List of references
Epidemiology of pediatric rheumatic diseases
(9th December 1999)

1. ARGUEDAS O, PORRAS O, FASTH A: Juvenile chronic arthritis in Costa Rica. A pilot referral study. Clin.Exp.Rheumatol. 1995, 13:119-123.
   Organism:Department of Immunology, National Children's Hospital Dr. Carlos Saenz Herrera, San Jose, Costa Rica.
   Abstract: In order to adequately care for patients with chronic disorders and to properly allocate resources, the epidemiology of the underlying disease must be know. Proper population based studies involve substantial planning and educational programs, however. To prepare for such a study of pediatric rheumatic disorders, we performed a referral-based pilot study. During an eleven-month period pediatricians all over Costa Rica were asked to refer to us all new cases of possible rheumatic disorders among children less than 16 years of age, using the EULAR criteria for juvenile chronic arthritis. The children were evaluated at the National Children's Hospital. An annual incidence of 5.9 cases of all types of pediatric rheumatic diseases per 100,000 was found. Incidences of 5.4 per 100,000 children below 16 years of age and 6.1 for children below 12 years of age were observed for juvenile chronic arthritis (JCA). 77% of the JCA cases were of pauciarticular onset, and 23% were of polyarticular onset. No cases of systemic JCA were diagnosed. The female to male ratio was 3:2. Antinuclear antibodies were positive in 13% of the JCA cases, and IgM rheumatoid factor was found in 15% of the children. Chronic iritis was noted in only 2 cases; both were girls and both were ANA positive. The incidence found was low compared to population-based studies, but in the same range as hospital-based investigations
2. ARGUEDAS O, FASTH A, ANDERSSON-GARE B, PORRAS O: Juvenile chronic arthritis in urban San Jose, Costa Rica: A 2 year prospective study. Rinsho Ganka 1998, 25:1844-1850.
   Organism:NATL CHILDRENS HOSP,DEPT IMMUNOL, APARTADO 1654
   Abstract: Objective. To find the incidence and prevalence of juvenile chronic arthritis (JCA) in the urban area of San Jose, Costa Rica. Methods. During the year preceding our 2 year prospective, population based study, we conducted an educational program on JCA. The physicians caring for children < 16 years of age from all centers in the study area followed the program. They were asked to refer all cases of possible JCA according to EULAR criteria. The children were all evaluated at the National Children's Hospital. Results. Of 189 children referred, 48 fulfilled EULAR criteria for JCA. The 2 year incidence rare for JCA was 13.7 per 100,000 children < 16 years old. This corresponds to an annual incidence per 100,000 children of 6.8 (95% CI 4.1-9.6). The incidence rate for pauciarticular onset JCA was 3.9 per 100,000. At the prevalence date, 122 cases of JCA were recorded, corresponding to a prevalence of 34.9 per 100,000 children < 16 years. When patients in remission were excluded, the prevalence was 31.4 per 100,000 (95% CI 25.5-37.2). The pauciarticular onset form was the most common, 71% of all prevalence cases. The highest incidence and prevalence were noted for pauciarticular girls with late onset JCA. No incidence peak was found in preschool age. The girl-to-boy ratio was 1.5/1. Antinuclear antibodies (ANA) were positive in only 7 cases (6.3%). IgM rheumatoid factor was found in 13 children (10.6%). Chronic iritis was observed in 4 cases, all of them ANA negative and older than 7 years of age at onset of arthritis. Conclusion. The incidence and prevalence observed were lower than those reported in other population based studies, but within the confidence intervals of their data. The incidence rate for pauciarticular JCA was significantly lower than that reported in other comparable studies, ANA positive pauciarticular preschool girls and associated uveitis were rarely encountered
3. BENELOVENSKAIA LI, ERDES SH, SHUBIN SV, SHOKH BN, MYLOV NM: [The epidemiology of spondylarthropathies among the native inhabitants of Chukotka (Eskimos and Chukchi). 1. The prevalence of spondylarthropathies among the Eskimos and the coast Chukchi] Epidemiologiia spondiloartropatii sredi korennykh zhitelei Chukotki (eskimosov i chukhei). Soobshchenie 1. Rasprostranennost' spondiloartropatii sredi eskimosov i beregovykh chukchei. Ter.Arkh. 1994, 66:12-15.
   Abstract: To establish the prevalence of spondyloarthropathies among the indigenous population of Chukot Peninsula, a one-stage cross- sectional study was made with a direct medical examination of the natives of the two settlements of Eastern Chukot Peninsula: Sireniki and Novo-Chaplino where the main part of Eskimos live. During expedition, 640 natives aged over 6 years lived in both settlements (382 and 258 respectively). 464 persons (72.5%) were examined. Of these, 7 persons (1.5%) were diagnosed to suffer from diseases belonging to the group of spondyloarthropathies: 2 persons (0.4%) had ankylosing spondyloarthritis, 2 (0.4%) Reiter's syndrome, 2 undifferentiated spondyloarthropathies, and 1 juvenile chronic arthritis. Of the 7 patients, 4 were Eskimos, 2 half-breeds and 1 was a Chukchi man. The incidence of ankylosing spondyloarthritis among Eskimos amounted to 0.9%, Reiter's syndrome to 0.5%, and undifferentiated spondyloarthropathies to 0.5%. Thus the one-stage expedition examination of the indigenous population of Chukotka Peninsula (Eskimos and Chukchi) has shown that diseases belonging to the group of spondyloarthropathies are widely prevalent among Eskimos
4. BENEVOLENSKAIA LI, ERDES SH, KRYLOV MI, CHEKALINA NA: [The epidemiology of spondyloarthropathies among the native inhabitants of Chukotka. 2. The prevalence of HLA-B27 in the population and among spondyloarthropathy patients] Epidemiologiia spondiloartropatii sredi korennykh zhitelei Chukotki. Soobshchenie 2. Raspredelenie HLA-B27 v populiatsii i sredi bol'nykh spondiloartropatiiami. Ter.Arkh. 1994, 66:41-44.
   Abstract: To establish the incidence of HLA-B27 among the indigenous population of Chukot Peninsula, a one-stage cross-sectional study was made of all the natives of the two settlements of eastern Chukot Peninsula (Sireniki and Novo-Chaplino). At the moment of examination altogether 640 natives lived in both settlements. Of these, 464 persons (72.5%) could be examined clinically; HLA typing could be performed in 439 persons (68.6%). Among the 439 natives examined, antigen B27 was identified in 141 cases (32.1%). Among Eskimos, the number of HLA-B27-positive individuals amounted to 39.7%, among Chukchi to 18.9% (p = 0.0005). Half-breeds occupied an intermediate position between the two groups. The frequency of NLA-B27-positive cases was 29.7% among them. 7 patients were diagnosed to have diseases belonging to the group of spondyloarthropathies. 2 persons presented with ankylosing spondyloarthritis, 2 with Reiter's syndrome, 2 with undifferentiated spondyloarthropathies and 1 with juvenile chronic arthritis. All the patients with ankylosing spondyloarthritis and Reiter's syndrome appeared HLA-B27-positive
5. BENJAMIN CM: Review of UK data on the rheumatic diseases--1. Juvenile chronic arthritis. Br.J.Rheumatol. 1990, 29:231-233.
   Organism:ARC Epidemiology Research Unit, University of Manchester.
6. CHALOM EC, GOLDSMITH DP, KOEHLER MA, BITTAR B, ROSE CD, OSTROV BE, KEENAN G: Prevalence and outcome of uveitis in a regional cohort of patients with juvenile rheumatoid arthritis. Rinsho Ganka 1997, 24:2031-2034.
   Organism:Division of Pediatric Rheumatology, The Children's Hospital ofPhiladelphia Philadelphia, PA United States^St. Christopher's Hospitalfor Children Philadelphia, PA United States^Alfred I. DupontInstitute Wilmington, DE United States^Milton S. Hershey Medica
   Abstract: rheumatoid arthritis (JRA). Methods. A retrospective analysis of 760patients with JRA followed in 4 pediatric rheumatology centers.Patients with chronic uveitis were identified and their medical andophthalmologic records were reviewed. Results. Seventy-four patientswith uveitis were identified. The prevalence of uveitis was 9.3%. Themean interval from the onset of JRA to the onset of uveitis was 21months, and 90% of the patients who developed uveitis did so within thefirst 4 years of their disease. Visual complications (synechiae, bandkeratopathy, cataract, or glaucoma) developed in 31% of the patientswith uveitis. Complications were more common in patients who presentedwith uveitis early in the course of their JRA. Complications were alsomore common in antinuclear antibody (ANA) negative than in ANA positivepatients. Visual loss to 20/50 or worse occurred in only 11% ofpatients with uveitis, and no patient became blind. Conclusion. In avery large cohort of patients with JRA, uveitis was uncommon and poorvisual outcome was rare. Visual complications did not necessarilyresult in a poor outcome
7. DENARDO BA, TUCKER LB, MILLER LC, SZER IS, SCHALLER JG: Demography of a regional pediatric rheumatology patient population. Affiliated Children's Arthritis Centers of New England. J.Rheumatol. 1994, 21:1553-1561.
   Organism:Department of Pediatrics, Floating Hospital for Children, Boston, MA 02111
   Abstract: To examine the descriptive epidemiology of a regional cohort of children with rheumatic disease, and to document the variety and frequency of diseases encountered among pediatric rheumatology centers. METHODS. Pediatric rheumatology centers in southern New England participated in a prospective multicenter patient registry. All outpatients attending clinics at 8 pediatric rheumatology centers were enrolled as subjects during the 8- year period of study (n = 4585). Diagnostic criteria defined the rheumatic disease cases which were determined by clinical examination by a pediatric rheumatologist, and record linkage was achieved to avoid duplication of subjects. RESULTS. Rheumatic conditions were diagnosed in 1742 subjects. Juvenile rheumatoid arthritis (JRA) was the most frequently encountered rheumatic condition (53%), followed by spondyloarthropathy syndromes (13%), vasculitis (10%), systemic lupus erythematosus (SLE) (6%), isolated Raynaud's phenomenon (5%), dermatomyositis/polymyositis (DM/PM) (5%), and scleroderma (2%). The mean annual incidence of JRA, spondyloarthropathy syndromes, SLE and DM/PM among children referred to pediatric rheumatology centers in Massachusetts was 4.0, 2.0, 0.4 and 0.4 per 100,000 children at risk, respectively. Nonrheumatic conditions were diagnosed in 2843 subjects, among which musculoskeletal conditions were most frequent (56%) followed by infectious disorders (18%), psychogenic disorders (3%), fever of unknown origin (2%), and abnormal immune serology without a specific diagnosis (2%). CONCLUSION. The use of a multicenter patient registry was successful in allowing the collection of descriptive epidemiologic data on a large and well defined sample of children with rare disorders
8. FUJIKAWA S: [Epidemiological studies of rheumatic diseases among Japanese children]. Ryumachi 1998, 38:555-561.
   Abstract: Type: JOURNAL ARTICLE
   Type: REVIEW
   Type: REVIEW, TUTORIAL
9. GARE BA, FASTH A: Epidemiology of juvenile chronic arthritis in southwestern Sweden: a 5-year prospective population study. Pediatrics 1992, 90:950-958.
   Abstract: 93065037 Department of Pediatrics, University of Goteborg, Sweden (UNITED STATES) 0031-4005 ENGLISH 9302 AIM^INDEX MEDICUS Previous epidemiological studies of juvenile chronic arthritis (JCA) report divergent results owing to differences in diagnostic criteria, patient retrieval, and study designs. To investigate incidence and prevalence of JCA in a total population, this prospective survey was performed in southwestern Sweden between 1984 and 1988. Cases were identified using the European League Against Rheumatism criteria for JCA and were reported annually from eight pediatric departments and local pediatricians in the studied area. During the 5 years, 213 new cases of JCA were found, corresponding to an incidence of 54.6 per 100,000 children younger than 16 years of age. The average annual incidence was 10.9 per 100,000. The peak incidence rate, 18.3 per 100,000 was found in girls 0 through 3 years old. The lowest incidence rate, 6.4 per 100,000, was found among boys 12 through 15 years old. In December 1988, 334 cases of JCA were recorded, giving a prevalence of 86.3 per 100,000. When patients in remission were omitted the prevalence was 64.1 per 100,000. The monoarticular+pauciarticular onset type constituted 68.3% of the prevalence cases, while 21.9 were polyarticular and 6.6% had systemic onset. To avoid underestimation of incidence and prevalence, and to get a correct picture of disease patterns, epidemiological surveys of JCA should be population-based rather than referral center-based. Further descriptive studies of JCA in different well- defined geographic areas are important to make valid comparisons. Such comparisons could give clues to etiological factors, both genetic and environmental 0 (Antibodies, Antinuclear);9009-79-4 (Rheumatoid Factor)
10. GARE BA: Epidemiology of rheumatic disease in children. Curr.Opin.Rheumatol. 1996, 8:449-454.
    Abstract: Major problems associated with interpreting and comparing epidemiologic studies on chronic arthropathies in children include the diversity of classification criteria and selection bias. A new set of classification criteria for peripheral arthritis in children, aiming toward defining biologically homogeneous subgroups, was recently proposed and should be further tested. Descriptive studies from all over the world are now emerging on childhood rheumatic diseases, increasing the potential for comparing the impact of genetic and environmental factors on disease frequency and manifestations. Awareness about pain syndromes in children, such as juvenile primary fibromyalgia and reflex sympathetic dystrophy, has increased, and this population now forms a substantial portion of clinic visits in pediatric rheumatology. The impact of the rheumatic diseases in children on disability and quality of life during childhood and in adult life is still to a large extent unknown and must be further studied in an epidemiologic context Type: JOURNAL ARTICLE Type: REVIEW Type: REVIEW, TUTORIAL ISSN: 1040-8711 Language: Eng
11. GARE BA: Epidemiology. Baillieres Clin Rheumatol 1998, 12:191-208.
    Organism:Department of Pediatrics, Ryhov County Hospital, J÷nk÷ping, Sweden.
    Abstract: Epidemiological research in the field of paediatric rheumatology is important for reasons such as the identification of possible aetiological factors, description of the natural history, identification of biologically homogeneous disease groups and health care planning. This review will focus on the epidemiology of 'idiopathic' juvenile arthritis (JA) where data are available for comparison in terms of time, space and ethnic origin. Methodological issues that make comparisons of data difficult, such as case definition, source population and case ascertainment, will be discussed in relation to the data presented. The incidence and prevalence of JA cover a wide range, but, in studies that use similar methodology, an incidence of 5-18 and a prevalence of 30-150 per 100,000 children under the age of 16 is found in Europe and on the American continent. Studies from other parts of the world indicate differences in age of onset and subgroup distribution related to geographical location and/or race
    Type: JOURNAL ARTICLE
    Type: REVIEW
    Type: REVIEW, MULTICASE
     
12. HAVELKA S, HOZA J, KAMENICKA E: [Epidemiology of juvenile chronic arthritis in Czechoslovakia]. Cesk.Pediatr. 1986, 41:531-534.
13. HOKONOHARA M: [Juvenile rheumatoid arthritis. Epidemiology and pathogenesis]. Ryumachi. 1980, 20:405-407.
14. KAIPIAINEN-SEPPANEN O, SAVOLAINEN A: Incidence of chronic juvenile rheumatic diseases in finland during 1980-1990. Clin Exp Rheumatol 1996, 14:441-444.
    Organism:Finland
    Abstract: Objective. To study trends in the incidence of juvenile rheumatoid arthritis (JRA) and to obtain information on the incidence of other juvenile rheumatic diseases in Finland. Methods. The present study covered those subjects entitled under the nationwide sickness insurance scheme to receive specially reimbursed medication for juvenile rheumatic diseases in 5/21 central hospital districts in Finland (population base about 270, 000 children < 16 years of age) in 1980, 1985 and 1990. Results. A total of 114 incident cases (34 boys, 80 girls) satisfied the criteria for JRA during the three study years: 1980, 1985 and 1990. Seven of the patients had systemic-onset disease. The incidence of JRA remained similar (14/100,000 in the population < 16 years of age). The female:male ratio was 2.4:1. Only one case of juvenile spondyloarthropathy was found. Seven patients had juvenile systemic lupus erythematosus and four had juvenile dermato/polymyositis. The corresponding annual incidence rates were 0.1, 0.9 and 0.5/100,000, respectively, in this population. Conclusion. The present study provides population-based figures on the occurrence of various chronic arthritic syndromes in childhood using a unified data base. The incidence of JRA remained quite similar for the three study years. The incidence figures for systemic rheumatic and connective tissue diseases were slightly higher than those reported in previous studies
15. KHUFFASH FA, MAJEED HA, LUBANI MM, NAJDI KN, GUNAWARDANA SS, BUSHNAQ R: Epidemiology of juvenile chronic arthritis and other connective tissue diseases among children in Kuwait. Ann.Trop.Paediatr. 1990, 10:255-259.
    Abstract: 91119377 Department of Paediatrics, Faculty of Medicine, Kuwait University, Safat (ENGLAND) 0272-4939 ENGLISH 9105 INDEX MEDICUS An 8-year hospital-based retrospective study on the epidemiology of juvenile chronic arthritis (JCA), systemic lupus erythematosus (SLE) and other connective tissue diseases among children in Kuwait is described. There were 108 children with JCA, 20 children with SLE, 23 children with other connective tissue diseases and 24 children with arthritis of familial Mediterranean fever (FMF). The average annual incidence of JCA was 2.84 cases/10(5) children under the age of 12 years and the 1988 prevalence was 18.7/10(5). The polyarticular, systemic and oligoarticular onset types were observed in 42, 29 and 29%, respectively. The incidence and prevalence of SLE were 0.53 and 3.37/10(5), respectively. The findings are compared with those from other countries
16. KIEM OEN, SCHROEDER M, JACOBSON K, ANDERSON S, WOOD S, CHEANG M, DOOLEY J: Juvenile rheumatoid arthritis in a canadian First Nations (aboriginal) population : Onset subtypes and HLA associations. Rinsho Ganka 1998, 25:783-790.
    Organism:Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada; HLA Laboratory, Children's Hospital, Health Sciences Centre, Winnipeg, Manitoba, Canada; Department of Community Health Sciences, University of Manitoba, Winnip
    Abstract: Objective. To determine onset subtypes and HLA associations of juvenile rheumatoid arthritis (JRA) in a First Nations (aboriginal) population; to determine whether population frequencies of HLA antigens may explain the distribution of subtypes of JRA in this population. Methods. All patients were children from Manitoba and Northwestem Ontario seen in a single pediatric rheumatology clinic between 1975 and 1996. Patients were identified from a clinic registry. Controls were adults of Algonkian Cree and Ojibway heritage. Class I and II major histocompatibility (HLA) typing was performed for First Nations patients and controls. Results. There were a total of 74 First Nations patients with JRA. The relative frequency of rheumatoid factor (RF) positive polyarticular JRA was higher and that of pauciarticular JRA was lower in First Nations compared with Caucasian patients (42 versus 3% and 22 versus 58%, respectively; p = 0.00000). HLA-DRB1*04 (63%), 08 (43%), and 1402 (25%) were the most common DRB I antigens among controls. The main subtypes of DRB1*04 were 0404 (33% of controls) and 0407 (23%). HLA typing was performed for 39 First Nations patients; 27 were Cree or Ojibway, 4 were from other tribes, and 8 were part First Nations. Among Cree and Ojibway, 59% of controls and 63% of patients with RF positive polyarticular JRA (n = 16) had HLA-DRB1 antigens bearing the rheumatoid arthritis (RA) shared epitope (OR 1.16, 95% CI: 0.38, 3.48). The OR for polyarticular RF positive JRA in those with DRB1*0802 and 0901 were 0.15, 95% CI: 0.02; and 1.24 and 5.83, 95% CI: 1.58, 28.38, respectively. Conclusion. There was a high frequency of the RA shared epitope represented by both HLA-DRB 1*0404 and 1402 in this Algonkian population. This high frequency may explain the high frequency of RF positive polyarticular JRA. DRB1*0802 may be protective, whereas DRB1*0901 may increase the risk for this subtype of JRA
17. KIESSLING U, DORING E, LISTING J, MEINCKE J, SCHONTUBE M, STRANGFELD A, ZINK A: Incidence and prevalence of juvenile chronic arthritis in East Berlin 1980-88. Rinsho Ganka 1998, 25:1837-1843.
    Organism:DEUTSCH RHEUMAFORSCHUNGSZENTRUM BERLIN,EPIDEMIOL UNIT, HANNOVER STR 27/D
    Abstract: Objective. To estimate the incidence and prevalence rates of juvenile chronic arthritis (JCA). Methods. The study population was children under 16 years of age living in the East Berlin area (part of the former German Democratic Republic). By admission order that was effective up to 1990, all children with symptoms of a rheumatic disease living in the East Berlin area had to be referred to the 2nd Children's Hospital at Berlin-Buch. This specific condition allowed us to ascertain cases from the clinical records and to calculate population rates. Based upon this data, the results of surveys with different methods of case ascertainment are compared. Results, An incidence rate of 3.5 per 100,000 and a prevalence rate of 2.0 per 10,000 children were calculated. The frequency of JCA is higher for girls, with an incidence of 4.3 per 100,000 and a prevalence of 2.3 per 10,000. The figures for boys are 2.7 per 100,000 and 1.7 per 10,000, respectively. Conclusion. Because of the specific prerequisites, the population rates of prevalence and incidence that were based on clinical records can be regarded as valid in this study. Deviant results of other surveys can be explained by differences in the study design or in the diagnostic procedures used
     
18. KONE-PAUT I: [Chronic juvenile arthritis] Arthrite chronique juvenile. Rev.Prat. 1994, 44:2561-2567.
    Organism:Unite de recherche en epidemiologie et immuno-oncologie pediatriques Faculte de medecine Hopital Nord, Marseille (FRANCE)
    Abstract: Juvenile chronic arthritis encompasses a heterogeneous spectrum of diseases that all include at least one persistent inflammatory arthritis. Its definition is based upon clinical criteria after exclusion of a long list of differential diagnoses. Three main types of onset are generally considered according to the clinical features during the first 3 months of evolution: systemic (20%), oligoarticular (50%), polyarticular (30%). Systemic forms present with acute general symptoms and a wide variety of articular features, from polyarthritis to isolated arthralgias. Oligoarticular forms involve 4 or fewer joints and are often complicated with iridocyclitis especially in case of positive antinuclear antibodies in the serum. Polyarticular forms involve at least 5 joints and include the presence of rheumatoid factor in the serum in 10% of cases. The clinical course of juvenile chronic arthritis is unpredictable and the reliability of the current classification is limited by taking into account only the first 3 months of evolution
19. LEACH M: Juvenile chronic arthritis: epidemiology and genetics. Nurs.Times. 1997, 93:46-48.
    Organism:Institute for Bone and Joint Medicine, Medical School, University of Sheffield
    Abstract: This article looks at the classification, epidemiology and possible causes of juvenile chronic arthritis. The clinical manifestations of the different types of this disease are discussed. Finally the course and prognosis of this disease are described. A second article on juvenile chronic arthritis will appear on May 28 1997 Type: JOURNAL ARTICLE Type: REVIEW Type: REVIEW, TUTORIAL ISSN: 0954-7762 Language: Eng
20. LOESENER C, HOFER M, JOB-DESLANDRE C, SOMMELET D, GROUTEAU E, LE GALL E, KONE-PAUT I, MOUY R, PRIEUR AM: REPALME A PEDIATRIC RHEUMATOLOGY DISEASE REGISTRY IN FRANCE. 1997,
    Organism:Groupe Français de Rhumatologie Pédiatrique, Hôpital des Enfants Malades, 75743 PARIS, France.
    Abstract: The objective of our survey is to describe the population referred to outpatient clinics in pediatric rheumatology in France and to allow a rapid access to these patients for future studies. This registry has been established since October 1995 and involves at the present time 7 centers throughout France. In 15 months of activity, 1120 patients (mean age: 10.3 year) were included. Patients with juvenile arthritis, including psoriatic arthritis and spondylarthropathy, were the largest group with more than 50% of the patients (see Table). Patients with mechanical or orthopedic problems represented less than 20% of the studied population, which is consistent with previous studies done in tertiary referral centers.
    
    Rheumatic disorder category Patients (%)
    Juvenile arthritis 657 (58.7%)
    Connective tissue diseases 77 (6.8%)
    Vasculitis 52 (4.6%)
    Other inflammatory diseases 49 (4.4%)
    Infection 64 (5.7%)
    Mechanical or orthopedic 206 (18.4%)
    Hematological 2 (0.2%)
    Other 125 (11.2%)
    
    This registry is very helpful to study the relative frequencies and epidemiological characteristics of rheumatic diseases in children. These informations will allow to go further for research purposes in homogeneous groups of patients.
    This work was supported by Association Kourir and DRC Assistance Publique - Hôpitaux de Paris.
21. MARCHETTI F, BONATI M, MARFISI RM, LA GAMBA G, BIASINI GC, TOGNONI G: Parental and primary care physicians' views on the management of chronic diseases: a study in Italy. The Italian Collaborative Group on Paediatric Chronic Diseases. Acta Paediatr. 1995, 84:1165-1172.
    Organism:Laboratory of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, S. Maria Imbaro (Chieti), Italy.
    Abstract: A survey on the burden and quality of care and the parental and primary care physicians' views on management of eight chronic illnesses and disabilities was conducted from 1990 to 1993. Data were collected on 993 children and adolescents from family interviews and physicians' postal questionnaires. Approximately 70% of patients used two or more services for care management and 149 children were treated outside their region. Only 36% of the physicians were case managers and half of these agreed that better communication with other care providers could facilitate their role. A wide difference in parental satisfaction was found between medical and disabling conditions. Approximately 90% of the parents expressed satisfaction with care for children with coeliac disease (112/120), asthma (80/89) and diabetes (98/111), whereas approximately one-third of parents of children with cerebral palsy and Down's syndrome were dissatisfied (88/242 and 72/189, respectively). Primary care physicians expressed similar satisfaction with case management. Distance from hospital, the need for more information on disease management and financial aid were the sources of greatest dissatisfaction. Children with disabling diseases had more problems integrating at school than children with other chronic disorders. Closer interaction between health services, providers and families is necessary to manage the needs of disabled (Italian) children better
22. MIELANTS H, VEYS EM, MAERTENS M, GOEMAERE S, DE CLERCQ L, CASTRO S, PRAET J: Prevalence of inflammatory rheumatic diseases in an adolescent urban student population, age 12 to 18, in Belgium. Clin.Exp.Rheumatol. 1993, 11:563-567.
    Organism:Department of Rheumatology, University of Ghent, Belgium
    Abstract: In order to determine the prevalence of inflammatory rheumatic diseases in an urban secondary school student population, a questionnaire dealing with past or present joint, tendon, axial, gastrointestinal, ocular and dermatological symptoms was completed by 2,990 students of secondary schools in Antwerp and Ghent. The parents were asked to complete a questionnaire regarding the family medical history. From these 2,990 students, 524 were selected for further investigation by a rheumatology resident, who checked the answers to the first questionnaire and performed a clinical examination. Forty-one adolescents with a presumptive history or present symptoms of inflammatory rheumatic diseases were retained. These students were examined by the medial staff of the rheumatology department; if necessary, a complementary biochemical and radiological examination was performed. Five cases of definite juvenile chronic arthritis (JCA) (with polyarticular onset in 1 case and late pauciarticular onset in 4 cases) and 4 cases of presumptive late pauciarticular onset JCA were detected, resulting in a prevalence of 167 per 100, 000 for definite JCA and of 301 per 100,000 for possible JCA. This prevalence rate is higher than that generally described. This method of investigation effectively allows the detection of milder and spontaneously remitting cases of JCA. It further enabled us to definite case and 4 presumptive cases of various previously undiagnosed forms of JCA
23. MOE N, RYGG M: Epidemiology of juvenile chronic arthritis in northern Norway: a ten-year retrospective study. Clin Exp Rheumatol 1998, 16:99-101.
    Organism:Department of Pediatrics, University of Tromso, Norway.
    Abstract: OBJECTIVE: To study the incidence and prevalence of juvenile chronic arthritis (JCA) in northern Norway. METHODS: Cases from the period 1985-1994 were retrospectively identified from the hospital files of the only pediatric department treating JCA in the study area. The European League Against Rheumatism (EULAR) criteria for JCA were used. RESULTS: The annual incidence of JCA was 22.6/100,000 children under 16 years of age. The incidence of oligoarticular JCA was 11.8, and the incidence of systemic JCA was 0.8/100,000. In the incidence group 25% were ANA positive, 14% developed uveitis and 42% of the tested patients were HLA-B27 positive. The point prevalence was 148.1/100,000. CONCLUSION: These incidence and prevalence data are higher than those reported in most other studies. The impact of genetic differences, cyclic variations and other factors in relation to the onset and course of JCA merit further investigation
    Type: JOURNAL ARTICLE
24. NEUBERGER JS, NEUBERGER GB: Epidemiology of the rheumatic diseases. Nurs.Clin.North Am. 1984, 19:713-725.
25. OEN K, FAST M, POSTL B: Epidemiology of juvenile rheumatoid arthritis in Manitoba, Canada, 1975-92: cycles in incidence. J.Rheumatol. 1995, 22:745-750.
    Abstract: 95311270 Department of Pediatrics and Child Health, University of Manitoba, Canada (CANADA) 0315-162X ENGLISH 9509 INDEX MEDICUS OBJECTIVE. To determine the yearly incidence of juvenile rheumatoid arthritis (JRA) and to seek correlations between this and cyclic infections occurring in the province of Manitoba, Canada, during the same period. METHODS. An estimate of the incidence of JRA in Manitoba was determined from a disease registry of the Pediatric Rheumatology Clinic, Children's Hospital, Winnipeg. The numbers of confirmed Mycoplasma pneumoniae and viral respiratory infections were determined from annual reports of Cadham Provincial Laboratory. Both facilities provide centralized services for the province. RESULTS. Between 1975 and 1992 the onset of JRA occurred in 261 patients (136 with pauciarticular, 91 polyarticular, and 34 systemic onset). The average annual incidence of JRA for this period was 5.34/100,000. However, a cyclic incidence was apparent with peaks in 1979, 1982, 1986, and 1990-91. Increases in confirmed M. pneumoniae infections were concurrent with peaks in the incidence of JRA. A significant correlation was found between the incidence of JRA and the number of M. pneumoniae infections detected in the province between 1985 and 1992 (R = 0.76, p = 0.044). In contrast, there was no consistent variation in the incidence of seronegative spondyloarthropathies in children (n = 103 patients). CONCLUSION. These data suggest the need for further study of a possible infectious etiology for JRA
26. OEN KG, CHEANG M: Epidemiology of chronic arthritis in childhood. Semin.Arthritis Rheum. 1996, 26:575-591.
    Organism:Canada
    Abstract: This study was performed to review reports of the descriptive epidemiology of chronic arthritis in childhood and to analyze the factors that may explain differences in its reported frequency. Articles were retrieved by searching MEDLINE and EMBASE under the following index terms: juvenile rheumatoid arthritis (JRA), juvenile chronic arthritis (JCA), spondyloarthropathy, epidemiology, prevalence, and incidence. For reports published between 1977 to 1982, the Index Medicus was used. All original articles that provided prevalence or incidence rates, population size, or number of cases, were reviewed and entered into the analysis. Variables analyzed were disease prevalence and incidence. Modifier variables investigated were diagnostic criteria, source population, geographic origin of the report (Europe or North America), duration of the study, and race of the population studied. Diagnostic criteria had no effect on reported prevalence or incidence rates. Prevalence per 100,000 at risk obtained from population studies (132, 95% CI: 119, 145) was significantly higher than values derived from practitioner- (26, 95% CI: 23, 29) or clinic- based studies (12, 95% CI: 10, 15) (P = .02). North American clinic-based studies had higher prevalence values compared with European reports (32, 95% CI: 26, 38 versus 8, 95% CI: 5, 11, P = .009). None of the factors analyzed accounted for the variability in reported incidence rates. An effect of race was detected only in the distribution of patients among onset subsets. Thus, the percentage of patients with pauciarticular JRA was highest in series of North American and European caucasian patients (58, 95% CI: 56, 60) compared with series of East Indian (25, 95% CI: 20, 31), native North American Indian (26, 95% CI: 15, 37), or other races (31, 95% CI: 28, 35) (P = .001). In contrast, the percentage of patients with polyarticular JRA was lowest in the former (27, 95% CI: 25, 28) compared with the other racial groups (East Indian, 61, 95% CI: 55, 66; native North American Indian, 64, 95% CI: 53, 76; other races, 34, 95% CI: 30, 38) (P= .004). Although an effect of source population on reported prevalence was confirmed, the effect of geographic origin suggests that environmental or ethnic differences also may influence the prevalence of chronic arthritis in children. Differences in the percentages of patients with pauciarticular and polyarticular JRA may reflect racial differences in the prevalence of these conditions
27. PEACOCK DJ, COOPER C: Epidemiology of the rheumatic diseases. Curr.Opin.Rheumatol. 1995, 7:82-86.
    Abstract: 95283908 Department of Rheumatology, Queen Alexandra Hospital, Cosham, Portsmouth, UK (UNITED STATES) 1040-8711 ENGLISH 9509 INDEX MEDICUS Epidemiologic studies are important for both understanding and defining rheumatology practice. Controversy still exists over whether the incidence of rheumatoid arthritis is declining, and genetic studies indicate a diversity of HLA haplotypes in rheumatoid arthritis. Large longitudinal osteoarthritis studies have helped define diagnostic criteria and the role of obesity in disease progression. The negative association between osteoarthritis and osteoporosis at specific sites continues to be explored, and the value of long-term estrogen therapy in preventing bone loss has been examined. Both retrospective and prospective population studies have been used to describe the relationship between silicone gel breast implants and connective tissue disease. These and other studies have helped to define the important role of epidemiologic research in the understanding of rheumatic diseases
28. PETERSON LS, MASON T, NELSON AM, O'FALLON WM, GABRIEL SE: Juvenile rheumatoid arthritis in Rochester, Minnesota 1960-1993. Is the epidemiology changing? Arthritis Rheum. 1996, 39:1385-1390.
    Organism:Mayo Clinic, Rochester, Minnesota 55905, USA.
    Abstract: OBJECTIVE. To examine trends in the incidence and prevalence of juvenile rheumatoid arthritis (JRA) in Rochester, Minnesota, over 33 years. METHODS. The diagnostic retrieval system of the Rochester Epidemiology Project was utilized to screen medical records of all Rochester residents with any potential diagnoses of JRA from 1978 to 1993 (based on the American College of Rheumatology 1977 revised criteria). In addition, all cases of JRA from our previously identified cohort from 1960-1979 were verified, and the 2 data sets were combined, resulting in an incidence cohort spanning 33 years (1960-1993). RESULTS. Of the 1, 240 medical records screened, we identified 65 cases of JRA diagnosed between 1960 and 1993 (48 females, 17 males). The average followup for cases was 12.7 years (range 0-34 years) for a total of 833 person-years of observation. A bimodal distribution of age at diagnosis was observed, with peaks between 0 and 4 years and 9 and 15 years. Seventy-two percent of patients had pauciarticular-onset, 17% had polyarticular-onset, and 11% had systemic-onset disease. Progression of pauciarticular to polyarticular disease occurred in 11% of the cases. The overall age- and sex-adjusted incidence rate was 11.7 per 100,000 population (95% confidence intervals 8.7, 14.8). The incidence rate per 100,000 population was 15.0, 14.1, and 7.8 for the time periods 1960-1969, 1970-1979, and 1980-1993, respectively (P = 0.024). A 3-year, centered, moving average, which was used to display time trends in incidence, suggested a cyclical pattern, with incidence peaks in 1967, 1975, and 1987. CONCLUSION. An overall decrease in the incidence rate over the last decade was observed, most marked in the pauciarticular- and systemic-onset subtypes. This decrease, along with the observed cyclical pattern, suggest that environmental factors may influence disease frequency
29. RASPE HH, ZINK A: [Epidemiology of rheumatic diseases in the German Federal Republic-- current state and perspectives]. Z.Rheumatol. 1992, 51:14-19.
    Abstract: During the last few years epidemiologic research on rheumatic diseases in the Federal Republic of Germany has been sponsored, primarily, by the Ministry of Research and Technology. The projects, either completed, ongoing or planned, concentrate on health services research, population studies of the prevalence of specific diseases or complaints (rheumatoid arthritis, back pain, juvenile chronic arthritis, osteoarthritis) and clinical epidemiology, especially concerning early arthritis. As a result of the general shortage of public funds, less projects could be sponsored than expected. The aim of the Ministry to establish research organizations that will continue to exist even if public funding is curtailed seems to be jeopardized. Therefore, not only the federal government, but also the federal states and institutions like the Deutsche Forschungsgemeinschaft should be engaged in this field. More groups should have the opportunity to work in epidemiology of rheumatic diseases, and groups which are able to work in close connection with basic scientists and rheumatological clinicians should be institutionally affiliated on a permanent basis. This is critical for the further development of this discipline which is important for health services research, quality assurance, as well as for analytical research and prevention Institut fur Sozialmedizin, Medizinischen Universitat LubeckPMID- 1574931
30. RHODES VJ: Physical therapy management of patients with juvenile rheumatoid arthritis. Phys.Ther. 1991, 71:910-919.
    Organism:Newington Children's Hospital, CT 06111.
    Abstract: Juvenile rheumatoid arthritis (JRA) is the most common pediatric rheumatic disease and is a leading cause of childhood disability. Physical therapists play a crucial role in the treatment of these children and serve as essential members of the interdisciplinary treatment team. An understanding of the etiology and background of this disease is critical to appropriate evaluation, goal setting, and treatment planning. This review article will provide an overview of the epidemiology, immune system pathophysiology, and clinical characteristics of JRA. Physical therapy principles of care, evaluation procedures, and treatment techniques will be covered in depth. In addition, common orthopedic manifestations and their management, including surgical approaches, will be discussed
31. RODARY C, HAYEM F, MOZZICONACCI P: Essai d'enquête concernant l'influence de l'arthrite chronique juvénile en France (année 1972). Ann.Pediatr. 1977, 424-426.
32. SAFAVI KH, HEYSE SP, HOCHBERG MC: Estimating the incidence and prevalence of rare rheumatologic diseases: a review of methodology and available data sources [editorial]. J Rheumatol 1990, 17:990-993.
    Organism:Address: National Institute of Arthritis, Musculoskeletal and Skin Diseases, Bethesda, MD 20892
    Abstract: Where the need for descriptive epidemiology is great, population based registries can be established, at considerable cost, to provide the desired data. In many instances, however, there may be existing data and information systems that provide morbidity information on sufficiently large, well defined populations to allow reasonable estimates of the incidence and prevalence of rare rheumatologic diseases Type: EDITORIAL ISSN: 0315-162X Language: Eng
33. SCHNED ES: Epidemiology of juvenile arthritis in Rochester, Minnesota [letter]. Arthritis Rheum. 1985, 28:239-239.
34. SYMMONS DP, JONES M, OSBORNE J, SILLS J, SOUTHWOOD TR, WOO P: Pediatric rheumatology in the United Kingdom: data from the British Pediatric Rheumatology Group National Diagnostic Register. J Rheumatol 1996, 23:1975-1980.
    Organism:Arthritis and Rheumatism Council Epidemiology Research Unit, University of Manchester, UK
    Abstract: OBJECTIVE: To establish a computerized national diagnostic register for pediatric rheumatology in the UK; to describe the demography and diagnostic classification of children referred to pediatric rheumatology clinics; to estimate the current incidence of juvenile arthritis (JA) in the UK. METHODS: A diagnostic register was established in 1989: 23 centers have contributed data on all new cases seen since they joined the register; 18 centers have also contributed data on all current attenders. For 2 centers with well defined catchment areas, the incidence of JA was estimated. RESULTS: A total of 4948 cases were registered, of whom 2962 (60%) were female. 1991 (40%) had a diagnosis of JA. The 2nd largest category was mechanical/orthopedic problems (24%). Pauciarticular juvenile chronic arthritis was the most common subtype of JA. Seropositive RA was rare. Tertiary referral centers saw proportionately more JA and district general hospitals saw proportionately more mechanical problems. The annual incidence rate for JA from 2 centers was 10/100,000, and for all rheumatic disorders was 32-42/100,000 children under age 16. CONCLUSION: The relative proportion of patient diagnoses varies between centers. Nevertheless, the incidence of hospital referred JA seems very uniform Type: JOURNAL ARTICLE Type: MULTICENTER STUDY ISSN: 0315-162X Language: Eng
35. TOWNER SR, MICHET CJ, Jr., O'FALLON WM, NELSON AM: The epidemiology of juvenile arthritis in Rochester, Minnesota 1960- 1979. Arthritis Rheum. 1983, 26:1208-1213.
    Abstract: A 20-year community-based study of the epidemiology of juvenile arthritis in Rochester, Minnesota from January 1, 1960 to January 1, 1980 is described. Cases were identified using the 1977 revised American Rheumatism Association criteria for juvenile arthritis. Higher incidence and prevalence rates and a greater predominance of pauciarticular disease were observed than previously reported. Lower rates were observed when a minimum of 3 months' disease duration was used to identify incidence