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Research ArticleAccepted Article

Early abnormal nailfold capillary changes are predictive of calcinosis development in juvenile dermatomyositis

Tomo Nozawa, Audrey Bell-Peter, Jo-Anne Marcuz, Kristi Whitney, Ophir Vinik, Rachel Shupak, Saunya Dover and Brian M. Feldman
The Journal of Rheumatology August 2022, jrheum.220249; DOI: https://doi.org/10.3899/jrheum.220249
Tomo Nozawa
The source(s) of support in the form of grants or industrial support: Tomo Nozawa was supported by research fellowships of Japan Society of Allergology, Mochida Memorial Foundation, and Gushinkai. Brian Feldman is supported by the Ho Family Chair in Autoimmune Diseases. Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Rheumatology, Saint Michael's Hospital, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Departments of Pediatrics and Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Conflict of Interests: The authors have no potential conflicts of interest relevant to this article to disclose. Corresponding author: Tomo Nozawa MD, Department of Pediatrics, Yokohama City University Graduate School of Medicine, Address: 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan. Email: tnozawa@yokohama-cu.ac.jp
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Audrey Bell-Peter
The source(s) of support in the form of grants or industrial support: Tomo Nozawa was supported by research fellowships of Japan Society of Allergology, Mochida Memorial Foundation, and Gushinkai. Brian Feldman is supported by the Ho Family Chair in Autoimmune Diseases. Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Rheumatology, Saint Michael's Hospital, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Departments of Pediatrics and Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Conflict of Interests: The authors have no potential conflicts of interest relevant to this article to disclose. Corresponding author: Tomo Nozawa MD, Department of Pediatrics, Yokohama City University Graduate School of Medicine, Address: 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan. Email: tnozawa@yokohama-cu.ac.jp
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Jo-Anne Marcuz
The source(s) of support in the form of grants or industrial support: Tomo Nozawa was supported by research fellowships of Japan Society of Allergology, Mochida Memorial Foundation, and Gushinkai. Brian Feldman is supported by the Ho Family Chair in Autoimmune Diseases. Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Rheumatology, Saint Michael's Hospital, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Departments of Pediatrics and Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Conflict of Interests: The authors have no potential conflicts of interest relevant to this article to disclose. Corresponding author: Tomo Nozawa MD, Department of Pediatrics, Yokohama City University Graduate School of Medicine, Address: 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan. Email: tnozawa@yokohama-cu.ac.jp
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Kristi Whitney
The source(s) of support in the form of grants or industrial support: Tomo Nozawa was supported by research fellowships of Japan Society of Allergology, Mochida Memorial Foundation, and Gushinkai. Brian Feldman is supported by the Ho Family Chair in Autoimmune Diseases. Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Rheumatology, Saint Michael's Hospital, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Departments of Pediatrics and Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Conflict of Interests: The authors have no potential conflicts of interest relevant to this article to disclose. Corresponding author: Tomo Nozawa MD, Department of Pediatrics, Yokohama City University Graduate School of Medicine, Address: 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan. Email: tnozawa@yokohama-cu.ac.jp
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Ophir Vinik
The source(s) of support in the form of grants or industrial support: Tomo Nozawa was supported by research fellowships of Japan Society of Allergology, Mochida Memorial Foundation, and Gushinkai. Brian Feldman is supported by the Ho Family Chair in Autoimmune Diseases. Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Rheumatology, Saint Michael's Hospital, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Departments of Pediatrics and Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Conflict of Interests: The authors have no potential conflicts of interest relevant to this article to disclose. Corresponding author: Tomo Nozawa MD, Department of Pediatrics, Yokohama City University Graduate School of Medicine, Address: 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan. Email: tnozawa@yokohama-cu.ac.jp
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Rachel Shupak
The source(s) of support in the form of grants or industrial support: Tomo Nozawa was supported by research fellowships of Japan Society of Allergology, Mochida Memorial Foundation, and Gushinkai. Brian Feldman is supported by the Ho Family Chair in Autoimmune Diseases. Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Rheumatology, Saint Michael's Hospital, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Departments of Pediatrics and Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Conflict of Interests: The authors have no potential conflicts of interest relevant to this article to disclose. Corresponding author: Tomo Nozawa MD, Department of Pediatrics, Yokohama City University Graduate School of Medicine, Address: 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan. Email: tnozawa@yokohama-cu.ac.jp
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Saunya Dover
The source(s) of support in the form of grants or industrial support: Tomo Nozawa was supported by research fellowships of Japan Society of Allergology, Mochida Memorial Foundation, and Gushinkai. Brian Feldman is supported by the Ho Family Chair in Autoimmune Diseases. Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Rheumatology, Saint Michael's Hospital, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Departments of Pediatrics and Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Conflict of Interests: The authors have no potential conflicts of interest relevant to this article to disclose. Corresponding author: Tomo Nozawa MD, Department of Pediatrics, Yokohama City University Graduate School of Medicine, Address: 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan. Email: tnozawa@yokohama-cu.ac.jp
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Brian M. Feldman
The source(s) of support in the form of grants or industrial support: Tomo Nozawa was supported by research fellowships of Japan Society of Allergology, Mochida Memorial Foundation, and Gushinkai. Brian Feldman is supported by the Ho Family Chair in Autoimmune Diseases. Division of Rheumatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, Yokohama City University Graduate School of Medicine, Yokohama City, Kanagawa, Japan; Department of Rehabilitation, The Hospital for Sick Children, Toronto, Ontario, Canada; Division of Rheumatology, Saint Michael's Hospital, Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada; Departments of Pediatrics and Institute of Health Policy Management & Evaluation, University of Toronto, Toronto, Ontario, Canada. Conflict of Interests: The authors have no potential conflicts of interest relevant to this article to disclose. Corresponding author: Tomo Nozawa MD, Department of Pediatrics, Yokohama City University Graduate School of Medicine, Address: 3-9 Fukuura, Kanazawa-ku, Yokohama, Japan. Email: tnozawa@yokohama-cu.ac.jp
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Abstract

Objective The long-term outcomes of juvenile dermatomyositis (JDM) are more favorable in recent years. However, calcinosis is still among the complications that can cause serious functional impairment. Little is known about the pathogenesis and risk factors of calcinosis. The aim of this study is to determine risk factors for the development of calcinosis in JDM.

Methods This was a single-center, retrospective cohort study. All patients were diagnosed and followed at The Hospital for Sick Children's multidisciplinary JDM clinic, from January 1, 1989 until May 31, 2018. To investigate predictors of incident calcinosis, Cox regression analysis was performed.

Results A total of 172 patients met inclusion criteria, median age at diagnosis of 7.7 years (interquartile range [IQR] 4.9-12.1), median follow-up of 8.5 years (IQR 8.5-12.6, range 0.13-28.3). The only risk factor significantly associated with the development of calcinosis in the univariate analysis was nailfold abnormality at baseline (hazard ratio [HR] 4.857, p = 0.029), and the other variables had no significant relationship with calcinosis. In multivariable analysis, including nailfold abnormality, age of diagnosis, sex, and duration from onset to diagnosis, the only statistically significant risk factor for calcinosis was the presence of nailfold abnormalities (HR 4.975, p = 0.027). Furthermore, calcinosis was significantly increased in patients with a chronic course (chi-square 25.8, p = 0.00001).

Conclusion The presence of abnormal nailfold capillary changes at baseline is predictive for the development of calcinosis in children with idiopathic inflammatory myopathies.

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The Journal of Rheumatology
Vol. 49, Issue 8
1 Aug 2022
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Accepted manuscript
Early abnormal nailfold capillary changes are predictive of calcinosis development in juvenile dermatomyositis
Tomo Nozawa, Audrey Bell-Peter, Jo-Anne Marcuz, Kristi Whitney, Ophir Vinik, Rachel Shupak, Saunya Dover, Brian M. Feldman
The Journal of Rheumatology Aug 2022, jrheum.220249; DOI: 10.3899/jrheum.220249

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Accepted manuscript
Early abnormal nailfold capillary changes are predictive of calcinosis development in juvenile dermatomyositis
Tomo Nozawa, Audrey Bell-Peter, Jo-Anne Marcuz, Kristi Whitney, Ophir Vinik, Rachel Shupak, Saunya Dover, Brian M. Feldman
The Journal of Rheumatology Aug 2022, jrheum.220249; DOI: 10.3899/jrheum.220249
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