Bibliography December 2002
- BROSTROM E, HAGLUND-AKERLIND Y, HAGELBERG S, CRESSWELL AG: Gait in children with juvenile chronic arthritis: Timing and force parameters. Scandinavian Journal Of Rheumatology 2002, 31:317-323.
Organism:E. Brostrom, Department of Woman and Child Health, Karolinska Institute, SE-171 76 Stockholm
Abstract: Objectives: To examine gait in children with juvenile chronic arthritis (JCA) with reference to velocity, ground reaction forces and temporal parameters. Methods: Fifteen children with JCA were assigned into two groups (uni- and bilateral involvement and classified as pauci- or polyarticular arthritis). Fourteen healthy children participated in the control group. Light-beams were used to determine walking velocity and the children with JCA rated their pain on a visual analogue scale. Two force plates registered the ground reaction forces and foot-switches were used to obtain temporal parameters. Results: The mean velocity for the children with JCA was significantly less than for the healthy controls. Velocity normalized to height showed a tendency for the children with JCA to walk slower than controls. Differences between JCA children and healthy controls were observed for peak vertical forces during heel contact and push-off. No temporal differences were observed between the groups. Conclusions: Such kinetic and temporal information may provide the clinician with a sensitive tool for pre- and post assessment of intra-articular steroid injections and/or physical therapy
Internet : Eva.Brostrom@kbh.ki.se - BRUHN C: Meloxicam for the treatment of juvenile rheumatoid arthritis. Deutsche Apotheker Zeitung 2002, 142:52-53.
- CORDNER S, DE CEULAER K: Musculoskeletal manifestations of hemoglobinopathies. Curr.Opin.Rheumatol. 2003, 15:44-47.
Abstract: Patients with sickle cell disease often seek treatment for rapid periorbital swelling due to infarction of the orbital bones. Because of resulting orbital compression syndrome, treatment with corticosteroids and antibiotics is advisable. If spinal tuberculosis occurs in patients with sickle cell anemia, radiologic signs will be a combination of the two conditions. The diagnosis of juvenile rheumatoid arthritis is usually delayed in patients with sickle cell disease. Sulphasalazine is the disease-modifying drug of choice for treating juvenile rheumatoid arthritis, because it also reduces the adhesiveness of sickled red cells. TNF-alpha inhibitors may also be useful for treating these patients. A volumetric method to determine the size and special distribution of the necrotic lesions of the femoral head has been developed using magnetic resonance imaging scans. With this method it will be easier to determine which early lesions require core decompression, or which ones should be treated conservatively. Osteomyelitis can be differentiated from bone infarction with the use of segmental radionuclide bone-marrow and bone scans. Reduction in frequency of painful crises can be achieved by increasing fetal hemoglobin with the use of hydroxyurea. The treatment of the actual pain requires decisions about the analgesics that are used as well as the route of their administration. Ketorolac monotherapy is likely to fail in the presence of an initial high pain score or with involvement of four or more pain sites
Internet : PM:12496509 - DAIBATA M, TAGUCHI H: Human herpesvirus 6 and adult-onset Still's disease. American Journal of Medicine 2002, 113:532
Organism:Department of Medicine, Kochi Medical School, Kochi, Japan Japan - ELISOFON SA, EMERICK KM, SWEET E, SINACORE J, ALONSO EM: Quality of life in patients with Alagille syndrome. Hepatology 2002, 36:336A
Organism:Children's Memorial Hospital, Chicago, IL USA - FAWCETT PT, FAWCETT LB, ROSE CD, GIBNEY KM, STETSON TG: Synoviocytes from Lyme arthritis patients produce elevated IL-6 levels in culture. Abstracts of the General Meeting of the American Society for Microbiology 2002, 102:491
Organism:Alfred I. duPont Hospital for Children, Wilmington, DE USA
Abstract: Background: Arthritis, particularly in large joints, is one of the clinical manifestations of infection with Borrelia burgdorferi, the spirochete that causes Lyme disease. Some Lyme arthritis patients develop a chronic form of the disease characterized by recurrent swelling, joint pain and possible destruction of articular surfaces, despite adequate treatment with antibiotics. Methods: This study examined the growth characteristics and responsiveness to exogenous stimuli of a normal synoviocyte cell line with synoviocyte cell lines (greater than 10 passages) established from two patients diagnosed with chronic Lyme arthritis. The synoviocytes cultured from Lyme arthritis patients resembled those observed and reported for rheumatoid and juvenile rheumatoid arthritis patients. Unlike the control normal synoviocytes, these cells showed rapid division, lacked contact inhibition and displayed morphologic characteristics of semi-transformed cells. Cultures of each cell type were assayed for IL-6 production as a marker of activation under resting and stimulated conditions (addition of PMA, heat killed Borrelia burgdorferi and OspA vaccine). Results: Unstimulated (control media) synoviocytes from Lyme arthritis patients produced much higher levels of IL-6 than did normal synoviocytes. Indeed IL-6 levels from unstimulated Lyme synoviocytes were similar to those produced by PMA-stimulated normal synoviocytes. Addition of OspA vaccine to the cultures stimulated IL-6 production in all three cell lines. Interestingly, two of the cell lines (normal and Lyme arthritis 2) stimulated to produce IL-6 by the OspA vaccine were not stimulated by the addition of whole heat killed B. burgdorferi to the media. Conclusion: Findings of this study suggest that some chronic Lyme arthritis may result from hyperactivity of synoviocytes, as opposed to an autoimmune mechanism - FILIPPUCCI E, FARINA A, CERVINI C, GRASSI W: [Juvenile chronic arthritis and imaging: comparison of different techniques]. Reumatismo. 2001, 53:63-67.
Organism:Clinica Reumatologica, Universita degli Studi di Ancona, Ospedale "A Murri", Via dei Colli, 52, 60035 Jesi (AN), Italy reuman@popcsiunianit
Abstract: OBJECTIVE: The aim of this study was to compare imaging findings obtained with different techniques in a patient with juvenile chronic arthritis. METHODS: The patient was a 12 years-old child with a 7-months history of arthritis of the first metatarsophalangeal joint of the right foot. The involved area was explored with the following imaging techniques: X-ray, technetium bone scintigraphy, magnetic resonance, gray-scale and power-Doppler ultrasonography. RESULTS: No abnormalities were detected with conventional X-ray. Scintigraphy showed an abnormal uptake of the radionuclide in the first metatarsophalangeal joint of the right foot. Magnetic resonance without contrast revealed clearly evident features of an active process of synovitis. Ultrasonography was able to detect the presence of joint effusion, synovial proliferation, bone erosion of the first metatarsal head. Power-Doppler examination revealed evident signs of soft tissue hyperaemia. CONCLUSIONS: Comparative assessment of different imaging techniques in this patient with recent-onset juvenile chronic arthritis indicates that high resolution ultrasonography provides the most detailed evaluation of the joint involvement with respect to the other imaging techniques
Internet : PM:12461580 - FITZCHARLES M-A, CLAYTON D, MENARD HA: The use of infliximab in academic rheumatology practice: An audit of early clinical experience. Rinsho Ganka 2002, 29:2525-2530.
Organism:Dr. M.-A. Fitzcharles, McGill University Health Centre, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Que. H3G 1A4
Abstract: Objective. To audit a first clinical experience of treating rheumatic disease patients with infliximab in the setting of an academic tertiary care rheumatology practice. Methods. The infusion history of patients referred to the McGill University Health Centre during the first 18 month period of a special access program for treatment with infliximab, a tumor necrosis factor-alpha antibody, was audited for disease characteristics, dosing schedule for infliximab, concomitant treatments, response rate, and side effect profile. Results. Forty-one patients received a total of 300 infusions of infliximab over a period of 9 +/- 5 months (mean +/- standard deviation). Rheumatic disease indications were rheumatoid arthritis in 30, spondyloarthropathy in 6, psoriatic arthritis in 2, juvenile onset polyarthritis in 2, and scleroderma in one. Disease duration was 17 +/- 11 years. Concomitant treatment with steroids and methotrexate was present in 68% and 54%, respectively. Infliximab treatment was continued beyond 5 infusions or 22 weeks in 63%. Of the 26 patients continuing treatment, adjustment to dosing and/or interval schedule of infusions was made in 58%. The clinical response rate was moderately to greatly improved in 96%. Severe side effects considered directly related to the treatment were observed in 6 (15%) patients; less severe side effects, which did not preclude continuation of treatment but frequently required medical intervention, were noted in 93%. Conclusion. Infliximab is a valuable treatment for patients with resistant rheumatic diseases in the short term. Both the serious, and the frequent, more benign complication rate observed in this group of patients should alert physicians to be vigilant in the routine care of patients treated with infliximab
Internet : mary-ann.fitzcharles@muhc.mcgill.ca - FOELDVARI I: A selective COX-2 inhibitor, meloxicam, as a treatment option in patients with juvenile idiopathic arthritis and gastrointestinal side effects from naproxen [4]. Clinical And Experimental Rheumatology 2002, 20:874
Organism:I. Foeldvari, Pediatric Rheumatology Clinic, A-K-Eilbek, Friedrichsberger Str. 60, 22081 Hamburg - GANSER G: [Physical therapy in juvenile chronic arthritis and connective tissue diseases in childhood.]
<ORIGINAL> Physikalische Therapie bei juveniler chronischer Arthritis und Kollagenosen. Aktuelle Rheumatologie 2002, 27:213-220.
Organism:Abt. Kinder- und Jugendrheumatologie, St. Josef Stift Sendenhorst, 48318, Postfach 1164/1165, Sendenhorst Germany^E-Mail: ganser@st-josef-stift.de
Abstract: Physical and occupational therapy programmes are vital to the management of rheumatic diseases in children. As early as possible these regimens should be initiated together with medical treatment of acutely inflamed joints. These therapies aim at decreasing of inflammation, pain, limitation of motion and disturbances of growth. A variety of modalities and treatment approaches are used in paediatric rheumatology units in Germany. The physical therapies are depending on the kind of the rheumatic disease, age of the patient, experience of the physical or occupational therapist in the treatment of children with chronic inflammatory diseases of the joints. Therapeutic exercises and occupational therapy are mentioned in the literature (1,2). The physical therapies are mainly cold therapies in acute inflammatory diseases of the joints and the spine to reduce pain and the limitation of movement, heat therapies (e.g. in warm water of about 32degreeC) for chronic disease to reduce muscle pain, stiffness, to perform exercises in the water (easier weight bearing). The different modalities of electrotherapy are indicated in case of chronic pain, inflammation of the tendons (enthesopathy), as well as in muscular pain due to contractures or limitation of activities in daily living. Phonophoresis is used in enthesopathies as well. Massage of the muscles or of the connective tissue is also used to influence swelling, edema or limitation of motion according to muscle pain and to improve circulation in the lymphatic system. As an example for the treatment with physical therapies the therapeutic aims of the different methods are shown according to the symptoms of connective tissue diseases in childhood - GERHARDT CA, VANNATTA K, MCKELLOP JM, ZELLER M, TAYLOR J, PASSO M, NOLL RB: Comparing parental distress, family functioning, and the role of social support for caregivers with and without a child with juvenile rheumatoid arthritis. J.Pediatr.Psychol. 2003, 28:5-15.
Organism:Children's Hospital Medical Center and the University of Cincinnati
Abstract: Objective To assess parental distress, family functioning, and social support among parents of children with a lifetime diagnosis of juvenile rheumatoid arthritis (JRA) and comparison families. Methods Parents of 64 children with JRA (64 mothers, 46 fathers) completed questionnaires and in-home interviews along with 64 matched comparison families. Average time since diagnosis for children with JRA was 70 months. Results Families of children with JRA generally reported levels of parental distress, family functioning, and social support similar to those for comparison families. More mothers of children with JRA exceeded the clinical cutoff on the SCL-90-R than comparison mothers. Although disease characteristics and social support did not distinguish subgroups of parents at greater risk for problems, family supportiveness and conflict were associated with caseness for mothers of children with JRA. Conclusions Families of children with JRA exhibited substantial resilience over the long term. Further multisite study of children recently diagnosed and with more severe forms of JRA is warranted to determine intervention needs, especially for mothers
Internet : PM:12490626 - HAAPASAARI J, KAUTIAINEN H, HANNULA S, POHJANKOSKI H, HAKALA M: Good results from combining etanercept to prevailing DMARD therapy in refractory juvenile idiopathic arthritis. Clinical And Experimental Rheumatology 2002, 20:867-870.
Organism:Dr. J. Haapasaari, Rheumatism Foundation Hospital, FIN-18120 Heinola
Abstract: Objective. To assess the effect of etanercept added to prevailing drug therapy in patients with juvenile idiopathic arthritis (JIA) whose disease was refractory to conventional disease-modifying antirheumatic drug (DMARD) treatment, including combinations of different DMARDs. Methods. Data on 31 JIA patients with a disease resistant to conventional DMARD treatment were retrospectively collected from medical records and assessed for a one-year period after the introduction of etanercept or to the time of cessation of the drug due to a lack of efficacy or side effects. Efficacy was assessed based on the normal laboratory indexes of inflammation and changes in the following parametres: number of DMARDs used and intraarticular (i.a.) glucocorticoid injections. The numbers of inpatient days needed were also recorded. Results. Etanercept was well tolerated. Only two patients stopped discontinued the treatment because of allergic rash, after 3 weeks of treatment in one case and after 4 months in another. In two cases the treatment was discontinued because of a lack of efficacy. During the treatment, there was a significant decrease in the number of DMARDs used and the i.a. glucocorticoid injections needed as well as in the dose of per oral glucocorticoids. The laboratory parameters also improved. In addition, there was a significant decrease in the number of inpatient days per 3-month period before and during the etanercept treatment. Conclusion. The addition of etanercept to conventional DMARD therapy in children with the most severe cases of JIA leads to an excellent clinical response during the first 12 months. The tolerability of the drug is good in combination therapy with various DMARDs
Internet : jarkko.haapasaari@reuma.fi - HAFNER R: The importance of imaging for evaluation of diagnosis and course of juvenile arthritis - Differences to imaging of adults. Aktuelle Rheumatologie 2002, 27:253-258.
Organism:Dr. R. Hafner, Rheumaklinik fur Kinder/Jugendliche, Gehfeldstrasse 24, 82467 Garmisch-Partenkirchen
Abstract: Imaging procedures are most valuable for diagnosis and course of juvenile idiopathic arthritis. Initially they are very important for excluding other diseases like orthopaedic problems, septic arthritis or even malignant processes. In juvenile idiopathic a arthritis the individual procedures are of different significance in evaluating disease activity and progression. Ultrasound is the procedure of choice to demonstrate joint activity by depicting synovial effusion and swelling, and is also helpful in differentiating tenosynovitis from arthritis. Synovial cysts can be analysed in respect of their position, extension and echogeneity. Especially in children with systemic arthritis synovial cysts are seen in the upper arm, extending from the shoulder joint. These cysts are often very echodense and difficult to delimit from the surrounding muscles. The X-ray primarily demonstrates bony progression. In children it is also important to evaluate growth disturbances. These may occur as accelerated growth and ossification due to hyperaemia, but also as a growth delay for example of a hand or foot resulting from minor use of the painful extremity. In older children an early closure of the epiphysis may lead to permanent shortening of individual digits. A special X-ray finding in children concerns periosteal reactions of the phalanges. They are a clue to flexotenosynovitis, but they are only seen for a rather short period. After some time the periosteal reaction ossifies, leaving a broadening of the phalanx. Ankylosis of peripheral joints is rare in children. It may occur in the wrist or tarsus, sometimes without overt destructive changes. It is, however common in the cervical spine where it usually extends from cranial to caudal, finally blocking the whole cervical spine. Sometimes there is only partial blocking with the risk of instability. Atlanto-axial dislocation in children is rare. If inflammation subsides children have a high potential for repair of bone and cartilage. The X-ray demonstrates widening of the joint space as well as filling of bony erosions and cysts. MRI should be restricted to special aspects. These include visualisation of problem areas such as the cervical spine or the sacroiliac joints. Sometimes an exact joint status by MRI is helpful in surgery planning - HAUGEN MA, LIEN G, FLATO B, KVAMMEN JA, VINJE O, SORSKAAR D, FORRE O: Minor impact of juvenile arthritis on nutritional status in young adult patients. Arthritis Care and Research 2002, 47:623-629.
Organism:M.A. Haugen, Center for Rheumatic Diseases, Rikshospitalet, Sognsvannsveien 20
Abstract: Objective. Growth abnormalities and poor nutritional status have been reported in children with juvenile idiopathic arthritis (JIA). The aim of this study was to evaluate the impact of juvenile chronic rheumatic disease on current nutritional status in adult patients in remission or with active disease. Methods. One hundred thirty-eight women and 82 men, aged >20 years, with JIA were studied after a mean disease duration of 15.5 +/- 2.3 years. Eighty-four (61%) of the women and 49 (60%) of the men were in remission. Forty-one healthy women and 54 healthy men served as a reference group. Body composition was analyzed by dual-energy x-ray absorptiometry. Results. There was no difference in height or body mass index (BMI) between patients and healthy subjects. However, female patients with systemic disease had significantly reduced BMI compared with those with pauciarticular JIA (P < 0.001), and female patients who used or had been using corticosteroids had significantly lower weight, height, and BMI compared with the patients who had never used corticosteroids (P < 0.05). Female patients in remission had significantly more lean body mass compared with healthy controls (P < 0.05) and significantly less body fat was found in both women and men (P < 0.01 for both). Patients with active disease had the same amount of lean body mass as the healthy controls, but significantly less body fat (P < 0.05 for women and P < 0.01 for men). Conclusion. Adult patients with JIA had attained normal height, weight, and BMI, with the exception of women with systemic JIA and those who were using or had used corticosteroids. Patients with JIA in remission seemed to have a better nutritional status than healthy subjects
Internet : margaretha.haugen@fhi.no - HOMEFF G, BURGOS-VARGAS R: TNF-alpha antagonists for the treatment of juvenile-onset spondyloarthritides. Clin.Exp.Rheumatol. 2002, 20:S137-S142
Organism:Department of Paediatrics, Martin-Luther University Halle-Wittenberg, Halle, Germany gerdhorneff@medizinuni-hallede
Abstract: Juvenile-onset spondyloarthritides (SpA) is a term for a group of HLA-B27 related disorders. The hallmark signs and symptoms of this group of disorders include peripheral arthritis and enthesitis while sacroiliitis and spondylitis develop in some cases later on and extrarticular manifestations such as anterior uveitis occurs occasionally. Conventional medical therapy in children consists of non-steroidal anti-inflammatory drugs and corticosteroids that are administered intraarticulary, even in the sacroiliac joints. Sulfasalazine and methotrexate are given in cases of chronic synovitis or enthesitis. Unfortunately, these forms of therapy have limited efficacy in many cases and disease activity and damage may lead to various degrees of functional impairment. Recently, experience with TNFalpha-antagonists in adults has opened new perspectives for treating patients with refractory SpA, particularly ankylosing spondylitis (AS). So far there is only little experience in the treatment of juvenile-onset SpA, consisting of case reports and case series where etanercept or infliximab have been given to children suffering from refractory juvenile-onset AS and psoriatic arthritis. From these observations there is evidence that treatment seems to be as effective as in adults. Risks are likely to be the same as in patients suffering from other forms of juvenile idiopathic arthritides. However, without further studies no recommendations can be provided for indication for treatment, dosing, intervals and duration of treatment
Internet : PM:12463465 - JOH R, HASEGAWA K, TORII N, OGAWA M, KANAI N, NARITOMI T, ISHIKAWA K, IIZUKA A, SHIZUMA T, HASHIMOTO E, HAYASHI N: Repeated jaundice due to YMDD mutant in a patient with prolonged lamivudine therapy for chronic hepatitis B under prednisolone treatment for Still's disease. Internal Medicine (Tokyo) 2002, 41:701-705.
Organism:Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan Japan
Abstract: A 50-year-old woman patient began receiving lamivudine because of acute exacerbation of chronic hepatitis B. She also suffered from adult-onset Still's disease and had received prednisolone for 5 years. Lamivudine was effective for treatment of the first flare. Fifteen months after lamivudine treatment was started, a breakthrough due to lamivudine-resistant strain M552I occurred. Between 10 and 12 months after the breakthrough, flare with jaundice occurred 3 times. We decided interferon would not be suitable, because it could induce activation of Still's disease. Prolonged lamivudine therapy is only recommended in cases of hepatitis B in which there is no alternative treatment - KALLEN K: The role of transsignalling via the agonistic soluble IL-6 receptor in human diseases. Biochimica et Biophysica Acta 2002, 1592:323-343.
Organism:Biochemisches Institut, Christian-Albrechts-Universitaet zu Kiel, Olshausenstr. 40, D-24098, Kiel, Germany Germany^E-Mail: kjkallen@biochem.uni-kiel.de
Abstract: The activation of cells that do not express the membrane bound interleukin-6 6 receptor (IL-6R) by IL-6 and the soluble IL-6 receptor (sIL-6R) is termed transsignalling. Transsignalling may be an pathogenetic factor in human diseases as diverse as multiple myeloma (MM), Castleman's disease, prostate carcinoma, Crohn's disease, systemic sclerosis, Still's disease, osteoporosis and cardiovascular diseases. IL-6 and sIL-6R may directly or indirectly enhance their own production on endothelial or bone marrow stromal cells. Positive feedback autocrine loops thus created in affected organs may either cause or maintain disease progression. In autoimmune or vasculitic disease, the ability of the IL-6/sIL-6R complex to inhibit apoptosis of autoreactive T-cells may be central to the development of tissue specific autoimmunity. The anti-apoptotic effect of the IL-6/sIL-6R complex may be involved in tumour genesis and resistance to chemotherapy. Only in rare cases, where counterregulation has failed, there is a notable systemic effect of IL-6/sIL-6R. Appropriate animal models are necessary to establish the pathogenetic role of the IL-6/sIL-6R complex. A specific treatment option for diseases influenced by the sIL-6R could be based on gp130-Fc, a soluble gp130 (sgp130) linked to the Fc-fragment of IgG1. gp130-Fc has shown efficacy in vivo in animal models of Crohn's disease - LATKANY PA, JABS DA, SMITH JR, ROSENBAUM JT, TESSLER H, SCHWAB IR, WALTON RC, THORNE JE, MAGUIRE AM: Multifocal choroiditis in patients with familial juvenile systemic granulomatosis. Am.J.Ophthalmol. 2002, 134:897-904.
Organism:Dr. D.A. Jabs, Wilmer Eye Institute, 550 North Broadway, Baltimore, MD 21205
Abstract: PURPOSE: To document clinical features of uveitis in patients with familial juvenile systemic granulomatosis. DESIGN: Retrospective chart review. METHODS: Ophthalmologic examination, medical history, and clinical course in 16 patients from eight families examined at six academic medical centers. RESULTS: Of the 16 patients, 15 had evidence of panuveitis with multifocal choroiditis. One patient had only an anterior uveitis. Ischemic optic neuropathy, presumably due to a small vessel vasculopathy, and retinal vasculopathy each occurred in one patient. Ocular complications were common, including cataracts in 11, glaucoma in six, band keratopathy in six, cystoid macular edema in six, and optic disk edema in six. All 16 patients had polyarthritis, and at least nine had skin rash. Often patients were misdiagnosed initially as having either juvenile rheumatoid arthritis or sarcoidosis. CONCLUSIONS: Familial juvenile systemic granulomatosis is an uncommon genetic disease characterized by polyarthritis and uveitis. Panuveitis and multifocal choroiditis often may be present. Patients with a diagnosis of juvenile rheumatoid arthritis but having a family history of the disease and multifocal choroiditis should be suspected of having familial juvenile systemic granulomatosis. (c) 2002 by Elsevier Science Inc. All rights reserved
Internet : djabs@jhmi.edu - LUKE AC: Hip pain in a hockey player. Medicine & Science in Sports & Exercise 2002, 34:S162
Organism:University of Western Ontario, London, ON, Canada Canada - MINDEN K, NIEWERTH M, GANSER G, SCHONTUBE M, ZINK A: Adults with juvenile idiopathic arthritis - Outcome and health care provision. Aktuelle Rheumatologie 2002, 27:247-252.
Organism:Dr. K. Minden, Deutsches Rheumaforsch. Ztr. Berlin, Schumannstrasse 21/22, 10117 Berlin
Abstract: Approximately 50% of patients with juvenile idiopathic arthritis (JIA) continue to have active disease in early adulthood. JIA-related morbidity in adulthood results from persisting active disease, as well as from sequelae on bodily level, such as joint damage, growth abnormalities, osteoporosis and poor visual acuity. The impairments on bodily level lead to activity limitations in less than half of all patients, with one in ten patients being in need of help to cope with their daily life. Consequently, one in five adults with JIA are limited in their participation in society, reflected among others in JIA-related work disability. Despite the worth-mentioning burden of illness, less than half of those still having active disease are in specialised care, with at least one-third being inadequately supplied with medical and non-medical treatment. These deficits in health care provision should lead to an evaluation of existing health care services for young adults with juvenile idiopathic arthritis
Internet : minden@drfz.de - MORHART R: [Juvenile systemic lupus erythematosus: A case report.]
<ORIGINAL> Juveniler systemischer Lupus erythematodes: Eine Falldarstellung. Aktuelle Rheumatologie 2002, 27:198-200.
Organism:Klinik fuer Kinder- und Jugendrheumatologie, Gehfeldstr. 24, 82467, Garmisch-Partenkirchen Germany
Abstract: We present the case of a now 20-year old young woman suffering from juvenile systemic lupus erythematosus (JSLE) which began 7 years ago. The course of the disease was complicated by a macrophage activation syndrome (MAS), a reactive haemophagocytic lymphohistiocytosis. The MAS is a rare, but due to the high mortality, important complication of rheumatic disorders in childhood, especially the systemic onset of juvenile chronic arthritis and SLE. On treating the MAS with high dose steroid pulse therapy the patient developed an acute pancreatitis. This is a well known rare complication in SLE but also a possible adverse effect of the steroid pulse therapy. With adequate therapy we were fortunately able to control the disease effectively. The patient is under continual treatment and is now feeling very well and able to work full-time - NEIDEL J: [Intra-articular steroid therapy for inflammatory rheumatic diseases in children and adolescents]. Orthopade 2002, 31:1175-1178.
Organism:Klinik und Poliklinik fur Orthopadie,Charite Berlin
Abstract: In addition to systemic medication,physiotherapy, and operative measures, intraarticular therapy with corticosteroids (iaST) is a well established treatment for juvenile idiopathic arthritis (JIA). IaST is indicated in children whose inflamed joints do not respond sufficiently to systemic antiarthritic drugs and is normally carried out under in-patient conditions. Triamcinolone hexacetonide (TH) is the drug of choice for iaST because of its well documented, long-lasting effects. In younger children or those who require simultaneous injections into multiple joints, a short general anesthesia is useful, while single injections in older children can be administered after topical application of a local anesthetic. Intensive physiotherapy after iaST is important for regaining mobility lost due to the arthritis, and 2 or 3 days of post-injection rest should be adhered to after iaST of joints of the lower extremities.Several studies demonstrate long-lasting remission in the majority of the injected joints in JIA patients, with good pain-relief, improved mobility, and a significant delay in further joint destruction in comparison with joints in which the synovitis could not be adequately controlled.Various sub-types of JIA have been shown to respond differently to iaST. Intraarticular steroids can also be used to treat coxitis, since recent data failed to show a subsequent increase in the rate of femoral head necrosis. Septic arthritis, the mostfeared complication after iaTH, seems to be extremely rare in children. Other complications, like periarticular calcifications or subcutaenous atrophy, also occur only rarely, provided the steroid is injected correctly. The present data indicate that iaST is an effective and safe treatment for JIA. The therapeutic approach to children with JIA is multidisciplinary, and these young patients should be treated in specialised centres
Internet : PM:12486543 - PACKHAM JC, HALL MA, PIMM TJ: Long-term follow-up of 246 adults with juvenile idiopathic arthritis: predictive factors for mood and pain. Rheumatology (Oxford) 2002, 41:1444-1449.
Organism:Oxford Regional Paediatric Rheumatology Unit, Wexham Park Hospital, Slough SL2 4HL and Oxford Regional Rheumatic Diseases Research Centre, Stoke Mandeville Hospital, Aylesbury HP21 8AL, UK
Abstract: OBJECTIVE: To examine the predictive factors for anxiety, depression and pain in adults with juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: Two hundred and forty-six adults identified with long-standing JIA had an average disease duration of 28.3 yr. Candidate factors potentially predictive for pain, anxiety and depression were assessed by multiple regression analysis. RESULTS: Of the patients, 31.6% were anxious, 5.2% were depressed, and 21.1% had previously suffered from depression. The percentage of the variance accounted for by other variables was 78.8 for anxiety variance and 54.5 for depression, but there was little influence from physical disease-related factors. Severe pain, measured on a visual analogue scale, occurred in 32.9% of patients, and 22.8% had poor perceived control over their pain. Function, coping strategies, pain self-efficacy, inflammation and previous depression could predict 39.6% of the variance in pain. CONCLUSIONS: Comparing adults with children, disease activity and control over pain remain predictors of pain but become less important than disability and coping strategies
Internet : PM:12468828 - PELKONEN P, LAHDENNE P, LANTTO R, HONKANEN V: Chronic arthritis associated with chromosome deletion 22q11.2 syndrome. Rinsho Ganka 2002, 29:2648-2650.
Organism:Dr. V. Honkanen, Rheumatism Foundation Hospital, FIN-18120 Heinola
Abstract: We describe 3 children with chromosome deletion 22q11.2 and chronic arthritis. The onset of arthritis occurred between the ages of 8 and 17 months. The disease course has been polyarticular in all 3. Neither iridocyclitis nor antinuclear antibody positivity was present. On the basis of the findings in these 3 patients and 9 reported in the literature, chronic arthritis in the 22q11.2 deletion syndrome seems to be characterized by very early onset and severe polyarticular course. Based on our findings the prevalence of chronic arthritis in patients with del 22q11.2 is estimated to be 25fold compared to that in the general population
Internet : visa.honkanen@reuma.fi - POUCHOT J, LARBRE J-P, LEMELLE I, SOMMELET D, GROUTEAU E, DAVID L, DUQUESNE A, DESLANDRE CJ, PAUT IK, PILLET P, GOUMY L, BARBIER C, GUYOT M-H, MAZINGUE F, LALOUM SG, FISCHBACH M, QUARTIER P, GUYOT C, JEAN S, LEGALL E, PLOUVIER E, BOST M, DE LUMLEY L, BREGEON C, GUILLEMIN F, COSTE J, PRIEUR A-M, BREGEON C, DUMONT D, ENGERRAN L, GOGUEL J, LE FRANC c, LE QUINTREC JS, MARAVIC M, MAS F, MARTY M, PERROT S, SANY J: Validation of the French version of the Childhood Health Assessment Questionnaire (CHAQ) in juvenile idiopathic arthritis. Joint Bone Spine 2002, 69:468-481.
Organism:J. Pouchot, Internal medicine department, Medecine Interne, Hopital Louis Mourier, 178, rue des Renouillers, Colombes
Abstract: Objectives. To translate, cross-culturally adapt, and validate the functional disability tool Childhood Health Assessment Questionnaire (CHAQ), a variant of the Health Assessment Questionnaire (HAQ), in children with juvenile idiopathic arthritis (JIA). Children and methods. The disability index is the mean of the scores on the eight domains of the CHAQ and can range from 0 (no disability) to 3 (maximum disability). The CHAQ was first translated into French and adapted, then validated in a multicenter cross-sectional study in 306 children with JIA (systemic onset, 23%; polyarticular onset, 22%; extended oligoarticular subtype, 25%; and persistent oligoarticular subtype, 30%). Results. Overall CHAQ scores discriminated between the four JIA subtypes (systemic: 1.1 +/- 0.9; polyarticular: 0.8 +/- 0.7, extended oligoarticular: 0.8 +/- 0.7, and persistent oligoarticular: 0.4 +/- 0.5 [P < 0.0001]). Reproducibility evaluated by test-retest at a 7-day interval was excellent (intraclass coefficient, 0.91), as was agreement between the Parent's and Children's versions of the questionnaire (intraclass coefficient, 0.89). Significant correlations were found between the overall CHAQ score and variables reflecting disease severity (joint counts, physician's and parent's global assessments, and erythrocyte sedimentation rate), indicating excellent convergent validity of the tool. Conclusions. The French version of the CHAQ displays good psychometric characteristics, although its sensitivity to change remains to be established. The French version of the CHAQ should prove useful in international studies and can be expected to be helpful for monitoring individual patients with JIA. (c) 2002 Editions scientifiques et medicales Elsevier SAS
Internet : jacques.pouchot@lmr.ap-hop-paris.fr - REITER-PURTILL J, GERHARDT CA, VANNATTA K, PASSO MH, NOLL RB: A controlled longitudinal study of the social functioning of children with juvenile rheumatoid arthritis. J.Pediatr.Psychol. 2003, 28:17-28.
Organism:Children's Hospital Medical Center and the University of Cincinnati
Abstract: Objective To complete an assessment of social functioning of children with juvenile rheumatoid arthritis (JRA) and nonchronically ill controls who had been evaluated 2 years earlier (Noll et al., 2000) and to examine the impact of disease severity or disease activity over time on the social functioning of children with JRA. Methods Peer-, teacher-, and self-reports of social functioning were obtained from 57 children with JRA and 63 controls. Social reputation and social acceptance were examined cross-sectionally and longitudinally. Results Cross-sectional analyses indicated no significant differences between children with JRA and controls on measures of social functioning. For children with more severe disease, like ratings declined over the 2-year period relative to children with mild disease. Children with active disease were chosen fewer times over the 2-year period as a best friend than children in remission. Conclusions Because children with severe or active JRA may be at risk for difficulties with social acceptance over time, they are appropriate targets for interventions that ameliorate or prevent these difficulties
Internet : PM:12490627 - SALLFORS C, FASTH A, HALLBERG LRM: Oscillating between hope and despair - A qualitative study. Child: Care, Health and Development 2002, 28:495-505.
Organism:C. Sallfors, The Nordic School of Public Health, Box 121 33, S-402 42 Goteborg
Abstract: Objective. The aim of this qualitative study was to elucidate the life situation and psychosocial processes of living with chronic pain in children suffering from juvenile chronic arthritis (JCA). Methods. Taped open qualitative interviews with 22 children (aged 6-17 years) were transcribed verbatim and analysed using the comparative method for grounded theory. Results. A core category, labelled oscillating between hope and despair, was identified and related to four additional categories labelled disturbed order, dependency, ambivalence and uncertainty about the future. There were relationships between the children's subjective experience of pain and their experiences of disturbed order in daily life, dependency on treatment, health care and significant others, ambivalence related to environmental reactions and uncertainty about the future. Chronic pain and disease control the children's lives and lead to restricted participation in social life. Conclusions. Chronic pain is a substantial problem for children with JCA, which must be considered in health care. The pain affected and disturbed the children's ordinary way of life. It blocked a number of goals. Psychological and physiological processes interact in the phenomenological experience of pain, and the response of the environment elicits, maintains or decreases the experience of pain. Hopefully, the findings contribute to a deeper understanding of the life situation of children suffering from JCA and can be of importance in developing rehabilitation programmes for these children
Internet : christina.sallfors@telia.com - SCHAAL S, BEIRAN I, BRIK R, MILLER B: Acute iridocyclitis in antinuclear antibody-positive pauciarticular juvenile rheumatoid arthritis detected a decade earlier. Journal of Pediatric Ophthalmology and Strabismus 2002, 39:365-366.
Organism:Dr. B. Miller, Alberto Moscona Dept. of Ophthalmol., Rambam Medical Center, P.O. Box 9602, 31096 Haifa - SCHRODER N, CRABTREE MJ, LYALL-WATSON S: The effectiveness of splinting as perceived by the parents of children with juvenile idiopathic arthritis. British Journal of Occupational Therapy 2002, 65:75-80.
Organism:N. Schroder, Department of Occupational Therapy, Princess Alexandra Hospital, Brisbane, QLD
Abstract: Juvenile idiopathic arthritis (JIA) is an important disease of childhood with far-reaching effects on the child and family. Splinting is a major treatment modality used by occupational therapists for children with JIA. Parents play a central role in whether, when and how splints are used with their children on a daily basis. This paper describes a qualitative research project, which was undertaken to evaluate an occupational therapy service for children with JIA whose treatment had involved splinting. Using semi-structured interviews, the study investigated five mothers' perceptions of the effectiveness of splinting for their children. The interviews revealed five major points. First, the informants generally believed the splinting to be effective. Secondly, the children involved generally resisted wearing splints because they were physically uncomfortable and made them feel different to other children. Thirdly, the mothers used a variety of strategies to ensure that their children wore the splints. Fourthly, the perception of having a positive and supportive relationship with the therapist enhanced the mothers' ability to adhere to splinting. Lastly, the mothers' grief at having a child with JIA influenced their ability to understand and attend to information about specific interventions such as splinting. Practical responses to these findings are outlined - SEVER L, GOKSEL A, KASAPCOPUR O, CALISKAN S, BALCI H, SEVER MS, ARISOY N: Microalbuminuria and tubular markers in children with juvenile rheumatoid artritis (JRA). Nephrology Dialysis Transplantation 2002, 17:97
Organism:Pediatric Nephrology, Cerrahpasa School of Medicine, Istanbul Turkey - STECHOVA K, VAVRINCOVA P, CHUDOBA D, FRANTLOVA M, REITZOVA H, SOSNA A, ZIMAK J, LEDNICKY L, DICKINSON AM, HROMADNIKOVA I: In vitro Autoreactivity against Skin and Synovial Cells in Patients with Juvenile Idiopathic and Rheumatoid Arthritis. Pathobiology 2002, 70:76-82.
Organism:2nd Department of Paediatrics, University Hospital Motol, Prague, Czech Republic
Abstract: In the present study we compared specific lysis of various autologous target cells in patients with juvenile idiopathic arthritis JIA; n = 8) or rheumatoid arthritis RA; n = 17) with those of healthy controls (n = 15). (51)Cr-release cytotoxic assay with autologous peripheral blood mononuclear cells as effector cells was used. When compared with controls, effector cells of patients with JIA or RA were found to lyse significantly autologous synovial cells (p < 0.0005) and epidermal keratinocytes (p < 0.0005), however, no difference was found for autologous dermal fibroblasts
Internet : PM:12476032 - TAKKEN T, HEMEL A, VAN DER NJ, HELDERS PJM: Aerobic fitness in children with juvenile idiopathic arthritis: A systematic review. Rinsho Ganka 2002, 29:2643-2647.
Organism:Prof. P.J.M. Helders, Dept. of Pediatric Physical Therapy, Univ. Hosp. for Children and Youth, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht
Abstract: Objective. To determine whether children with juvenile idiopathic arthritis (JIA) have lower physical fitness compared to healthy children, and to determine the clinical relevance of this impairment. Methods. A systematic literature search was performed using MEDLINE, CINAHL, EMBASE and SPORTDiscus. The appropriate titles were identified and the data were extracted from these publications. The maximal oxygen consumption (VOSUB2peak in ml.kgSUP-1.minSUP-1) during a maximal exercise test until volitional exhaustion was used as the main outcome for this review. Results. Nine studies were identified in the literature. Data from 5 studies (144 patients) were pooled in a metaanalysis. The VOSUB2peak of the patients with JIA was 21.8% (95% Cl 13.7, 29.9) lower than that of healthy children (p < 0.0001). Conclusion. The results of the metaanalysis suggest that children with JIA have moderate to heavy impairment in physical fitness as represented by maximal oxygen consumption compared to healthy children
Internet : p.j.m.helders@wkz.azu.nl - TAKKEN T, VAN DER NJ, HELDERS PJM: Association of physical fitness with functional ability in children with juvenile idiopathic arthritis (JIA). Medicine & Science in Sports & Exercise 2002, 34:S160
Organism:University Medical Center Utrecht, Utrecht, Netherlands Netherlands^E-Mail: t.takken@wkz.azu.nl - TAMBIC-BUKOVAC L, MALCIC I, PROHIC A: [In Process Citation]. Reumatizam 2002, 49:20-24.
Organism:Klinika za pedijatriju Medicinskoga fakulteta Sveucilista u Zagrebu KBC Zagreb, Salata 4, 10000 Zagreb
Abstract: Methotrexate was introduced in the treatment of juvenile idiopathic arthritis (JIA) about fifteen years ago. Today, methotrexate is the drug of choice in the basic treatment of JIA, especially for oligoarticular subtype The aim of this study is to show our experiences with this agent. In the period from 1996 to 2001 in the Pediatric Clinic--University of Zagreb 256 children with JIA were hospitalised--85 with polyarticular (33.2%) and 171 with oligoarticular subtype (66.8%). 34 of these patients (13.28%)--21 female and 13 male--16 with polyarticular and 18 with oligoarticular subtype were treated with methotrexate. The age at the beginning of the therapy was from 3 to 18 years (mean age 11.31 ys). The countinuos treatment with methotrexate lasted from 1 to 3 years. The dosage of methotrexate was 10-20 mg/m2, i.e. 0.3-0.5 mg/kg of body weight weekly. During patients' hospitalization the drug was administered parenterally, while at home it was continued to be given perorally. All of the patients took with methotrexate also nonsteroidal antiinflammatory drugs, and some corticosteroid therapy. All of the patients were submitted to regular physical therapy. The results of the treatment response were judged according to the global patients assessment (number of inflammated joints, degree of inflammation and functional disability), laboratory data (inflammation reactants, hemoglobin, RF). Statistically significant improvement of clinical and laboratory parameters (p < 0.01) was proved in 33 patients, while the improvement in one patient was minimal. Adverse reactions were rare and transitory
Internet : PM:12476749 - TEN CATE R, BRINKMAN DMC, VAN ROSSUM MAJ, LANKESTER AC, BREDIUS RGM, EGELER MRM, VAN TOL MJD, VOSSEN JM: Macrophage activation syndrome after autologous stem cell transplantation for systemic juvenile idiopathic arthritis. European Journal Of Pediatrics 2002, 161:685-686.
Organism:R. Ten Cate, Department of Paediatrics, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden
Internet : R.ten_Cate@lumc.nl - VARBANOVA B: Classificatory transformations of chronic arthritis in infants. ILAR classification - Last or final. Rheumatology 2002, 10:7-13.
Organism:Dr. B. Varbanova, Department of Pediatrics, Medical University, 55, Marin Drinov Str., Bg - 9002 Varna
Abstract: Arthritis in childhood can be an initial manifestation of a large and heterogeneous group of diseases, including autoimmune and connective tissue diseases, sepsis, trauma, leukemia, metabolic and inherited diseases, hemorrhagic diathesis, immunodeficiency etc. This review is aimed to outline in a chronological order the problems with the nomenclature and classification of the childhood arthritis and to popularize the new ILAR-classification, which for the first time unites the conceptions of EULAR and ACR - WALTON AG, WELBURY RR, FOSTER HE, WRIGHT WG, THOMASON JM: Sialochemistry in juvenile idiopathic arthritis. Oral Diseases 2002, 8:287-290.
Organism:Dr. A.G. Walton, White Knights, Pigdon, Morpeth, NE61 3SE
Abstract: Objectives: To investigate whether there are any differences in salivary flow rates and saliva composition that may contribute to the reported increase in caries prevalence in patients with juvenile idiopathic arthritis (JIA). Design: Randomized controlled trial. Setting: The sialochemistry of children with JIA has rarely been investigated. Methods: Unstimulated and stimulated whole saliva was collected from 17 randomly selected JIA patients and 17 age and sex matched controls. Both samples were analysed for salivary flow rate, pH, calcium and phosphate. Results: Unstimulated and stimulated JIA saliva flow rates, and the flow rate change from unstimulated to stimulated in JIA saliva were all significantly lower than the controls. There were no significant differences in the pH of unstimulated and stimulated JIA saliva compared with the controls, however, the change in pH (from unstimulated to stimulated) in the study group was significantly greater. The JIA patients had non-significantly lower levels of both calcium and phosphate ions in the unstimulated and stimulated samples. Conclusions: This data would suggest that there is both a reduced resting salivary flow and a reduced response to stimulation in JIA patients, which may contribute to a previously reported higher caries prevalence
Internet : graham@waltonknights.freeserve.co.uk - YUN AG, MARTIN S, ZURAKOWSKI D, SCOTT R: Bipolar hemiarthroplasty in juvenile rheumatoid arthritis: Long-term survivorship and outcomes. Journal Of Arthroplasty 2002, 17:978-986.
Organism:Dr. A.G. Yun, Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
Abstract: Because controversy surrounds the management of end-stage hip disease in juvenile rheumatoid arthritis (JRA), this study evaluated the long-term outcome of bipolar hemiarthroplasty as an alternative to conventional joint arthroplasty. A total of 24 JRA patients underwent 39 hemiarthroplasties: follow-up averaged 12 years (range, 3 to 15 years). There were 14 hips (36%) revised, and 25 hips (64%) maintained the original components. Mean Harris hip scores in surviving hips improved from 29 to 69 points (P<.001). Radiographs showed progressive bipolar superomedial migration (P<.01) despite attempted augmentation. Failure defined as revision to total hip arthroplasty or definite radiographic loosening occurred in 15 hips (38%). Ten-year Kaplan-Meier survivorship for all prostheses was 78%. Independent multivariate risk factors for failure included acetabular grafting (P = .006), prosthesis type (P<.001), and unilateral replacement (P<.001). Copyright 2002, Elsevier Science (USA). All rights reserved
Internet : yuna@hss.edu - ZORRILLA RJ, ALABAT TA, BELMONTE GM, SANCHEZ UC, PUJOLRIU MT: Juvenile chronic arthritis developed after a Campylobacter jejuni enteritis. A case report. Pediatrika 2002, 22:25-27.
Organism:Dr. C. Sanchez Ufarte, Serv. de Pediatria Extrahospitalaria, CAP Plaza Catalunya, Manresa-2, 08240 Manresa (Barcelona)
Abstract: Juvenile chronic arthritis is the most frecuent rheumatic patology in children. The early diagnosis and adecuate treatment in patients who have a discouraging prognosis is basic in the right evolution. We describe a case of juvenile chronic artritis developed after a Campylobacter jejuni enteritis
Internet : jzorrillar@hotmail.com