CARRA Newsletter
March 25, 2016
Table of Contents
If you have ideas for articles we should highlight, or you are interested in contributing to this column, please contact Jay ( ) or Brian ( ).

After Daniel Horton and his collaborators reported on the results of their nested case-controlled study regarding antibiotic exposure and JIA in Pediatrics ( 2015 vol 136 issue 2 ), the same group of data-miners did a similar, nested case-control study from UK's Health Improvement Network data on children aged 1-15 years with newly diagnosed psoriasis, excluding those children with "juvenile arthritis", immunodeficiency, or inflammatory bowel disease. Unlike the findings of their previous reports, which demonstrated an association between antibiotic exposure and newly-diagnosed JIA rather than between infections and JIA, in this study they found that infections are associated with pediatric psoriasis, and that antibiotic exposure "did not appear to contribute substantially to that risk".
In the JIA paper, Horton et al. did not break out systemic JIA as a subtype; the JAMA Dermatology paper did not mention whether the newly diagnosed children with psoriasis had testing for either HLA-B27 or HLA-C*06. Both Systemic JIA and psoriasis are considered autoinflammatory diseases rather than autoimmune diseases. However, Michael Ombrello's paper in the Proceedings of the National Academy of Science ( 112:1590-15975 ) describes their finding of HLA DRB1*ll and variants with a glutamate 68 as a strong risk factor for SJIA. Peter Nigrovic describes in the same issue the "bi-phasic hypothesis" in which an innate autoinflammatory process may then allow for a slip in immune tolerance and the evolution of an autoimmune component to the disease process.
If I meander back to psoriasis, in Rheumatology ( 2016, 55:221-229 ), Queiro and colleagues review of the relationship of HLA-B27 and psoriatic disease, the proclivity of HLA-B27 to be more strongly associated with a shorter interval between the onset of skin disease and the onset of psoriatic joint disease as compared to psoriasis patients who are HLA-C*06 + and HLA-B27 - . Finally, back to the initial question about the microbiome and early antibiotic exposure and "JIA". Without differentiation of subtype (Systemic or HLA-B27+ enthesitis-related), might there be more to understand?  What could be gleaned from data-mining? Is it possible to follow up on the pediatric psoriasis population, track for emergence of psoriatic arthritis, and assess their MHC status?  Retrospectively, could the subtypes of the JIA population Horton had in his paper be determined? I would be interested to learn whether there are distinctions to be found among the autoinflammatory (or Bi-phasic) or the HLA-B-27 + groups of arthritis syndromes and infection, antibiotic exposure and, eventually the microbiome.

If you have registered for the CARRA annual meeting, we look forward to seeing you in Toronto! If you have not registered, do so here ! Join almost 400 attendees as we work together to improve outcomes in pediatric rheumatologic diseases.
CARRA 2016 Elections and Proposed Changes to Charter
(For CARRA members only)

Please vote on changes to the CARRA Charter for the election of  key leadership positions and for the leaders of the organization. The proposed changes to the CARRA Charter have been approved by both the Steering Committee and Board of Directors. Please review the proposed changes to the Charter. Before voting in the elections, we recommend that you review the candidates' personal statements and biographical sketches. These may be found in the 2016 Election Guide . If you are a current voting member and did not receive an email through SurveyMonkey with the 2016 Ballot, please contact Heather Barnes, Communications and Operations Manager, at .

Help select the new CARRA logo
CARRA is developing a new, cohesive and modern branding approach for communications and marketing. We recently launched a logo design contest. From a pool of over 80 entries, we have narrowed the field to six finalists including our current logo. We want to hear from you! Please vote here for the logo you prefer , and feel free to share your thoughts about the design options.
CA RRA Registry Update
Luke Reichley's photo.JPGMore than 900 subjects have been enrolled in the CARRA Registry.  We are profiling key members of the team at Seattle Children's Hospital, Luke Reichley and Ching Hung. Luke and Ching share their passion for clinical research and for CARRA! 

Luke works as a Clinical Research Associate II. In partnership with principal investigators, he creates research materials including surveys, flyers, and consent documents while identifying and recruiting subjects. He conducts enrollment and follow up visits with patients and families. To maximize recruitment efforts, Luke prepares monthly, weekly, and daily patient schedules. Ching attributes Seattle Children's successful enrollment in CARRA to incorporating everyone's involvement in research and accountability. Ching and team have managed to integrate research into clinical care rather than have it be an afterthought. Medical assistants are trained as the front line to help identify participants and prompt providers. Nurses help to prompt the providers while they are seeing patients. Ching and Luke have clearly built a great relationship with the team that encourages success. READ MORE ...

What's stopping you from getting started with STOP-JIA? 

This PCORI funded study is enrolling newly diagnosed patients with Polyarticular JIA. Please remember to discuss this with your patients. For STOP-JIA, we need to enroll them at the visit when the diagnosis was made. More than 35 sites are now approved for enrollment!  Questions about whether or not a subject qualifies?  Contact Yuki Kimura ( ), Sarah Ringold ( ), Laura Schanberg ( ), or Jason Jones ( ).

CARRA Announcements

Kathryn Torok, MD, Children's Hospital of Pittsburgh and Assistant Professor of Pediatric Rheumatology at the University of Pittsburgh, received the Scleroderma Foundation Multi-Center Collaborative Research Grant for a project titled "Identifying juvenile scleroderma immunophenotype subsets". Co-investigators include Anne Stevens, MD, PhD, and Suzanne C. Li, MD, PhD. 

Several DCRI team members will be in Toronto and look forward to connecting with you there. 
Calling Pediatric Rheumatologists! Your help is needed to improve measurement of flares in lupus patients! The Criteria of Global Disease Flare in Children and Adolescents with Lupus were developed collaboratively in 2011, but require validation before they can be used in practice. As part of this effort, practicing pediatric rheumatologists are needed to rate a limited number of patient profiles describing disease courses in children and adolescents with SLE.To participate, please provide your contact information

The Pediatric Nephrology and Rheumatology Collaborative Group asks that you complete a survey to determine the most common approaches for treating children with refractory proliferative lupus nephritis, and isolated membranous lupus nephritis. The goal is to develop Best Care Protocols that can eventually be compared to one another. This survey is for CARRA members only.  Please participate!
AF Arthritis Foundation News and Announcements
The Arthritis Foundation recently underwent a strategic and geographic reorganization. They have a new office in Atlanta and a new regional division of the United States. Members of the AF will be attend the CARRA meeting in Toronto. Reach out to Grendel Burrell, , about how and where you can participate with your local and regional JA committees. Regional map and leadership are shown here.

The Arthritis Foundation's JA camps give kids with arthritis and related conditions the chance to make lasting memories. For many campers, it's the first time they've met other kids who live with the same challenges.  There are some 50 JA camps across the country.  To see camp locations, go to
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