrinsic role for Nod2 in protection against Th17-mediated uveitis
    Springer Science and Business Media LLC ; 2020
    In:  Nature Communications Vol. 11, No. 1 ( 2020-10-26)
    Details
    In: Nature Communications, Springer Science and Business Media LLC, Vol. 11, No. 1 ( 2020-10-26)
    Abstract: Mutations in nucleotide-binding oligomerization domain-containing protein 2 (NOD2) cause Blau syndrome, an inflammatory disorder characterized by uveitis. The antimicrobial functions of Nod2 are well-established, yet the cellular mechanisms by which dysregulated Nod2 causes uveitis remain unknown. Here, we report a non-conventional, T cell-intrinsic function for Nod2 in suppression of Th17 immunity and experimental uveitis. Reconstitution of lymphopenic hosts with Nod2 −/− CD4 + T cells or retina-specific autoreactive CD4 + T cells lacking Nod2 reveals a T cell-autonomous, Rip2-independent mechanism for Nod2 in uveitis. In naive animals, Nod2 operates downstream of TCR ligation to suppress activation of memory CD4 + T cells that associate with an autoreactive-like profile involving IL-17 and Ccr7. Interestingly, CD4 + T cells from two Blau syndrome patients show elevated IL-17 and increased CCR7. Our data define Nod2 as a T cell-intrinsic rheostat of Th17 immunity, and open new avenues for T cell-based therapies for Nod2-associated disorders such as Blau syndrome.
    Type of Medium: Online Resource
    ISSN: 2041-1723
    URL: Article
    DOI: 10.1038/s41467-020-18961-0
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2020
    detail.hit.zdb_id: 2553671-0
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