An online tool for juvenile arthritis, guidelines on childhood lupus, and good news about the response to treatment for ANCA-associated vasculitis
What's new in pediatric rheumatology?1. An online tool that helps teens with juvenile idiopathic arthritis improve their quality of life2. Recently released evidence-based guidelines on the diagnosis and treatment of childhood-onset systemic lupus erythematosus3. Good news about the response to treatment in the majority of children with anti-neutrophil cytoplasmic antibody-associated vasculitis
1. Stinson JN, Campillo S, Cellucci T, et al. A randomized controlled trial (RCT) of an internet-based self-management program for adolescents with juvenile idiopathic arthritis (JIA). Presented at 2017 ACR/ARHP Annual Meeting; San Diego, CA; October 26, 2017. Abstract 2952.2. Groot N, de Graeff N, Avcin T, et al. European evidence-based recommendations for diagnosis and treatment of childhood-onset systemic lupus erythematosus: the SHARE initiative. Ann Rheum Dis. 2017;76:1788-1796.3. Morishita KA, Moorthy LN, Lubieniecka JM, et al. Early outcomes in children with antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheumatol. 2017;69:1470-1479. doi: 10.1002/art.40112.
A randomized, controlled trial conducted for 3 months across 11 pediatric centers in Canada enrolled 333 adolescents between the ages of 12 and 18, including 109 males and 224 females.1 In the intervention group, 164 participants reviewed 12 online modules that included both disease education and self-management strategies. In a control group, 169 teenagers reviewed online material that included links to publicly available standard disease education only.
Adolescents who received the intervention had a significant overall reduction in pain interference with enjoyment of daily life, compared with the control group. Also, the intervention group reported significantly improved health-related quality of life after 12 months.
"Young people are digital natives, meaning that they are comfortable using technologies such as the internet to access health information resources, and it is a mode of social communication for youth. Internet-based educational programs are ideally suited to improve the accessibility and acceptability of disease self-management programs for young people with chronic health conditions such as JIA," said lead author Jennifer Stinson, RN-EC, PhD, of The Hospital for Sick Children (SickKids) in Toronto, Ontario.
An expert panel of 16 pediatric rheumatologists and pediatric nephrology representatives generated a total of 25 recommendations on key approaches to the diagnosis and treatment of childhood SLE, including 11 on diagnosis, 9 on disease monitoring, and 5 on general treatment.2 The topics evaluated included appropriate use of SLE classification criteria, disease activity, and damage indices; adequate assessment of autoantibody profiles; secondary macrophage activation syndrome; use of hydroxychloroquine and corticosteroid-sparing regimens; and importance of addressing poor adherence.
The guidelines emphasize the need for more research on diagnostic procedures, as well as treatment recommendations, in patients with childhood SLE, and the panelists suggest more international collaboration is needed.
The study included 105 children (median age, 13.8 years at diagnosis) who received corticosteroid treatment.3 Some 42% of patients achieved remission at 12 months, 49% had inactive disease at post-induction at 4 to 6 months, and 61% had inactive disease at 12 months.
The majority of patients improved, even if they did not achieve inactive disease. Minor relapses occurred in one-quarter of patients after inactive disease had been achieved post-induction.
"Although the study showed that a significant proportion of patients did not achieve remission, the majority of patients responded to treatment. Unfortunately, more than one-half of this patient cohort experienced damage to various organ systems early in their disease course," stated the researchers, led by Kimberly A. Morishita, MD, of the University of British Columbia, Vancouver, British Columbia, Canada.