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4. Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Author

McErlane, Flora, Beresford, Michael W., Baildam, Eileen M., Thomson, Wendy, Hyrich, Kimme, Chieng, Alice, Davidson, Joyce, Foster, Helen E., Gardner-Medwin, Janet, Lunt, Mark, Wedderburn, Lucy, Nikiphorou, Elena, Carpenter, Lewis, Kiely, Patrick, Walsh, David, Dixey, Josh, Young, Adam, Kapoor, Sabrina R., Filer, Andrew, Fitzpatrick, Martin, Fisher, Benjamin A., Taylor, Peter C., Buckley, Christopher, McInnes, Iain, Raza, Karim, Young, Stephen P., Dougados, Maxime, Kissel, Karsten, Amital, Howard, Conaghan, Philip, Martin-Mola, Emilio, Nasonov, Evgeny, Schett, Georg, Troum, Orrin, Veldi, Tiina, Bernasconi, Corrado, Huizinga, Tom, Durez, Patrick, Genovese, Mark C., Richards, Hanno B., Supronik, Jerzy, Dokoupilova, Eva, Aelion, Jacob A., Lee, Sang-Heon, Codding, Christine E., Kellner, Herbert, Ikawa, Takashi, Hugot, Sophie, Ligozio, Gregory, Mpofu, Shephard, Kavanaugh, Arthur, Emery, Paul, Fleischmann, Roy, Van Vollenhoven, Ronald, Pavelka, Karel, Guérette, Benoît, Santra, Sourav, Redden, Laura, Kupper, Hartmut, Smolen, Josef S., Wilkie, Ross, Tajar, Abdelouahid, McBeth, John, Hooper, Lindsey S., Bowen, Catherine J., Gates, Lucy, Culliford, David, Edwards, Christopher J., Arden, Nigel K., Adams, Jo, Ryan, Sarah, Haywood, Hannah, Pain, Helen, Siddle, Heidi J., Redmond, Anthony C., Waxman, Robin, Dagg, Abigail R., Alcacer-Pitarch, Begonya, Wilkins, Richard A., Helliwell, Philip S., Norton, Sam, Williams, Richard, Halls, Serena, Law, Rebecca-Jane, Jones, Jeremy, Markland, David, Maddison, Peter, Thom, Jeanette, Parker, Ben, Urowitz, Murray B., Gladman, Dafna D., Bruce, Ian, Croca, Sara C., Pericleous, Charis, Yong, Harry, Isenberg, David, Giles, Ian, Rahman, Anisur, Ioannou, Yiannis, Warrell, Clare E., Dobarro, David, Handler, Clive, Denton, Christopher P., Schreiber, Benjamin E., Coghlan, John G., Betteridge, Zoe E., Woodhead, Felix, Bunn, Christopher, Abraham, David, Desai, Sujal, du Bois, Roland, Wells, Athol, McHugh, Neil, Abignano, Giuseppina, Aydin, Sibel, Castillo-Gallego, Conception, Woods, Daniel, Meekings, Adam, McGonagle, Dennis, Del Galdo, Francesco, Vila, Josephine, Mitchell, Sheryl, Bowman, Simon, Price, Elizabeth, Pease, Colin T., Andrews, Jacqueline, Bombardieri, Michele, Sutcliffe, Nurhan, Pitzalis, Constantino, Lanyon, Peter, Hunter, John, Gupta, Monica, McLaren, John, Regan, Marian, Cooper, Annie, Vadivelu, Saravanan, Coady, David, Griffiths, Bridget, Lendrem, Dennis, Foggo, Heather, Tarn, Jessica, Ng, Wan-Fai, Goodhead, Charlotte, Shekar, Priya, Kelly, Clive, Francis, Gail, Bailey, Ann-Marie, Thompson, Lynsey, Hamilton, Jennifer, Salisbury, Chris, Foster, Nadine E., Bishop, Annette, Coast, Jo, Franchini, Angelo, Hall, Jeanette, Hollinghurst, Sandra, Hopper, Cherida, Grove, Sean, Kaur, Surinder, Montgomery, Alan, Paskins, Zoe, Sanders, Tom, Croft, Peter R., Hassell, Andy B., Coxon, Domenica E., Frisher, Martin, Jordan, Kelvin P., Jinks, Clare, Peat, George, Monk, Helen L., Muller, Sara, Mallen, Christian, Hider, Samantha L., Roddy, Edward, and Hayward, Richard

Abstract

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JADAS without inclusion of the ESR. Disclosure statement: All authors have declared no conflicts of interest. Table 1Spearman's correlation between JADAS 71 and single markers DA by ILAR subtype ILAR Subtype Systemic onset JIA Persistent oligo JIA Extended oligo JIA Rheumatoid factor neg JIA Rheumatoid factor pos JIA Enthesitis related JIA Psoriatic JIA Undifferentiated JIA Unknown subtype Total cohort Number of children 23 111 12 57 7 9 19 7 17 262 AJC 0.54 0.67 0.53 0.75 0.53 0.34 0.59 0.81 0.37 0.59 PGA 0.63 0.69 0.25 0.73 0.14 0.05 0.50 0.83 0.56 0.64 PGE 0.51 0.68 0.83 0.61 0.41 0.69 0.71 0.9 0.48 0.61 ESR 0.28 0.31 0.35 0.4 0.6 0.85 0.43 0.7 0.5 0.53 Limited 71 JC 0.29 0.51 0.23 0.37 0.14 -0.12 0.4 0.81 0.45 0.41 Parental pain 0.23 0.62 0.03 0.57 0.41 0.69 0.7 0.79 0.42 0.53 Childhood health assessment questionnaire 0.25 0.57 -0.07 0.36 -0.47 0.84 0.37 0.8 0.66 0.47

Published
2017

5. Oral abstracts 3: RA Treatment and outcomesO13. Validation of jadas in all subtypes of juvenile idiopathic arthritis in a clinical setting

Author

McErlane, Flora, Beresford, Michael W., Baildam, Eileen M., Thomson, Wendy, Hyrich, Kimme, Chieng, Alice, Davidson, Joyce, Foster, Helen E., Gardner-Medwin, Janet, Lunt, Mark, Wedderburn, Lucy, Nikiphorou, Elena, Carpenter, Lewis, Kiely, Patrick, Walsh, David, Dixey, Josh, Young, Adam, Kapoor, Sabrina R., Filer, Andrew, Fitzpatrick, Martin, Fisher, Benjamin A., Taylor, Peter C., Buckley, Christopher, McInnes, Iain, Raza, Karim, Young, Stephen P., Dougados, Maxime, Kissel, Karsten, Amital, Howard, Conaghan, Philip, Martin-Mola, Emilio, Nasonov, Evgeny, Schett, Georg, Troum, Orrin, Veldi, Tiina, Bernasconi, Corrado, Huizinga, Tom, Durez, Patrick, Genovese, Mark C., Richards, Hanno B., Supronik, Jerzy, Dokoupilova, Eva, Aelion, Jacob A., Lee, Sang-Heon, Codding, Christine E., Kellner, Herbert, Ikawa, Takashi, Hugot, Sophie, Ligozio, Gregory, Mpofu, Shephard, Kavanaugh, Arthur, Emery, Paul, Fleischmann, Roy, Van Vollenhoven, Ronald, Pavelka, Karel, Guérette, Benoît, Santra, Sourav, Redden, Laura, Kupper, Hartmut, Smolen, Josef S., Wilkie, Ross, Tajar, Abdelouahid, McBeth, John, Hooper, Lindsey S., Bowen, Catherine J., Gates, Lucy, Culliford, David, Edwards, Christopher J., Arden, Nigel K., Adams, Jo, Ryan, Sarah, Haywood, Hannah, Pain, Helen, Siddle, Heidi J., Redmond, Anthony C., Waxman, Robin, Dagg, Abigail R., Alcacer-Pitarch, Begonya, Wilkins, Richard A., Helliwell, Philip S., Norton, Sam, Williams, Richard, Halls, Serena, Law, Rebecca-Jane, Jones, Jeremy, Markland, David, Maddison, Peter, Thom, Jeanette, Parker, Ben, Urowitz, Murray B., Gladman, Dafna D., Bruce, Ian, Croca, Sara C., Pericleous, Charis, Yong, Harry, Isenberg, David, Giles, Ian, Rahman, Anisur, Ioannou, Yiannis, Warrell, Clare E., Dobarro, David, Handler, Clive, Denton, Christopher P., Schreiber, Benjamin E., Coghlan, John G., Betteridge, Zoe E., Woodhead, Felix, Bunn, Christopher, Abraham, David, Desai, Sujal, du Bois, Roland, Wells, Athol, McHugh, Neil, Abignano, Giuseppina, Aydin, Sibel, Castillo-Gallego, Conception, Woods, Daniel, Meekings, Adam, McGonagle, Dennis, Del Galdo, Francesco, Vila, Josephine, Mitchell, Sheryl, Bowman, Simon, Price, Elizabeth, Pease, Colin T., Andrews, Jacqueline, Bombardieri, Michele, Sutcliffe, Nurhan, Pitzalis, Constantino, Lanyon, Peter, Hunter, John, Gupta, Monica, McLaren, John, Regan, Marian, Cooper, Annie, Vadivelu, Saravanan, Coady, David, Griffiths, Bridget, Lendrem, Dennis, Foggo, Heather, Tarn, Jessica, Ng, Wan-Fai, Goodhead, Charlotte, Shekar, Priya, Kelly, Clive, Francis, Gail, Bailey, Ann-Marie, Thompson, Lynsey, Hamilton, Jennifer, Salisbury, Chris, Foster, Nadine E., Bishop, Annette, Coast, Jo, Franchini, Angelo, Hall, Jeanette, Hollinghurst, Sandra, Hopper, Cherida, Grove, Sean, Kaur, Surinder, Montgomery, Alan, Paskins, Zoe, Sanders, Tom, Croft, Peter R., Hassell, Andy B., Coxon, Domenica E., Frisher, Martin, Jordan, Kelvin P., Jinks, Clare, Peat, George, Monk, Helen L., Muller, Sara, Mallen, Christian, Hider, Samantha L., Roddy, Edward, Hayward, Richard, McErlane, Flora, Beresford, Michael W., Baildam, Eileen M., Thomson, Wendy, Hyrich, Kimme, Chieng, Alice, Davidson, Joyce, Foster, Helen E., Gardner-Medwin, Janet, Lunt, Mark, Wedderburn, Lucy, Nikiphorou, Elena, Carpenter, Lewis, Kiely, Patrick, Walsh, David, Dixey, Josh, Young, Adam, Kapoor, Sabrina R., Filer, Andrew, Fitzpatrick, Martin, Fisher, Benjamin A., Taylor, Peter C., Buckley, Christopher, McInnes, Iain, Raza, Karim, Young, Stephen P., Dougados, Maxime, Kissel, Karsten, Amital, Howard, Conaghan, Philip, Martin-Mola, Emilio, Nasonov, Evgeny, Schett, Georg, Troum, Orrin, Veldi, Tiina, Bernasconi, Corrado, Huizinga, Tom, Durez, Patrick, Genovese, Mark C., Richards, Hanno B., Supronik, Jerzy, Dokoupilova, Eva, Aelion, Jacob A., Lee, Sang-Heon, Codding, Christine E., Kellner, Herbert, Ikawa, Takashi, Hugot, Sophie, Ligozio, Gregory, Mpofu, Shephard, Kavanaugh, Arthur, Emery, Paul, Fleischmann, Roy, Van Vollenhoven, Ronald, Pavelka, Karel, Guérette, Benoît, Santra, Sourav, Redden, Laura, Kupper, Hartmut, Smolen, Josef S., Wilkie, Ross, Tajar, Abdelouahid, McBeth, John, Hooper, Lindsey S., Bowen, Catherine J., Gates, Lucy, Culliford, David, Edwards, Christopher J., Arden, Nigel K., Adams, Jo, Ryan, Sarah, Haywood, Hannah, Pain, Helen, Siddle, Heidi J., Redmond, Anthony C., Waxman, Robin, Dagg, Abigail R., Alcacer-Pitarch, Begonya, Wilkins, Richard A., Helliwell, Philip S., Norton, Sam, Williams, Richard, Halls, Serena, Law, Rebecca-Jane, Jones, Jeremy, Markland, David, Maddison, Peter, Thom, Jeanette, Parker, Ben, Urowitz, Murray B., Gladman, Dafna D., Bruce, Ian, Croca, Sara C., Pericleous, Charis, Yong, Harry, Isenberg, David, Giles, Ian, Rahman, Anisur, Ioannou, Yiannis, Warrell, Clare E., Dobarro, David, Handler, Clive, Denton, Christopher P., Schreiber, Benjamin E., Coghlan, John G., Betteridge, Zoe E., Woodhead, Felix, Bunn, Christopher, Abraham, David, Desai, Sujal, du Bois, Roland, Wells, Athol, McHugh, Neil, Abignano, Giuseppina, Aydin, Sibel, Castillo-Gallego, Conception, Woods, Daniel, Meekings, Adam, McGonagle, Dennis, Del Galdo, Francesco, Vila, Josephine, Mitchell, Sheryl, Bowman, Simon, Price, Elizabeth, Pease, Colin T., Andrews, Jacqueline, Bombardieri, Michele, Sutcliffe, Nurhan, Pitzalis, Constantino, Lanyon, Peter, Hunter, John, Gupta, Monica, McLaren, John, Regan, Marian, Cooper, Annie, Vadivelu, Saravanan, Coady, David, Griffiths, Bridget, Lendrem, Dennis, Foggo, Heather, Tarn, Jessica, Ng, Wan-Fai, Goodhead, Charlotte, Shekar, Priya, Kelly, Clive, Francis, Gail, Bailey, Ann-Marie, Thompson, Lynsey, Hamilton, Jennifer, Salisbury, Chris, Foster, Nadine E., Bishop, Annette, Coast, Jo, Franchini, Angelo, Hall, Jeanette, Hollinghurst, Sandra, Hopper, Cherida, Grove, Sean, Kaur, Surinder, Montgomery, Alan, Paskins, Zoe, Sanders, Tom, Croft, Peter R., Hassell, Andy B., Coxon, Domenica E., Frisher, Martin, Jordan, Kelvin P., Jinks, Clare, Peat, George, Monk, Helen L., Muller, Sara, Mallen, Christian, Hider, Samantha L., Roddy, Edward, and Hayward, Richard

Abstract

Background: Juvenile Arthritis Disease Activity Score (JADAS) is a 4 variable composite disease activity (DA) score for JIA (including active 10, 27 or 71 joint count (AJC), physician global (PGA), parent/child global (PGE) and ESR). The validity of JADAS for all ILAR subtypes in the routine clinical setting is unknown. We investigated the construct validity of JADAS in the clinical setting in all subtypes of JIA through application to a prospective inception cohort of UK children presenting with new onset inflammatory arthritis. Methods: JADAS 10, 27 and 71 were determined for all children in the Childhood Arthritis Prospective Study (CAPS) with complete data available at baseline. Correlation of JADAS 10, 27 and 71 with single DA markers was determined for all subtypes. All correlations were calculated using Spearman's rank statistic. Results: 262/1238 visits had sufficient data for calculation of JADAS (1028 (83%) AJC, 744 (60%) PGA, 843 (68%) PGE and 459 (37%) ESR). Median age at disease onset was 6.0 years (IQR 2.6-10.4) and 64% were female. Correlation between JADAS 10, 27 and 71 approached 1 for all subtypes. Median JADAS 71 was 5.3 (IQR 2.2-10.1) with a significant difference between median JADAS scores between subtypes (p < 0.01). Correlation of JADAS 71 with each single marker of DA was moderate to high in the total cohort (see Table 1). Overall, correlation with AJC, PGA and PGE was moderate to high and correlation with ESR, limited JC, parental pain and CHAQ was low to moderate in the individual subtypes. Correlation coefficients in the extended oligoarticular, rheumatoid factor negative and enthesitis related subtypes were interpreted with caution in view of low numbers. Conclusions: This study adds to the body of evidence supporting the construct validity of JADAS. JADAS correlates with other measures of DA in all ILAR subtypes in the routine clinical setting. Given the high frequency of missing ESR data, it would be useful to assess the validity of JA

6. Differentiation of Basal Cell Carcinoma Subtypes in Multi-Beam Swept Source Optical Coherence Tomography (MSS-OCT).

Author

Meekings A, Utz S, Ulrich M, Bienenfeld A, Nandanan N, Fisher J, McKenzie G, Siegel DM, Feldman E, and Markowitz O

Subjects
Diagnosis, Differential, Female, Humans, Male, Carcinoma, Basal Cell classification, Carcinoma, Basal Cell diagnostic imaging, Skin Neoplasms classification, Skin Neoplasms diagnostic imaging, Tomography, Optical Coherence methods
Abstract

Background: Optical coherence tomography (OCT) is a technique that enables real-time in-vivo examination of tissue. This technology provides the clinician with the potential to use a non-invasive tool in the identification and diagnosis of many skin lesions. However, the diagnostic features of basal cell carcinoma have not yet been described with comparison to their histopathology., , Objectives: To identify and describe key features of basal cell carcinoma (BCC) and its subtypes as they present in multi-beam Swept Source - OCT (MSS-OCT), and to correlate those against conventional histopathology.
, Methods: A total of 40 lesions were assessed by MSS-OCT prior to biopsy. 60-slice OCT images of the lesions were obtained and correlated with histology sections taken in the same plane. OCT scans were assessed retrospectively by a panel to determine the OCT criteria for BCC and its subtypes.
, Results: The following diagnostic criteria were identified: hyporeflective ovoid structures (40/40), dark halo boundaries (38/40), epidermal thinning (28/40), and collagen compression (14/40). Lesional tissue also showed a destruction of layers when compared to the surrounding normal tissue. In addition to the shared criteria, other subtypes showed distinct diagnostic criteria.
, Conclusion: With its higher sensitivity, using MSS-OCT allowed for non-invasive, accurate identification of the key diagnostic features of BCC and its subtypes with high correlation to the histopathologic features found with biopsy. , , J Drugs Dermatol. 2016;15(5):545-550.

Published
2016

7. Optical coherence tomography imaging of erythematotelangiectatic rosacea during treatment with brimonidine topical gel 0.33%: a potential method for treatment outcome assessment.

Author

Urban J, Siripunvarapon AH, Meekings A, Kalowitz A, and Markowitz O

Subjects
Administration, Cutaneous, Adrenergic alpha-2 Receptor Agonists administration & dosage, Adrenergic alpha-2 Receptor Agonists therapeutic use, Adult, Brimonidine Tartrate, Female, Gels, Humans, Quinoxalines administration & dosage, Rosacea pathology, Severity of Illness Index, Treatment Outcome, Quinoxalines therapeutic use, Rosacea drug therapy, Tomography, Optical Coherence methods
Abstract

Background: Patients with moderate to severe rosacea often seek treatment to reduce erythema and vascular markings. Few studies have looked at the effectiveness of the novel treatment, brimonidine topical gel 0.33%, trademark name Mirvaso®, in the treatment of rosacea. We report the use of optical coherence tomography (OCT) scanning to monitor the effectiveness of Mirvaso® on in vivo skin. OCT is a non-invasive optical imaging technique that can provide high-resolution imaging of vessel and cellular morphology. OCT may be useful as a pre-treatment assessment tool for identifying possible morphologic features in the skin that may serve as outcome predictors. OCT may also serve as a monitoring tool in the treatment of rosacea., Objective: To examine and describe how OCT skin morphology changes when exposed to brimonidine topical gel 0.33% in the treatment of erythematotelangiectatic rosacea., Methods: Normal in vivo telangiectasias and erythematous patches and papules were examined prior to treatment clinically, dermatoscopically, and through OCT scans. Brimonidine topical gel 0.33% was applied to the face and OCT images were acquired at defined time intervals: baseline; immediately (<5 minutes) after application; 4 hours after application; and after 2 weeks' once daily application. OCT morphology was then described., Results: OCT imaging showed an increase in the mean gray value (MGV), a measure of dermal reflectivity, corresponding to a decrease in dermal edema. MGV measurements for the nasal telangiectasia were: baseline, MGV 10,471 (standard deviation [SD] 6,847); immediate, MGV 15,634 (SD 8,983); after 4 hours, MGV 16,357 (SD 7,647); and after 2 weeks, MGV 15,505 (SD 6,870). MGV measurements for the chin erythema were: baseline, MGV 8,850 (SD 4,969); immediate, MGV 10,799 (SD 5,266); after 4 hours, MGV 12,419 (SD 6,714); and after 2 weeks, MGV 13,395 (SD 6,170). No significant change in vessel lumen diameter was appreciated. Vessel lumen diameter for the facial papule ranged from 0.13 mm at baseline, 0.09 mm immediately after treatment, 0.09 mm after 4 hours, and 0.11 mm after 2 weeks., Conclusions: OCT scanning showed a decrease in the dermal hyporeflectivity of the dermis consistent with a decrease in dermal edema. The OCT scans obtained did not show any significant change in vessel lumen diameter. These results may reflect an increase in vascular tone, which can be attributable to the clinical improvement and decreased erythema noted in the patient. This technology could potentially be used for the non-invasive in vivo monitoring of other topical treatments.

Published
2014

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