Rheumatoid Arthritis: Abinun M

Foster H, Davidson J, Baildam E, Abinun M, Wedderburn LR, Anonymous00192. · School Clinical Medical Science (Rheumatology), Medical School, Newcastle University, Framlington Place, Newcastle-upon-Tyne, UK. · Rheumatology (Oxford). · Pubmed #17077155 links to  free full text

This publication has no abstract.

Wedderburn LR, Abinun M, Palmer P, Foster HE. · Rheumatology Unit, Institute of Child Health, UCL and Great Ormond Street Hospital NHS Trust, London, UK. · Arch Dis Child. · Pubmed #12598377 links to  free full text

This publication has no abstract.

Foster HE, Eltringham MS, Kay LJ, Friswell M, Abinun M, Myers A. · Musculoskeletal Research Group, School Clinical Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. · Arthritis Rheum. · Pubmed #17665486 links to  free full text

Abstract: OBJECTIVE: To document pathways of care, management, and interval from onset of symptoms to first pediatric rheumatology multidisciplinary team (PRhMDT) assessment for children with incident juvenile idiopathic arthritis (JIA). METHODS: We conducted a retrospective observational study of children with incident JIA over a 3-year period. RESULTS: The study included 152 patients with JIA (87 females). The median interval from symptom onset to first PRhMDT assessment was 20 weeks (range 0-416), with significant variation between JIA subtypes (P = 0.0097); children with extended oligoarticular JIA had the longest interval (median 60 weeks, range 12-320). Prior to pediatric rheumatology assessment, many children had referrals to multiple secondary care specialties and had been subjected to multiple and often invasive procedures including arthroscopy/synovial biopsy (18 [11.8%] of 152), but none were referred for ophthalmologic screening, physical therapy, or nursing input and a diagnosis of JIA was rarely made (98%). At first PRhMDT assessment, most patients had untreated active disease with active joint count >or=1 (135 [89%] of 152), restricted joint count >or=1 (135 [89%] of 152), and functional disability by Child Health Assessment Questionnaire score >0 (53 [68%] of 118); 1 child had undetected uveitis. Following PRhMDT assessment, interventions were invariably indicated, including joint injections (69 [45%] of 152), methotrexate (49 [32%] of 152), and physical therapy programs (all patients). CONCLUSION: Delay in access to pediatric rheumatology assessment is common with complex pathways of referral. Many children were subjected to inappropriate invasive investigations and many had prolonged untreated active disease at the initial PRhMDT assessment. This delay is likely to affect long-term outcome and warrants further exploration.

De Kleer IM, Brinkman DM, Ferster A, Abinun M, Quartier P, Van Der Net J, Ten Cate R, Wedderburn LR, Horneff G, Oppermann J, Zintl F, Foster HE, Prieur AM, Fasth A, Van Rossum MA, Kuis W, Wulffraat NM. · Paediatric BMT unit, Suite KC 03.063, University Medical Centre Utrecht, PO box 85090, 3508 AB Utrecht, Netherlands. · Ann Rheum Dis. · Pubmed #15361393 links to  free full text

Abstract: OBJECTIVE: To evaluate the safety and efficacy of autologous stem cell transplantation (ASCT) for refractory juvenile idiopathic arthritis (JIA). DESIGN: Retrospective analysis of follow up data on 34 children with JIA who were treated with ASCT in nine different European transplant centres. Rheumatological evaluation employed a modified set of core criteria. Immunological reconstitution and infectious complications were monitored at three month intervals after transplantation. RESULTS: Clinical follow up ranged from 12 to 60 months. Eighteen of the 34 patients (53%) with a follow up of 12 to 60 months achieved complete drug-free remission. Seven of these patients had previously failed treatment with anti-TNF. Six of the 34 patients (18%) showed a partial response (ranging from 30% to 70% improvement) and seven (21%) were resistant to ASCT. Infectious complications were common. There were three cases of transplant related mortality (9%) and two of disease related mortality (6%). CONCLUSIONS: ASCT in severely ill patients with JIA induces a drug-free remission of the disease and a profound increase in general wellbeing in a substantial proportion of patients, but the procedure carries a significant mortality risk. The following adjustments are proposed for future protocols: (1) elimination of total body irradiation from the conditioning regimen; (2) prophylactic administration of antiviral drugs and intravenous immunoglobulins until there is a normal CD4+ T cell count.

Wulffraat NM, Brinkman D, Ferster A, Opperman J, ten Cate R, Wedderburn L, Foster H, Abinun M, Prieur AM, Horneff G, Zintl F, de Kleer I, Kuis W. · Department of Pediatrics, University Medical Center Utrecht, AB, Utrecht, The Netherlands. · Bone Marrow Transplant. · Pubmed #12931245 No free full text.

Abstract: Since 1997, autologous stem cell transplantation (ASCT) had been applied to more than 40 children with polyarticular or systemic juvenile idiopathic arthritis (JIA). For this review, results of the follow-up are available from 25 children with systemic JIA and six with polyarticular JIA that were reported in detail from eight different pediatric European transplant centers. Before ASCT all children had progressive disease despite the use of corticosteroids, methotrexate (MTX) up to 1 mg/kg/week, cyclosporin (2.5 mg/kg/day) and/or anti-TNFalpha therapy. The clinical follow-up of these children ranges from 8 to 60 months (median 33 months).

Ferreira RA, Vastert SJ, Abinun M, Foster HE, Modesto C, Olivé T, Kuis W, Wulffraat NM. · No affiliation provided · Bone Marrow Transplant. · Pubmed #16770315 No free full text.

This publication has no abstract.