Improving adherence to medical regimens for juvenile rheumatoid arthritis

Poor adherence to medical regimens can compromise the efficacy of treatments for children and adolescents with juvenile rheumatoid arthritis (JRA). The purpose of this review is to describe medical regimens for the treatment of JRA and the rates of adherence to these regimens. We also summarize and critically the few research studies aimed at improving adherence to regimens for JRA. Finally, we summarize strategies for enhancing adherence in clinical practice

Residual-liquid origin for a monzonitic intrusion in a mid-Proterozoic anorthosite complex: The Sybille intrusion, Laramie anorthosite complex, Wyoming

The Sybille intrusion (≈100 km2) is one of three large monzonitic intrusions in the 1.43 Ga Laramie anorthosite complex of southeastern Wyoming. The petrographic, geochemical, isotopic, and geophysical characteristics of Sybille monzonitic rocks are consistent with an origin by extensive crystallization of liquids residual to nearby anorthositic cumulates (ferrodiorites) and contamination by Archean wall rocks. The exposed part of the intrusion is composed mainly of coarse-grained monzosyenites with abundant alkali feldspar phenocrysts. The monzosyenites preserve mineralogical evidence for high crystallization temperatures (>1000°C), mid-crustal emplacement pressures (≈3 kbar), relatively reduced crystallization conditions (2 log units below the fayalite + magnetite + quartz [FMQ] oxygen buffer), and they crystallized in the presence of a CO2-rich fluid phase (Fuhrman et al. 1988; Frost and Touret, 1989). The eastern monzosyenites, those adjacent to contemporaneous anorthosite, are distinguished by an anhydrous mineral assemblage (Fo16-Fo8 olivine, high-Ca pyroxene) lacking modal quartz, silica contents of 60 wt%, and smaller Eu anomalies (Eu/Eu* = 1.2 to 1.3). Abundant xenoliths of Archean wall rocks and anorthosite from the adjacent intrusions in all monzosyenites attest to a sloping emplacement mechanism near the roof of the chamber. We propose that the monzosyenites represent a relatively thin, 0.5-1.0-km-thick, roof to a magma chamber dominated by dense ferrodioritic cumulates at depth. Extensive, open-system fractionation of a ferrodioritic parent magma, residual after crystallization of anorthosite, produced Fe-enriched monzodioritic and/or monzonitic magma in the upper part of the chamber and complementary Fe- and Ti-rich cumulates in the lower levels. We have corroborated the production of monzonitic liquids from crystallization of ferrodiorite through a series of reconnaissance equilibrium-crystallization experiments. The presence of dense ferrodioritic cumulates at depth is consistent with the prominent positive gravity anomaly associated with the Sybille intrusion (Hodge et al. 1973). In the upper parts of the chamber, the fractionated monzodioritic and/or monzonitic magmas eventually became saturated in alkali feldspar. Owing to density contrasts, the alkali feldspar phenocrysts floated to the roof of the chamber, thus producing the exposed porphyritic monzosyenites. In addition, the roof of the chamber was the site of significant melting of Archean gneiss and, locally, metapelite. The Sr and Nd isotopic compositions of the monzosyenites, with Sr isotopic ratios becoming increasingly radiogenic from east (ISr = 0.7059 and initial εNd = -2.5) to west (ISr = 0.7092 and initial εNd = -2.6), are consistent with a 5% to 15% addition of Archean orthogneiss to a ferrodioritic parent magma that had isotopic characteristics similar to adjacent anorthositic rocks. The stratigraphic and compositional similarity of the Sybille monzosyenites to mangerites in the Bjerkreim-Sokndal intrusion of the Rogaland anorthosite complex, southern Norway, indicates that similar open-system magmatic processes are capable of having produced high-temperature, K-rich monzonitic rocks in other Proterozoic anorthosite complexes.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

2016 American College of Rheumatology/European League Against Rheumatism Criteria for Minimal, Moderate, and Major Clinical Response in Juvenile Dermatomyositis An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation Collaborative Initiative

Objective. To develop response criteria for juvenile dermatomyositis (DM). Methods. We analyzed the performance of 312 definitions that used core set measures from either the International Myositis Assessment and Clinical Studies Group (IMACS) or the Paediatric Rheumatology International Trials Organisation (PRINTO) and were derived from natural history data and a conjoint analysis survey. They were further validated using data from the PRINTO trial of prednisone alone compared to prednisone with methotrexate or cyclosporine and the Rituximab in Myositis (RIM) trial. At a consensus conference, experts considered 14 top candidate criteria based on their performance characteristics and clinical face validity, using nominal group technique. Results. Consensus was reached for a conjoint analysis-based continuous model with a total improvement score of 0-100, using absolute percent change in core set measures of minimal (>= 30), moderate (>= 45), and major (>= 70) improvement. The same criteria were chosen for adult DM/polymyositis, with differing thresholds for improvement. The sensitivity and specificity were 89% and 91-98% for minimal improvement, 92-94% and 94-99% for moderate improvement, and 91-98% and 85-86% for major improvement, respectively, in juvenile DM patient cohorts using the IMACS and PRINTO core set measures. These criteria were validated in the PRINTO trial for differentiating between treatment arms for minimal and moderate improvement (P=0.009-0.057) and in the RIM trial for significantly differentiating the physician's rating for improvement (P <0.006). Conclusion. The response criteria for juvenile DM consisted of a conjoint analysis-based model using a continuous improvement score based on absolute percent change in core set measures, with thresholds for minimal, moderate, and major improvemen

2016 American College of Rheumatology/European League Against Rheumatism criteria for minimal, moderate, and major clinical response in juvenile dermatomyositis : An International Myositis Assessment and Clinical Studies Group/Paediatric Rheumatology International Trials Organisation collaborative initiative

To develop response criteria for juvenile dermatomyositis (DM). We analysed the performance of 312 definitions that used core set measures from either the International Myositis Assessment and Clinical Studies Group (IMACS) or the Paediatric Rheumatology International Trials Organisation (PRINTO) and were derived from natural history data and a conjoint analysis survey. They were further validated using data from the PRINTO trial of prednisone alone compared to prednisone with methotrexate or cyclosporine and the Rituximab in Myositis (RIM) trial. At a consensus conference, experts considered 14 top candidate criteria based on their performance characteristics and clinical face validity, using nominal group technique. Consensus was reached for a conjoint analysis-based continuous model with a total improvement score of 0-100, using absolute per cent change in core set measures of minimal (≥30), moderate (≥45), and major (≥70) improvement. The same criteria were chosen for adult DM/polymyositis, with differing thresholds for improvement. The sensitivity and specificity were 89% and 91-98% for minimal improvement, 92-94% and 94-99% for moderate improvement, and 91-98% and 85-86% for major improvement, respectively, in juvenile DM patient cohorts using the IMACS and PRINTO core set measures. These criteria were validated in the PRINTO trial for differentiating between treatment arms for minimal and moderate improvement ( p=0.009-0.057) and in the RIM trial for significantly differentiating the physician's rating for improvement (p<0.006). The response criteria for juvenile DM consisted of a conjoint analysis-based model using a continuous improvement score based on absolute per cent change in core set measures, with thresholds for minimal, moderate, and major improvement