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Article ; Online: Patterns and rates of confirmed transfer of care of patients with juvenile idiopathic arthritis at a tertiary paediatric rheumatology centre.

Tan, Joachim / Tiller, Georgina / Gowdie, Peter / Cox, Angela / Munro, Jane / Allen, Roger / Akikusa, Jonathan

2022 Volume 53, Issue 1, Page(s) 46–50

Abstract: Background: Disease activity in juvenile idiopathic arthritis (JIA) commonly persists into adulthood. Transfer of JIA patients to adult healthcare services can be challenging, with prior studies showing poor rates of success.: Aims: This audit sought ...

Abstract	Background: Disease activity in juvenile idiopathic arthritis (JIA) commonly persists into adulthood. Transfer of JIA patients to adult healthcare services can be challenging, with prior studies showing poor rates of success. Aims: This audit sought to examine characteristics of patients undergoing transfer of care within the rheumatology unit at the Royal Children's Hospital in Melbourne, with the aim of identifying areas for improvement. Specifically, we sought to determine the rate at which confirmation of established care with an adult service (confirmed transfer of care) was documented in the patient chart. Methods: Patients with a diagnosis of JIA who turned 18 years of age between 2012 and 2019 were identified. A chart review was undertaken to collect relevant data. Results: One hundred and seventy-seven patients were identified. In all, 64% (114/177) were referred for adult care. The commonest JIA subtypes referred were seronegative polyarticular (35/114; 30.7%) and oligoarticular JIA (22/114; 19.3%). Documentation of confirmed transfer of care occurred in 62.3% (71/114), with correspondence received from adult services in 49.1% (56/114). There was no difference in rate of return correspondence from public versus private providers (45% vs 53.8%; P = 0.38). The use of 'backstop appointments' was more likely in those with confirmed transfer of care (66% vs 30%; P = 0.0002). Conclusions: Lack of confirmed transfer of care for JIA patients is common and carries a risk of suboptimal outcomes. Strategies to improve communication with adult services, the routine use of 'backstop' appointments and vigilance regarding potential loss to follow up at the time of transfer would minimise this risk.
MeSH term(s)	Adolescent ; Humans ; Arthritis, Juvenile/diagnosis ; Arthritis, Juvenile/therapy ; Australia ; Hospital Units ; Hospitals, Pediatric ; Rheumatology ; Tertiary Care Centers ; Transition to Adult Care/statistics & numerical data
Language	English
Publishing date	2022-07-16
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2045436-3
ISSN	1445-5994 ; 1444-0903
ISSN (online)	1445-5994
ISSN	1444-0903
DOI	10.1111/imj.15509
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Article ; Online: Rheumatologic emergencies in newborns, children, and adolescents.

Akikusa, Jonathan D

Pediatric clinics of North America

2012 Volume 59, Issue 2, Page(s) 285–299

Abstract: This article presents five clinical scenarios in which the initial manifestations of pediatric rheumatic diseases constitute life-threatening medical emergencies. It is intended as a problem-oriented guide for pediatricians to assist in the recognition ... ...

Abstract	This article presents five clinical scenarios in which the initial manifestations of pediatric rheumatic diseases constitute life-threatening medical emergencies. It is intended as a problem-oriented guide for pediatricians to assist in the recognition of rheumatologic differentials in children presenting with critical illness and provides an approach to their initial investigation and management.
MeSH term(s)	Adolescent ; Cardiac Tamponade/diagnosis ; Cardiac Tamponade/etiology ; Cardiac Tamponade/therapy ; Child ; Emergencies ; Fever/etiology ; Heart Block/diagnosis ; Heart Block/etiology ; Heart Block/therapy ; Humans ; Infant, Newborn ; Multiple Organ Failure/diagnosis ; Multiple Organ Failure/etiology ; Multiple Organ Failure/therapy ; Pancytopenia/diagnosis ; Pancytopenia/etiology ; Pancytopenia/therapy ; Renal Insufficiency/diagnosis ; Renal Insufficiency/etiology ; Renal Insufficiency/therapy ; Respiratory Insufficiency/diagnosis ; Respiratory Insufficiency/etiology ; Respiratory Insufficiency/therapy ; Rheumatic Diseases/complications ; Rheumatic Diseases/diagnosis ; Rheumatic Diseases/therapy ; Thrombosis/diagnosis ; Thrombosis/etiology ; Thrombosis/therapy
Language	English
Publishing date	2012-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	215711-1
ISSN	1557-8240 ; 0031-3955
ISSN (online)	1557-8240
ISSN	0031-3955
DOI	10.1016/j.pcl.2012.03.001
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Article ; Online: Faltering growth with an 'unexpected' abdominal ultrasound finding.

Sullivan, Kate / Akikusa, Jonathan D

Journal of paediatrics and child health

2016 Volume 52, Issue 9, Page(s) 908

MeSH term(s)	Celiac Disease/complications ; Celiac Disease/diagnostic imaging ; Child, Preschool ; Failure to Thrive/etiology ; Humans ; Intestine, Small/diagnostic imaging ; Intussusception/diagnostic imaging ; Intussusception/etiology ; Male ; Ultrasonography
Language	English
Publishing date	2016-09
Publishing country	Australia
Document type	Case Reports ; Journal Article
ZDB-ID	1024476-1
ISSN	1440-1754 ; 1034-4810
ISSN (online)	1440-1754
ISSN	1034-4810
DOI	10.1111/jpc.1_13127
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Article ; Online: FDG-PET imaging in a child with Kawasaki disease: systemic and coronary artery inflammation without dilatation.

Danchin, Margaret H / Abo, Yara / Akikusa, Jonathan / Francis, Peter / Burgner, David

Archives of disease in childhood

2021 Volume 107, Issue 6, Page(s) 619

MeSH term(s)	Child ; Coronary Artery Disease/diagnostic imaging ; Coronary Artery Disease/etiology ; Coronary Vessels/diagnostic imaging ; Dilatation ; Dilatation, Pathologic ; Fluorodeoxyglucose F18 ; Humans ; Inflammation/diagnostic imaging ; Mucocutaneous Lymph Node Syndrome/complications ; Mucocutaneous Lymph Node Syndrome/diagnostic imaging ; Positron-Emission Tomography
Chemical Substances	Fluorodeoxyglucose F18 (0Z5B2CJX4D)
Language	English
Publishing date	2021-12-08
Publishing country	England
Document type	Journal Article
ZDB-ID	524-1
ISSN	1468-2044 ; 0003-9888 ; 1359-2998
ISSN (online)	1468-2044
ISSN	0003-9888 ; 1359-2998
DOI	10.1136/archdischild-2021-322447
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Article ; Online: Vaccination in paediatric rheumatology.

Akikusa, Jonathan D / Crawford, Nigel W

Current rheumatology reports

2014 Volume 16, Issue 8, Page(s) 432

Abstract: As awareness of the risk of vaccine-preventable diseases for children with rheumatic diseases has increased, vaccination has become an important clinical consideration and focus of research in paediatric rheumatology. Conflicting reports in the ... ...

Abstract	As awareness of the risk of vaccine-preventable diseases for children with rheumatic diseases has increased, vaccination has become an important clinical consideration and focus of research in paediatric rheumatology. Conflicting reports in the literature and differing advice from national bodies regarding the safety of different vaccines for this patient population have led to confusion in the minds of many rheumatologists as to what is appropriate. This article will provide an overview of crucial aspects of the recently published European League Against Rheumatism recommendations regarding vaccination of paediatric patients with rheumatic disease, and will review advances in this field since their publication.
MeSH term(s)	Child ; Humans ; Immunocompromised Host ; Influenza Vaccines ; Measles-Mumps-Rubella Vaccine ; Opportunistic Infections/complications ; Opportunistic Infections/immunology ; Opportunistic Infections/prevention & control ; Papillomavirus Vaccines ; Practice Guidelines as Topic ; Rheumatic Diseases/complications ; Rheumatic Diseases/immunology ; Vaccination ; Vaccines, Attenuated
Chemical Substances	Influenza Vaccines ; Measles-Mumps-Rubella Vaccine ; Papillomavirus Vaccines ; Vaccines, Attenuated
Language	English
Publishing date	2014-06-13
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2057357-1
ISSN	1534-6307 ; 1523-3774
ISSN (online)	1534-6307
ISSN	1523-3774
DOI	10.1007/s11926-014-0432-9
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Article: Vaccinations Do Not Increase Arthritis Flares in Juvenile Idiopathic Arthritis: A Study of the Relationship between Routine Childhood Vaccinations on the Australian Immunisation Schedule and Arthritis Activity in Children with Juvenile Idiopathic Arthritis.

Alfayadh, Naba M / Gowdie, Peter J / Akikusa, Jonathan D / Easton, Mee Lee / Buttery, Jim P

International journal of rheumatology

2020 Volume 2020, Page(s) 1078914

Abstract: Background: Juvenile idiopathic arthritis (JIA) is a collective term for a group of inflammatory conditions of uncertain origin, which causes chronic arthritis in one or more joints. The clinical course of JIA is characterised by episodes of increased ... ...

Abstract	Background: Juvenile idiopathic arthritis (JIA) is a collective term for a group of inflammatory conditions of uncertain origin, which causes chronic arthritis in one or more joints. The clinical course of JIA is characterised by episodes of increased activity, termed flares. Vaccinations have previously been proposed as a "trigger" for some flares, although evidence supporting this is scant. Objective: To explore whether routine childhood vaccinations are associated with an increased risk of flares of arthritis activity in children with JIA. Methods: Patients aged below 6 years with a diagnosis of JIA were recruited from the Rheumatology Clinical Database at the Royal Children's Hospital, Melbourne, Australia, from 1 January 2010 to 30 April 2016. Patient immunisation status was cross-checked with the Australian Childhood Immunisation Register (ACIR). The self-controlled case series methodology (Rowhani-Rahbar et al., 2012) was applied to determine whether the risk of arthritis flares in the three months following immunisation was greater than the baseline risk for each patient. Results: 138 patients were included in the study. 32 arthritis flares occurred in the 90 days following immunisation. The risk of arthritis flares during the 90 days following immunisation was reduced compared with patients' baseline risk (RR 0.59 (95% CI 0.39-0.89, Conclusion: Routine childhood immunisations were not associated with arthritis flare onset in patients with JIA. The risk of arthritis flares in the 90 days following vaccination was lower than the baseline risk. In the context of COVID19, vaccination will not increase interaction with the healthcare system beyond the immunisation encounter.
Keywords	covid19
Language	English
Publishing date	2020-08-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	2503284-7
ISSN	1687-9279 ; 1687-9260
ISSN (online)	1687-9279
ISSN	1687-9260
DOI	10.1155/2020/1078914
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Article ; Online: Ten-year safety and clinical benefit from open-label etanercept treatment in children and young adults with juvenile idiopathic arthritis.

Rheumatology (Oxford, England)

2023 Volume 63, Issue 1, Page(s) 140–148

Abstract: 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 JIA, categorized as extended oligoarticular arthritis (eoJIA), enthesitis-related arthritis (ERA) or ...

Abstract	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 JIA, categorized as extended oligoarticular arthritis (eoJIA), enthesitis-related arthritis (ERA) or 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 end point was occurrence of malignancy. Efficacy assessments included proportions achieving JIA ACR 30/50/70/90/100 criteria and ACR inactive disease criteria, and clinical remission (ACR criteria) or Juvenile Arthritis DAS (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 34 (27%) participants achieved JADAS and ACR clinical remission, respectively. 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 favourable. Trial registration: ClinicalTrials.gov IDs: CLIPPER (NCT00962741); CLIPPER2 (NCT01421069).
MeSH term(s)	Child ; Humans ; Young Adult ; Child, Preschool ; Adolescent ; Etanercept/adverse effects ; Arthritis, Juvenile/drug therapy ; Antirheumatic Agents/adverse effects ; Arthritis, Psoriatic/drug therapy ; Treatment Outcome ; Neoplasms/drug therapy
Chemical Substances	Etanercept (OP401G7OJC) ; Antirheumatic Agents
Language	English
Publishing date	2023-04-19
Publishing country	England
Document type	Case Reports ; Clinical Trial, Phase III ; Journal Article
ZDB-ID	1464822-2
ISSN	1462-0332 ; 1462-0324
ISSN (online)	1462-0332
ISSN	1462-0324
DOI	10.1093/rheumatology/kead183
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Article: Vaccinations Do Not Increase Arthritis Flares in Juvenile Idiopathic Arthritis: A Study of the Relationship between Routine Childhood Vaccinations on the Australian Immunisation Schedule and Arthritis Activity in Children with Juvenile Idiopathic Arthritis

Alfayadh, Naba M / Gowdie, Peter J / Akikusa, Jonathan D / Easton, Mee Lee / Buttery, Jim P

Int J Rheumatol

Abstract	Background: Juvenile idiopathic arthritis (JIA) is a collective term for a group of inflammatory conditions of uncertain origin, which causes chronic arthritis in one or more joints. The clinical course of JIA is characterised by episodes of increased activity, termed flares. Vaccinations have previously been proposed as a "trigger" for some flares, although evidence supporting this is scant. Objective: To explore whether routine childhood vaccinations are associated with an increased risk of flares of arthritis activity in children with JIA. Methods: Patients aged below 6 years with a diagnosis of JIA were recruited from the Rheumatology Clinical Database at the Royal Children's Hospital, Melbourne, Australia, from 1 January 2010 to 30 April 2016. Patient immunisation status was cross-checked with the Australian Childhood Immunisation Register (ACIR). The self-controlled case series methodology (Rowhani-Rahbar et al., 2012) was applied to determine whether the risk of arthritis flares in the three months following immunisation was greater than the baseline risk for each patient. Results: 138 patients were included in the study. 32 arthritis flares occurred in the 90 days following immunisation. The risk of arthritis flares during the 90 days following immunisation was reduced compared with patients' baseline risk (RR 0.59 (95% CI 0.39-0.89, p = 0.012)). Conclusion: Routine childhood immunisations were not associated with arthritis flare onset in patients with JIA. The risk of arthritis flares in the 90 days following vaccination was lower than the baseline risk. In the context of COVID19, vaccination will not increase interaction with the healthcare system beyond the immunisation encounter.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #729431
Database	COVID19

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Article ; Online: Juvenile idiopathic arthritis managed in the new millennium: one year outcomes of an inception cohort of Australian children.

Tiller, Georgina / Buckle, Joanne / Allen, Roger / Munro, Jane / Gowdie, Peter / Cox, Angela / Akikusa, Jonathan

Pediatric rheumatology online journal

2018 Volume 16, Issue 1, Page(s) 69

Abstract: Background: The advent of new treatments for Juvenile Idiopathic Arthritis (JIA) has prompted interest in systematically studying the outcomes of patients treated in the 'modern era'. Such data provide both benchmarks for assessing local outcomes and ... ...

Abstract	Background: The advent of new treatments for Juvenile Idiopathic Arthritis (JIA) has prompted interest in systematically studying the outcomes of patients treated in the 'modern era'. Such data provide both benchmarks for assessing local outcomes and important information for use in counselling families of newly diagnosed patients. While data are available for cohorts in Europe and North America, no such data exist for Australian patients. The aim was to examine the demographics, treatment and outcomes at 12 months of an inception cohort of newly diagnosed patients with JIA at a single tertiary referral paediatric rheumatology centre in Australia. Methods: Retrospective review of prospectively collected data from patients newly diagnosed with JIA between 2010 and 2014 at the Royal Children's Hospital in Melbourne. Results: One hundred thirty four patients were included (62% female). Oligoarthritis was the single largest category of JIA (36%) and rheumatoid factor positive polyarthritis the least common (2%). Undifferentiated JIA accounted for 13% of patients and was the third largest category. Across the cohort 94% received NSAIDs, 53% oral steroids, 62% methotrexate and 15% a biologic DMARD. Intra-articular steroids were used in 62%, most commonly in the oligoarticular subtype (94%). 95% of patients achieved a joint count of zero at a median of 4.1 months, however flares occurred in 42%. At 12 months 65% had no active joint disease, though more than half remained on medication. Conclusion: Australian children with JIA managed in the modern era have similar characteristics and achieve short term outcomes comparable to cohorts in Europe and North America, with high rates of joint remission in the first 12 months of follow-up but with a significant relapse rate and requirement for ongoing medication.
MeSH term(s)	Adolescent ; Antirheumatic Agents/therapeutic use ; Arthritis, Juvenile/diagnosis ; Arthritis, Juvenile/drug therapy ; Australia ; Child ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Male ; Prospective Studies ; Retrospective Studies ; Severity of Illness Index ; Treatment Outcome
Chemical Substances	Antirheumatic Agents
Language	English
Publishing date	2018-11-09
Publishing country	England
Document type	Journal Article
ZDB-ID	2279468-2
ISSN	1546-0096 ; 1546-0096
ISSN (online)	1546-0096
ISSN	1546-0096
DOI	10.1186/s12969-018-0288-z
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Article ; Online: Recurrent fevers in children: TRAPS for young players.

Hodgson, Kate Alison / Crawford, Nigel W / Akikusa, Jonathan D

BMJ case reports

2014 Volume 2014

Abstract: We present the case of an 11-month-old girl who presented with recurrent febrile episodes and was found to have tumour necrosis factor receptor-associated periodic syndrome due to a novel mutation in the TNFRSF1A gene. The concept of autoinflammatory ... ...

Abstract	We present the case of an 11-month-old girl who presented with recurrent febrile episodes and was found to have tumour necrosis factor receptor-associated periodic syndrome due to a novel mutation in the TNFRSF1A gene. The concept of autoinflammatory diseases is discussed and the management of this condition reviewed.
MeSH term(s)	Female ; Fever/etiology ; Hereditary Autoinflammatory Diseases/complications ; Hereditary Autoinflammatory Diseases/diagnosis ; Humans ; Infant ; Recurrence
Language	English
Publishing date	2014-04-12
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1757-790X
ISSN (online)	1757-790X
DOI	10.1136/bcr-2013-201627
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