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Article ; Online: Keeping lupus patients on hydroxychloroquine during the COVID-19 pandemic.

Littlejohn, Emily

2020

Abstract: Hydroxychloroquine (HCQ) is in short supply as a result of the coronavirus disease 2019 (COVID-19) pandemic, presenting a challenge to rheumatologists to ensure their patients with systemic lupus erythematosus (SLE) continue to take this essential drug. ... ...

Abstract	Hydroxychloroquine (HCQ) is in short supply as a result of the coronavirus disease 2019 (COVID-19) pandemic, presenting a challenge to rheumatologists to ensure their patients with systemic lupus erythematosus (SLE) continue to take this essential drug. HCQ is the only SLE treatment shown to increase survival and any change in the HCQ regimen is potentially dangerous. Changes in the HCQ regimen should be made jointly with the patient after a discussion of the available evidence and expert opinion and the patient's preferences. Providers need to make thoughtful, informed decisions in this time of medication shortage.
Keywords	covid19
Language	English
Publishing date	2020-05-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.87a.ccc023
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Article ; Online: Hydroxychloroquine use in the COVID-19 patient.

Littlejohn, Emily

Cleveland Clinic journal of medicine

2020

Abstract: Hydroxychloroquine (HCQ) has multiple potential antiviral mechanisms of action that differ according to the pathogen studied (eg, Chikungunya, Dengue virus, human immunodeficiency virus, poliovirus, Zika virus). Data on HCQ for treatment of COVID-19 are ... ...

Abstract	Hydroxychloroquine (HCQ) has multiple potential antiviral mechanisms of action that differ according to the pathogen studied (eg, Chikungunya, Dengue virus, human immunodeficiency virus, poliovirus, Zika virus). Data on HCQ for treatment of COVID-19 are rapidly evolving. To date, there is no evidence from randomized controlled trials that HCQ, or any single therapy, improves outcomes in patients infected with COVID-19. There are also no clinical trial data supporting prophylactic HCQ therapy in COVID-19. Use of HCQ in patients with COVID-19 is being investigated for prophylaxis, postexposure prophylaxis, and treatment.
Keywords	covid19
Language	English
Publishing date	2020-09-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	639116-3
ISSN	1939-2869 ; 0891-1150
ISSN (online)	1939-2869
ISSN	0891-1150
DOI	10.3949/ccjm.87a.ccc011
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Article ; Online: Pregnancy and rheumatoid arthritis.

Littlejohn, Emily Adele

Best practice & research. Clinical obstetrics & gynaecology

2019 Volume 64, Page(s) 52–58

Abstract: Rheumatoid arthritis commonly affects women of childbearing age. Fertility, family planning, control of disease activity and birth outcomes are all important issues to be discussed at preconception counseling. New data has offered insight on trends of ... ...

Abstract	Rheumatoid arthritis commonly affects women of childbearing age. Fertility, family planning, control of disease activity and birth outcomes are all important issues to be discussed at preconception counseling. New data has offered insight on trends of fertility, disease control during pregnancy, and birth outcomes. This chapter provides an updated overview on expected disease course and management issues at each juncture with a particular focus on maintenance of tight disease control.
MeSH term(s)	Antirheumatic Agents/adverse effects ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/complications ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/drug therapy ; Contraception/methods ; Counseling/methods ; Disease Progression ; Family Planning Services ; Female ; Fertility ; Humans ; Preconception Care/methods ; Pregnancy ; Pregnancy Complications/diagnosis ; Pregnancy Complications/drug therapy ; Reproductive Behavior ; Severity of Illness Index
Chemical Substances	Antirheumatic Agents
Language	English
Publishing date	2019-10-09
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2050090-7
ISSN	1532-1932 ; 1521-6934
ISSN (online)	1532-1932
ISSN	1521-6934
DOI	10.1016/j.bpobgyn.2019.09.005
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Article: Keeping lupus patients on hydroxychloroquine during the COVID-19 pandemic

Littlejohn, Emily

Clevel. clin. j. med

Abstract	Hydroxychloroquine (HCQ) is in short supply as a result of the coronavirus disease 2019 (COVID-19) pandemic, presenting a challenge to rheumatologists to ensure their patients with systemic lupus erythematosus (SLE) continue to take this essential drug. HCQ is the only SLE treatment shown to increase survival and any change in the HCQ regimen is potentially dangerous. Changes in the HCQ regimen should be made jointly with the patient after a discussion of the available evidence and expert opinion and the patient's preferences. Providers need to make thoughtful, informed decisions in this time of medication shortage.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #257699
Database	COVID19

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Article: Hydroxychloroquine use in the COVID-19 patient

Littlejohn, Emily

Clevel. clin. j. med

Abstract	Hydroxychloroquine (HCQ) has multiple potential antiviral mechanisms of action that differ according to the pathogen studied (eg, Chikungunya, Dengue virus, human immunodeficiency virus, poliovirus, Zika virus). Data on HCQ for treatment of COVID-19 are rapidly evolving. To date, there is no evidence from randomized controlled trials that HCQ, or any single therapy, improves outcomes in patients infected with COVID-19. There are also no clinical trial data supporting prophylactic HCQ therapy in COVID-19. Use of HCQ in patients with COVID-19 is being investigated for prophylaxis, postexposure prophylaxis, and treatment.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #186505
Database	COVID19

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Article ; Online: Utilization of glucocorticoids among White and Black patients with systemic lupus erythematosus: Observations from the enrollment visit of a prospective registry.

Sullivan, James K / Littlejohn, Emily A

Lupus

2021 Volume 30, Issue 14, Page(s) 2298–2303

Abstract: Background: Black patients with systemic lupus erythematosus (SLE) face higher rates of morbidity and mortality compared to White patients. Long-term glucocorticoid use has been associated with worse health outcomes among patients with SLE. We sought to ...

Abstract	Background: Black patients with systemic lupus erythematosus (SLE) face higher rates of morbidity and mortality compared to White patients. Long-term glucocorticoid use has been associated with worse health outcomes among patients with SLE. We sought to quantify chronic glucocorticoid use among Black and White patients with SLE within a prospective registry. Methods: Using enrollment data from a registry at a large academic institution, we compared glucocorticoid use among Black and White patients with SLE. Multivariable logistic regression of race and glucocorticoid use was performed, adjusting for covariates exhibiting a bivariate association with glucocorticoids at significance level Results: 114 White participants (mean age 45; standard deviation (SD) 15) and 59 Black participants (mean age 42; SD 14) were analyzed. White participants had mean SLEDAI-2K score of 3.7 (SD 5.2). Black participants had mean SLEDAI-2K scores of 6.3 (SD 6.0). Among Black participants, 43 (72%) utilized glucocorticoids compared to White participants 39 (34%) (unadjusted odds ratio (OR) 5.17; 95% confidence interval (CI) 2.59-10.33). We did not observe differences between unadjusted hydroxychloroquine (OR 0.69; 95% CI 0.28-1.65) or conventional disease-modifying anti-rheumatic drug (cDMARD) (OR 1.07; 95% CI 0.57-2.01) utilization among Black and White participants. SLEDAI-2K, disability, recent hospitalization, and past or present hydroxychloroquine or cDMARD use were included in a logistic regression model. Adjusting for covariates, Black participants were more likely to be on glucocorticoids (adjusted OR 5.69; 95% CI 2.17-14.96); Conclusion: Adjusting for disease activity and other medications, Black patients had more exposure to chronic glucocorticoids than White patients in the Cleveland Clinic SLE registry. These patients may face increased glucocorticoid-related morbidity, which could contribute significantly to long-term health outcomes and utilization of health care resources. Future research in larger, more diverse registries should be conducted to further characterize patterns of glucocorticoid use.
MeSH term(s)	Adult ; Antirheumatic Agents/therapeutic use ; Glucocorticoids/therapeutic use ; Humans ; Hydroxychloroquine/therapeutic use ; Lupus Erythematosus, Systemic/drug therapy ; Middle Aged ; Registries ; Severity of Illness Index
Chemical Substances	Antirheumatic Agents ; Glucocorticoids ; Hydroxychloroquine (4QWG6N8QKH)
Language	English
Publishing date	2021-11-21
Publishing country	England
Document type	Journal Article
ZDB-ID	1154407-7
ISSN	1477-0962 ; 0961-2033
ISSN (online)	1477-0962
ISSN	0961-2033
DOI	10.1177/09612033211055817
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Article ; Online: Corrigendum to "Pregnancy and autoimmune connective tissue diseaes" [Best Practice & Research Clinical Rheumatology 30 (2016) 63-80].

Marder, Wendy / Littlejohn, Emily A / Somers, Emily C

Best practice & research. Clinical rheumatology

2020 Volume 34, Issue 6, Page(s) 101490

Language	English
Publishing date	2020-04-02
Publishing country	Netherlands
Document type	Published Erratum
ZDB-ID	2052323-3
ISSN	1532-1770 ; 1521-6942
ISSN (online)	1532-1770
ISSN	1521-6942
DOI	10.1016/j.berh.2020.101490
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Article ; Online: Paediatric asthma education: Implementation of video-based education for families.

Frydenberg, Alexis / Oborne, Naomi / Polley, Clare / Littlejohn, Emily / Gray, Amy

Journal of paediatrics and child health

2022 Volume 58, Issue 5, Page(s) 868–872

Abstract: Aim: To understand the impact of an asthma education video resource introduced to the short stay unit (SSU) of a tertiary paediatric hospital on: (i) parental understanding of and confidence in managing their child's asthma; (ii) the impact of this ... ...

Abstract	Aim: To understand the impact of an asthma education video resource introduced to the short stay unit (SSU) of a tertiary paediatric hospital on: (i) parental understanding of and confidence in managing their child's asthma; (ii) the impact of this resource on nurse-led education practices; and (iii) readmission rates. Methods: A mixed methods study was conducted in the SSU over an 18-month period using quantitative survey data from parents and nursing staff and qualitative data from nursing staff focus groups. Results: Of 117 parents surveyed, 94% reported an increase in their understanding of asthma. Following the introduction of the resource, there were fewer nurse-led education sessions delivered (1.91 vs. 1.54, P = 0.04) and a trend towards reduction in time spent delivering this education (27.24 vs. 24.98 min, P = 0.47). Nursing staff confidence in the family's understanding of asthma education was similar pre- and post-implementation (4.22 vs. 4.30, P = 0.97). Readmission rates dropped by 25% (readmissions within 1 month) and by 33.3% (readmission within a week) in the post-intervention cohort. Conclusions: Our asthma education video resource was demonstrated to be an acceptable and effective way of delivering asthma education to families. It created efficiency and consistency for nursing education and practice in our SSU. This resource was viewed by nursing staff as a useful adjunct to their education, enabling consistent messaging and helping structure education delivery. It has been incorporated into hospital systems and national resources which we hope will translate to a reduction in burden of asthma across the community.
MeSH term(s)	Asthma/therapy ; Child ; Education, Nursing ; Humans ; Parents ; Surveys and Questionnaires
Language	English
Publishing date	2022-01-17
Publishing country	Australia
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1024476-1
ISSN	1440-1754 ; 1034-4810
ISSN (online)	1440-1754
ISSN	1034-4810
DOI	10.1111/jpc.15862
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Article ; Online: Lack of Association Between Sex Hormones, MDSCs, LDGs and pDCs in Males and Females With Systemic Lupus Erythematosus.

Jones, Jessica M / Smith, Frances / Littlejohn, Emily / Jorgensen, Trine N

Frontiers in immunology

2022 Volume 13, Page(s) 888501

Abstract: Plasmacytoid dendritic cells (pDCs) and low-density granulocytes (LDGs) are interferon-alpha producing cells that create a pro-inflammatory response in Systemic Lupus Erythematosus (SLE) leading to auto antibody production and organ damage. Both pDCs and ...

Abstract	Plasmacytoid dendritic cells (pDCs) and low-density granulocytes (LDGs) are interferon-alpha producing cells that create a pro-inflammatory response in Systemic Lupus Erythematosus (SLE) leading to auto antibody production and organ damage. Both pDCs and LDGs have been shown to be dysfunctional in patients with active SLE. Myeloid-derived suppressor cells (MDSCs) have the capacity to control T and B cell activation and differentiation, and have recently been identified as cells of interest in SLE as well. While not fully understood, previous studies have suggested that pDCs are regulated in part by both X chromosome inactivation and estradiol. Whether sex chromosomes or sex hormones regulate MDSCs and LDGs remain to be determined. We aimed to explore the relative role of sex and sex hormones on pDC, MDSC and LDG frequency and function in SLE patients. We recruited patients with SLE as defined by ACR or SLICC classification criteria and healthy controls in conjunction with the Cleveland Clinic Lupus Cohort and Clinical Research Unit. We analyzed serum sex hormone levels by ELISA, and frequencies of pDCs, MDSCs, and LDGs among PBMCs and serum cytokine levels by flow cytometry. PBMCs were further analyzed for expression of genes involved in or induced by toll-like receptor (TLR)7 or TLR9 stimulation. In all SLE patients, the serum estradiol/testosterone ratio and levels of granulocytic MDSCs and LDGs were increased, while levels of pDCs were decreased. Furthermore, pDCs from active SLE patients expressed lower levels of TLR7 and TLR9 and showed diminished production of TLR9-induced IFNα and TNFα as compared to healthy controls. LDGs from healthy controls and SLE patients expressed very low levels of TLR7 and TLR9 and largely failed to respond to TLR9 stimulation. Thus, regardless of sex and sex-hormone levels, frequencies of pDCs, MDSCs and LDGs, TLR7 and TLR9 expression, and TLR9-driven cytokine production were similarly altered in male and female SLE patients.
MeSH term(s)	Cytokines/metabolism ; Dendritic Cells ; Estradiol/metabolism ; Female ; Gonadal Steroid Hormones/metabolism ; Granulocytes/metabolism ; Humans ; Interferon-alpha/metabolism ; Lupus Erythematosus, Systemic ; Male ; Myeloid-Derived Suppressor Cells/metabolism ; Toll-Like Receptor 7/metabolism ; Toll-Like Receptor 9/metabolism
Chemical Substances	Cytokines ; Gonadal Steroid Hormones ; Interferon-alpha ; Toll-Like Receptor 7 ; Toll-Like Receptor 9 ; Estradiol (4TI98Z838E)
Language	English
Publishing date	2022-06-27
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2022.888501
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Article ; Online: Early Diagnosis and Treatment of Rheumatoid Arthritis.

Littlejohn, Emily A / Monrad, Seetha U

Primary care

2018 Volume 45, Issue 2, Page(s) 237–255

Abstract: Rheumatoid arthritis is the most common inflammatory arthritis, and a significant cause of morbidity and mortality. Primary care providers should be able to distinguish the clinical presentation of rheumatoid arthritis from osteoarthritis, because the ... ...

Abstract	Rheumatoid arthritis is the most common inflammatory arthritis, and a significant cause of morbidity and mortality. Primary care providers should be able to distinguish the clinical presentation of rheumatoid arthritis from osteoarthritis, because the treatment and outcomes differ greatly between these 2 common forms of arthritis. This article provides a current overview of our understanding of rheumatoid arthritis, with an emphasis on early diagnosis and approaches to treatment.
MeSH term(s)	Anti-Inflammatory Agents, Non-Steroidal/therapeutic use ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/diagnosis ; Arthritis, Rheumatoid/drug therapy ; Diagnosis, Differential ; Disease Progression ; Early Diagnosis ; Humans ; Prognosis
Chemical Substances	Anti-Inflammatory Agents, Non-Steroidal ; Antirheumatic Agents
Language	English
Publishing date	2018-04-17
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	604005-6
ISSN	1558-299X ; 0095-4543
ISSN (online)	1558-299X
ISSN	0095-4543
DOI	10.1016/j.pop.2018.02.010
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