Jelena Vojinovic - Academia.edu (original) (raw)

Papers by Jelena Vojinovic

Annals of the Rheumatic Diseases, Jun 1, 2015

Objectives: To explore whether a 4 weeks multidisciplinary intervention including hydrotherapy an... more Objectives: To explore whether a 4 weeks multidisciplinary intervention including hydrotherapy and combined spa-exercise therapy in patients with recent sick-leave due to MSKD improved work outcome at acceptable costs in a period of up to 6 months compared to persons receiving usual care. Methods: Patients in the program-group were compared with a usual care group (UC-group) of subjects matched from an occupational health service database based on age, gender and type of MSKD. Days of sick leave and hazard of work resumption were compared by a bootstrapped independent sample t-test and Cox regression, respectively. The program costs per working day gained in the program group were calculated assuming no changes in healthcare utilization. Within the program-group, healthcare costs and EuroQol (EQ) for the 6 months before and after the program were compared. Results: One hundred eleven program-participants provided data 6 months after the program with a mean age of 47 (±9.9) and of which 77 (69.4%) women. Days absent from work during follow-up since the first sick leave-day were 58.21 (±34.43) and 75.54 (39.78) in the program and UC-group (p=0.002). The Kaplan-Meier curve showed a median time until work resumption of 60 working days in the program-group and 85 working days in the UC-group (Fig.1) The hazard of work resumption in program-participants was not significantly lower than in the UC-group during the first 20 days of observation [hazard ratio (HR) 0.54 (95% CI 0.25-1.15)] but significantly higher thereafter [HR 1.60 (95% CI 1.22-2.11)]. Average productivity costs were 11,457 (±9,265/median 8,549) in the program-group and 15,680 (±10,864/ median 12,848) in the UC-group (p=0.001). Program costs were 6172 and costs per working day gained were 356. Costs of healthcare utilization in program-participants decreased from 1887 (±3755)/6 months/patient to 1112 (±1470)/6 months/patient.EQ-5D/EQ-VAS improved significantly from 0.57 (±0.26) to 0.70 (±0.22) and from 56.07 (±15.06) to 69.44 (±13.56) 6 months after the program. Conclusions: In MSKD-patients on recent sick leave, the multidisciplinary program reduces the total length of sick leave compared to usual care. Costs of the treatment program are partially offset by improvement in health and healthcare costs. References: [1] Waddell et al. Report for the Vocational Rehabilitation Task Group; TSO; 2008. [2] van Tubergen et al. Arthritisand Rheumatism; 2001.

Background/Purpose: Image fusion is an advanced imaging technology, which enables fusion of ultra... more Background/Purpose: Image fusion is an advanced imaging technology, which enables fusion of ultrasound (US) and magnetic resonance imaging (MRI). This fusion gives for each US probe position an exact projection of the corresponding anatomical area on a previously obtained MR image, during a live US assessment. This study is the first to address image fusion of US and MRI tenosynovitis. The aim of this study was to assess and compare US and MRI visualisation of tenosynovitis using image fusion technique. Methods: Fifteen rheumatoid arthritis patients with US verified tenosynovitis in the wrist or hand had an MRI performed of the affected wrist or hand. A subsequent image fusion was performed, i.e. the MR images and a live US assessment of one tendon sheath were fused. In order to compare the two imaging modalities quantitatively, the area of the tendon and tendon sheath in the transverse axis was measured on US and MRI for each image fusion. Due to partial volume artefacts (voxel containing two different tissues and therefore possessing a signal average of tendon and tendon sheath) on MRI two measures were performed; area 1) the circumference of the black tendon, i.e. excluding voxels containing two types of tissue 2) the circumference of the grey line that surrounds the black tendon, i.e. including voxels containing two types of tissue. Tenosynovitis was assessed using the proposed OMERACT semi-quantitative scoring system for US and MRI. US scoring was therefore based on both grey scale and Doppler, whereas MRI scoring was based only on post-contrast tenosynovial enhancement, measured as distance from the tendon to end of the enhanced tendon sheath. Results: The median circumference area of the tendons and tendon sheaths on US and MRI 1 and 2 were respectively 0.16 (25;75 pctl: 0.10;0.25), 0.9 (0.06-0.18) and 0.13 of (0.10;0.25) for the tendons and 0.18 (0.13-0.26), 0.27 (0.20-0.45) and 0.23 (0.16-0.40) for the tendon sheaths. Statistically significant differences were found for all measured areas between US and MRI, except for the US tendon area and the MRI tendon area 2 (Wilcoxon's test; p=0.47). Overall agreement between US and MRI tenosynovitis scoring systems was good (see table 1). Conclusion: In conclusion, we found that US and MRI have good agreement for quantitative assessment of tendons and scoring of tenosynovitis, when comparing the two modalities using image fusion, if the partial volume artefacts on MRI are included in the measure.

Rheumatology, Oct 1, 2017

Rheumatology, Oct 6, 2021

Objectives. Burden of comorbidities are largely unknown in JIA. From 2000, national and internati... more Objectives. Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/ internationally-UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild-to quantify the occurrence of selected comorbidities in patients with JIA. Methods. Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. Results. 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1-1.8%) and uveitis (15-19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). Conclusion. This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies.

Acta Medica Medianae, Sep 15, 2021

In the last decade, tumor necrosis factor- (TNF-) inhibitors have shown excellent control of oc... more In the last decade, tumor necrosis factor- (TNF-) inhibitors have shown excellent control of ocular inflammation in juvenile idiopathic arthritis (JIA)-associated uveitis. We have retrospectively evaluated the long-term efficacy and safety of adalimumab in 19 biologically naive patients with JIA-associated uveitis from our biologic registry. Demographic data and blood samples were collected at different time points. Uveitis activity was evaluated by slit-lamp biomicroscopy. Adverse events were recorded. The registry records provided a ten-year follow-up of 11 (57.90%) female patients diagnosed with oligo/extended oligoarticular JIA-associated uveitis and 8 (42.10%) males diagnosed with enthesitis-related arthritis (ERA) with uveitis. Adalimumab was the first biologic prescribed to JIA patients with active uveitis that failed to respond to standard treatment. A ten-year long follow-up period has shown that there were no new relapsis of uveitis while patients were receiving adalimumab and metotrexate. All of our patients after adalimumab introduction were able to gradually tapper and stop treatment with topical steroids. Thirty-six point eighty-four percent of our patients were able to stop biological treatment 36 months after adalimumab commencing. Uveitis has relapsed three monts after the adalimumab discontinuation only in two patients (10.53%). No serious adverse events were recorded. Thirty-one point fifty-eight percent of patients expirienced minor adverse events. During a long-term follow-up, adalimumab showed good efficacy and safety profile in JIA patients with active inflammatory ocular disease.

Annals of the Rheumatic Diseases, Jun 1, 2015

Background: Studies on obesity and the risk for development of rheumatoid arthritis (RA) have sho... more Background: Studies on obesity and the risk for development of rheumatoid arthritis (RA) have shown diverse results, and studies with prospectively collected data are few. Objectives: To evaluate the association between obesity and subsequent risk for development of RA. Methods: In The Västerbotten Interventional Program (VIP) or/and The WHO project Multinational MONItoring of Trends and Determinants of CArdiovascular Disease (MONICA) 1985-2013 individuals with RA (year of onset of symptoms 1989-2013) were identified (cases, n=550), and data from the latest visit antedating onset of RA symptoms were retrieved. From the same populationbased, prospective cohorts 1650 controls, matched for age, sex, cohort, inclusion year, cohort and area of inhabitance (rural/urban) were randomly selected. Prospectively collected data on body mass index (BMI; weight/lenght 2), smoking habits, and educational level was used in calculations of odds ratio; OR (95% confidence interval) in conditional logistical regression assessing associations between obesity and the risk for development of RA. Results: The cases (mean age at RA symptom onset 58 SD 11 years, 68% women) had been included in the cohorts (MONICA n=49, VIP n=501) at median 6.7 (IQR 6.4) years before the onset of symptoms of RA. Obesity (BMI≥30) was associated with an increased risk for RA development, OR 1.4 (1.1-1.9), compared to those with normal weight (BMI 18.5-25). The association was stronger in male subjects (Table 1). Stratifying the patients on age at onset of symptoms of RA the association between obesity and the risk of RA was only observed in the quartile with earliest disease debut, 32-50 years, OR for obesity vs. normal weight 1.9 (1.1-3.7).

Annals of the Rheumatic Diseases, Jun 1, 2016

33 to use. The experiences of using tRAppen seemed to be influenced by physical and mental state ... more 33 to use. The experiences of using tRAppen seemed to be influenced by physical and mental state and personal preferences. Conclusions: The use of co-design in the development of the physical activity self-management service tRAppen was successful. The first test version was perceived as feasible and to have the potential to support a physically active lifestyle. Co-design in collaborative workshops involved an extensive decisionmaking process that put high demands on the participants' ability to find solutions, negotiate, come to agreements, and reach final decisions. References: [1] Revenäs Å, Opava C, Åsenlöf P. Lead users' ideas on core features to support physical activity in rheumatoid arthritis: a first step in the development of an Internet service using participatory design.

Srpski arhiv za celokupno lekarstvo

Introduction/Objective. The aim of our study was to retrospectively analyze data about efficacy a... more Introduction/Objective. The aim of our study was to retrospectively analyze data about efficacy and persistence on different anti-TNF? treatment in spondyloarthritis (SpA). Methods. We retrospectively analyzed SpA patients whose data were entered into the Serbian national SpA registry. All patients were divided in two groups: non-switcher (patients who were treated with one anti-TNF?) and switcher group (who has switched from first to second and third anti-TNF?). Disease activity was measured by the Ankylosing Spondylitis Disease Score and the Bath Ankylosing Spondylitis Disease Activity Index and functional status was measured by the Bath Ankylosing Spondylitis Functional Index. Results. We identified 290 SpA patients ? 250 patients with axial SpA (axSpA) and 40 patients with peripheral SpA (pSpA). Among 250 patients with axSpA, 192 (76.8%) did not change first anti-TNF?, while 58 (23.2%) switched to the second and 14 (5.6%) switched to the third anti-TNF?. Among 40 patients with p...

Annals of the Rheumatic Diseases, Jun 1, 2014

Background: IL-17 is a proinflammatory cytokine, which overproduction promotes the autoimmune rea... more Background: IL-17 is a proinflammatory cytokine, which overproduction promotes the autoimmune reaction in rheumatoid arthritis (RA). Recent studies have shown that IL-17 production in lymphocytes or its function could be regulated by miR-223 by targeting Roquin ubiquitin ligase or its receptors 1-4. Objectives: To examine a possible correlation between the expression levels of miR-223 and IL-17A in peripheral blood (PB) and synovial fluid (SF) of RA patients. Methods: Expression levels of miR-223 were determined in matched PB and SF samples of RA patients by relative quantitation method 2-DDCt. As reference control for normalisation RNU6B gene was used. Concentrations of IL-17A in matched serum and SF samples were determined by Human IL-17A ELISA kit (Gene probe, Diaclone). The results were compared to healthy control (HCs) as well as within the RA group. Results: 58,73% of the RA patients showed overexpression of miR-223 in PB when compared to HCs (p=0.008) with AUC=0.673 (95 CI: 0.562/0.784), with 71.4% sensitivity and 46.9% specificity (p=0.006). miR-223 was overexpressed in 79.17% of RA SF (p=1.64 × 10-3) when compared to HCs SF with AUC=0.841 (95 CI: 0.724/0.958) with 87.5% sensitivity and 72.7% specificity (p=4.6 × 10-4). Within the RA group, SF miR-223 was underexpressed in 58.7% of the patients compared to its systemic levels. Levels of IL-17A were higher in RA SF compared to serum (8.645 pg/ml versus 0.315 pg/ml, p=0.012). Conclusions: The difference between the systemic and local levels of miR-223 and IL17A in RA patients shows that the inflammatory disease process leads to their altered expression with a possible role of both molecules in the disease pathogenesis. The opposite changes in their systemic and local levels confirm the data about the possible role of miR-223 in regulating IL-17 function.

Rheumatology International, Jan 24, 2019

Oxidative stress is believed to be of great importance for both the etiology and the persistence ... more Oxidative stress is believed to be of great importance for both the etiology and the persistence of juvenile idiopathic arthritis (JIA). The aim of this study was to investigate the association of-262C/T polymorphism of the catalase (CAT) gene with JIA, as well as to evaluate whether this polymorphism can influence plasma CAT activity and outcome in JIA patients treated with etanercept. A total of 154 subjects (60 JIA patients and 94 healthy volunteers) were screened for CAT-262C/T gene polymorphism using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Plasma CAT activity was determined using the spectrophotometric method according to Goth, prior to and 12 months after anti-TNF (etanercept) therapy. Clinical outcome was assessed using the JIA ACR (American College of Rheumatology) response criteria. The genotype and allele frequency distributions of CAT-262C/T polymorphism in the patients were significantly different from those of the controls (p = 0.014, p = 0.006). The TT genotype (polymorphic homozygous) was associated with a 4.36-fold higher likelihood of having JIA (95% CI 1.545-12.323, p = 0.005) as compared to the CC genotype (wildtype). At month 12 of treatment, JIA patients, carriers of the CC genotype, showed significantly higher plasma CAT activity (p = 0.004) and achieved the JIA ACR 70 response more often (p = 0.003) than the patients, carriers of the CT/TT genotype. This is the first study implying the possible association of CAT-262C/T polymorphism with JIA. The results suggest the potential protective effect of the CC genotype, with regard to CAT activity and treatment outcome.

Dermatologic Therapy, Dec 4, 2019

Linear IgA dermatosis (LAD) is a rare autoimmune disorder in children. A 9‐year‐old boy was prese... more Linear IgA dermatosis (LAD) is a rare autoimmune disorder in children. A 9‐year‐old boy was presented with blisters on the intact skin (face, body, arms, hands, soles, perigenital and perianal area) after amoxicillin treatment. Systemic corticosteroids and dapsone treatment for 6 weeks was successful. Clinical and immunofluorescence examinations are most important for differentiation of LAD and other drug‐induced bullous dermatoses. They enable an early introduction of proper therapy.

RMD Open, Oct 1, 2015

Objective: To produce educational guidelines for the conduct, content and format of theoretical a... more Objective: To produce educational guidelines for the conduct, content and format of theoretical and practical teaching at EULAR musculoskeletal ultrasound (MSUS) Teaching the Teachers (TTT) Courses. Methods: A Delphi-based procedure with 24 recommendations covering five main areas (Duration and place of the course; Faculty members; Content of the course; Evaluation of the teaching skills; TTT competency assessment) was distributed among a group of experts involved in MSUS teaching, in addition to an advisory educational expert being present. Consensus for each recommendation was considered achieved when the percentage of agreement was >75%. Results: 21 of 24 invited participants responded to the first Delphi questionnaire (88% response rate). All 21 participants also responded to the second round. Agreement on 19 statements was obtained after two rounds. Conclusions: This project has led to the development of guidelines for the conduct, content and format of teaching at the EULAR MSUS TTT Courses that are organised annually, with the aim of training future teachers of EULAR MSUS Courses, EULAR Endorsed MSUS Courses, as well as national and local MSUS Courses. The presented work gives indications on how to homogenise the teaching at the MSUS TTT Courses, thus resolving current discrepancies in the field.

Rheumatology, May 4, 2023

Objectives: CLIPPER2 was an 8-year, open-label extension of the phase 3b, 2-year CLIPPER study on... more Objectives: CLIPPER2 was an 8-year, open-label extension of the phase 3b, 2-year CLIPPER study on the safety and efficacy of etanercept in patients with juvenile idiopathic arthritis (JIA), categorized as extended oligoarticular arthritis (eoJIA), enthesitis-related arthritis (ERA), or psoriatic arthritis (PsA). Methods: Participants with eoJIA (2-17 years old), ERA, or PsA (each 12-17 years old) who received ≥1 etanercept dose (0.8 mg/kg weekly; maximum 50 mg) in CLIPPER could enter CLIPPER2. Primary endpoint was occurrence of malignancy. Efficacy assessments included proportions achieving JIA American College of Rheumatology (ACR) 30/50/70/90/100 criteriaand ACR inactive disease criteria, and clinical remission (ACR criteria) or Juvenile Arthritis Disease Activity Score (JADAS) ≤1. Results: Overall, 109/127 (86%) CLIPPER participants entered CLIPPER2 (n=55 eoJIA, n=31 ERA, n=23 PsA; 99 [78%] on active treatment); 84 (66%) completed 120 months' follow-up (32 [25%] on active treatment). One malignancy (Hodgkin's disease in 18-year-old patient with eoJIA treated with methotrexate for 8 years) was reported; there were no cases of active tuberculosis or deaths. Numbers and incidence rates [events per 100 patient-years] of TEAEs (excluding infections/ISRs) decreased from 193 [173.81] in Year 1 to 9 [27.15] in Year 10; TE infections and serious infections also decreased. Over 45% of participants (N=127) achieved JIA ACR50 responses from Month 2 onwards; 42 (33%) and 17 34 (27%) participants achieved JADAS and ACR clinical remission, respectively. 4 Conclusions: Etanercept treatment up to 10 years was well tolerated, consistent with the known safety profile, with durable response in the participants still on active treatment. The benefit-risk assessment of etanercept in these JIA categories remains favorable.

RMD Open, Jul 1, 2022

Background Despite the worldwide increasing request of education on paediatric musculoskeletal ul... more Background Despite the worldwide increasing request of education on paediatric musculoskeletal ultrasound (PedMSUS), content, conduct and format of PedMSUS courses have never been internationally agreed. Objectives To produce educational procedures for the conduct, content and format of EULAR/PReS PedMSUS courses. Methods After a systemic literature review and expert opinion collection, a panel of items for the development of procedures on PedMSUS courses was identified. Agreement on the items was assessed through Delphi surveys among a taskforce of 24 members, which included 18 experts in PedMSUS (8 rheumatologists, 1 radiologist, 9 paediatric rheumatologists), 1 methodologist and rheumatologist expert in MSUS, 2 patient research partners, 1 health professional in rheumatology and 2 EMEUNET/EMERGE members, from 8 different European countries. Each item was assessed through a 5-point Likert scale (0, full disagreement; 5, full agreement); agreement was reached for >75% of answers rating 4-5. All items with agreement were included in the preliminary core set of educational procedures, which underwent external assessment by a broader Consensus group (Faculty and Tutors of previous EULAR PedMSUS courses and PReS Imaging Working Party members), through Delphi survey. Results Two Delphi surveys produced the preliminary core set of procedures for basic, intermediate, advanced and teach-the-teachers (TTT) PedMSUS courses. A Delphi survey within the Consensus group produced agreement on the proposed procedures. Conclusions Shared EULAR/PReS procedures for the conduct, content and format of basic, intermediate, advanced and TTT PedMSUS courses were identified on international basis.

Individual patient-level variables were obtained from a single institution TKR and THR registry b... more Individual patient-level variables were obtained from a single institution TKR and THR registry between 5/1/07 and 2/1/11. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years after elective TKR and THR were collected and retrospectively analysed. We included patients living in New York, Connecticut and New Jersey which is the catchment area for the hospital. Individuals' geocodable addresses were used to obtain the number of primary care physicians (PCPs) and specialists in each census tract using the ArcGIS software. Provider density was calculated and broken down into percentage quartiles. Comparisons were made using Kruskal-Wallis tests. Results: A total of 3606 TKR, and 4295 THR patients were included. (figure 1) Mean number of PCPs were 5.4(SD 9.5) and specialists were 15.8(SD 41.1) per census tract. The median number of PCPs were 2 (IQR 1, 6) and specialists were 3 (IQR 1, 13). Neighbourhood poverty or education correlated poorly with the number of PCPs and specialists. Baseline WOMAC pain and function scores (table 1) are statistically significantly better in neighbourhoods with a higher proportion of specialists, but not PCPs. These differences were no longer present 2 years after surgery. Abstract OP0338-Table 1 Association of specialist proportions in neighbourhoods with WOMAC* scores Abstract OP0338-Figure 1 Map of New York, New Jersey and Connecticut with census tract specialist provider density and baseline WOMAC pain scores of individual patients. Conclusions: Patients from neighbourhoods with fewer specialists seek arthroplasty with worse baseline pain and function than those from neighbourhoods with more specialists. However, once these patients receive arthroplasty (i.e. specialty care), these differences resolve by 2 years. These data suggest that once a patient can access specialty care in the health care system, their outcomes improve despite worse baseline pain and function.

Annals of the Rheumatic Diseases, Jun 1, 2013

Value in Health, May 1, 2010

and to analyse the determinants of differences between countries. METHODS: This is a multi-countr... more and to analyse the determinants of differences between countries. METHODS: This is a multi-country survey study, based on a combination of desk research and direct contact with national RA stakeholders. Data was collected using a pre-defined questionnaire. Affordability was measured using affordability index, calculated comparing the health care expenditures index to the price index, using Poland as an index of 1. A higher index indicates more limited affordability. RESULTS: The percentage of patients on biologic treatment in 2009 was highest in Hungary (5%), followed by Slovenia (4.5%), Slovakia (3.5%), Czech (2.92%), Romania (2.19%), Estonia (1.8%), Croatia (1.4%) and Serbia (1.3%), lowest in Poland (1%). Infliximab, etanercept, adalimumab and rituximab are included in the reimbursement system in all countries (latest in Bulgaria), abatacept and tocilizumab-only in Slovakia. In Slovenia public payer covered 75% of the price, 25% was covered by supplementary health insurance; in Bulgaria public payer covered 50% of etanercept and adalimumab costs, and 75% of rituximab cost. In other countries biological drugs were reimbursed in 100%. Affordability index for biologic drugs was lowest in Slovenia (0.4), followed by Hungary (0.6), Czech Rep. (0.7), Estonia (0.9), while countries with health care expenditures below 500 USD/capita (Bulgaria, Romania and Serbia) had the highest indexes (1.4-1.9). In each country national guidelines defined which patients were eligible for biologic tretament, and some also defined the sequence in which drugs should be used. DAS28 of over 5.1. and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria. CONCLUSIONS: The most important factors of limited access to biologic anti-RA treatment CEE region are macroeconomic conditions and restrictive treatment guidelines.

Annals of the Rheumatic Diseases

BackgroundSeveral studies have suggested a potential role for ultrasonography (US) in detecting e... more BackgroundSeveral studies have suggested a potential role for ultrasonography (US) in detecting enthesitis in children, thus enhancing the accuracy of the classification of juvenile idiopathic arthritis (JIA) and improving the therapeutic approach. Because of no consensual definition of ultrasonographic enthesitis in children, the pediatric sub-taskforce of the OMERACT working group posed the research question of whether there are sufficient data to support the role of US in the diagnosis and follow-up of enthesitis in JIA, particularly enthesitis related arthritis (ERA).ObjectivesWe performed a systematic literature review (SLR) to assess the value of US for detecting enthesitis in JIA. The main objectives were to determine: i.which elementary lesions have been evaluated by US in JIA patients; ii.which definitions and scoring systems were used; and iii.the measurement properties of US in evaluating enthesitis in JIA according to the OMERACT Filter 2.1 Instrument Selection Algorithm...

Annals of the Rheumatic Diseases

BackgroundNew outcome measures are needed to optimize personalized tailored treatment and to pred... more BackgroundNew outcome measures are needed to optimize personalized tailored treatment and to predict response in patients with juvenile idiopathic arthritis (JIA).ObjectivesAim of this multicenter, longitudinal study is to identify biomarker (clinical examination of the joints, ultrasound and inflammatory biomarkers) for the evaluation of disease activity in children with JIA.MethodsDAISY study planned to recruit 120 patients with JIA polyarticular and at least 30 patients with JIA oligoarticular disease course according to International League of Association for Rheumatology (ILAR) classification criteria, with active disease calculated by JADAS 10 and 27 and treated according to current recommendations[1,2]. At enrollment, 3, 6 and 12 months patients were simultaneously evaluated for disease activity status (JADAS 10 and 27), examined by musculoskeletal ultrasound (MSUS) gray-scale (GS) and power-doppler (PD) in 44 joints using OMERACT synovitis scoring system by an expert in pedi...

Annals of the Rheumatic Diseases, Jun 1, 2015

Objectives: To explore whether a 4 weeks multidisciplinary intervention including hydrotherapy an... more Objectives: To explore whether a 4 weeks multidisciplinary intervention including hydrotherapy and combined spa-exercise therapy in patients with recent sick-leave due to MSKD improved work outcome at acceptable costs in a period of up to 6 months compared to persons receiving usual care. Methods: Patients in the program-group were compared with a usual care group (UC-group) of subjects matched from an occupational health service database based on age, gender and type of MSKD. Days of sick leave and hazard of work resumption were compared by a bootstrapped independent sample t-test and Cox regression, respectively. The program costs per working day gained in the program group were calculated assuming no changes in healthcare utilization. Within the program-group, healthcare costs and EuroQol (EQ) for the 6 months before and after the program were compared. Results: One hundred eleven program-participants provided data 6 months after the program with a mean age of 47 (±9.9) and of which 77 (69.4%) women. Days absent from work during follow-up since the first sick leave-day were 58.21 (±34.43) and 75.54 (39.78) in the program and UC-group (p=0.002). The Kaplan-Meier curve showed a median time until work resumption of 60 working days in the program-group and 85 working days in the UC-group (Fig.1) The hazard of work resumption in program-participants was not significantly lower than in the UC-group during the first 20 days of observation [hazard ratio (HR) 0.54 (95% CI 0.25-1.15)] but significantly higher thereafter [HR 1.60 (95% CI 1.22-2.11)]. Average productivity costs were 11,457 (±9,265/median 8,549) in the program-group and 15,680 (±10,864/ median 12,848) in the UC-group (p=0.001). Program costs were 6172 and costs per working day gained were 356. Costs of healthcare utilization in program-participants decreased from 1887 (±3755)/6 months/patient to 1112 (±1470)/6 months/patient.EQ-5D/EQ-VAS improved significantly from 0.57 (±0.26) to 0.70 (±0.22) and from 56.07 (±15.06) to 69.44 (±13.56) 6 months after the program. Conclusions: In MSKD-patients on recent sick leave, the multidisciplinary program reduces the total length of sick leave compared to usual care. Costs of the treatment program are partially offset by improvement in health and healthcare costs. References: [1] Waddell et al. Report for the Vocational Rehabilitation Task Group; TSO; 2008. [2] van Tubergen et al. Arthritisand Rheumatism; 2001.

Background/Purpose: Image fusion is an advanced imaging technology, which enables fusion of ultra... more Background/Purpose: Image fusion is an advanced imaging technology, which enables fusion of ultrasound (US) and magnetic resonance imaging (MRI). This fusion gives for each US probe position an exact projection of the corresponding anatomical area on a previously obtained MR image, during a live US assessment. This study is the first to address image fusion of US and MRI tenosynovitis. The aim of this study was to assess and compare US and MRI visualisation of tenosynovitis using image fusion technique. Methods: Fifteen rheumatoid arthritis patients with US verified tenosynovitis in the wrist or hand had an MRI performed of the affected wrist or hand. A subsequent image fusion was performed, i.e. the MR images and a live US assessment of one tendon sheath were fused. In order to compare the two imaging modalities quantitatively, the area of the tendon and tendon sheath in the transverse axis was measured on US and MRI for each image fusion. Due to partial volume artefacts (voxel containing two different tissues and therefore possessing a signal average of tendon and tendon sheath) on MRI two measures were performed; area 1) the circumference of the black tendon, i.e. excluding voxels containing two types of tissue 2) the circumference of the grey line that surrounds the black tendon, i.e. including voxels containing two types of tissue. Tenosynovitis was assessed using the proposed OMERACT semi-quantitative scoring system for US and MRI. US scoring was therefore based on both grey scale and Doppler, whereas MRI scoring was based only on post-contrast tenosynovial enhancement, measured as distance from the tendon to end of the enhanced tendon sheath. Results: The median circumference area of the tendons and tendon sheaths on US and MRI 1 and 2 were respectively 0.16 (25;75 pctl: 0.10;0.25), 0.9 (0.06-0.18) and 0.13 of (0.10;0.25) for the tendons and 0.18 (0.13-0.26), 0.27 (0.20-0.45) and 0.23 (0.16-0.40) for the tendon sheaths. Statistically significant differences were found for all measured areas between US and MRI, except for the US tendon area and the MRI tendon area 2 (Wilcoxon's test; p=0.47). Overall agreement between US and MRI tenosynovitis scoring systems was good (see table 1). Conclusion: In conclusion, we found that US and MRI have good agreement for quantitative assessment of tendons and scoring of tenosynovitis, when comparing the two modalities using image fusion, if the partial volume artefacts on MRI are included in the measure.

Rheumatology, Oct 1, 2017

Rheumatology, Oct 6, 2021

Objectives. Burden of comorbidities are largely unknown in JIA. From 2000, national and internati... more Objectives. Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/ internationally-UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild-to quantify the occurrence of selected comorbidities in patients with JIA. Methods. Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. Results. 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1-1.8%) and uveitis (15-19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). Conclusion. This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies.

Acta Medica Medianae, Sep 15, 2021

In the last decade, tumor necrosis factor- (TNF-) inhibitors have shown excellent control of oc... more In the last decade, tumor necrosis factor- (TNF-) inhibitors have shown excellent control of ocular inflammation in juvenile idiopathic arthritis (JIA)-associated uveitis. We have retrospectively evaluated the long-term efficacy and safety of adalimumab in 19 biologically naive patients with JIA-associated uveitis from our biologic registry. Demographic data and blood samples were collected at different time points. Uveitis activity was evaluated by slit-lamp biomicroscopy. Adverse events were recorded. The registry records provided a ten-year follow-up of 11 (57.90%) female patients diagnosed with oligo/extended oligoarticular JIA-associated uveitis and 8 (42.10%) males diagnosed with enthesitis-related arthritis (ERA) with uveitis. Adalimumab was the first biologic prescribed to JIA patients with active uveitis that failed to respond to standard treatment. A ten-year long follow-up period has shown that there were no new relapsis of uveitis while patients were receiving adalimumab and metotrexate. All of our patients after adalimumab introduction were able to gradually tapper and stop treatment with topical steroids. Thirty-six point eighty-four percent of our patients were able to stop biological treatment 36 months after adalimumab commencing. Uveitis has relapsed three monts after the adalimumab discontinuation only in two patients (10.53%). No serious adverse events were recorded. Thirty-one point fifty-eight percent of patients expirienced minor adverse events. During a long-term follow-up, adalimumab showed good efficacy and safety profile in JIA patients with active inflammatory ocular disease.

Annals of the Rheumatic Diseases, Jun 1, 2015

Background: Studies on obesity and the risk for development of rheumatoid arthritis (RA) have sho... more Background: Studies on obesity and the risk for development of rheumatoid arthritis (RA) have shown diverse results, and studies with prospectively collected data are few. Objectives: To evaluate the association between obesity and subsequent risk for development of RA. Methods: In The Västerbotten Interventional Program (VIP) or/and The WHO project Multinational MONItoring of Trends and Determinants of CArdiovascular Disease (MONICA) 1985-2013 individuals with RA (year of onset of symptoms 1989-2013) were identified (cases, n=550), and data from the latest visit antedating onset of RA symptoms were retrieved. From the same populationbased, prospective cohorts 1650 controls, matched for age, sex, cohort, inclusion year, cohort and area of inhabitance (rural/urban) were randomly selected. Prospectively collected data on body mass index (BMI; weight/lenght 2), smoking habits, and educational level was used in calculations of odds ratio; OR (95% confidence interval) in conditional logistical regression assessing associations between obesity and the risk for development of RA. Results: The cases (mean age at RA symptom onset 58 SD 11 years, 68% women) had been included in the cohorts (MONICA n=49, VIP n=501) at median 6.7 (IQR 6.4) years before the onset of symptoms of RA. Obesity (BMI≥30) was associated with an increased risk for RA development, OR 1.4 (1.1-1.9), compared to those with normal weight (BMI 18.5-25). The association was stronger in male subjects (Table 1). Stratifying the patients on age at onset of symptoms of RA the association between obesity and the risk of RA was only observed in the quartile with earliest disease debut, 32-50 years, OR for obesity vs. normal weight 1.9 (1.1-3.7).

Annals of the Rheumatic Diseases, Jun 1, 2016

33 to use. The experiences of using tRAppen seemed to be influenced by physical and mental state ... more 33 to use. The experiences of using tRAppen seemed to be influenced by physical and mental state and personal preferences. Conclusions: The use of co-design in the development of the physical activity self-management service tRAppen was successful. The first test version was perceived as feasible and to have the potential to support a physically active lifestyle. Co-design in collaborative workshops involved an extensive decisionmaking process that put high demands on the participants' ability to find solutions, negotiate, come to agreements, and reach final decisions. References: [1] Revenäs Å, Opava C, Åsenlöf P. Lead users' ideas on core features to support physical activity in rheumatoid arthritis: a first step in the development of an Internet service using participatory design.

Srpski arhiv za celokupno lekarstvo

Introduction/Objective. The aim of our study was to retrospectively analyze data about efficacy a... more Introduction/Objective. The aim of our study was to retrospectively analyze data about efficacy and persistence on different anti-TNF? treatment in spondyloarthritis (SpA). Methods. We retrospectively analyzed SpA patients whose data were entered into the Serbian national SpA registry. All patients were divided in two groups: non-switcher (patients who were treated with one anti-TNF?) and switcher group (who has switched from first to second and third anti-TNF?). Disease activity was measured by the Ankylosing Spondylitis Disease Score and the Bath Ankylosing Spondylitis Disease Activity Index and functional status was measured by the Bath Ankylosing Spondylitis Functional Index. Results. We identified 290 SpA patients ? 250 patients with axial SpA (axSpA) and 40 patients with peripheral SpA (pSpA). Among 250 patients with axSpA, 192 (76.8%) did not change first anti-TNF?, while 58 (23.2%) switched to the second and 14 (5.6%) switched to the third anti-TNF?. Among 40 patients with p...

Annals of the Rheumatic Diseases, Jun 1, 2014

Background: IL-17 is a proinflammatory cytokine, which overproduction promotes the autoimmune rea... more Background: IL-17 is a proinflammatory cytokine, which overproduction promotes the autoimmune reaction in rheumatoid arthritis (RA). Recent studies have shown that IL-17 production in lymphocytes or its function could be regulated by miR-223 by targeting Roquin ubiquitin ligase or its receptors 1-4. Objectives: To examine a possible correlation between the expression levels of miR-223 and IL-17A in peripheral blood (PB) and synovial fluid (SF) of RA patients. Methods: Expression levels of miR-223 were determined in matched PB and SF samples of RA patients by relative quantitation method 2-DDCt. As reference control for normalisation RNU6B gene was used. Concentrations of IL-17A in matched serum and SF samples were determined by Human IL-17A ELISA kit (Gene probe, Diaclone). The results were compared to healthy control (HCs) as well as within the RA group. Results: 58,73% of the RA patients showed overexpression of miR-223 in PB when compared to HCs (p=0.008) with AUC=0.673 (95 CI: 0.562/0.784), with 71.4% sensitivity and 46.9% specificity (p=0.006). miR-223 was overexpressed in 79.17% of RA SF (p=1.64 × 10-3) when compared to HCs SF with AUC=0.841 (95 CI: 0.724/0.958) with 87.5% sensitivity and 72.7% specificity (p=4.6 × 10-4). Within the RA group, SF miR-223 was underexpressed in 58.7% of the patients compared to its systemic levels. Levels of IL-17A were higher in RA SF compared to serum (8.645 pg/ml versus 0.315 pg/ml, p=0.012). Conclusions: The difference between the systemic and local levels of miR-223 and IL17A in RA patients shows that the inflammatory disease process leads to their altered expression with a possible role of both molecules in the disease pathogenesis. The opposite changes in their systemic and local levels confirm the data about the possible role of miR-223 in regulating IL-17 function.

Rheumatology International, Jan 24, 2019

Oxidative stress is believed to be of great importance for both the etiology and the persistence ... more Oxidative stress is believed to be of great importance for both the etiology and the persistence of juvenile idiopathic arthritis (JIA). The aim of this study was to investigate the association of-262C/T polymorphism of the catalase (CAT) gene with JIA, as well as to evaluate whether this polymorphism can influence plasma CAT activity and outcome in JIA patients treated with etanercept. A total of 154 subjects (60 JIA patients and 94 healthy volunteers) were screened for CAT-262C/T gene polymorphism using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method. Plasma CAT activity was determined using the spectrophotometric method according to Goth, prior to and 12 months after anti-TNF (etanercept) therapy. Clinical outcome was assessed using the JIA ACR (American College of Rheumatology) response criteria. The genotype and allele frequency distributions of CAT-262C/T polymorphism in the patients were significantly different from those of the controls (p = 0.014, p = 0.006). The TT genotype (polymorphic homozygous) was associated with a 4.36-fold higher likelihood of having JIA (95% CI 1.545-12.323, p = 0.005) as compared to the CC genotype (wildtype). At month 12 of treatment, JIA patients, carriers of the CC genotype, showed significantly higher plasma CAT activity (p = 0.004) and achieved the JIA ACR 70 response more often (p = 0.003) than the patients, carriers of the CT/TT genotype. This is the first study implying the possible association of CAT-262C/T polymorphism with JIA. The results suggest the potential protective effect of the CC genotype, with regard to CAT activity and treatment outcome.

Dermatologic Therapy, Dec 4, 2019

Linear IgA dermatosis (LAD) is a rare autoimmune disorder in children. A 9‐year‐old boy was prese... more Linear IgA dermatosis (LAD) is a rare autoimmune disorder in children. A 9‐year‐old boy was presented with blisters on the intact skin (face, body, arms, hands, soles, perigenital and perianal area) after amoxicillin treatment. Systemic corticosteroids and dapsone treatment for 6 weeks was successful. Clinical and immunofluorescence examinations are most important for differentiation of LAD and other drug‐induced bullous dermatoses. They enable an early introduction of proper therapy.

RMD Open, Oct 1, 2015

Objective: To produce educational guidelines for the conduct, content and format of theoretical a... more Objective: To produce educational guidelines for the conduct, content and format of theoretical and practical teaching at EULAR musculoskeletal ultrasound (MSUS) Teaching the Teachers (TTT) Courses. Methods: A Delphi-based procedure with 24 recommendations covering five main areas (Duration and place of the course; Faculty members; Content of the course; Evaluation of the teaching skills; TTT competency assessment) was distributed among a group of experts involved in MSUS teaching, in addition to an advisory educational expert being present. Consensus for each recommendation was considered achieved when the percentage of agreement was >75%. Results: 21 of 24 invited participants responded to the first Delphi questionnaire (88% response rate). All 21 participants also responded to the second round. Agreement on 19 statements was obtained after two rounds. Conclusions: This project has led to the development of guidelines for the conduct, content and format of teaching at the EULAR MSUS TTT Courses that are organised annually, with the aim of training future teachers of EULAR MSUS Courses, EULAR Endorsed MSUS Courses, as well as national and local MSUS Courses. The presented work gives indications on how to homogenise the teaching at the MSUS TTT Courses, thus resolving current discrepancies in the field.

Rheumatology, May 4, 2023

Objectives: CLIPPER2 was an 8-year, open-label extension of the phase 3b, 2-year CLIPPER study on... more Objectives: CLIPPER2 was an 8-year, open-label extension of the phase 3b, 2-year CLIPPER study on the safety and efficacy of etanercept in patients with juvenile idiopathic arthritis (JIA), categorized as extended oligoarticular arthritis (eoJIA), enthesitis-related arthritis (ERA), or psoriatic arthritis (PsA). Methods: Participants with eoJIA (2-17 years old), ERA, or PsA (each 12-17 years old) who received ≥1 etanercept dose (0.8 mg/kg weekly; maximum 50 mg) in CLIPPER could enter CLIPPER2. Primary endpoint was occurrence of malignancy. Efficacy assessments included proportions achieving JIA American College of Rheumatology (ACR) 30/50/70/90/100 criteriaand ACR inactive disease criteria, and clinical remission (ACR criteria) or Juvenile Arthritis Disease Activity Score (JADAS) ≤1. Results: Overall, 109/127 (86%) CLIPPER participants entered CLIPPER2 (n=55 eoJIA, n=31 ERA, n=23 PsA; 99 [78%] on active treatment); 84 (66%) completed 120 months' follow-up (32 [25%] on active treatment). One malignancy (Hodgkin's disease in 18-year-old patient with eoJIA treated with methotrexate for 8 years) was reported; there were no cases of active tuberculosis or deaths. Numbers and incidence rates [events per 100 patient-years] of TEAEs (excluding infections/ISRs) decreased from 193 [173.81] in Year 1 to 9 [27.15] in Year 10; TE infections and serious infections also decreased. Over 45% of participants (N=127) achieved JIA ACR50 responses from Month 2 onwards; 42 (33%) and 17 34 (27%) participants achieved JADAS and ACR clinical remission, respectively. 4 Conclusions: Etanercept treatment up to 10 years was well tolerated, consistent with the known safety profile, with durable response in the participants still on active treatment. The benefit-risk assessment of etanercept in these JIA categories remains favorable.

RMD Open, Jul 1, 2022

Background Despite the worldwide increasing request of education on paediatric musculoskeletal ul... more Background Despite the worldwide increasing request of education on paediatric musculoskeletal ultrasound (PedMSUS), content, conduct and format of PedMSUS courses have never been internationally agreed. Objectives To produce educational procedures for the conduct, content and format of EULAR/PReS PedMSUS courses. Methods After a systemic literature review and expert opinion collection, a panel of items for the development of procedures on PedMSUS courses was identified. Agreement on the items was assessed through Delphi surveys among a taskforce of 24 members, which included 18 experts in PedMSUS (8 rheumatologists, 1 radiologist, 9 paediatric rheumatologists), 1 methodologist and rheumatologist expert in MSUS, 2 patient research partners, 1 health professional in rheumatology and 2 EMEUNET/EMERGE members, from 8 different European countries. Each item was assessed through a 5-point Likert scale (0, full disagreement; 5, full agreement); agreement was reached for >75% of answers rating 4-5. All items with agreement were included in the preliminary core set of educational procedures, which underwent external assessment by a broader Consensus group (Faculty and Tutors of previous EULAR PedMSUS courses and PReS Imaging Working Party members), through Delphi survey. Results Two Delphi surveys produced the preliminary core set of procedures for basic, intermediate, advanced and teach-the-teachers (TTT) PedMSUS courses. A Delphi survey within the Consensus group produced agreement on the proposed procedures. Conclusions Shared EULAR/PReS procedures for the conduct, content and format of basic, intermediate, advanced and TTT PedMSUS courses were identified on international basis.

Individual patient-level variables were obtained from a single institution TKR and THR registry b... more Individual patient-level variables were obtained from a single institution TKR and THR registry between 5/1/07 and 2/1/11. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores at baseline and 2 years after elective TKR and THR were collected and retrospectively analysed. We included patients living in New York, Connecticut and New Jersey which is the catchment area for the hospital. Individuals' geocodable addresses were used to obtain the number of primary care physicians (PCPs) and specialists in each census tract using the ArcGIS software. Provider density was calculated and broken down into percentage quartiles. Comparisons were made using Kruskal-Wallis tests. Results: A total of 3606 TKR, and 4295 THR patients were included. (figure 1) Mean number of PCPs were 5.4(SD 9.5) and specialists were 15.8(SD 41.1) per census tract. The median number of PCPs were 2 (IQR 1, 6) and specialists were 3 (IQR 1, 13). Neighbourhood poverty or education correlated poorly with the number of PCPs and specialists. Baseline WOMAC pain and function scores (table 1) are statistically significantly better in neighbourhoods with a higher proportion of specialists, but not PCPs. These differences were no longer present 2 years after surgery. Abstract OP0338-Table 1 Association of specialist proportions in neighbourhoods with WOMAC* scores Abstract OP0338-Figure 1 Map of New York, New Jersey and Connecticut with census tract specialist provider density and baseline WOMAC pain scores of individual patients. Conclusions: Patients from neighbourhoods with fewer specialists seek arthroplasty with worse baseline pain and function than those from neighbourhoods with more specialists. However, once these patients receive arthroplasty (i.e. specialty care), these differences resolve by 2 years. These data suggest that once a patient can access specialty care in the health care system, their outcomes improve despite worse baseline pain and function.

Annals of the Rheumatic Diseases, Jun 1, 2013

Value in Health, May 1, 2010

and to analyse the determinants of differences between countries. METHODS: This is a multi-countr... more and to analyse the determinants of differences between countries. METHODS: This is a multi-country survey study, based on a combination of desk research and direct contact with national RA stakeholders. Data was collected using a pre-defined questionnaire. Affordability was measured using affordability index, calculated comparing the health care expenditures index to the price index, using Poland as an index of 1. A higher index indicates more limited affordability. RESULTS: The percentage of patients on biologic treatment in 2009 was highest in Hungary (5%), followed by Slovenia (4.5%), Slovakia (3.5%), Czech (2.92%), Romania (2.19%), Estonia (1.8%), Croatia (1.4%) and Serbia (1.3%), lowest in Poland (1%). Infliximab, etanercept, adalimumab and rituximab are included in the reimbursement system in all countries (latest in Bulgaria), abatacept and tocilizumab-only in Slovakia. In Slovenia public payer covered 75% of the price, 25% was covered by supplementary health insurance; in Bulgaria public payer covered 50% of etanercept and adalimumab costs, and 75% of rituximab cost. In other countries biological drugs were reimbursed in 100%. Affordability index for biologic drugs was lowest in Slovenia (0.4), followed by Hungary (0.6), Czech Rep. (0.7), Estonia (0.9), while countries with health care expenditures below 500 USD/capita (Bulgaria, Romania and Serbia) had the highest indexes (1.4-1.9). In each country national guidelines defined which patients were eligible for biologic tretament, and some also defined the sequence in which drugs should be used. DAS28 of over 5.1. and failure of 2 or more disease-modifying anti-RA drugs, including methotrexate, are commonly used criteria. CONCLUSIONS: The most important factors of limited access to biologic anti-RA treatment CEE region are macroeconomic conditions and restrictive treatment guidelines.

Annals of the Rheumatic Diseases

BackgroundSeveral studies have suggested a potential role for ultrasonography (US) in detecting e... more BackgroundSeveral studies have suggested a potential role for ultrasonography (US) in detecting enthesitis in children, thus enhancing the accuracy of the classification of juvenile idiopathic arthritis (JIA) and improving the therapeutic approach. Because of no consensual definition of ultrasonographic enthesitis in children, the pediatric sub-taskforce of the OMERACT working group posed the research question of whether there are sufficient data to support the role of US in the diagnosis and follow-up of enthesitis in JIA, particularly enthesitis related arthritis (ERA).ObjectivesWe performed a systematic literature review (SLR) to assess the value of US for detecting enthesitis in JIA. The main objectives were to determine: i.which elementary lesions have been evaluated by US in JIA patients; ii.which definitions and scoring systems were used; and iii.the measurement properties of US in evaluating enthesitis in JIA according to the OMERACT Filter 2.1 Instrument Selection Algorithm...

Annals of the Rheumatic Diseases

BackgroundNew outcome measures are needed to optimize personalized tailored treatment and to pred... more BackgroundNew outcome measures are needed to optimize personalized tailored treatment and to predict response in patients with juvenile idiopathic arthritis (JIA).ObjectivesAim of this multicenter, longitudinal study is to identify biomarker (clinical examination of the joints, ultrasound and inflammatory biomarkers) for the evaluation of disease activity in children with JIA.MethodsDAISY study planned to recruit 120 patients with JIA polyarticular and at least 30 patients with JIA oligoarticular disease course according to International League of Association for Rheumatology (ILAR) classification criteria, with active disease calculated by JADAS 10 and 27 and treated according to current recommendations[1,2]. At enrollment, 3, 6 and 12 months patients were simultaneously evaluated for disease activity status (JADAS 10 and 27), examined by musculoskeletal ultrasound (MSUS) gray-scale (GS) and power-doppler (PD) in 44 joints using OMERACT synovitis scoring system by an expert in pedi...