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Allergy medication use in children with juvenile idiopathic arthritis PowerPoint Presentation

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Allergy medication use in children with juvenile idiopathic arthritis Presentation Transcript

Slide 1 - Allergy medication use in children with juvenile idiopathic arthritis—potential association with chronic anterior uveitis Sylvia Yoo1, Ira Wong2, Jennifer Frankovich3 1Department of Pediatrics, 2Department of Ophthalmology, 3Department of Pediatrics, Division of Rheumatology Lucile Packard Children’s Hospital Stanford University
Slide 2 - No relevant financial relationships to disclose or conflicts of interest to resolve
Slide 3 - JIA and Chronic Uveitis Uveitis can be blinding complication of JIA Frequency 2% to 34% ANA status and JIA subtype determines eye screening Little data for other risk factors High rate of allergic rhinitis in JIA cases complicated by chronic anterior uveitis Allergic rhinitis more easily diagnosed
Slide 4 - Objectives Test a priori hypothesis: allergic rhinitis associated with chronic anterior uveitis in JIA patients Conduct subgroup analysis to determine association with different JIA subtypes
Slide 5 - Goldmuntz EA. Pediatrics in Review. 2006
Slide 6 - Chronic Anterior Uveitis Inflammation of anterior uvea Can be silent Diagnosis requires slit-lamp exam Inflammatory cells in anterior chamber Complications: synechiae, band keratopathy, cataract, glaucoma, blindness © Up To Date
Slide 7 - Methods Stanford Translational Research Integrated Database Environment (STRIDE) Clinical data warehouse >1.3 million pediatric and adult patients since 1995 >8 million clinical encounters Anonymous Cohort Identification Tool HIPAA compliance stride.stanford.edu
Slide 8 - Methods STRIDE Anonymous Cohort Identification Tool ICD-9 codes for JIA diagnoses Age at diagnosis less than 18 years old ~1,120 JIA patients identified Allergy medications as a surrogate marker Medication reconciliation Flonase®, Nasacort®, Singulair®, Claritin®, Zyrtec®, Allegra®
Slide 9 - ppt slide no 9 content not found
Slide 10 - STRIDE Results
Slide 11 - Conclusions First report of potential association between allergic rhinitis and chronic uveitis in JIA Strongest association in spondyloarthropathy Suspect physiologic or anatomic mechanism Intranasal treatment for allergic conjunctivitis
Slide 12 - Study Weaknesses Anonymous Cohort Identification Tool Rounded search results give estimate Searches at four separate points in time Unable to view individual records to identify confounders Errors in ICD-9 coding Report of allergy medications in medication reconciliation may be incomplete
Slide 13 - Next Steps and Future Directions Analyze individual data with logistic regression Control for confounders Verify results of STRIDE Tool Chart review to verify association Confirm and compare ANA status Prospective study Validated atopy questionnaire Assess association between atopy and uveitis in JIA patients
Slide 14 - Acknowledgements Dr. Gomathi Krishnan, Dr. Susan Weber and Dr. Todd Ferris for their ongoing support with the STRIDE database Dr. Vivian Saper and Dr. Robert Bocian for their generous input on this project
Slide 15 - References Cassidy J, et al. Ophthalmologic Examinations in Children With Juvenile Rheumatoid Arthritis. Pediatrics. 2006;117:1843-1845. Goldmuntz EA, White PH. Juvenile Idiopathic Arthritis: A Review for the Pediatrician. Pediatrics in Review. 2006;27:e24-e32. Grassi A, et al. Prevalence and Outcome of Juvenile Idiopathic Arthritis-Associated Uveitis and Relation to Articular Disease. The Journal of Rheumatology. 2007;34:1139-1145. Kasapçopur Ö, et al. Uveitis and Anti Nuclear Antibody Positivity in Children with Juvenile Idiopathic Arthritis. Indian Pediatrics. 2004;41:1035-1039. Okano M. Current status of intranasal glucocorticosteroids in the management of allergic rhinitis. Clinical and Experimental Allergy Reviews. 2008;8:57-61 Stanford Center for Clinical Informatics. stride.stanford.edu.
 

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