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Article ; Online: Case 33-2022: An 11-Year-Old Girl with Redness of the Eyes.

Cohen, Ezra M / Sobrin, Lucia / Figueiro Longo, Maria G / Pier, Danielle B / Brown, Daniel R / Stagner, Anna M

2022 Volume 387, Issue 17, Page(s) 1598–1607

MeSH term(s)	Child ; Female ; Humans ; Erythema/etiology ; Eye ; Eye Diseases/etiology ; Color
Language	English
Publishing date	2022-10-27
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMcpc2201235
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Article ; Online: Integrative Medicine for Gastrointestinal Disease.

Dossett, Michelle L / Cohen, Ezra M / Cohen, Jonah

Primary care

2017 Volume 44, Issue 2, Page(s) 265–280

Abstract: Gastrointestinal conditions are prevalent in the population and account for significant morbidity and health care costs. Patients with gastrointestinal conditions use integrative medicine. There is growing evidence that integrative medicine approaches ... ...

Abstract	Gastrointestinal conditions are prevalent in the population and account for significant morbidity and health care costs. Patients with gastrointestinal conditions use integrative medicine. There is growing evidence that integrative medicine approaches can improve symptoms and affect physiology and disease course. This article reviews data on some common and well-studied approaches, including mind-body therapies, acupuncture, diet, probiotics, and dietary supplements and herbs. Although clear recommendations can be made for some conditions, in others there are challenges in translating these findings owing to small study size, lack of standardization, and trial heterogeneity.
MeSH term(s)	Complementary Therapies/methods ; Diet Therapy/methods ; Dietary Supplements ; Gastroesophageal Reflux/therapy ; Gastrointestinal Diseases/therapy ; Humans ; Inflammatory Bowel Diseases/therapy ; Integrative Medicine/methods ; Integrative Medicine/organization & administration ; Non-alcoholic Fatty Liver Disease/therapy ; Primary Health Care/organization & administration
Language	English
Publishing date	2017-05-15
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.2017.02.002
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Zs.A 1154: Show issues

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Article: Risk of Diabetes Mellitus in Patients with Juvenile Idiopathic Arthritis.

Lee, Hemin / Jin, Yinzhu / Liu, Jun / Cohen, Ezra M / Chen, Sarah K / Kim, Seoyoung C

The Journal of rheumatology

2019 Volume 47, Issue 9, Page(s) 1405–1408

Abstract: Objective: To examine the risk of type 1 diabetes (T1D) associated with juvenile idiopathic arthritis (JIA).: Methods: Using the IBM MarketScan database, we compared JIA patients with asthma patients and healthy individuals for the risk of incident ... ...

Abstract	Objective: To examine the risk of type 1 diabetes (T1D) associated with juvenile idiopathic arthritis (JIA). Methods: Using the IBM MarketScan database, we compared JIA patients with asthma patients and healthy individuals for the risk of incident T1D. Results: We included patients with 15,210 JIA, 76,050 patients with asthma, and 76,050 healthy individuals matched 1:5 on age, sex, and index date. After adjustment for confounders, the multivariable HR of T1D associated with JIA was 1.48 (95% CI 0.86-2.56) versus asthma and 1.81 (95% CI 1.03-3.17) versus healthy individuals. Conclusion: JIA appears to be associated with an increased risk of T1D compared to patients with asthma and healthy children.
MeSH term(s)	Arthritis, Juvenile/complications ; Arthritis, Juvenile/epidemiology ; Child ; Databases, Factual ; Diabetes Mellitus, Type 1/complications ; Diabetes Mellitus, Type 1/epidemiology ; Humans
Language	English
Publishing date	2019-12-01
Publishing country	Canada
Document type	Journal Article
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.190644
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Zs.A 1168: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 135: Show issues

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Article ; Online: Factors associated with insomnia and complementary medicine use in children: results of a national survey.

Cohen, Ezra M / Dossett, Michelle L / Mehta, Darshan H / Davis, Roger B / Lee, Yvonne C

Sleep medicine

2018 Volume 44, Page(s) 82–88

Abstract: Objectives: Sleep difficulties are a serious health problem in children, and interest in using complementary and alternative medicine (CAM) therapies to treat sleep is growing. In this study, we aimed to identify: the prevalence of sleep difficulties in ...

Abstract	Objectives: Sleep difficulties are a serious health problem in children, and interest in using complementary and alternative medicine (CAM) therapies to treat sleep is growing. In this study, we aimed to identify: the prevalence of sleep difficulties in children, and the prevalence and patterns of CAM use among children with trouble sleeping. Methods: We used the 2012 National Health Interview Survey (NHIS) dataset to estimate the prevalence of sleep difficulties and CAM use in children ages 6-17 years. Prevalence estimates were weighted to reflect the survey's sampling design. We used logistic regression to explore associations between sleep difficulties, psychosocial factors, comorbidities and CAM use. Results: 6.4% of children in the 2012 NHIS dataset reported regular difficulty sleeping in the last year, corresponding to an estimated 1.5 million children in the US. Older age, poorer health status, more missed school days, and multiple comorbidities were all associated with sleep difficulties (p ≤ 0.001). Among children with sleep difficulties, 29% used at least one CAM therapy. Of the CAM therapies surveyed, non-vitamin, non-mineral supplements were the most commonly used (14.6%), followed by manipulation therapies (9.2%) and mind-body techniques (8.8%). Parental education and CAM use were most strongly associated with child CAM use (p ≤ 0.001). Conclusions: CAM therapies, particularly non-vitamin, non-mineral supplements, are commonly used among children with sleeping problems. More research is needed to characterize the safety and efficacy of CAM therapies for sleep in this population.
MeSH term(s)	Adolescent ; Child ; Comorbidity ; Complementary Therapies/statistics & numerical data ; Female ; Health Status ; Health Surveys ; Humans ; Male ; Pediatrics ; Prevalence ; Sleep Initiation and Maintenance Disorders/epidemiology ; United States/epidemiology
Language	English
Publishing date	2018-01-31
Publishing country	Netherlands
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2012041-2
ISSN	1878-5506 ; 1389-9457
ISSN (online)	1878-5506
ISSN	1389-9457
DOI	10.1016/j.sleep.2018.01.007
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Zs.A 5315: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 635: Show issues

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Article ; Online: A systematic review of psychosocial therapies for children with rheumatic diseases.

Cohen, Ezra M / Morley-Fletcher, Alessio / Mehta, Darshan H / Lee, Yvonne C

Pediatric rheumatology online journal

2017 Volume 15, Issue 1, Page(s) 6

Abstract: Background: To assess the quality of evidence for the effects of psychosocial therapies on pain and function in children with rheumatic diseases.: Methods: We conducted a literature search of MEDLINE and PsycINFO for randomized clinical trials of ... ...

Abstract	Background: To assess the quality of evidence for the effects of psychosocial therapies on pain and function in children with rheumatic diseases. Methods: We conducted a literature search of MEDLINE and PsycINFO for randomized clinical trials of psychosocial interventions for pain and disability in children with rheumatic diseases from January 1969 to September 2015. Studies with a sample size less than 10 subjects were excluded. Study quality was assessed using the Jadad score. Results: Five articles met inclusion criteria, for a total of 229 patients, aged 5 to 18 years. Two studies included children with fibromyalgia. Three studies included children with juvenile arthritis. Neither study in fibromyalgia reported the statistical significance of immediate between-group pre-post changes in functioning or pain. One study examining the effects of an internet-based psychosocial intervention in children with juvenile arthritis reported significant differences in post-intervention pain scores (p = 0.03). However, 2 studies did not show improvements in pain scores among children with juvenile arthritis treated with psychosocial interventions vs. a wait-list control or vs. an active control (massage). No studies reported significant between-group differences for functional outcomes in children with juvenile arthritis. Conclusions: The available data were limited by the scarcity of randomized trials. Definite conclusions about the immediate effect of psychosocial interventions on pain and function in children with fibromyalgia could not be made because between-group comparisons of post-treatment change scores were not reported. For children with juvenile inflammatory arthritis, results of between-group comparisons for pain differed across studies, and analyses examining disability revealed no significant differences between groups.
MeSH term(s)	Adolescent ; Arthritis, Juvenile/therapy ; Child ; Child, Preschool ; Fibromyalgia/therapy ; Humans ; Meditation/methods ; Mind-Body Therapies/methods ; Musculoskeletal Pain/prevention & control ; Psychotherapy/methods ; Randomized Controlled Trials as Topic
Language	English
Publishing date	2017-01-17
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2279468-2
ISSN	1546-0096 ; 1546-0096
ISSN (online)	1546-0096
ISSN	1546-0096
DOI	10.1186/s12969-016-0133-1
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Article ; Online: Factors associated with complementary medicine use in pediatric musculoskeletal conditions: Results from a national survey.

Cohen, Ezra M / Dossett, Michelle L / Mehta, Darshan H / Davis, Roger B / Lee, Yvonne C

Complementary therapies in medicine

2017 Volume 31, Page(s) 53–58

Abstract: Objectives: Complementary and alternative medicine (CAM) use is common in children, but its use has only been investigated in children with musculoskeletal conditions (MSK) to a limited extent. We aimed to characterize factors associated with CAM use in ...

Abstract	Objectives: Complementary and alternative medicine (CAM) use is common in children, but its use has only been investigated in children with musculoskeletal conditions (MSK) to a limited extent. We aimed to characterize factors associated with CAM use in children with MSK conditions. Methods: Within the 2012 National Health Interview Survey dataset (including its child CAM supplement), we examined factors associated with CAM use in children with MSK conditions and performed an analysis examining the perceived usefulness of CAM therapies for MSK conditions. Results: Overall, there were 10,218 children in the dataset. 28.0% of children with MSK conditions used CAM, compared to 8.8% of children without MSK conditions. Gender (p=0.003), region (p=0.001), race (p=0.001), parental CAM use (p<0.001), education (<0.001), and having anxiety, stress or depression (p=0.030) were correlated with CAM use. Among 90 children who reported on CAM use, 89.7% said that CAM helped some or a great deal for their MSK condition. Conclusions: Several factors, particularly parental education and parental CAM use, were associated with CAM use, and self-reported improvement rates were high. Interventional trials are needed to determine the efficacy of specific CAM therapies for treating different MSK conditions in children.
MeSH term(s)	Adolescent ; Child ; Child, Preschool ; Complementary Therapies/statistics & numerical data ; Cross-Sectional Studies ; Female ; Humans ; Integrative Medicine ; Male ; Musculoskeletal Diseases/epidemiology ; Musculoskeletal Diseases/therapy ; Pediatrics ; Rheumatology ; United States/epidemiology
Language	English
Publishing date	2017-02-05
Publishing country	Scotland
Document type	Journal Article
ZDB-ID	1155895-7
ISSN	1873-6963 ; 0965-2299
ISSN (online)	1873-6963
ISSN	0965-2299
DOI	10.1016/j.ctim.2017.02.001
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Zs.A 3726: Show issues

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Article ; Online: Disordered T cell-B cell interactions in autoantibody-positive inflammatory arthritis.

Julé, Amélie M / Lam, Ki Pui / Taylor, Maria / Hoyt, Kacie J / Wei, Kevin / Gutierrez-Arcelus, Maria / Case, Siobhan M / Chandler, Mia / Chang, Margaret H / Cohen, Ezra M / Dedeoglu, Fatma / Halyabar, Olha / Hausmann, Jonathan / Hazen, Melissa M / Janssen, Erin / Lo, Jeffrey / Lo, Mindy S / Meidan, Esra / Roberts, Jordan E /

Wobma, Holly / Son, Mary Beth F / Sundel, Robert P / Lee, Pui Y / Sage, Peter T / Chatila, Talal A / Nigrovic, Peter A / Rao, Deepak A / Henderson, Lauren A

Frontiers in immunology

2023 Volume 13, Page(s) 1068399

Abstract: T peripheral helper (Tph) cells, identified in the synovium of adults with seropositive rheumatoid arthritis, drive B cell maturation and antibody production in non-lymphoid tissues. We sought to determine if similarly dysregulated T cell-B cell ... ...

Abstract	T peripheral helper (Tph) cells, identified in the synovium of adults with seropositive rheumatoid arthritis, drive B cell maturation and antibody production in non-lymphoid tissues. We sought to determine if similarly dysregulated T cell-B cell interactions underlie another form of inflammatory arthritis, juvenile oligoarthritis (oligo JIA). Clonally expanded Tph cells able to promote B cell antibody production preferentially accumulated in the synovial fluid (SF) of oligo JIA patients with antinuclear antibodies (ANA) compared to autoantibody-negative patients. Single-cell transcriptomics enabled further definition of the Tph gene signature in inflamed tissues and showed that Tph cells from ANA-positive patients upregulated genes associated with B cell help to a greater extent than patients without autoantibodies. T cells that co-expressed regulatory T and B cell-help factors were identified. The phenotype of these Tph-like Treg cells suggests an ability to restrain T cell-B cell interactions in tissues. Our findings support the central role of disordered T cell-help to B cells in autoantibody-positive arthritides.
MeSH term(s)	Humans ; Autoantibodies ; Arthritis, Rheumatoid ; T-Lymphocytes, Helper-Inducer ; Arthritis, Juvenile ; B-Lymphocytes
Chemical Substances	Autoantibodies
Language	English
Publishing date	2023-01-05
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	2606827-8
ISSN	1664-3224 ; 1664-3224
ISSN (online)	1664-3224
ISSN	1664-3224
DOI	10.3389/fimmu.2022.1068399
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Article ; Online: Pain and Catastrophizing in Patients With Rheumatoid Arthritis: An Observational Cohort Study.

Cohen, Ezra M / Edwards, Robert R / Bingham, Clifton O / Phillips, Kristine / Bolster, Marcy B / Moreland, Larry W / Neogi, Tuhina / Marder, Wendy / Wohlfahrt, Alyssa / Clauw, Daniel / Lee, Yvonne C

Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

2018 Volume 25, Issue 5, Page(s) 232–236

Abstract: Background: The aims of this study were to define changes in catastrophizing that occur with initiation of a new disease-modifying antirheumatic drug (DMARD) and to examine the relationship between changes in Clinical Disease Activity Index (CDAI) and ... ...

Abstract	Background: The aims of this study were to define changes in catastrophizing that occur with initiation of a new disease-modifying antirheumatic drug (DMARD) and to examine the relationship between changes in Clinical Disease Activity Index (CDAI) and changes in catastrophizing. Methods: Participants in an ongoing multisite, observational study completed the Pain Catastrophizing Scale (PCS) before and 12 weeks after DMARD initiation. We used multivariable linear regression models to examine the association between changes in CDAI as the exposure and change in pain catastrophizing as the outcome. We also assessed the relationship between changes in each component of CDAI and change in PCS, using multivariable linear regression models. Results: Among the 165 rheumatoid arthritis patients with data on CDAI at both time points, CDAI decreased from 22 to 11.5 on a 76-point scale (p < 0.0001) after 12 weeks. Pain intensity decreased from a median of 5 to 3 on a 10-point numeric rating scale (p < 0.0001), and catastrophizing decreased, from 16.0 to 12.0 on the 52-point PCS (p = 0.0005). Among the 163 with complete data for the regression analysis, changes in CDAI were positively correlated with changes in catastrophizing (standardized β = 0.19, p = 0.01). Of the components of the CDAI, change in assessor global score was most strongly associated with changes in catastrophizing (standardized β = 0.24, p = 0.003). Conclusions: Pain catastrophizing decreases, in conjunction with disease activity, after initiation of a new DMARD. These findings provide support for catastrophizing as a dynamic construct that can be altered with treatment directed at decreasing inflammatory disease activity and pain.
MeSH term(s)	Adult ; Aged ; Antirheumatic Agents/therapeutic use ; Arthritis, Rheumatoid/drug therapy ; Arthritis, Rheumatoid/psychology ; Catastrophization ; Female ; Humans ; Male ; Middle Aged ; Pain Measurement ; Severity of Illness Index
Chemical Substances	Antirheumatic Agents
Language	English
Publishing date	2018-08-26
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	1283266-2
ISSN	1536-7355 ; 1076-1608
ISSN (online)	1536-7355
ISSN	1076-1608
DOI	10.1097/RHU.0000000000000834
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Zs.A 4815: Show issues

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Article: An Evidence-Based Guideline Improves Outcomes for Patients With Hemophagocytic Lymphohistiocytosis and Macrophage Activation Syndrome.

Taylor, Maria L / Hoyt, Kacie J / Han, Joseph / Benson, Leslie / Case, Siobhan / Chandler, Mia T / Chang, Margaret H / Platt, Craig / Cohen, Ezra M / Day-Lewis, Megan / Dedeoglu, Fatma / Gorman, Mark / Hausmann, Jonathan S / Janssen, Erin / Lee, Pui Y / Lo, Jeffrey / Priebe, Gregory P / Lo, Mindy S / Meidan, Esra /

Nigrovic, Peter A / Roberts, Jordan E / Son, Mary Beth F / Sundel, Robert P / Alfieri, Maria / Yeun, Jenny Chan / Shobiye, Damilola M / Degar, Barbara / Chang, Joyce C / Halyabar, Olha / Hazen, Melissa M / Henderson, Lauren A

The Journal of rheumatology

2022 Volume 49, Issue 9, Page(s) 1042–1051

Abstract: Objective: To compare clinical outcomes in children with hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) who were managed before and after implementation of an evidence-based guideline (EBG).: Methods: A management ... ...

Abstract	Objective: To compare clinical outcomes in children with hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS) who were managed before and after implementation of an evidence-based guideline (EBG). Methods: A management algorithm for MAS-HLH was developed at our institution based on literature review, expert opinion, and consensus building across multiple pediatric subspecialties. An electronic medical record search retrospectively identified hospitalized patients with MAS-HLH in the pre-EBG (October 15, 2015, to December 4, 2017) and post-EBG (January 1, 2018, to January 21, 2020) time periods. Predetermined outcome metrics were evaluated in the 2 cohorts. Results: After the EBG launch, 57 children were identified by house staff as potential patients with MAS-HLH, and rheumatology was consulted for management. Ultimately, 17 patients were diagnosed with MAS-HLH by the treating team. Of these, 59% met HLH 2004 criteria, and 94% met 2016 classification criteria for MAS complicating systemic juvenile idiopathic arthritis. There was a statistically significant reduction in mortality from 50% before implementation of the EBG to 6% in the post-EBG cohort ( Conclusion: While the observed improvements may be partially attributed to advances in treatment of MAS-HLH that have accumulated over time, this analysis also suggests that a multidisciplinary treatment pathway for MAS-HLH contributed meaningfully to favorable patient outcomes.
MeSH term(s)	Humans ; Child ; Macrophage Activation Syndrome/drug therapy ; Macrophage Activation Syndrome/diagnosis ; Lymphohistiocytosis, Hemophagocytic/therapy ; Retrospective Studies ; C-Reactive Protein ; Biomarkers
Chemical Substances	C-Reactive Protein (9007-41-4) ; Biomarkers
Language	English
Publishing date	2022-07-15
Publishing country	Canada
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, N.I.H., Extramural
ZDB-ID	194928-7
ISSN	1499-2752 ; 0315-162X
ISSN (online)	1499-2752
ISSN	0315-162X
DOI	10.3899/jrheum.211219
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Zs.A 1168: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Th1 polarization defines the synovial fluid T cell compartment in oligoarticular juvenile idiopathic arthritis.

Julé, Amélie M / Hoyt, Kacie J / Wei, Kevin / Gutierrez-Arcelus, Maria / Taylor, Maria L / Ng, Julie / Lederer, James A / Case, Siobhan M / Chang, Margaret H / Cohen, Ezra M / Dedeoglu, Fatma / Hazen, Melissa M / Hausmann, Jonathan S / Halyabar, Olha / Janssen, Erin / Lo, Jeffrey / Lo, Mindy S / Meidan, Esra / Roberts, Jordan E /

Son, Mary Beth F / Sundel, Robert P / Lee, Pui Y / Chatila, Talal / Nigrovic, Peter A / Henderson, Lauren A

JCI insight

2021 Volume 6, Issue 18

Abstract: Oligoarticular juvenile idiopathic arthritis (oligo JIA) is the most common form of chronic inflammatory arthritis in children, yet the cause of this disease remains unknown. To understand immune responses in oligo JIA, we immunophenotyped synovial fluid ...

Abstract	Oligoarticular juvenile idiopathic arthritis (oligo JIA) is the most common form of chronic inflammatory arthritis in children, yet the cause of this disease remains unknown. To understand immune responses in oligo JIA, we immunophenotyped synovial fluid T cells with flow cytometry, bulk RNA-Seq, single-cell RNA-Seq (scRNA-Seq), DNA methylation studies, and Treg suppression assays. In synovial fluid, CD4+, CD8+, and γδ T cells expressed Th1-related markers, whereas Th17 cells were not enriched. Th1 skewing was prominent in CD4+ T cells, including Tregs, and was associated with severe disease. Transcriptomic studies confirmed a Th1 signature in CD4+ T cells from synovial fluid. The regulatory gene expression signature was preserved in Tregs, even those exhibiting Th1 polarization. These Th1-like Tregs maintained Treg-specific methylation patterns and suppressive function, supporting the stability of this Treg population in the joint. Although synovial fluid CD4+ T cells displayed an overall Th1 phenotype, scRNA-Seq uncovered heterogeneous effector and regulatory subpopulations, including IFN-induced Tregs, peripheral helper T cells, and cytotoxic CD4+ T cells. In conclusion, oligo JIA is characterized by Th1 polarization that encompasses Tregs but does not compromise their regulatory identity. Targeting Th1-driven inflammation and augmenting Treg function may represent important therapeutic approaches in oligo JIA.
MeSH term(s)	Adolescent ; Arthritis, Juvenile/genetics ; Arthritis, Juvenile/immunology ; CD4-Positive T-Lymphocytes/physiology ; CD8-Positive T-Lymphocytes/physiology ; Case-Control Studies ; Cell Polarity ; Child ; Child, Preschool ; DNA Methylation ; Female ; Humans ; Immunophenotyping ; Infant ; Intraepithelial Lymphocytes/physiology ; Male ; Sequence Analysis, RNA ; Single-Cell Analysis ; Synovial Fluid/immunology ; T-Lymphocytes/physiology ; T-Lymphocytes, Regulatory/physiology ; Th1 Cells/physiology ; Transcriptome
Language	English
Publishing date	2021-09-22
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2379-3708
ISSN (online)	2379-3708
DOI	10.1172/jci.insight.149185
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