Race is a risk factor for calcinosis in patients with JDM – early results from the CARRAnet...
2
POSTER PRESENTATION Open Access Race is a risk factor for calcinosis in patients with JDM – early results from the CARRAnet registry study Mark F Hoeltzel 1* , Mara L Becker 1 , Angela B Robinson 5 , Brian M Feldman 6 , Adam Huber 2 , Ann M Reed 3 , Juvenile Myositis CARRA Subgroup 4 , CARRAnet Investigators 4 From 2011 Pediatric Rheumatology Symposium sponsored by the American College of Rheumatology Miami, FL, USA. 2-5 June 2011 Purpose Previously established risk factors for calcinosis include duration of disease and the length of time to treatment, suggesting early aggressive treatment may be important in preventing calcinosis. Race has also been suggested to be a risk factor, but this observation was thought to be secondary to delays in treatment. We utilized the CAR- RAnet registry to investigate potential risk factors for calcinosis. Methods Children with juvenile dermatomyositis (JDM) in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) registry study were included in this analysis. Race and ethnicity were self-reported. Subjects with cur- rent or past calcinosis were identified, and bi-variable associations between clinical variables and calcinosis were evaluated by Chi-square test, Fisher exact test, two-sample t-test, or Wilcoxon Rank Sum test as appropriate. A multi- variable stepwise logistic regression model was run that included variables that were significantly associated in the bi-variable analysis, defined by P<0.1. All statistical ana- lyses were conducted using JMP Stats version 8.0 (SAS Institute, Cary, NC). Results Prior to December 28, 2010, 102 subjects meeting modi- fied Bohan and Peter criteria for JDM were enrolled from 23 U.S. sites. Fifteen subjects were excluded due to lack of data regarding calcinosis or race. Ten of the remaining 87 patients had a history of calcinosis. Potential predictors of calcinosis identified a priori included race, ethnicity, sex, ANA status, age, age of onset, duration of disease, and time to rheumatologic care. Bi-variable analyses revealed a significant association between calcinosis and African American (AA) race (P=0.029), disease duration (P=0.005), absence of antinuclear antibodies (P=0.024), and male gen- der (P=0.037) (Table 1). Analyzing these four variables in a multiple stepwise logistic regression model revealed that AA ancestry was the most significant predictor of calcino- sis (OR [95% CI] 5.8 [1.3, 24.8] P=0.019). When demo- graphic variables and outcome assessments were compared between AA patients and non-AA patients, only CHAQ scores were statistically significantly different in AA patients (mean (±SD), 0.54 (±0.51) vs. 0.29 (±0.52) in non-AA patients [P= 0.033]). Conclusion Children with JDM of African American ancestry have increased odds of developing calcinosis, even after con- trolling for duration of disease and time to rheumatolo- gic care. Male gender, negative ANA status, and disease duration were associated with calcinosis in bi-variable analysis, however, these variables were limited by incomplete data capture, which may have affected the results of the multi-variable regression model. Analysis of a larger more complete cohort is needed to confirm these observations. Disclosure Mark F. Hoeltzel: None; Mara L. Becker: None; Angela B. Robinson: None; Brian M. Feldman: None; Adam Huber: None; Ann M. Reed: None; Juvenile Myositis CARRA Subgroup: None; CARRAnet Investigators: None. 1 Children’s Mercy Hospital, Kansas City, MO, USA Full list of author information is available at the end of the article Hoeltzel et al. Pediatric Rheumatology 2012, 10(Suppl 1):A65 http://www.ped-rheum.com/content/10/S1/A65 © 2012 Hoeltzel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Transcript of Race is a risk factor for calcinosis in patients with JDM – early results from the CARRAnet...
POSTER PRESENTATION Open Access
Race is a risk factor for calcinosis in patients withJDM – early results from the CARRAnet registrystudyMark F Hoeltzel1*, Mara L Becker1, Angela B Robinson5, Brian M Feldman6, Adam Huber2, Ann M Reed3,Juvenile Myositis CARRA Subgroup4, CARRAnet Investigators4
From 2011 Pediatric Rheumatology Symposium sponsored by the American College of RheumatologyMiami, FL, USA. 2-5 June 2011
PurposePreviously established risk factors for calcinosis includeduration of disease and the length of time to treatment,suggesting early aggressive treatment may be importantin preventing calcinosis. Race has also been suggested tobe a risk factor, but this observation was thought to besecondary to delays in treatment. We utilized the CAR-RAnet registry to investigate potential risk factors forcalcinosis.
MethodsChildren with juvenile dermatomyositis (JDM) in theChildhood Arthritis and Rheumatology Research Alliance(CARRA) registry study were included in this analysis.Race and ethnicity were self-reported. Subjects with cur-rent or past calcinosis were identified, and bi-variableassociations between clinical variables and calcinosis wereevaluated by Chi-square test, Fisher exact test, two-samplet-test, or Wilcoxon Rank Sum test as appropriate. A multi-variable stepwise logistic regression model was run thatincluded variables that were significantly associated in thebi-variable analysis, defined by P<0.1. All statistical ana-lyses were conducted using JMP Stats version 8.0 (SASInstitute, Cary, NC).
ResultsPrior to December 28, 2010, 102 subjects meeting modi-fied Bohan and Peter criteria for JDM were enrolled from23 U.S. sites. Fifteen subjects were excluded due to lack ofdata regarding calcinosis or race. Ten of the remaining 87patients had a history of calcinosis. Potential predictors of
calcinosis identified a priori included race, ethnicity, sex,ANA status, age, age of onset, duration of disease, andtime to rheumatologic care. Bi-variable analyses revealed asignificant association between calcinosis and AfricanAmerican (AA) race (P=0.029), disease duration (P=0.005),absence of antinuclear antibodies (P=0.024), and male gen-der (P=0.037) (Table 1). Analyzing these four variables in amultiple stepwise logistic regression model revealed thatAA ancestry was the most significant predictor of calcino-sis (OR [95% CI] 5.8 [1.3, 24.8] P=0.019). When demo-graphic variables and outcome assessments werecompared between AA patients and non-AA patients,only CHAQ scores were statistically significantly differentin AA patients (mean (±SD), 0.54 (±0.51) vs. 0.29 (±0.52)in non-AA patients [P= 0.033]).
ConclusionChildren with JDM of African American ancestry haveincreased odds of developing calcinosis, even after con-trolling for duration of disease and time to rheumatolo-gic care. Male gender, negative ANA status, and diseaseduration were associated with calcinosis in bi-variableanalysis, however, these variables were limited byincomplete data capture, which may have affected theresults of the multi-variable regression model. Analysisof a larger more complete cohort is needed to confirmthese observations.
DisclosureMark F. Hoeltzel: None; Mara L. Becker: None; AngelaB. Robinson: None; Brian M. Feldman: None; AdamHuber: None; Ann M. Reed: None; Juvenile MyositisCARRA Subgroup: None; CARRAnet Investigators:None.
1Children’s Mercy Hospital, Kansas City, MO, USAFull list of author information is available at the end of the article
Hoeltzel et al. Pediatric Rheumatology 2012, 10(Suppl 1):A65http://www.ped-rheum.com/content/10/S1/A65
© 2012 Hoeltzel et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.
Author details1Children’s Mercy Hospital, Kansas City, MO, USA. 2IWK Health Centre, Halifax,NS, Canada. 3Mayo Clinic, Rochester, MN, USA. 4Rainbow Babies andChildrens Hospital, Cleveland, OH, USA. 5The Hospital for Sick Children,Toronto, ON, Canada. 6Stanford, CA, USA.
Published: 13 July 2012
doi:10.1186/1546-0096-10-S1-A65Cite this article as: Hoeltzel et al.: Race is a risk factor for calcinosis inpatients with JDM – early results from the CARRAnet registry study.Pediatric Rheumatology 2012 10(Suppl 1):A65.
Submit your next manuscript to BioMed Centraland take full advantage of:
• Convenient online submission
• Thorough peer review
• No space constraints or color figure charges
• Immediate publication on acceptance
• Inclusion in PubMed, CAS, Scopus and Google Scholar
• Research which is freely available for redistribution
Submit your manuscript at www.biomedcentral.com/submit
Table 1 Analysis of calcinosis risk factors
Number (%) or Mean (+/-SD) withcalcinosis
Bi-variable analysis (p-value)
Stepwise logistic regression analysis (OR [95%CI] pvalue
African Americanancestry
4 (33%) 0.03* 5.8 [1.3, 24.8] 0.02*
Non-AA ancestry 6 (8%)
Male 5 (26%) 0.04* NS
Female 5 (7%)
Negative ANA 6 (19%) 0.02* NS
Positive ANA 1 (2%)
Disease duration, yrs 7.2 (+/-4.1) <0.01* NS
Hoeltzel et al. Pediatric Rheumatology 2012, 10(Suppl 1):A65http://www.ped-rheum.com/content/10/S1/A65
Page 2 of 2
