Bibliography September2001- Anonymous36th Workshop for Pediatric Research, Goettingen, Germany, February 17-18, 2000. European Journal Of Pediatrics 2000, 159:R2-R10
Abstract: This meeting contains abstracts of 36 papers, written in English, covering topics in pediatric research, including hyperinsulinism, endocrine deficiencies, gene mutations, growth disturbance, cardiomyopathy, familial hypomagnesemia, Fanconi anemia, acute lymphoblastic leukemia, Ewing's sarcoma and other pediatric tumors, cytodifferentiation, respiratory syncytial virus, juvenile rheumatoid arthritis, tuberculosis, cystic fibrosis, congenital heart defect, preterm birth, Down syndrome, autism, microdialysis, therapeutic drug monitoring in human children and experimental animal models - AFSHARI NA, AFSHARI MA, FOSTER CS: Inflammatory conditions of the eye associated with rheumatic diseases. Curr.Rheumatol.Rep. 2001, 3:453-458.
Organism:Massachusetts Eye and Ear Infirmary, Harvard Medical School, 243 Charles Street, Boston, MA 02114, USA Fosters@Uveitisorg
Abstract: Ocular inflammation occurs in many patients with systemic rheumatic disease. The best examples are rheumatoid arthritis, juvenile rheumatoid arthritis, temporal arteritis, systemic lupus erythematosus, Wegener's granulomatosis, polyarteritis nodosa, relapsing polychondritis, and Adamantiades-Behcet's disease. Ocular inflammation may precede the symptoms of the systemic disease and can be helpful in systemic diagnosis. After diagnosis, ocular inflammation can mark the severity of the systemic condition. Thus, prompt diagnosis and treatment of inflammatory conditions of the eye are warranted and may be s
Internet : PM:11564378 - ASSOCIATION FOR OR: Annual General Meeting of the Association for Orthopedic Rheumatology (Assoziation fuer Orthopaedische Rheumatologie), Hamburg, Germany, May 26-27, 2000. Aktuelle Rheumatologie 2000, 25:158-176.
Abstract: This meeting contains abstracts of 78 papers, including 20 posters, written in German, covering topics in orthopedic rheumatology, such as endoprosthetics, endoscopic operations, arthroscopy, synovectomy, implant infections, juvenile chronic arthritis, osteoarthritis, psoriatic arthritis, rheumatism, diagnosis and treatment options in humans - BELLAH R: Ultrasound in pediatric musculoskeletal disease: techniques and applications. Radiol.Clin.North Am. 2001, 39:597-618, ix.
Organism:University of Pennsylvania School of Medicine, Department of Radiology, The Children's Hospital of Philadelphia, USA
Abstract: The increased ratio of nonossified cartilage to bone in children makes ultrasound (US) a particularly suitable technique for evaluating pediatric musculoskeletal disorders. US allows the examiner to compare quickly and meticulously an affected to unaffected area of interest in different orthogonal planes without a need for sedation. Developmental dysplasia of the hip is the most common indication for pediatric musculoskeletal US. Sonography is also a cost-effective, useful, and complementary imaging tool for evaluating pediatric musculoskeletal trauma, inflammation-infection, and masses
Internet : PM:11549162 - COSIC V, VOJINOVIC J, SAVIC D, ZVEZDANOVIC L, JOVIC M, KUNDALIC S, DJORDJEVIC B, V: Effects of vitamin D3 therapy on antioxidant enzymes in children with juvenile rheumatoid arthritis. Clinical Chemistry and Laboratory Medicine 2001, 39:S119
Organism:Center of Medical Biochemistry, Clinical Center Nis, Nis Yugoslavia - DONN RP, SHELLEY E, OLLIER WER, THOMSON W, ABINUN M, BECKER M, BELL A, CRAFT A, CRAWLEY E, DAVID J, FOSTER H, GARDENER-MEDWIN J, GRIFFIN J, HALL A, HALL M, HERRICK A, HOLLINGWORTH P, HOLT L, JONES S, POUNTAIN G, RYDER C, SOUTHWOOD T, STEWART I, VENNING H, WEDDERBURN L, WOO P, WYATT S: A novel 5prime-flanking region polymorphism of macrophage migration inhibitory factor is associated with systemic-onset juvenile idiopathic arthritis. Arthritis And Rheumatism 2001, 44:1782-1785.
Organism:Dr. R.P. Donn, Epidemiology Unit, Arthritis Research Campaign, Stopford Building, Oxford Road, Manchester M13 9PT
Abstract: Objective. To determine if polymorphisms of the macrophage migration inhibitory factor (MIF) gene are associated with systemic-onset juvenile idiopathic arthritis (JIA). Methods. Denaturing high-performance liquid chromatography was used to screen for the MIF gene in 32 healthy Caucasian subjects. One hundred seventeen UK Caucasian patients with systemic-onset JIA and 172 unrelated healthy UK Caucasian controls were genotyped for a single-nucleotide polymorphism (SNP) identified in the 5prime-flanking region of the gene, using polymerase chain reaction-restriction fragment length analysis. Results. A G-to-C transition was identified at position -173 of the MIF gene. The presence of a C at -173 creates an activator protein 4 transcription factor binding site. Allele and genotype frequencies differed significantly between the patients and controls for the MIF-173 polymorphism. Individuals possessing a MIF-173*C allele have an increased risk of systemic-onset JIA (36.8% versus 20.3%) (odds ratio 2.3, 95% confidence interval 1.34-3.86; P = 0.0005). Conclusion. This is the first report of a SNP in the MIF gene. This polymorphism is associated with systemic-onset JIA - GERLONI V, CIMAZ R, GATTINARA M, ARNOLDI C, PONTIKAKI I, FANTINI F: Efficacy and safety profile of cyclosporin A in the treatment of juvenile chronic (idiopathic) arthritis. Results of a 10-year prospective study. Rheumatology 2001, 40:907-913.
Organism:R. Cimaz, Paediatric Department, Istituti Clinici di Perfezionamento, Via Commenda 9, 20122 Milan
Abstract: Objective. This open prospective trial was performed in order to assess the efficacy and safety of cyclosporin A in the treatment of patients with juvenile chronic arthritis (JCA). Methods. Thirty-four of the patients enrolled were affected by systemic-onset disease and seven by chronic anterior uveitis associated with JCA. The cyclosporin dose was usually 3-5 mg/kg per day. The average duration of therapy was 1.4 yr, with a maximum of 7.2 yr. Results. The efficacy of treatment was mainly evident in terms of control of fever and reduction of steroid therapy. The benefits with respect to arthritis, laboratory parameters and uveitis seemed to be less clear-cut. Side-effects were frequent but usually mild or reversible. Sixty-six percent of the study population withdrew from therapy because of inefficacy or side-effects. Eight systemic patients withdrew from therapy owing to complete remission. Conclusion. Cyclosporin can be used in the treatment of JCA, its main benefits being the control of fever and a steroid-sparing effect - GRAY D, PARKER-COHEN NY, WHITE T, CLARK ST, SEINER SH, ACHILLES J, MCMAHON WM: A comparison of individual and family psychology of adolescents with chronic fatigue syndrome, rheumatoid arthritis, and mood disorders. J.Dev.Behav.Pediatr. 2001, 22:234-242.
Organism:Dr. D. Gray, University of Utah, Department of Psychiatry, Div. of Child/Adolescent Psychiatry, 546 South Chipeta Way, Salt Lake City, UT 84108
Abstract: Chronic fatigue syndrome (CFS) is a controversial diagnosis with unknown cause. Adult studies indicate high rates of psychosocial dysfunction and psychiatric comorbidity. The authors compared three groups of pediatric patients selected by diagnosis-(1) CFS (n = 15), (2) juvenile rheumatoid arthritis (n = 15), and (3) mood disorders (n = 15)-across many psychological measures. CFS subjects had dramatic elevation of the Somatic Complaints subscale (mean T score = 75), whereas the mood disorders group had higher externalizing scores (mean T score = 68) on the Child Behavior Checklist. The CFS subjects missed significantly more school compared with the two control groups. After the onset of CFS, 13 of 15 of the CFS patients required significant educational accommodation. Only 4 of the 15 CFS patients had an Axis I psychiatric diagnosis, as determined by the Computerized Diagnostic Interview for Children. Despite a low rate of psychiatric diagnosis in the CFS sample, these data attest to their psychosocial and school dysfunction
Internet : Douglas.gray@hsc.utah.edu - GRAY D, PARKER-COHEN NY, WHITE T, CLARK ST, SEINER SH, ACHILLES J, MCMAHON WM: A comparison of individual and family psychology of adolescents with chronic fatigue syndrome, rheumatoid arthritis, and mood disorders. Journal of Developmental & Behavioral Pediatrics 2001, 22:234-242.
Organism:Department of Psychiatry, Division of Child and Adolescent Psychiatry, Red Butte Health Center, University of Utah, 546 South Chipeta Way, Suite 457, Salt Lake City, UT, 84108: Douglas.gray@hsc.utah.edu USA
Abstract: Chronic fatigue syndrome (CFS) is a controversial diagnosis with unknown cause. Adult studies indicate high rates of psychosocial dysfunction and psychiatric comorbidity. The authors compared three groups of pediatric patients selected by diagnosis-(1) CFS (n=15), (2) juvenile rheumatoid arthritis (n=15), and (3) mood disorders (n=15)-across many psychological measures. CFS subjects had dramatic elevation of the Somatic Complaints subscale (mean T score=75), whereas the mood disorders group had higher externalizing scores (mean T score=68) on the Child Behavior Checklist. The CFS subjects missed significantly more school compared with the two control groups. After the onset of CFS, 13 of 15 of the CFS patients required significant educational accommodation. Only 4 of the 15 CFS patients had an Axis I psychiatric diagnosis, as determined by the Computerized Diagnostic Interview for Children. Despite a low rate of psychiatric diagnosis in the CFS sample, these data attest to their psychosocial and school dysfunction - GYLYS-MORIN VM, BRENT GT, BLEBEA JS, DARDZINSKI BJ, LAOR T, JOHNSON ND, OESTREICH AE, PASSO MH: Knee in early juvenile rheumatoid arthritis: MR imaging findings. Radiology 2001, 220:696-706.
Organism:Dr. V.M. Gylys-Morin, Departments of Radiology, Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039
Abstract: PURPOSE: To determine the magnetic resonance (MR) imaging findings in the knee in early juvenile rheumatoid arthritis. MATERIALS AND METHODS: MR imaging (1.5 T) was performed in the more symptomatic knee in 30 children with juvenile rheumatoid arthritis with a symptom duration 1 year or less. Conventional, fast spin-echo, three-dimensional gradient-echo, and gadolinium-enhanced T1-weighted images were assessed. Two radiologists independently read the images, and a third resolved disagreements. These images were compared with knee radiographs in 27 children. RESULTS: Mean maximal synovial thickness was 4.8 mm +/- 2.4 (SD). Mean synovial volume was 15.4 mL +/- 10.8. Suprapatellar joint effusions were seen in 26 (87%) of 30 knees, meniscal hypoplasia in 11 (37%) of 30 knees, and abnormal epiphyseal marrow in eight (27%) of 30 knees. Three knees had articular cartilage contour irregularity, fissures, and/or thinning. One knee had a bone erosion. Knee radiographs showed suprapatellar fullness in 78% of the knees, joint space narrowing in one knee, and no bone abnormalities. CONCLUSION: Synovial hypertrophy and joint effusions are the most frequent MR imaging findings of knees in early juvenile rheumatoid arthritis. Early in the disease, radiographically occult cartilage and bone erosions are uncommonly seen at MR imaging. The potential relationship of synovitis to cartilage abnormalities deserves further study
Internet : gylys.morin@chmcc.org - HUEMER C, HUEMER M, DORNER T, FALGER J, SCHACHERL H, BERNECKER M, ARTACKER G, PILZ I: Incidence of pediatric rheumatic diseases in a regional population in Austria. Rinsho Ganka 2001, 28:2116-2119.
Organism:Dr. C. Huemer, Department of Pediatrics, University of Vienna, Wahringer Gurtel 18-20, A-1090 Vienna
Abstract: Objective. To establish a population based disease registry for pediatric rheumatology in a defined population of Austria; to describe the demographic and diagnostic classification of children referred to pediatric rheumatology clinics; and to estimate the incidence of pediatric rheumatic diseases in Eastern Austria. Methods. For 2 years (1997-98) all pediatric rheumatology centers in the area contributed data on all new cases to a prospective multicenter patient registry. Diagnostic criteria defined the rheumatic disease cases, determined by a pediatric rheumatologist, and record linkage was carded out to avoid duplication of subjects. Results. Rheumatic conditions were diagnosed in 107 subjects. Juvenile rheumatoid arthritis (JRA) was the most frequently encountered rheumatic condition (49.5%), followed by spondyloarthropathy (SPA, 33.6%) and systemic lupus erythematosus (SLE, 5.6%). The mean annual incidence of JRA, SpA, and SLE among children referred to pediatric rheumatology centers was 4.28, 2,9, and 0.48 per 100,000 children at risk, respectively. Conclusion. Establishment of a population based disease registry led to collection of descriptive epidemiologic data on a defined regional cohort of children with rare disorders. Our registry will provide data on pediatric rheumatic diseases in a European population and will allow more accurate comparisons between populations for future research. Our data also indicate that more resources should be designated for the care of pediatric rheumatic diseases in view of the relatively high incidences of these diseases
Internet : christian.huemer@akh.wien.ac.at - HUEMER C, HUEMER M, DORNER T, FALGER J, SCHACHERL H, BERNECKER M, ARTACKER G, PILZ I: Incidence of pediatric rheumatic diseases in a regional population in Austria. J.Rheumatol. 2001, 28:2116-2119.
Organism:Department of Pediatrics, University of Vienna, Gottfried von Preyersches Kinderspital, Austria christianhuemer@akh-wienacat
Abstract: OBJECTIVE: To establish a population based disease registry for pediatric rheumatology in a defined population of Austria; to describe the demographic and diagnostic classification of children referred to pediatric rheumatology clinics; and to estimate the incidence of pediatric rheumatic diseases in Eastern Austria. METHODS: For 2 years (1997-98) all pediatric rheumatology centers in the area contributed data on all new cases to a prospective multicenter patient registry. Diagnostic criteria defined the rheumatic disease cases, determined by a pediatric rheumatologist, and record linkage was carried out to avoid duplication of subjects. RESULTS: Rheumatic conditions were diagnosed in 107 subjects. Juvenile rheumatoid arthritis (JRA) was the most frequently encountered rheumatic condition (49.5%), followed by spondyloarthropathy (SpA, 33.6%) and systemic lupus erythematosus (SLE, 5.6%). The mean annual incidence of JRA, SpA, and SLE among children referred to pediatric rheumatology centers was 4.28, 2.9, and 0.48 per 100,000 children at risk, respectively. CONCLUSION: Establishment of a population based disease registry led to collection of descriptive epidemiologic data on a defined regional cohort of children with rare disorders. Our registry will provide data on pediatric rheumatic diseases in a European population and will allow more accurate comparisons between populations for future research. Our data also indicate that more resources should be designated for the care of pediatric rheumatic diseases in view of the relatively high incidences of these diseases
Internet : PM:11550984 - KAIPIAINEN-SEPPANEN O, SAVOLAINEN A: Changes in the incidence of juvenile rheumatoid arthritis in Finland. Rheumatology 2001, 40:928-932.
Organism:O. Kaipiainen-Seppanen, Department of Medicine, Kuopio University Hospital, PO Box 1777, 70211 Kuopio
Abstract: Objective. To study trends in the incidence of juvenile rheumatoid arthritis (JRA). Methods. The study covered subjects who were entitled under the nation-wide sickness insurance scheme to receive specially reimbursed medication for juvenile rheumatic diseases in 11 of 21 central hospital districts in Finland (the base population comprised about 445 000 children <16 yr of age) in 1995. Data from the years 1980, 1985 and 1990 were compared with data from 1995 concerning the central part of the area, which had been included in a previous study by us. Results. A total of 87 incident cases (58 girls and 29 boys) satisfied criteria for JRA in 1995 in the study area. The incidence of JRA was 19.5 per 100 000 [95% confidence interval (CI) 15.6-24.1] of the population <16 yr of age for the whole area. It was 22.7 per 100 000 (95% CI 17.3-29.2) for the area that had been covered by the earlier study (five districts) and 14.9 per 100 000 (95% CI 9.8-21.7) for the new area (six additional districts). The incidence of JRA was significantly higher than in the earlier years (1980, 1985 and 1990) in the same district (trend, P = 0.024). The highest incidence, 60.3 per 100 000 (95% CI 35.8-95.4), was noted in 1995 among girls in the age group 10-15 yr in the southernmost part of the study area. Conclusions. There was both temporal and regional variation in the incidence of JRA. Results of the present study suggest that environmental factors may influence the frequency of JRA - KAMPHUIS SS, DE JAGER W, DE KLEER IM, GORDON G, KOFFEMAN E, MASSA M, MARTINI A, RIJKERS GT, VAN EDEN W, KUIS W, PRAKKEN AB, ALBANI S: V1.2. recognition of multiple hsp60 epitopes in patients with juvenile idiopathic arthritis opens the way for antigen-specific immunotherapy. Ann.Rheum.Dis. 2001, 60 Suppl 1:II7-II15
Organism:Wilhelmina Children's Hospital, Utrecht, the Netherlands
Internet : PM:11567928 - KOGA Y, KUROMARU R, TAKADA H, HARA T: Juvenile idiopathic arthritis associated with autoimmune thyroid disorders and autoimmune cholangitis [3]. Rheumatology 2001, 40:942-943.
Organism:R. Kuromaru, Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka - MYERS LK, HIGGINS GC, FINKEL TH, REED AM, THOMPSON JW, WALTON RC, HENDRICKSON J, KERR NC, PANDYA-LIPMAN RK, SHLOPOV BV, STASTNY P, POSTLETHWAITE AE, KANG AH: Juvenile arthritis and autoimmunity to type II collagen. Arthritis And Rheumatism 2001, 44:1775-1781.
Organism:Dr. L.K. Myers, 956 Court Avenue, Memphis, TN 38163
Abstract: Objective. Joint inflammation in juvenile rheumatoid arthritis (JRA) is sometimes associated with an autoimmune response to type II collagen (CII), a cartilage-specific protein. To test the hypothesis that down-regulation of autoimmunity to CII can be accomplished in JRA by oral administration of CII, an open-label study of CII was performed in 9 patients with JRA. Methods. Seven rheumatoid factor-negative JRA patients with polyarticular disease and 2 JRA patients with pauciarticular disease (1 with early onset and 1 with late onset) were treated for 3 months with oral bovine CII. Patients were examined for disease activity and underwent routine laboratory testing at monthly intervals. Two of the patients had flares of disease when treatment was discontinued, and these patients were re-treated for an additional 3 months. To test the hypothesis that oral tolerance induces an immune deviation of T cells, peripheral blood mononuclear cells from patients were collected before and after treatment and cultured with CII. Supernatants and RNA were collected and analyzed for the presence of various cytokines. Results. Eight patient trials met the criteria for clinical improvement outlined by Giannini and coworkers in 1997. None of the patients had any side effects from the treatment. In 6 of the 8 patients who improved, interferon-gamma production decreased after oral CII therapy, correlating with clinical improvement, while 6 patients had increases in levels of transforming growth factor beta3. Conclusion. These results are encouraging. The possible beneficial effect of oral CII in JRA merits further investigation - NISTALA K, MURRAY KJ: Co-existent sickle cell disease and juvenile rheumatoid arthritis. Two cases with delayed diagnosis and severe destructive arthropathy. Rinsho Ganka 2001, 28:2125-2128.
Organism:Dr. K.J. Murray, Paediatric Rheumatology Unit, Great Ormond Street Hospital, London WC1N 3JH
Abstract: We describe 2 pediatric patients with sickle cell disease (SCD) who developed seropositive juvenile rheumatoid arthritis (JRA). Both patients have severe joint damage, the compound effect of both disease processes. The bone and cartilage destruction, which poses serious therapeutic challenges, highlights the difficulty of making a diagnosis of chronic inflammatory disease in the setting of SCD. There may be a correlation between increased levels of tumor necrosis factor-alpha in the synovial tissue of joints damaged by arthritis and local sickling. The resultant ischemia and corresponding inflammatory infiltrates could in turn worsen existing synovial proliferation and cartilage destruction as well as trigger further sickling - NISTALA K, MURRAY KJ: Co-existent sickle cell disease and juvenile rheumatoid arthritis. Two cases with delayed diagnosis and severe destructive arthropathy. J.Rheumatol. 2001, 28:2125-2128.
Organism:Paediatric Rheumatology Unit, Great Ormond Street Hospital, London, England
Abstract: We describe 2 pediatric patients with sickle cell disease (SCD) who developed seropositive juvenile rheumatoid arthritis (JRA). Both patients have severe joint damage, the compound effect of both disease processes. The bone and cartilage destruction, which poses serious therapeutic challenges, highlights the difficulty of making a diagnosis of chronic inflammatory disease in the setting of SCD. There may be a correlation between increased levels of tumor necrosis factor-alpha in the synovial tissue of joints damaged by arthritis and local sickling. The resultant ischemia and corresponding inflammatory infiltrates could in turn worsen existing synovial proliferation and cartilage destruction as well as trigger further sickling
Internet : PM:11550986 - NORWEGIAN SOCIETY fR: Annual Meeting of the Norwegian Society for Rheumatology, Oslo, Norway, November 20, 2000. Scandinavian Journal Of Rheumatology 2001, 30:53-57.
Abstract: This meeting contains abstracts of 20 papers, written in English, covering topics in clinical rheumatology including Sjogren's syndrome, juvenile idiopathic arthritis, rheumatoid arthritis, sacroiliitis, fracture, inflammatory rheumatic disease, Wegener's granulomatosis, systemic lupus erythematosus, diagnosis, and treatment in humans - PACHECO-TENA C, ALVARADO DLB, LOPEZ-VIDAL Y, VAZQUEZ-MELLADO J, RICHAUD-PATIN Y, AMIEVA RI, LLORENTE L, MARTINEZ A, ZUN t, CIFUENTES-ALVARADO M, BURGOS-VARGAS R: Bacterial DNA in synovial fluid cells of patients with juvenile onset spondyloarthropathies. Rheumatology 2001, 40:920-927.
Organism:R. Burgos-Vargas, Servicio de Reumatologia, Hospital General de Mexico, Univ. Nacional Autonoma de Mexico, Dr Balmis 148, Mexico DF 06726
Abstract: Objective. To identify bacterial DNA in synovial fluid cells of patients with active juvenile onset spondyloarthropathy (SpA). Methods. The main group of study constituted 22 patients with juvenile onset SpA. In addition, five patients with adult onset SpA and nine with rheumatoid arthritis (RA) were studied. Polymerase chain reaction (PCR) with either genus- or species-specific primers was performed on synovial fluid cells to detect DNA sequences of Chlamydia trachomatis, Yersinia enterocolitica, Salmonella sp., Shigella sp., Campylobacter sp. and Mycobacterium tuberculosis. The presence of antibacterial antibodies in sera and synovial fluid was also determined by enzyme-linked immunoassay. Results. The synovial fluid of nine patients with juvenile onset SpA, three with adult onset SpA and one with RA contained bacterial DNA. Five juvenile onset SpA samples had DNA of one single bacterium; two juvenile onset SpA and three adult onset SpA had DNA of two bacteria and two juvenile onset SpA had DNA of three bacteria. Overall, Salmonella sp. DNA was detected in seven synovial fluid samples, Shigella sp., Campylobacter sp. and M. tuberculosis were found in four samples each, and C. trachomatis was found in two. The bacterial DNA findings correlated with neither diagnosis nor disease duration. One RA synovial fluid had DNA of Campylobacter sp. Neither serum nor synovial fluid antibacterial antibodies correlated with DNA findings or clinical diagnosis. Conclusion. In this study, single and several combinations of bacterial DNA were identified in the synovial fluid of patients with long-term undifferentiated and definite juvenile onset SpA and adult onset SpA. Of relevance is that bacterial DNA corresponds to bacteria producing endemic disease in our population - PEDERSEN TK, JENSEN JJ, MELSEN B, HERLIN T: Resorption of the temporomandibular condylar bone according to subtypes of juvenile chronic arthritis. Rinsho Ganka 2001, 28:2109-2115.
Organism:Dr. T.K. Pedersen, Department of Orthodontics, Royal Dental College, Aarhus University, Vennelyst Boulevard, DK-8000 Aarhus C
Abstract: Objective. To evaluate the relative impact of sex, type of onset, course of disease, age at onset, duration of disease and status of HLA-B27, antinuclear antibodies (ANA), and rheumatoid factor on the risk of developing a condylar erosion. Methods. Condylar changes of the temporomandibular joint (TM J) were diagnosed on orthopantomograms from 169 consecutive patients with juvenile chronic arthritis (JCA). A multiple regression analysis was applied to establish the relative weight of the independent variables affecting the severity of the condylar erosion. Results. It was found that 62.1% of the patients exhibited condylar resorption. The highest prevalence was seen in children with a polyarticular onset or course of disease and early age at onset and severe resorption was also frequent in these groups. Patients with positive ANA also had a high prevalence but with a mild degree of resorption. In contrast, HLA-B27 positive patients had a lower risk of TMJ involvement and resorptive changes of the condyle. Conclusion. Polyarticular and early onset arthritis are associated with a high risk for TMJ involvement and a severe condylar bone loss can be expected. ANA positive patients have a high prevalence, and B27 positive patients have a low prevalence of TMJ arthritis but in both subgroups, the outcome of the bone resorptive process is mild - PEDERSEN TK, JENSEN JJ, MELSEN B, HERLIN T: Resorption of the temporomandibular condylar bone according to subtypes of juvenile chronic arthritis. J.Rheumatol. 2001, 28:2109-2115.
Organism:Department of Orthodontics, Pediatric Rheumatology Clinic, Aarhus University Hospital, Denmark
Abstract: OBJECTIVE: To evaluate the relative impact of sex, type of onset, course of disease, age at onset, duration of disease and status of HLA-B27, antinuclear antibodies (ANA), and rheumatoid factor on the risk of developing a condylar erosion. METHODS: Condylar changes of the temporomandibular joint (TMJ) were diagnosed on orthopantomograms from 169 consecutive patients with juvenile chronic arthritis (JCA). A multiple regression analysis was applied to establish the relative weight of the independent variables affecting the severity of the condylar erosion. RESULTS: It was found that 62.1% of the patients exhibited condylar resorption. The highest prevalence was seen in children with a polyarticular onset or course of disease and early age at onset and severe resorption was also frequent in these groups. Patients with positive ANA also had a high prevalence but with a mild degree of resorption. In contrast, HLA-B27 positive patients had a lower risk of TMJ involvement and resorptive changes of the condyle. CONCLUSION: Polyarticular and early onset arthritis are associated with a high risk for TMJ involvement and a severe condylar bone loss can be expected. ANA positive patients have a high prevalence, and B27 positive patients have a low prevalence of TMJ arthritis but in both subgroups, the outcome of the bone resorptive process is mild
Internet : PM:11550983 - PRAHALAD S, BOVE KE, DICKENS D, LOVELL DJ, GROM AA: Etanercept in the treatment of macrophage activation syndrome. Rinsho Ganka 2001, 28:2120-2124.
Organism:Dr. A.A. Grom, Division of Rheumatology, Pav. 2-129, Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039
Abstract: Macrophage activation syndrome (MAS), a recognized complication of systemic juvenile rheumatoid arthritis (sJRA), has been associated with significant morbidity and mortality. Dysregulation of macrophage-lymphocyte interactions leading to uncontrolled proliferation of highly activated macrophages and massive release of proinflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha) appears to be central to the pathogenesis of this syndrome. Until now the mainstay of therapy has been corticosteroids and cyclosporin A. We describe a patient with MAS and sJRA successfully treated with the anti-TNF agent etanercept. The outcome in this patient suggests etanercept might be an effective therapeutic agent in MAS
Internet : groma0@chmcc.org - PRAHALAD S, BOVE KE, DICKENS D, LOVELL DJ, GROM AA: Etanercept in the treatment of macrophage activation syndrome. J.Rheumatol. 2001, 28:2120-2124.
Organism:Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Ohio 45229-3039, USA
Abstract: Macrophage activation syndrome (MAS), a recognized complication of systemic juvenile rheumatoid arthritis (sJRA), has been associated with significant morbidity and mortality. Dysregulation of macrophage-lymphocyte interactions leading to uncontrolled proliferation of highly activated macrophages and massive release of proinflammatory cytokines including tumor necrosis factor-alpha (TNF-alpha) appears to be central to the pathogenesis of this syndrome. Until now the mainstay of therapy has been corticosteroids and cyclosporin A. We describe a patient with MAS and sJRA successfully treated with the anti-TNF agent etanercept. The outcome in this patient suggests etanercept might be an effective therapeutic agent in MAS
Internet : PM:11550985 - PRIEUR AM, CHEDEVILLE G: Prognostic factors in juvenile idiopathic arthritis. Curr.Rheumatol.Rep. 2001, 3:371-378.
Organism:Unite d'Immunologie, Hematologie et Rhumatologie Pediatriques, Hopital Necker Enfants Malades, 149 rue de Sevres, 75743 Paris cedex 15, France anne-marieprieur@nckap-hop-parisfr
Abstract: Prognostic factors in juvenile arthritis are related to many variables that must be evaluated according to the different subtypes. The International League of Associations of Rheumatologists (ILAR) recently proposed six different categories referred to as the Durban criteria, under the eponym of juvenile idiopathic arthritis (JIA). The aim of this classification was to define homogeneous groups according to their clinical and biologic features. The prognostic factors were classified into the different categories of JIA. A poor outcome in the systemic form correlated with markers of disease activity, such as fever and polyarticular involvement, within the first 6 months. The risk of joint destruction in oligoarthritis correlated with the severity of arthritis within the first 2 years. Polyarthritis with positive rheumatoid factor is associated with marked disability in adulthood. In a group of psoriatic patients, the risk of developing sacroiliitis is higher in male and HLA-B27-positive patients. Patients with enthesitis-related arthritis with lower limb, knee, and tarsal involvement also are at greater risk of developing sacroiliitis. Chronic uveitis is a complication of JIA observed mainly in patients with oligoarthritis associated with positive antinuclear antibodies in serum. Secondary amyloidosis is observed mainly in children with systemic JIA. The long-term outcome must be discussed according to the various therapies. Corticosteroids contribute to growth retardation and osteoporosis, for which the use of human recombinant growth hormone and biphosphonates may be an option. Newer encouraging therapies such as anticytokines have been proposed for children with active disease. Autologous stem cell transplantation is being evaluated in some centers with promising results; however, it has a high rate of mortality. Further discussion regarding which patients should undergo autologous stem cell transplantion is needed, as is further discussion regarding the technical adaptations necessary
Internet : PM:11564367 - RAMANAN AV, BAILDAM EM, JUDGE MR: Atrophoderma and juvenile idiopathic arthritis [6]. Annals of the Rheumatic Diseases 2001, 60:900-901.
Organism:Dr. A.V. Ramanan, Flat 508, Elm Street, Toronto, Ont. M5 G1H4
Internet : avramanan@hotmail.com - RAMANAN AV, BAILDAM EM, JUDGE MR: Atrophoderma and juvenile idiopathic arthritis. Ann.Rheum.Dis. 2001, 60:900-901.
Internet : PM:11534508 - RAVELLI A, VIOLA S, MIGLIAVACCA D, PISTORIO A, RUPERTO N, MARTINI A: Discordance between proxy-reported and observed assessment of functional ability of children with juvenile idiopathic arthritis. Rheumatology 2001, 40:914-919.
Organism:A. Martini, Clinical Pediatrica, IRCCS, Dipt. Scienze Pediatriche dell Univ., S. Matteo, P. le Golgi 2, 27100 Pavia
Abstract: Objective. To determine the level of agreement between parents and clinicians in rating dysfunction in children with juvenile idiopathic arthritis (JIA). Methods. A parent of each patient completed the Italian version of the Childhood Health Assessment Questionnaire (CHAQ). Subsequently, an examiner assessed, in a specially equipped room, the child's performance of tasks as described by the CHAQ. Demographic and clinical variables were recorded for all patients. Results. Seventy consecutive JIA patients and their parents were included. The mean proxy-reported and observed CHAQ score was 0.64 +/- 0.53 and 0.47 +/- 0.62 respectively, the difference ranging from -1.75 to 1.5. There were 30 cases (43%) of agreement (difference <=0.25 CHAQ units) between the parent's and clinician's ratings, whereas in 40 cases (57%) there was discordance (difference >0.25 CHAQ units). In 30 cases the parent rated the child's functional ability as worse than that observed by the clinician (i.e. the parent underestimated the child's function), whereas in 10 cases the parent rated the child's functional ability as better than that observed by the clinician (i.e. overestimated the child's function). Multivariate regression analysis showed that children's functional ability was overestimated by parents with increasing erythrocyte sedimentation rate and global articular severity score and underestimated with increasing level of pain. Among the functional areas of the CHAQ, the level of agreement was poorest in the areas of eating and hygiene and was best for activities. Conclusions. Discordance between proxy-reported and observed functional ability was frequent in our patients with JIA. The children's functional ability was overestimated by parents as the severity of arthritis increased and underestimated as the level of pain increased - RAVELLI A, MANZONI SM, VIOLA S, PISTORIO A, RUPERTO N, MARTINI A: Factors affecting the efficacy of intraarticular corticosteroid injection of knees in juvenile idiopathic arthritis. Rinsho Ganka 2001, 28:2100-2102.
Organism:Dr. A. Martini, Clinica Pediatrica, IRCCS S. Matteo, P. le Golgi 2, 27100 Pavia
Abstract: Objective. To determine in a prospective analysis whether baseline demographic, clinical, and laboratory variables predict the outcome of intraarticular corticosteroid (IAC) injection of the knees in children with juvenile idiopathic arthritis (JIA). Methods. We studied consecutive patients who met the criteria for the diagnosis of JIA and received their initial injection of triamcinolone hexacetonide in one or both knees. Predictor variables included sex, age, age at onset of JIA, onset subtype, disease duration, drug therapy at the time of IAC injection, physician and parent global assessment of disease status, Childhood Health Assessment Questionnaire disability index, erythrocyte sedimentation rate (ESR), C-reactive protein, involvement of other joints besides knees, amount of fluid aspirated, and dose of IAC injected. The primary outcome measure was persistence of complete clinical response at 6 months, i.e., no evidence of synovitis clinically. Results. Ninety-four patients were available for analysis. At 6 months after the IAC injection, 65 (69%) patients showed a sustained complete clinical response, whereas 29 (31%) had had a recurrence of joint inflammation. Univariate statistical analyses showed that patients who had a sustained clinical response had a significantly higher ESR than those who did not (p = 0.023). The ESR was the only variable that remained in the best-fit model from multivariate logistic regression analysis (OR 2.61, p = 0.049). Conclusion. Our findings indicate that patients with JIA who have a higher ESR are more likely to benefit from IAC injection of the knees
Internet : amartini@smatteo.pv.it - RAVELLI A, MANZONI SM, VIOLA S, PISTORIO A, RUPERTO N, MARTINI A: Factors affecting the efficacy of intraarticular corticosteroid injection of knees in juvenile idiopathic arthritis. J.Rheumatol. 2001, 28:2100-2102.
Organism:Dipartimento di Scienze Pediatriche dell'Universita, Clinica e Biometria, IRCCS Policlinico San Matteo, Pavia, Italy
Abstract: OBJECTIVE: To determine in a prospective analysis whether baseline demographic, clinical, and laboratory variables predict the outcome of intraarticular corticosteroid (IAC) injection of the knees in children with juvenile idiopathic arthritis (JIA). METHODS: We studied consecutive patients who met the criteria for the diagnosis of JIA and received their initial injection of triamcinolone hexacetonide in one or both knees. Predictor variables included sex, age, age at onset of JIA, onset subtype, disease duration, drug therapy at the time of IAC injection, physician and parent global assessment of disease status, Childhood Health Assessment Questionnaire disability index, erythrocyte sedimentation rate (ESR), C-reactive protein, involvement of other joints besides knees, amount of fluid aspirated, and dose of IAC injected. The primary outcome measure was persistence of complete clinical response at 6 months, i.e., no evidence of synovitis clinically. RESULTS: Ninety-four patients were available for analysis. At 6 months after the IAC injection, 65 (69%) patients showed a sustained complete clinical response, whereas 29 (31%) had had a recurrence of joint inflammation. Univariate statistical analyses showed that patients who had a sustained clinical response had a significantly higher ESR than those who did not (p = 0.023). The ESR was the only variable that remained in the best-fit model from multivariate logistic regression analysis (OR 2.61, p = 0.049). CONCLUSION: Our findings indicate that patients with JIA who have a higher ESR are more likely to benefit from IAC injection of the knees
Internet : PM:11550981 - REIFF A, TAKEI S, SADEGHI S, STOUT A, SHAHAM B, BERNSTEIN B, GALLAGHER K, STOUT T: Etanercept therapy in children with treatment-resistant uveitis. Arthritis & Rheumatism 2001, 44:1411-1415.
Organism:Division of Rheumatology, Childrens Hospital Los Angeles, 4650 Sunset Boulevard, Los Angeles, CA, 90027 USA
Abstract: Objective: To evaluate the safety and efficacy of the tumor necrosis factor fusion protein etanercept in children with treatment-resistant uveitis. Methods: Ten children with chronic active uveitis (7 girls and 3 boys, mean age 7.5 years (range 3-12 years)) were enrolled in this prospective study. In 7 children, uveitis was associated with pauciarticular juvenile rheumatoid arthritis. Five children were antinuclear antibody positive. All patients had failed previous therapy with topical steroids and methotrexate and/or cyclosporine. All were treated with etanercept at a dosage of 0.4 mg/kg twice weekly for the first 3 months, and then, if eyes did not improve, with 25 mg twice weekly (mean 1.1 mg/kg) for at least 3 additional months. Results: At the beginning of the trial, uveitis affected 18 eyes in the 10 children. Within 3 months, 10 of 16 affected eyes (63%; P=0.017) showed a rapid decrease in anterior chamber cell density, including remission of uveitis in 4 eyes. In children with visual acuity of less than 20/25, 4 of 10 eyes (40%) improved. An exacerbation of uveitis during etanercept therapy occurred in only 1 child (1 of 14 eyes (7%)). Other ocular outcome parameters, such as intraocular pressure, synechia formation, and lens clarity, remained unchanged. Following a dosage increase to an average of 1.1 mg/kg after 3 months in 7 children, no further improvement was noted. Conclusion: Our data suggest that etanercept injected subcutaneously twice a week has a beneficial effect on treatment-resistant chronic uveitis in children. Further controlled studies with etanercept in systemic or topical form are necessary to confirm its efficacy and optimal mode of administration - ROBERTSON LP, HICKLING P: Chronic recurrent multifocal osteomyelitis is a differential diagnosis of juvenile idiopathic arthritis. Annals of the Rheumatic Diseases 2001, 60:828-831.
Organism:Dr. L.P. Robertson, Department of Rheumatology, Royal Cornwall Hospital, Truro, Cornwall TR1 3LJ
Internet : rwmlpr@eurobell.co.uk - RODGERS GL, MORTENSEN JE, GOLDSMITH DP: Pyogenic arthritis caused by Capnocytophaga gingivalis in an immunocompetent three-year-old male. Journal of Clinical Rheumatology 2001, 7:265-267.
Organism:Dr. D.P. Goldsmith, Pediatric Rheumatology, St. Christopher's Hosp. for Children, Erie Avenue, Philadelphia, PA 19134
Abstract: Capnocytophaga gingivalis is most often isolated as normal oral flora or with periodontal disease. This organism is also associated with sepsis usually in immunocompromised hosts. We identified pyogenic arthritis caused by C. gingivalis in a 3-year-old immunocompetent male, whose clinical course closely resembled monoarticular onset pauciarticular juvenile rheumatoid arthritis. This is the first report of C. gingivalis septic arthritis in the world literature, but there are increasing reports of infections with this carbon dioxide-loving organism at other sites in nonimmunocompromised individuals. The subacute presentation of the monoarthritis with this organism of low virulence led to a long delay in diagnosis and treatment. Any monoarthritis must continue to raise concern about infection - SHAHIN AA, EL MOFTY SA, EL SHEIKH EA, HAFEZ HA, RAGAB OM: Power Doppler sonography in the evaluation and follow-up of knee involvement in patients with juvenile idiopathic arthritis. Zeitschrift fuer Rheumatologie 2001, 60:148-155.
Organism:453 Al-Ahram Street, Al-Ahram, Giza: rughe@rusys.eg.net Egypt
Abstract: Introduction This study was undertaken to evaluate the role of ultrasound (US), conventional color (CD) and power Doppler (PD) in the detection and quantification of inflammatory signs of the knee in children with juvenile idiopathic arthritis (JIA) and to correlate these findings with patient history, clinical, laboratory and radiological findings. Patients and methods Thirty patients with JIA who had clinical signs of knee involvement as well as 15 healthy children as a control group where subjected to full clinical examination and laboratory investigations on the same day of US examination. The knee joints were evaluated with plain radiography, US, and color Doppler in 13 patients, while the remaining 17 were assessed with power Doppler. Fourteen patients were subjected to follow-up assessment. Results A highly significant difference in synovial thickening and cartilage thickness detected by US between JIA affected knees and those of controls (p < 0.0001). Knee effusion was demonstrated in 93% of patients. Synovial vessles were detected by Doppler in 76.7% of patients. A significant correlation was detected between the degree of vascularity detected by PD and knee score (p < 0.05), and JAFAR score (P < 0.05). On comparing the findings of the follow-up with those of the initial examination, a significant positive correlation was detected between the differences in the knee score and those in synovial thickness (p < 0.05), and with the vascularity scale detected by PD (p < 0.05). Conclusion This study suggests the Doppler sonography as a non-invasive, low-cost, and readily available tool for the evaluation and follow-up of articular involvement in knees of JIA patients - STERN A, RILEY R, BUCKLEY L: Worsening of macrophage activation syndrome in a patient with adult onset Still's disease after initiation of etanercept therapy. Journal of Clinical Rheumatology 2001, 7:252-256.
Organism:Dr. A. Stern, Department of Medicine, Medical College of Virginia, Virginia Commonwealth University, P.O. Box 980647, Richmond, VA 23298-0647
Abstract: The macrophage activation syndrome (MAS) is a rare, potentially fatal, clinical syndrome, which has been described in childhood rheumatic disorders. MAS is defined by a prolonged period of fevers, pancytopenia, and hypertriglyceridemia (with or without hypofibrinogenemia). Histopathological examination of bone marrow, spleen, or lymph nodes shows hemophagocytosis by mononuclear phagocytes. In patients with Still's disease, observed triggering events for MAS have included both infectious processes and pharmacological agents, such as parenteral gold and non-steroidal anti-inflammatory drugs. We report the case of a young woman with adult-onset Still's disease (AOSD), complicated by an Epstein-Barr virus infection and subsequent MAS, whose course worsened after administration of the soluble tumor necrosis factor-alpha receptor, etanercept. Subsequent treatment with pulse corticosteroids and cyclosporine A induced a dramatic clinical improvement. Treatment data regarding the use of etanercept in AOSD are lacking; given our experience and recent reports in children with Still's disease, we would suggest caution using this agent in patients with AOSD, particularly when complicated by MAS - TAKKEN T, VANDERNET J, HELDERS PJM: Aquatic physical training program for children with juvenile idiopathic arthritis (JIA): A randomized controlled trial. Medicine & Science in Sports & Exercise 2001, 33:S37
Organism:University Medical Center Utrecht, Utrecht: t.takken@wkz.azu.nl Netherlands - VON KOSKULL S, TRUCKENBRODT H, HOLLE R, HORMANN A: Incidence and prevalence of juvenile arthritis in an urban population of southern Germany: a prospective study. Ann.Rheum.Dis. 2001, 60:940-945.
Organism:Rheuma-Kinderklinik der Rummelsberger Anstalten, Gehfeldstrasse 24, D-82467 Garm
Abstract: OBJECTIVE: To ascertain the incidence and prevalence of juvenile arthritis in a German urban population. METHODS: All 766 paediatricians, orthopaedists, and rheumatologists working in practices or outpatient clinics in 12 south German towns were asked to report all patients who consulted them for juvenile arthritis during the year 1995. Patients with continuing symptoms were followed up for 9-12 months to obtain a final diagnosis. Extended measures of quality control were taken to control for known biases. RESULTS: Of 457 reported cases, 294 were diagnosed with para-/postinfectious arthritis (PPA), 78 with juvenile chronic arthritis (JCA), and 18 with other forms of arthritis. Half of the PPA cases were classified as transient synovitis of the hip (SH). For JCA the reported annual incidence was 6.6 and the prevalence 14.8 per 100 000 subjects under 16 years of age. For PPA the reported incidence was 76 and the prevalence 4.4 per 100 000 subjects under 16. The incidence of rheumatic fever was clearly below 1 per 100 000 people under 16. A correction model was used to control for known biases and to adjust the estimates accordingly. CONCLUSIONS: The results of this first prospective study on the incidence and prevalence of juvenile arthritis in Germany are consistent with a retrospective study performed in the Berlin area. Based on these results it was estimated that the annual frequency of juvenile arthritis in Germany is as follows: 750-900 incident JCA cases, 21 000 incident SH cases, and 21 000 incidence cases of other forms of PPA a year. The number of incidence cases of rheumatic fever is expected to be markedly lower than 150 a year. The total prevalence is expected to be 3600-4350 JCA cases, 2250-3000 SH cases, and the same number of other forms of PPA
Internet : PM:11557650