Bibliography November 04- ALSUFYANI K, ORTIZ-ALVAREZ O, CABRAL DA, TUCKER LB, PETTY RE, MALLESON PN: Relative ineffectiveness of triamcinolone acetonide in the treatment of juvenile idiopathic arthritis [6]. Arthritis and Rheumatism (United States ) 50:11 3737-3738, 2004
- ARTACKER G: Current treatment of pediatric rheumatologic disorders
AKTUELLE THERAPIE DES KINDLICHEN RHEUMAS. Journal fur Mineralstoffwechsel (Austria ) 11:3 27-30, 2004
Abstract: The Austrian Work Group for Pediatric Rheumatology and the current step by step approach to therapy of pediatric rheumatologic disorders is presented according to the criteria of evidence based medicine. First-line therapy include nonsteroidal anti-inflammatory drugs and intraarticular corticosteroid injections, but an adequate response to these therapies cannot be achieved frequently. Since introduction of methotrexate in therapy of juvenile idiopathic arthritis, two thirds of patients can be treated adequately. The tumor necrosis factor inhibitor etanercept has improved outcome of a further group of patients. Concomitant therapies to achieve relief of pain are physical therapy and local application of cold. Some reduction of inflammation can be achieved by selective nutrition. In single patients surgical synoviectomy is necessary to reduce pain and retardation of radiologic progression of arthritis - BAILEY KM, MCDONAGH JE, PRIEUR AM: Systemic juvenile idiopathic arthritis presenting in a young child with long term disability as an adolescent. Ann Rheum Dis 63:12 1544-1548, 2004
Organism: Department of Rheumatology, Birmingham Children's Hospital, UKFAU - Bailey, K M - BARLOW JH, ELLARD DR: Psycho-educational interventions for children with chronic disease, parents and siblings: an overview of the research evidence base. Child Care Health Dev 30:6 637-645, 2004
Organism: Interdisciplinary Research Centre in Health, School of Health and Social Sciences, Coventry University, Coventry, UK jbarlow@coventryacukFAU - Barlow, J H
Abstract: BACKGROUND: The role of psycho-educational interventions in facilitating adaptation to chronic disease has received growing recognition and is in keeping with policy developments advocating greater involvement of patients in their own care. The purpose of this paper is to provide an overview of the current literature regarding the effectiveness of psycho-educational interventions for children and adolescents with chronic disease, their parents and siblings. METHODS: Electronic searches were conducted using AMED, CINAHL, Cochrane Database, DARE, HTA, MEDLINE, NHS EED, PsycLIT, PsycINFO, and PubMED. Inclusion criteria were systematic reviews, meta-analyses and overviews based on traditional reviews of published literature. The titles of papers were reviewed, abstracts were obtained and reviewed, and full copies of selected papers were obtained. RESULTS: No reviews of psycho-educational interventions were found for either parents or siblings. Twelve reviews of interventions for children and adolescents were identified: chronic disease in general (three); chronic pain (one); asthma (three); chronic fatigue syndrome (CFS)/myalgic encephalomyelitis (ME) (one); diabetes (two); juvenile idiopathic arthritis (JIA) (one) and one informational intervention for paediatric cancer patients. The main focus was on disease management (particularly in asthma and diabetes) with less attention being paid to psychosocial aspects of life with a chronic condition. Overall, there is evidence of effectiveness for interventions incorporating cognitive-behavioural techniques on variables such as self-efficacy, self-management of disease, family functioning, psychosocial well-being, reduced isolation, social competence, knowledge, hope, pain (for chronic headache), lung function (asthma), days absent from school (asthma), visits to A & E (asthma), fatigue (CFS), and metabolic control (diabetes). A number of gaps and limitations were identified across all disease categories, such as inadequate description of interventions, small sample sizes, and lack of evidence regarding cost-effectiveness. CONCLUSION: This overview has highlighted the need to extend the evidence base for psycho-educational interventions, particularly in a UK context. It is essential that effective interventions are implemented and embedded in service provision in order to maximize empowerment through self-care for children, adolescents and their parents - BRITTO MT, DEVELLIS RF, HORNUNG RW, DEFRIESE GH, ATHERTON HD, SLAP GB: Health care preferences and priorities of adolescents with chronic illnesses. Pediatrics 114:5 1272-1280, 2004
Organism: Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039, USA mariabritto@cchmcorgFAU - Britto, Maria T
Abstract: BACKGROUND: Efforts to make health care for adolescents with chronic illnesses more patient-centered must be grounded in an understanding and clear measures of adolescents' preferences and priorities. OBJECTIVE: To develop a measure of health care preferences of adolescents with chronic illnesses and to determine demographic, developmental, and health factors associated with adolescents' preferences. DESIGN: Mixed-method questionnaire development and survey. SETTING: Subspecialty clinics of a tertiary care children's hospital. PARTICIPANTS: All adolescents (age: 11-19 years) with juvenile rheumatoid arthritis, sickle cell disease, inflammatory bowel disease, or cystic fibrosis of at least 2-year duration who were being treated at the participating center were eligible to participate, and 155 of 251 did so (62%). The participants had a mean age of 15.5 +/- 2.4 years, 45% were male, and 75% were white. INTERVENTION: None. MAIN OUTCOME MEASURES: Ratings of 65 items related to quality of care and 17 items related to physician-patient communication styles. RESULTS: An 82-item questionnaire, devised from qualitative analysis of focus group results, contained 65 Likert scale items that adolescents considered important for health care quality and 17 forced-choice items related to adolescents' preferences for communication. Among the first 65 items, the group of questions related to physician trust and respect had the highest rating of 5.24 +/- 0.62 of 6, followed by patient power and control (mean rating: 4.72 +/- 0.77) and then caring and closeness in the patient-doctor relationship (mean rating: 4.19 +/- 0.91). For the communication items, the adolescents, on average, preferred communication directly to them rather than to their parents and were nearly neutral regarding physicians' inquiries about personal issues. CONCLUSIONS: Participants rated aspects of interpersonal care (especially honesty, attention to pain, and items related to respect) as most important in their judgments of quality. As in most previous studies of adults, technical aspects of care were also rated highly, suggesting that adolescents understand and value both scientific and interpersonal aspects of care - FUNG LAI-WAH EVA, GANESAN V: Arteriovenous malformations presenting with papilloedema. Developmental Medicine & Child Neurology 46:9 626-627, 2004
Abstract: Cerebral arteriovenous malformations (AVMs) are fairly common and the majority of paediatric patients with this condition also present with intracranial haemorrhage. Two patients who had an incidental finding of an AVM associated with papilloedema are described here. The first was a 13-year-old male who presented after an accidental kick to the eyes. Examination revealed bilateral papilloedema. He gave a 2-year history of intermittent headache. Brain magnetic resonance imaging (MRI) showed an unruptured AVM in the temporal lobe. Lumbar puncture revealed elevated cerebrospinal fluid pressure. Visual acuity and visual fields were normal. He was treated with acetazolamide and improved within a few weeks. He subsequently underwent stereotactic radiosurgery to the AVM. He discontinued acetazolamide due to adverse side effects and there was no recurrence of headache and papilloedema. The second patient was a 14-year-old male who had polyarticular juvenile chronic arthritis and received low-dose steroids and methotrexate. Bilateral papilloedema was discovered during routine ophthalmology surveillance and he was otherwise asymptomatic neurologically. Brain MRI revealed an AVM in the posterior fossa. He had three embolization procedures, which have resulted in significant reduction in lesion size. The papilloedema resolved completely after the first two procedures, and visual acuity and fields remained normal. Here, possible underlying mechanism of raised intracranial pressure and importance of visual assessment in those with AVMs and their management are discussed - HAAPASAARI J, KAUTIAINEN HJ, ISOMAKI HA, HAKALA M: Etanercept does not essentially increase the total costs of the treatment of refractory juvenile idiopathic arthritis. J Rheumatol 31:11 2286-2289, 2004
Organism: Rheumatism Foundation Hospital, Heinola, Finland jarkkohaapasaari@reumafiFAU - Haapasaari, Jarkko
Abstract: OBJECTIVE: To assess the costs of adding etanercept to the prevailing drug therapy for a one-year period in a group of 31 children with juvenile idiopathic arthritis (JIA) whose disease was refractory to conventional disease modifying antirheumatic drugs. METHODS: The changes in total costs were retrospectively collected from medical records and by interviewing parents 6 months before the initiation of etanercept treatment and during a 12-month followup divided into 3-month periods. RESULTS: Direct median costs increased during the first 3 months after the introduction of etanercept, but decreased later during the followup. The estimated median direct costs per patient increased by 4200 US dollars per year, and the indirect costs were reduced by 50%, i.e., 1700 US dollars . The estimated median total cost per patient was increased by about 2700 US dollars per year (10%). CONCLUSION: After combining etanercept with the prevailing treatment, the total costs of refractory JIA calculated per year were only slightly higher than those of traditional therapy. This finding must be evaluated in light of the reduced inflammatory activity of the joint disease and the probable reduction of lifetime pain and disability produced by the disease - HSU C-T, LIN Y-T, YANG Y-H, CHIANG B-L: Factors affecting clinical and therapeutic outcomes of patients with juvenile rheumatoid arthritis. Scandinavian Journal of Rheumatology (Norway ) 33:5 312-317, 2004
Abstract: Objective: To investigate clinical features, medications, and therapeutic responses of juvenile rheumatoid arthritis (JRA) among Taiwanese children. Methods: A retrospective chart review was conducted among all children newly diagnosed with JRA at the National Taiwan University Hospital between 1996 and 2001. Results: Forty boys and 30 girls were enrolled in the study. The mean follow-up was 45 months. Oligoarticular onset was the most common type. A bimodal distribution of age at onset was observed, with peaks at 4 and 10 years. All patients received non-steroidal anti-inflammatory drugs (NSAIDs); 27 (39%) received corticosteroids, and 44 (63%) had second-line drugs during the first course of treatment. Forty-three patients (69%) achieved clinical remission after a mean of 14.8 months of medication, and 19 (31%) were drug-dependent. The major factors related to the failure of first remission were human leukocyte antigen B27 (HLA-B27), high C-reactive protein (CRP) level, and thrombocytosis at diagnosis. Conclusion: There are different phenotypic features among Taiwanese children with JRA. Factors related to the failure of first remission were HLA-B27, high CRP level, and thrombocytosis at diagnosis - HULSE MA: Current concepts in pediatric musculoskeletal imaging: Magnetic resonance imaging. Current Opinion in Orthopaedics (United States ) 15:6 428-433, 2004
Abstract: Purpose of review: The cartilaginous structures at the ends of growing bones of the immature skeleton are best seen with magnetic resonance imaging. Technologic advances in pediatric musculoskeletal magnetic resonance imaging have led to the development of advances in coil design with improved spatial resolution of both large and small joints. New sequences and higher field strengths now provide new insights into articular cartilage abnormalities. Recent findings: The imaging of articular abnormalities in children includes those that affect the synovium, epiphyseal cartilage, and growth plate. Magnetic resonance imaging provides important information in the diagnosis of pediatric musculoskeletal trauma and the management of growth disturbances. Magnetic resonance imaging is now evolving as a tool to manage and monitor injuries that result in juvenile osteochondritis dissecans. Magnetic resonance classification of osteochondral injuries is helping to guide therapy with respect to nonsurgical management of juvenile osteochondritis dissecans. New magnetic resonance sequences are increasing our understanding of the structural changes of cartilage and could be used to monitor children with juvenile rheumatoid arthritis. Summary: Understanding the technologic advances in pediatric musculoskeletal magnetic resonance imaging will make it easier to identify the cartilaginous structures of the immature skeleton and common abnormalities. New magnetic resonance imaging techniques are improving the resolution of subtle abnormalities of the cartilaginous structures, permitting earlier detection of abnormalities that may result in growth disturbances or articular cartilage injury. Magnetic resonance imaging techniques from ongoing research in adults are now being applied to, and have validated current research in, the cartilaginous changes in juvenile rheumatoid arthritis. These new advances in pediatric musculoskeletal magnetic resonance imaging are providing reproducible information of the cartilaginous structures and cartilage content of the immature skeleton and changes resulting from cartilage loss. (c) 2004 Lippincott Williams & Wilkins - INUI K, MAENO T, TADA M, TAKAOKA K, KOIKE T: Open reduction of the dislocated hip in juvenile idiopathic arthritis: A case report. Modern Rheumatology (Japan ) 14:5 399-401, 2004
Abstract: An 8-year-old girl with systemic-onset juvenile idiopathic arthritis (JIA) required surgical reduction for a dislocated left hip joint following failure of skin traction for 1 week. Unaided walking was achieved by 3 months postoperatively. Incongruence and irregularity of the hip joint remained but may resolve with maturation. Joint laxity caused by synovitis, flexion/adduction contracture with pain, and acetabular dysplasia by growth disturbance apparently caused hip dislocation. (c) Japan College of Rheumatology and Springer-Verlag Tokyo 2004 - KASAPCOPUR O, YOLOGLU N, OZYAZGAN Y, ERCAN G, CALISKAN S, SEVER L, OZDOGAN H, ARISOY N: Uveitis and anti nuclear antibody positivity in children with juvenile idiopathic arthritis. Indian Pediatrics (India ) 41:10 1035-1039, 2004
Abstract: This study was conducted to determine the frequency of antinuclear antibodies (ANA) positivity and uveitis in our newly diagnosed juvenile idiopathic arthritis (JIA) patients classified according to International League Against Rheumatology (ILAR) classification criteria. Ninety-two girls and 106 boys, totally 198 children were enrolled in the study. of them 36 (18.2%) were found to be ANA positive. Chronic anterior uveitis was detected in 20 (10.1%) patients. ANA positivity was determined in 4 of the systemic JIA patients, in whom no uveitis had been detected. Twenty-five of 37 patients with oligoarticular JIA were ANA positive, in 10 of them uveitis was also diagnosed. ANA were positive in 3 of 34 patients with RF positive polyarticulat JIA, only one patient had positive ANA, and another one had uveitis. Nine patients were extended JIA and in none of them, ANA positivity or uveitis were present. Of 43 patients classified as enthesitis related arthritis (ERA), uveitis was diagnosed in 6 and there was no evidence of ANA positivity, but one had uveitis. We conclude that the incidence of ANA positivity and uveitis is low in Turkish children with JIA - KASAPCOPUR O, ALTUN S, ASLAN M, KARAARSLAN S, KAMBUROGLU-GOKSEL A, SARIBAS S, ARISOY N, KOCAZEYBEK B: Diagnostic accuracy of anti-cyclic citrullinated peptide antibodies in juvenile idiopathic arthritis. Ann Rheum Dis 63:12 1687-1689, 2004
Organism: Department of Paediatric Rheumatology, Cerrahpasa Medical School, Istanbul, Turkey ozgurcopur@e-kolaynetFAU - Kasapcopur, O
Abstract: OBJECTIVE: To correlate serum anti-cyclic citrullinated peptide antibodies (anti-CCP) levels with juvenile idiopathic arthritis (JIA) subtypes and with an erosive disease course. METHODS: The study group comprised 122 children with JIA; 16 were evaluated during both active disease and remission. Nineteen children with systemic lupus erythematosus (SLE), 27 with rheumatoid arthritis (RA), and 15 healthy children were also included in the study. Twelve children with JIA were rheumatoid factor (RF) positive, and 34 patients had persistent erosive joint disease. Anti-CCP antibody levels were determined by ELISA; values above 5 relative units were regarded as positive. RESULTS: Three girls with seropositive polyarticular JIA and erosive joint disease had positive anti-CCP values. Children evaluated during active disease and remission, patients with SLE, and healthy children all had negative anti-CCP antibody levels. However, 19/27 (70%) adult patients with RA had positive anti-CCP antibody values. CONCLUSIONS: In contrast with RA, anti-CCP positivity is only rarely found in patients with JIA. In patients with RF positivity and/or in patients with erosive joint disease, anti-CCP can be detected - MURRAY MJ, TANG T, RYDER C, MABIN D, NICHOLSON JC: Childhood leukaemia masquerading as juvenile idiopathic arthritis. British Medical Journal (United Kingdom ) 329:7472 959-961, 2004
- OESTENSEN M, FOERGER F, NELSON JL, SCHUMACHER A, HEBISCH G, VILLIGER PM: Pregnancy in patients with rheumatic disease: anti- inflammatory cytokines increase in pregnancy and decrease post partum. Ann Rheum Dis .: 2004
Organism: Department of Rheumatology and Clinical Immunology and Allergology, Switzerland
Abstract: OBJECTIVE: To investigate changes in the levels of circulating cytokines with a focus on the Th1/Th2 balance during and after pregnancy in patients with rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA) and ankylosing spondylitis (AS). METHODS: Plasma and serum samples of 19 RA, 6 JIA, and 9 AS pregnant patients, of 30 healthy pregnant women, 20 non-pregnant patients and 10 non-pregnant healthy women were analysed for levels of IFNg, IL-1b, IL-10, IL-1Ra, soluble TNFR (sTNFR), and soluble CD30 (sCD30) by ELISA. Clinical assessment and blood sampling in pregnant women was done once in each trimester and 6, 12 and 24 weeks post-partum. Disease activity in the patients was evaluated by validated clinical instruments and correlated to circulating levels of cytokines. RESULTS: Low levels of IL-10 were sporadically found whereas IFNg and IL-1b were below detection level in the samples tested. Significantly higher concentrations of sTNFR and IL-1Ra were measured in pregnant compared to non-pregnant individuals. An increase of IL-1Ra from the second to the third trimester correlated with improvement of disease activity in both RA and AS patients. Compared to non- pregnant patients and to the other pregnant women, RA patients showed markedly elevated levels of sCD30 during pregnancy. CONCLUSIONS: IFN-a and IL-10, markers of a Th1 and Th2 response respectively, were either low or undetectable in the cohorts analyzed. The increase of cytokine inhibitors Il-1Ra and sTNFR proved to be a pregnancy related phenomenon independent of an underlying disease. An effect of these anti-inflammatory mediators on disease activity appears likely - PIETREWICZ E, URBAN M, GORSKA A: Cytokine levels in serum of patients with juvenile idiopathic arthritis depending on subtype and disease activity
STEZENIE CYTOKIN W SUROWICY U CHORYCH Z Ml(stroke)ODZIENCZYM IDIOPATYCZNYM ZAPALENIEM STAWOW W ZALEZNOSCI OD POSTACI CHOROBY I STOPNIA JEJ AKTYWNOSCI. Polski Merkuriusz Lekarski (Poland ) 17:99 232-234, 2004
Abstract: We investigated serum levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNFalpha) in 25 patients with juvenile idiopathic arthritis (JIA) during both: active and inactive phases of the disease. The polyarticular JIA patients had the highest IL-6 level during both active and inactive periods, TNFalpha level was the highest in the systemic JIA, active and inactive periods. IL-6 and TNFalpha levels were significantly lower than those of controls (p<0.0003) in oligoarticular JIA. IL-6 correlated significantly with C-related protein (CRP) in active period (p<0.001) and inactive period (p<0.05) in oligoarticular JIA patients, such correlation was not found for TNFalpha. In conclusion, IL-6 and CRP may play an important role in JIA and may be used as a marker of disease activity - RETHY LA, BALO-BANGA JM: [The allergic and other side effects of non-steroid antiinflammatory drugs and gold salts]. Orv Hetil 145:38 1943-1949, 1919
Organism: Magyar Tudomanyos Akademia-Pecsi Tudomanyegyetem, Klinikai Genetikai Munkacsoport, Pecs retlaj@helkaiifhuFAU - Rethy, Lajos Attila
Abstract: The wider usage of non steroid antiinflammatory drugs (NSAIDs) raises the significance of their side effects. The discovery of the two different cyclo-oxygenases (COX 1 and COX-2) led to the incorporation of more selective enzyme inhibitors into the therapeutic tools against disorders with pain and inflammation, in order to minimize the frequency of the side effects. Selective COX-2 inhibitors are well tolerated by most of the patients with a history of sensitivity against classical NSAIDs. The well-known gastrointestinal side effects (ulcers, bleedings) are much less frequent in the case of selective COX-2 inhibitors in comparison with non-selective COX inhibitors. However, the lack of "healing" prostaglandins as an effect of COX-2 antagonism may prevent the improvement of existing ulcers. In addition almost all other organs have been found to be affected in COX-2 knockout mice (COX-2 paradoxon). Hepatotoxicity is usually rare, its reason is most probably idiosyncrasy. Persistent nephropathy can be worsened by the inhibition of COX-2, however normal renal functions have not been changed in humans using selective COX-2 inhibitors. Authors' registry consists of 1000 patients with a history of suspected drug-allergy, during a 15 years' period. Approximately 30% of the cases have been connected with NSAIDs and with antirheumatic drugs. Because of functional similarities gold salts, proved suitable for the treatment of juvenile rheumatoid arthritis (JRA) and of osteoarthritis (OA) were included as well. Besides rheumatologic applications the second most common indication for these drugs was pain and/or fever. Among cutaneous symptoms intolerance was present at a relatively low frequency--as salicylates had not been taken into consideration. Next to salicylates the most frequent side effects were caused by pyrazolon derivates. Urticaria and angioedema were the most frequently observed symptoms on the skin--our observations are in accordance with other publications. Conclusions: Non-selective NSAIDs show a mixed effect of inhibitions of COX-1 and COX-2. The most important indications of modern selective COX-2 inhibitors are: 1. Prevention of the gastrointestinal side effects 2. Avoidance of cross-sensitivity against non-selective NSAIDs - ROMICKA AM, MUSIEJ-NOWAKOWSKA E, SZYMANSKA-JAGIELLO W: Juvenile idiopathic arthritis
Ml(stroke)ODZIENCZE IDIOPATYCZNE ZAPALENIE STAWOW. ZASADY ROZPOZNAWANIA I LECZENIE. Reumatologia (Poland ) 42:SUPPL. 1 17-26, 2004
Abstract: Juvenile idiopathic arthritis (JIA) is the most frequent inflammatory arthropathy in childhood. There are three types of onset: systemic, polyarticular and oligoarticular. This article presents classification, diagnostic criteria, clinical picture and therapeutical management - ROYEN-KERKHOF A, VAN DER POL WL, VAN SORGE NM, SANDERS EAM, KUIS W: Autoimmunity and polymorphisms of the innate and specific immune system
AUTO-IMMUNITEIT EN POLYMORFISMEN VAN HET AANGEBOREN EN SPECIFIEKE IMMUUNSYSTEEM. Tijdschrift voor Kindergeneeskunde (Netherlands ) 72:5 184-190, 2004
Abstract: In this article the relevance of genetic polymorphism of the immune system for the development and disease course of autoimmune disorders will be discussed. Systemic lupus erythematosus and juvenile idiopathic arthritis are used as examples of systemic autoimmune diseases. Factors of the innate immunity and specific immunity are discussed separately - ROZENBAUM M, ROSNER I: Severe outcome of juvenile idiopathic arthritis (JIA) associated with familial Mediterranean fever (FMF). Clin Exp Rheumatol 22:4 Suppl 34 S75-S78, 2004
Organism: Department of Rheumatology, Bnai Zion Medical Center, Haifa, Israel mrozenb@netvisionnetilFAU - Rozenbaum, M
Abstract: Juvenile Idiopathic Arthritis (JIA) and Familial Mediterranean Fever (FMF) may involve the same population of children and be confused at times. In a cohort of 350 consecutive FMF patients followed by us, 98 had onset before 10 years of age and, of those, JIA was present in 3. All three had the M694 V mutation of the MEFV gene and were of North African ancestry. The prognosis of these 3 was extremely poor: one developed bilateral knee osteonecrosis with total joint replacement, repeated ileal obstruction with small bowel resection, renal failure and sterility due to amyloidosis and osteoporotic fractures and died at 42 years of age; a second developed deforming erosive arthropathy and underwent bilateral total hip replacement; the third developed severe erosive polyarthritis and also underwent bilateral hip replacements. Aggressive treatment is indicated when JIA and FMF coexist - RUTKOWSKA-SAK L: Movalis in the treatment of patients with juvenile idiopathic arthritis (JIA)
MOVALIS (MELOKSYKAM) W LECZENIU Ml(stroke)ODZIENCZEGO IDIOPATYCZNEGO ZAPALENIA STAWOW. Reumatologia (Poland ) 42:3 453-457, 2004
Abstract: The aim of the study was an assessment of Movalis (Boehringer Ingelheim) efficacy in patients affected with juvenile idiopathic arthritis (JIA). The drug was given in the form of 7.5 mg tablets in 30 patients (20 girls, 10 boys), the aged from 10 to 18 years (x = 14.5), suffering from JIA with articular (24 pts) as well as systemic (6 pts) onset. A follow up period of 3 months was planed. 3 patients dropped out the study: 2 - because of lack of therapeutic effect (1 pt with JCA complicated with amyloidosis), 1 - because of adverse effects. A considerable clinical improvement was observed in 82% of the 27 patients who completed the 3-month study. Movalis had beneficial effect on fever, joints pain and swelling and morning stiffness as well. The significant decrease in laboratory indices of the acute phase was observed in these patients. This study results indicated that the treatment with Movalis in patients with JIA aged > 10y is useful and safe - SAILA H, PITKANIEMI J, TUOMILEHTO J, SAVOLAINEN A, ALAKULPPI N, TUOMILEHTO-WOLF E, LEIRISALO-REPO M, AHO K: HLA and susceptibility to juvenile idiopathic arthritis: a study of affected sibpairs in an isolated Finnish population. J Rheumatol 31:11 2281-2285, 2004
Organism: Rheumatism Foundation Hospital, Heinola, Finland HannaSaila@reumafiFAU - Saila, Hanna
Abstract: OBJECTIVE: To determine the effects of class I (A, B, and C) and II (DRB1 and DQB1) HLA loci alleles and DRB1-DQB1 haplotypes on genetic susceptibility to juvenile idiopathic arthritis (JIA) in families with 2 or more affected siblings. METHODS: A total of 83 affected siblings belonging to 38 families and corresponding to 50 affected sibpairs, their parents, and 45 healthy sibs were typed for HLA in A, C, B, DRB1, and DQB1 loci. Two study designs were used to explore linkage and association: a case-population control design and a family design using the linkage method: identical-by-descent (IBD) allele-sharing and the association analysis methods. Associations in family data were analyzed using the independent transmission disequilibrium test (TDT) for linkage in the presence of association. This was supplemented by the family-based association test (FBAT) to look for association in the presence of linkage, and is robust for population stratification and phenotype-based selection of data. RESULTS: Significantly increased HLA allele frequencies among the affected siblings compared to Finnish bone marrow donors were observed for HLA alleles Cw4 (odds ratio, OR, 1.7), B27 (1.8), B35 (1.7), and DR8 (3.7). The observed ratio of sharing 0, 1, and 2 HLA haplotypes (A, C, B, DRB1, and DQB1) among affected sibpairs (ASP) was 10:23:17, significantly different from expected (p < 0.001), using a formula that takes into account disease prevalence and the sibling recurrence risk. In the univariate association analysis, both independent TDT and FBAT found significantly increased transmission of the DRB1*0801 and DQB1*0402 alleles and Cw*0401. Independent positive allele effects of Cw*0401, DRB1*0801, and DQB1*0402 as well as negative effects of Cw*0701 and DQB1*0302 were shown by the family-based association analysis of the joint allele main effects. Multi-allelic test for association of each locus confirmed significant associations of the DRB1 and DQB1 loci in the risk of JIA. We found DRB1*0801/DQB1*0402 haplotype to be strongly associated (p < 0.001) with JIA, supporting findings of the haplotype associations-based ASP design. CONCLUSION: Both linkage analysis of the affected sibpairs and association analysis of nuclear families with JIA provided overwhelming evidence of the major contribution of HLA to genetic susceptibility to JIA. The association analysis of HLA-A, C, B, DRB1, and DQB1 alleles by both TDT and FBAT tests confirmed in the Finnish population that the most significant associations prevailed for DRB1*0801, DQB1*0402, as expected from previous observations, and supported the independent role of Cw*0401 - SALGADO M: Rheumatic disease in childhood
DOENCA REUMATICA NA CRIANCA. Nascer e Crescer (Portugal ) 13:3 S267-S275, 2004
Abstract: The osseous and joints complaints can be a result of many pathologic conditions, immunological or not. The 796 patients observed in 18 years on Rheumatic Consult of Pediatric Hospital of Coimbra (RCPHC), were classified in two big groups - pediatric rheumatic diseases (PRD) and non rheumatic pediatric diseases (NRPD) - compared to the published by others Rheumatic Pediatric Centers. In RCPHP the PRD were responsible for 40% of patients (in others series between 34% and 46%. Juvenile idiopathic arthritis (JIA) totalized 22% of patients (21% - 31,5% in others series). From the 103 JIA followed by 5 years, 63% were in remission. Based on the Portuguese population census of 2001, it was possible to determine the regional prevalence and incidence (per 100.000) of rheumatic diseases in the Center of Portugal in 225.000 children less than 16 years of age. The results of prevalence found were: total number of patients (TNP) 161, PRD 56 and JIA 31. For incidence calculations, were analyzed the new cases observed in 3 years (October 2001 to September 2004). The incidence results obtained were: TNP 25, RPD 8,4 and JIA 4,3. Theses numbers are within inferior values published in others countries. This, associated with the delay in referring the patients to RCPHC, in more than 6 months (a personal study with 140 patients), suggest that patients are attending others outpatients clinics or a PRD subdiagnosis - SMITH GR, TYMMS KE, FALK M: Etanercept treatment of renal amyloidosis complicating rheumatoid arthritis. Internal Medicine Journal (Australia ) 34:9-10 570-572, 2004
Abstract: Rheumatoid arthritis and juvenile arthritis represent the commonest diseases complicated by AA amyloidosis in developed countries. Up to 5% of patients with rheumatoid arthritis will develop AA amyloidosis, with renal failure being the commonest cause of mortality. To date, treatment of this condition has focused on suppressing the underlying inflammatory condition with drugs such as cyclophosphamide and chlorambucil, but both these drugs are associated with myelotoxicity, leukaemia and sterility. Tumour necrosis factor-alpha (TNF-alpha) is thought to be involved in amyloid deposition. The efficacy of anti-TNF-alpha therapy (etanercept) in the treatment of renal amyloidosis complicating rheumatoid arthritis is demonstrated here and the current scientific data on this subject are presented - TEKLENBURG G, ALBANI S: The role of immune tolerance in preventing and treating arthritis. Curr Rheumatol Rep 6:6 434-441, 2004
Abstract: It has become increasingly clear that the innate and adaptive arms of the immune response cooperate in generating autoimmune damage in the pathogenesis of rheumatoid arthritis and juvenile idiopathic arthritis. Treatment targets the immunologic pathophysiology of the disease and is based on regaining immune tolerance. Recently introduced biological agents neutralize or simply block cytokines and their proinflammatory pathways, with favorable clinical outcome. However, major downsides are their lack of specificity and the need of continuous administration to be effective. Possibly, more can be gained from a specific approach. Indeed, recent findings suggest that targeting antigen-specific T cells can reinstate regulatory mechanisms and thus induce immune tolerization. This improved understanding has paved the way to novel immunotherapeutic approaches, some of which will be discussed here - URBAN M, PIETREWICZ E, GORSKA A, GL S: Lipids and homocysteine level in juvenile idiopathic arthritis
OCENA WYBRANYCH PARAMETROW GOSPODARKI LIPIDOWEJ I HOMOCYSTEINY W Ml(stroke)ODZIENCZYM IDIOPATYCZNYM ZAPALENIU STAWOW U DZIECI. Polski Merkuriusz Lekarski (Poland ) 17:99 235-238, 2004
Abstract: We investigated serum levels of lipids (total cholesterol, HDL-cholesterol, LDL-cholesterol, triglicerides), homocysteine, C-reactive protein (CRP) in 25 children with juvenile idiopathic arthritis (JIA) and 15 healthy control. We found statistically significant increase of total cholesterol, LDL-cholesterol, triglicerides (p<0.05) and decreased of HDL-cholesterol (p<0.05) in JIA patients compare to control group. Homocysteine correlated significantly with total cholesterol (r=0.47; p<0.05) and with LDL-cholesterol (r=0.53; p<0.05). In JIA children we found adverse lipids profile and increase of homocysteine level which may lead to early atherosclerosis - WALLACE CA, RUPERTO N, GIANNINI EH: Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis. Journal of Rheumatology (Canada ) 31:11 2290-2294, 2004
Abstract: Objectives. To develop preliminary criteria for inactive disease and clinical remission for select categories of juvenile idiopathic arthritis (JIA), and to decide what such clinical states should predict in terms of probability of disease recurrence. Methods. A Delphi serial questionnaire consensus-formation approach was used initially to gather criteria in use by pediatric rheumatologists (PR) for defining clinical remission in oligoarticular (persistent and extended), rheumatoid factor (RF) positive and negative polyarticular, and systemic JIA. Results from sequential questionnaires provided an agenda for a nominal group technique (NGT) conference to reach consensus on unresolved questions. Results. One hundred and thirty PR from 34 countries responded to the questionnaires and 20 PR from 9 countries attended the conference. Draft criteria for inactive disease include the following: no active arthritis; no fever, rash, serositis, splenomegaly, or generalized lymphadenopathy attributable to JIA; no active uveitis; normal erythrocyte sedimentation rate or C-reactive protein; and a physician's global assessment of disease activity rated at the best score possible for the instrument used According to consensus vote, 6 continuous months of inactive disease on medication defines clinical remission on medication, while 12 months of inactive disease off all anti-arthritis (and anti-uveitis) medications defines clinical remission off medication. The finalized criteria for remission off medication ideally should predict that a patient has <= 20% probability of disease recurrence within the next 5 years. Conclusion. Using consensus formation techniques, we formulated preliminary criteria for inactive disease and clinical remission on and off medication for use in select categories of JIA. Retrospective validation is in progress; prospective validation will follow. Future efforts will include other categories of JIA