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  1. Article ; Online: Tackling global challenges in pediatric rheumatology.

    Lewandowski, Laura B

    Current opinion in rheumatology

    2020  Volume 32, Issue 5, Page(s) 414–420

    Abstract: Purpose of the review: To highlight the current challenges in diagnosis and clinical care of pediatric rheumatic disease and barriers to research and education of pediatric rheumatologists worldwide.: Recent findings: Recent studies and reports ... ...

    Abstract Purpose of the review: To highlight the current challenges in diagnosis and clinical care of pediatric rheumatic disease and barriers to research and education of pediatric rheumatologists worldwide.
    Recent findings: Recent studies and reports demonstrate a paucity of studies on epidemiology, outcomes, and management guidelines from many regions of the world. There have been noteworthy efforts to bridge the gap in under resourced areas. An analysis of the global burden of rheumatic disease has demonstrated that while understudied, musculoskeletal diseases are prevalent and increasingly contribute to loss of years of healthy life. In juvenile idiopathic arthritis, two milestone publications in global pediatric rheumatology have recently been published. An international study evaluated the epidemiology, treatment, and outcomes of juvenile idiopathic arthritis and demonstrated global diversity in both clinical manifestations and outcomes. Notably, the first guidelines for managing pediatric rheumatic disease in a less resourced setting have been published for juvenile idiopathic arthritis. This document offers the first publication targeted to address challenges faced by pediatric rheumatology caregivers in low-resourced settings. These documents serve as exemplars for international collaboration in pediatric rheumatology and can be used as models for other pediatric rheumatic disease research. Other efforts are making progress in various arenas towards increasing access to care, education, and training in pediatric rheumatology.
    Summary: The global burden of rheumatic disease in the pediatric population is poorly understood but unrecognized disease greatly impacts the overall morbidity and mortality in this population. More studies in lesser resourced regions are needed to prioritize access to pediatric rheumatology care and prioritize a further increase in research capacity and education moving forward.
    MeSH term(s) Child ; Global Burden of Disease ; Humans ; Prevalence ; Rheumatic Diseases/diagnosis ; Rheumatic Diseases/epidemiology ; Rheumatic Diseases/therapy ; Rheumatology
    Keywords covid19
    Language English
    Publishing date 2020-07-13
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1045317-9
    ISSN 1531-6963 ; 1040-8711
    ISSN (online) 1531-6963
    ISSN 1040-8711
    DOI 10.1097/BOR.0000000000000726
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Barriers and facilitators to medical care retention for pediatric systemic lupus erythematosus in South Africa: a qualitative study.

    Ikram, Naira / Lewandowski, Laura B / Watt, Melissa H / Scott, Christiaan

    Research square

    2024  

    Abstract: Background: Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE ... ...

    Abstract Background: Systemic lupus erythematosus (SLE) is a life-threatening, chronic, autoimmune disease requiring long term subspecialty care due to its complex and chronic nature. Childhood-onset SLE (cSLE) is more severe than adult-onset, and the cSLE population in South Africa has been reported to have an even higher risk than patients elsewhere. Therefore, it is critical to promptly diagnose, treat, and manage cSLE. In this paper, we aim to describe and evaluate barriers and enablers of appropriate long-term care of cSLE South Africa from the perspective of caregivers (parents or family members).
    Methods: Caregivers (n=22) were recruited through pediatric and adult rheumatology clinics. Individuals were eligible if they cared for youth (≤19 years) who were diagnosed with cSLE and satisfied at least four of the eleven ACR SLE classification criteria.Individual in-depth, semi-structured interviews were conducted between January 2014 and December 2014, and explored barriers to and facilitators of ongoing chronic care for cSLE. Data were analyzed using applied thematic analysis.
    Results: Four barriers to chronic care engagement and retention were identified: knowledge gap, financial burdens, social stigma of SLE, and complexity of the South African medical system. Additionally, we found three facilitators: patient and caregiver education, robust support system for the caregiver, and financial support for the caregiver and patient.
    Conclusion: These findings highlight multiple, intersecting barriers to routine longitudinal care for cSLE in South Africa and suggest there might be a group of diagnosed children who don't receive follow-up care and are subject to attrition. cSLE requires ongoing treatment and care; thus, the different barriers may interact and compound over time with each follow-up visit. South African cSLE patients are at high risk for poor outcomes. South African care teams should work to overcome these barriers and place attention on the facilitators to improve care retention for these patients and create a model for other less resourced settings.
    Language English
    Publishing date 2024-02-28
    Publishing country United States
    Document type Preprint
    DOI 10.21203/rs.3.rs-3919073/v1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Global rheumatology in the time of COVID-19.

    Lewandowski, Laura B / Hsieh, Evelyn

    The Lancet. Rheumatology

    2020  Volume 2, Issue 5, Page(s) e254–e255

    Keywords covid19
    Language English
    Publishing date 2020-04-06
    Publishing country England
    Document type Journal Article
    ISSN 2665-9913
    ISSN (online) 2665-9913
    DOI 10.1016/S2665-9913(20)30091-6
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Tackling global challenges in pediatric rheumatology

    Lewandowski, Laura B

    Curr Opin Rheumatol

    Abstract: PURPOSE OF THE REVIEW: To highlight the current challenges in diagnosis and clinical care of pediatric rheumatic disease and barriers to research and education of pediatric rheumatologists worldwide. RECENT FINDINGS: Recent studies and reports ... ...

    Abstract PURPOSE OF THE REVIEW: To highlight the current challenges in diagnosis and clinical care of pediatric rheumatic disease and barriers to research and education of pediatric rheumatologists worldwide. RECENT FINDINGS: Recent studies and reports demonstrate a paucity of studies on epidemiology, outcomes, and management guidelines from many regions of the world. There have been noteworthy efforts to bridge the gap in under resourced areas. An analysis of the global burden of rheumatic disease has demonstrated that while understudied, musculoskeletal diseases are prevalent and increasingly contribute to loss of years of healthy life. In juvenile idiopathic arthritis, two milestone publications in global pediatric rheumatology have recently been published. An international study evaluated the epidemiology, treatment, and outcomes of juvenile idiopathic arthritis and demonstrated global diversity in both clinical manifestations and outcomes. Notably, the first guidelines for managing pediatric rheumatic disease in a less resourced setting have been published for juvenile idiopathic arthritis. This document offers the first publication targeted to address challenges faced by pediatric rheumatology caregivers in low-resourced settings. These documents serve as exemplars for international collaboration in pediatric rheumatology and can be used as models for other pediatric rheumatic disease research. Other efforts are making progress in various arenas towards increasing access to care, education, and training in pediatric rheumatology. SUMMARY: The global burden of rheumatic disease in the pediatric population is poorly understood but unrecognized disease greatly impacts the overall morbidity and mortality in this population. More studies in lesser resourced regions are needed to prioritize access to pediatric rheumatology care and prioritize a further increase in research capacity and education moving forward.
    Keywords covid19
    Publisher WHO
    Document type Article
    Note WHO #Covidence: #682650
    Database COVID19

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  5. Article ; Online: Pediatric Rheumatic Disease in Lower to Middle-Income Countries: Impact of Global Disparities, Ancestral Diversity, and the Path Forward.

    Scott, Christiaan / Sawhney, Sujata / Lewandowski, Laura B

    Rheumatic diseases clinics of North America

    2021  Volume 48, Issue 1, Page(s) 199–215

    Abstract: Pediatric rheumatology subspecialists treat chronic autoimmune diseases with onset in childhood. Prompt diagnosis and ongoing management of these conditions are imperative to prevent damage from ongoing inflammation. Here, we aim to describe the current ... ...

    Abstract Pediatric rheumatology subspecialists treat chronic autoimmune diseases with onset in childhood. Prompt diagnosis and ongoing management of these conditions are imperative to prevent damage from ongoing inflammation. Here, we aim to describe the current landscape of pediatric rheumatic disease in lower to middle-income countries (LMICs) and explore current barriers to understanding global disease burden. We then examine innovative strategies to promote a more equitable future for children and young people living with rheumatic diseases worldwide.
    MeSH term(s) Adolescent ; Child ; Developing Countries ; Humans ; Income ; Rheumatic Diseases/diagnosis ; Rheumatic Diseases/epidemiology ; Rheumatic Diseases/therapy ; Rheumatology
    Language English
    Publishing date 2021-10-29
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 92118-x
    ISSN 1558-3163 ; 0889-857X
    ISSN (online) 1558-3163
    ISSN 0889-857X
    DOI 10.1016/j.rdc.2021.09.001
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Global rheumatology in the time of COVID-19

    Lewandowski, Laura B / Hsieh, Evelyn

    The Lancet Rheumatology

    2020  Volume 2, Issue 5, Page(s) e254–e255

    Keywords covid19
    Language English
    Publisher Elsevier BV
    Publishing country us
    Document type Article ; Online
    ISSN 2665-9913
    DOI 10.1016/s2665-9913(20)30091-6
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  7. Article ; Online: Health Equity Implications of Missing Data Among Youths With Childhood-Onset Systemic Lupus Erythematosus: A Proof-of-Concept Study in the Childhood Arthritis and Rheumatology Research Alliance Registry.

    Woo, Jennifer M P / Simmonds, Faith / Dennos, Anne / Son, Mary Beth F / Lewandowski, Laura B / Rubinstein, Tamar B

    Arthritis care & research

    2023  Volume 75, Issue 11, Page(s) 2285–2294

    Abstract: Objective: Health disparities in childhood-onset systemic lupus erythematosus (SLE) disproportionately impact marginalized populations. Socioeconomically patterned missing data can magnify existing health inequities by supporting inferences that may ... ...

    Abstract Objective: Health disparities in childhood-onset systemic lupus erythematosus (SLE) disproportionately impact marginalized populations. Socioeconomically patterned missing data can magnify existing health inequities by supporting inferences that may misrepresent populations of interest. Our objective was to assess missing data and subsequent health equity implications among participants with childhood-onset SLE enrolled in a large pediatric rheumatology registry.
    Methods: We evaluated co-missingness of 12 variables representing demographics, socioeconomic position, and clinical factors (e.g., disease-related indices) using Childhood Arthritis and Rheumatology Research Alliance Registry childhood-onset SLE enrollment data (2015-2022; n = 766). We performed logistic regression to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) for missing disease-related indices at enrollment (Systemic Lupus Erythematosus Disease Activity Index 2000 [SLEDAI-2K] and/or Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index [SDI]) associated with data missingness. We used linear regression to assess the association between socioeconomic factors and SLEDAI-2K at enrollment using 3 analytic methods for missing data: complete case analysis, multiple imputation, and nonprobabilistic bias analyses, with missing values imputed to represent extreme low or high disadvantage.
    Results: On average, participants were missing 6.2% of data, with over 50% of participants missing at least 1 variable. Missing data correlated most closely with variables within data categories (i.e., demographic). Government-assisted health insurance was associated with missing SLEDAI-2K and/or SDI scores compared to private health insurance (OR 2.04 [95% CI 1.22, 3.41]). The different analytic approaches resulted in varying analytic sample sizes and fundamentally conflicting estimated associations.
    Conclusion: Our results support intentional evaluation of missing data to inform effect estimate interpretation and critical assessment of causal statements that might otherwise misrepresent health inequities.
    MeSH term(s) Child ; Humans ; Adolescent ; Arthritis, Juvenile/diagnosis ; Arthritis, Juvenile/epidemiology ; Arthritis, Juvenile/complications ; Health Equity ; Rheumatology ; Lupus Erythematosus, Systemic/diagnosis ; Lupus Erythematosus, Systemic/epidemiology ; Lupus Erythematosus, Systemic/therapy ; Registries ; Severity of Illness Index
    Language English
    Publishing date 2023-05-30
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Intramural ; Research Support, Non-U.S. Gov't
    ZDB-ID 645059-3
    ISSN 2151-4658 ; 0893-7524 ; 2151-464X
    ISSN (online) 2151-4658
    ISSN 0893-7524 ; 2151-464X
    DOI 10.1002/acr.25136
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Renal Response Outcomes of the EuroLupus and National Institutes of Health Cyclophosphamide Dosing Regimens in Childhood-Onset Proliferative Lupus Nephritis.

    Wang, Christine S / Sadun, Rebecca E / Zhou, Wenru / Miller, Kristen R / Pyle, Laura / Ardoin, Stacey P / Bacha, Christine / Hause, Emily / Hui-Yuen, Joyce / Ling, Nicole / Pereira, Maria / Riebschleger, Meredith / Rouster-Stevens, Kelly / Sarkissian, Aliese / Shalen, Julia / Soulsby, William / Twilt, Marinka / Wu, Eveline Y / Lewandowski, Laura B /
    Wenderfer, Scott E / Cooper, Jennifer C

    Arthritis & rheumatology (Hoboken, N.J.)

    2024  Volume 76, Issue 3, Page(s) 469–478

    Abstract: Objective: We compared clinical characteristics and renal response in patients with childhood-onset proliferative lupus nephritis (LN) treated with the EuroLupus versus National Institutes of Health (NIH) cyclophosphamide (CYC) regimen.: Methods: A ... ...

    Abstract Objective: We compared clinical characteristics and renal response in patients with childhood-onset proliferative lupus nephritis (LN) treated with the EuroLupus versus National Institutes of Health (NIH) cyclophosphamide (CYC) regimen.
    Methods: A retrospective cohort study was conducted at 11 pediatric centers in North America that reported using both CYC regimens. Data were extracted from the electronic medical record at baseline and 3, 6, and 12 months after treatment initiation with CYC. To evaluate the adjusted association between CYC regimen (EuroLupus vs NIH) and renal response over time, generalized estimating equations with a logit link were used. An interaction between time and CYC regimen was included, and a contrast between CYC regimens at 12 months was used to evaluate the primary outcome.
    Results: One hundred forty-five patients (58 EuroLupus, 87 NIH) were included. EuroLupus patients were on average older at the start of current CYC therapy, had longer disease duration, and more commonly had relapsed or refractory LN compared with the NIH group. After multivariable adjustment, there was no significant association between CYC regimen and achieving complete renal response at 12 months (odds ratio [OR] of response for the EuroLupus regimen, reference NIH regimen: 0.76; 95% confidence interval [CI] 0.29-1.98). There was also no significant association between CYC regimen and achieving at least a partial renal response at 12 months (OR 1.35, 95% CI 0.57-3.19).
    Conclusion: Our study failed to demonstrate a benefit of the NIH regimen over the EuroLupus CYC regimen in childhood-onset proliferative LN. However, future prospective outcome studies are needed.
    MeSH term(s) United States ; Child ; Humans ; Lupus Nephritis/drug therapy ; Immunosuppressive Agents ; Retrospective Studies ; Cyclophosphamide/therapeutic use ; Kidney
    Chemical Substances Immunosuppressive Agents ; Cyclophosphamide (8N3DW7272P)
    Language English
    Publishing date 2024-01-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2756371-6
    ISSN 2326-5205 ; 2326-5191
    ISSN (online) 2326-5205
    ISSN 2326-5191
    DOI 10.1002/art.42725
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  9. Article ; Online: Update on cardiovascular disease in lupus.

    Lewandowski, Laura B / Kaplan, Mariana J

    Current opinion in rheumatology

    2016  Volume 28, Issue 5, Page(s) 468–476

    Abstract: Purpose of review: Atherosclerotic cardiovascular disease confers significant morbidity and mortality in patients with systemic lupus erythematosus (SLE) and cannot be fully explained by traditional cardiovascular risk factors. Recent immunologic ... ...

    Abstract Purpose of review: Atherosclerotic cardiovascular disease confers significant morbidity and mortality in patients with systemic lupus erythematosus (SLE) and cannot be fully explained by traditional cardiovascular risk factors. Recent immunologic discoveries have outlined putative pathways in SLE that may also accelerate the development of atherosclerosis.
    Recent findings: Aberrant innate and adaptive immune responses implicated in lupus pathogenesis may also contribute to the development of accelerated atherosclerosis in these patients. Defective apoptosis, abnormal lipoprotein function, autoantibodies, aberrant neutrophil responses, and a dysregulated type I interferon pathway likely contribute to endothelial dysfunction. SLE macrophages have an inflammatory phenotype that may drive progression of plaque.
    Summary: Recent discoveries have placed increased emphasis on the immunology of atherosclerotic cardiovascular disease. Understanding the factors that drive the increased risk for cardiovascular disease in SLE patients may provide selective therapeutic targets for reducing inflammation and improving outcomes in atherosclerosis.
    MeSH term(s) Adaptive Immunity/immunology ; Apoptosis/immunology ; Atherosclerosis/immunology ; Autoantibodies/immunology ; Cardiovascular Diseases/immunology ; Disease Progression ; Endothelium, Vascular/immunology ; Endothelium, Vascular/physiopathology ; Humans ; Immunity, Innate/immunology ; Inflammation/immunology ; Interferon Type I/immunology ; Lipoproteins/immunology ; Lupus Erythematosus, Systemic/immunology ; Macrophages/immunology ; Neutrophils/immunology ; Plaque, Atherosclerotic/immunology ; Risk Factors
    Chemical Substances Autoantibodies ; Interferon Type I ; Lipoproteins
    Language English
    Publishing date 2016-05-27
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1045317-9
    ISSN 1531-6963 ; 1040-8711
    ISSN (online) 1531-6963
    ISSN 1040-8711
    DOI 10.1097/BOR.0000000000000307
    Database MEDical Literature Analysis and Retrieval System OnLINE

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