Bibliography January 06

1. Methotrexate and chronic uveitis associated with juvenile idiopathic arthritis [1]. Journal of Rheumatology (Canada ) 33:1 198, 2006

2. Effective medications for juvenile idiopathic arthritis. Journal of the National Medical Association (United States ) 98:1 101-102, 2006
   Abstract: JIA, previously called juvenile rheumatoid arthritis, is the most common rheumatic disease of childhood. Symptoms include persistent arthritis for >6 weeks, with onset at age <16 years. To evaluate the effectiveness of medical therapy, the investigators thoroughly searched multiple database,s including Medline, EMBASE, the Cochrane Registry of Controlled Trials, published systematic reviews, and abstracts from major pediatric, and rheumatology conferences. No indication is given that an independent assessment of trial review and evaluation occurred. From a total of 279 studies, the search iden tified 28 double-blind trials. Methodologic quality of the individual trials is poor. Outcomes were assessed using validated criteria from the American College of Rheumatology Pediatric. Less than one-third of patients, and primarily only those with oligoarthritis, responded to NSAIDs. NSAIDs reduce pain and stiffness but are not disease modifying. Evidence supports the effectiveness of intraarticular injections of corticosteroids, particularly in patients with oligoarthritis. Methotrexate is beneficial, especially for patients with extended oligoarthritis. No controlled studies reported a benefit for hydroxychloroquine, oral gold, intravenous immunoglobulin or D-penicillamine. Biologic modifiers, including etanercept and infliximab, appear to have some benefit. Patients with polyarthritis and a positive rheumatoid factor respond poorly to medications. This review contains further material on management of medication side effects and algorithms for each disease presentation

3. AVCIN T, SILVERMAN ED, FORTE V, SCHNEIDER R: Erratum: Nasal septal perforation: A novel clinical manifestation of systemic juvenile idiopathic arthritis/adult onset Still's disease (Journal of Rheumatology). Journal of Rheumatology (Canada ) 33:1 199-200, 2006

4. BARLOW JH, ELLARD DR: The psychosocial well-being of children with chronic disease, their parents and siblings: an overview of the research evidence base. Child Care Health Dev 32:1 19-31, 2006
   Organism: Interdisciplinary Research Centre in Health, Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry CV1 5FB, UK jbarlow@coventryacukFAU - Barlow, J H
   Abstract: BACKGROUND: Chronic disease of childhood may have implications for the psychosocial well-being of children and their families. The purpose of this paper is to provide an overview of the current literature regarding the psychosocial well-being of children 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 (1990 to week 24, 2004). 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: Six reviews of the psychosocial well-being of children were identified: three on chronic disease in general, one on asthma, one on juvenile idiopathic arthritis and one on sickle cell disease. Two reviews of psychosocial well-being among parents and two reviews of sibling psychosocial well-being were identified. Evidence from meta-analyses shows that children were at slightly elevated risk of psychosocial distress, although only a minority experience clinical symptomatology. The proportion that experience distress remains to be clarified, as do contributory risk factors. Few conclusions can be drawn from the two reviews of parents. However, a meta-analysis of siblings showed that they are at risk from a number of negative effects. CONCLUSION: This overview has highlighted the need to extend the evidence base for psychosocial well-being of children, parents and siblings

5. FOELDVARI I, WIERK A: Methotrexate and Chronic Uveitis Associated with Juvenile Idiopathic Arthritis: Dr. Foeldvari and Ms Wierk reply. J Rheumatol 33:1 198, 2006

6. GIORDANO N, AMENDOLA A, PAPAKOSTAS P, CIPOLLI F, AGATE VM, BATTISTI E, MARCHI B, NUTI R: Immune and autoimmune disorders in HCV chronic liver disease: personal experience and commentary on literature. New Microbiol 28:4 311-317, 2005
   Organism: Department of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, University of Siena, Italy giordanon@unisiitFAU - Giordano, Nicola
   Abstract: HCV chronic liver disease can be associated with a plethora of immune and autoimmune perturbations and many authors claim that HCV chronic infection can play an important role in the pathogenesis of these disorders. To compare our experience with literature reports, we performed a retrospective study on the case histories of 265 patients with HCV chronic liver disease, evaluating the type and prevalence of the associated immune and autoimmune manifestations. We found that the patients with HCV chronic liver disease can present arthromyalgias (7.1% of the patients), Sjorgen's syndrome (5.2%), thyroiditis (4.1%), rheumatoid arthritis (2.2%), autoimmune thrombocytopenia (2.6%), mixed cryoglobulinemia (1.5%), autoimmune anemia (0.3%) and oral lichen planus (0.3%). We claim that HCV liver infection is able to induce immune and autoimmune perturbations, without playing a significant role in the pathogenesis of a well-defined disorder

7. GOKTEPE S, ALACA R: Juvenile rheumatoid arthritis: 1. Clinical features, classification and medical treatment
   JUVENIL ROMATOID ARTRIT: 1. KLINIK, SINIFLANDIRMA VE TIBBI TEDAVI. Journal of Rheumatology and Medical Rehabilitation (Turkey ) 13:2 132-138, 2002
   Abstract: Juvenile rheumatoid arthritis is the most frequent pediatric connective tissue disease. By adulthood, disease activity decreases considerably, but the deformities can not be reversed in most cases. Therefore, early diagnosis and treatment is of great importance. There is no consensus for nomenclature and classification of the disease currently. Different scholars offer different classifications. New DMARDs and biological agents being used in adult rheumatoid arthritis are currently being added to classical therapeutic agents. In this article clinical findings, different classifications, and new therapeutic agents are reviewed using information from current literature

8. GOKTEPE S, ALACA R: Juvenile rheumatoid arthritis: Rehabilitation
   JUVENIL ROMATOID ARTRIT: REHABILITASYON. Journal of Rheumatology and Medical Rehabilitation (Turkey ) 13:3 206-210, 2002
   Abstract: Rehabilitation of juvenile rheumatoid arthritis is considerably different from adult rheumatoid arthritis. Therapy regimes should have a comprehensive approach going beyond applying only medical treatment. The purpose is highest-level quality of life and lowest impact of arthritis on the joints of the patient. Daily or intermittent exercises, self-care and daily living activities, home and school arrangements, adopting joint protection principles to daily life, and vocational rehabilitation are of great importance in these patients. Because juvenile rheumatoid arthritis is a self-limiting disease, the patients can live a normal life incase their deformities are prevented. In this article basic principles of rehabilitation and different approaches are reviewed using information from current literature

9. HAREL L, PRAIS D, UZIEL Y, MUKAMEL M, HASHKES P, HAREL G, AMIR J, MONSELISE Y, PRESS J: Increased prevalence of antithyroid antibodies and subclinical hypothyroidism in children with juvenile idiopathic arthritis. Journal of Rheumatology (Canada ) 33:1 164-166, 2006
   Abstract: Objective. To estimate the occurrence of antithyroid antibodies (ATA) and hypothyroidism in children with juvenile idiopathic arthritis (JIA) compared to matched healthy controls. Methods. The occurrence of ATA, including antithyroglobulin (anti-TG) and antithyroid peroxidase (anti-TPO) antibodies, was evaluated by quantitative immunometric ELISA in children with JIA and in a healthy matched control group. Thyroid function was assessed in both groups. Results. The study group included 66 patients with JIA (50 girls, 16 boys) of mean age 11.7 +/- 4.4 years (range 2-23). The control group included 89 children (71 girls, 18 boys) of mean age 10.8 +/- 4.2 years (range 2-18). Mean age at onset of joint disease was 7.3 +/- 3.6 years (range 1-15). Anti-TG antibodies were found in 7 of 62 patients (11.3%) in the JIA group and 2 of 89 controls (2.2%) (p = 0.03); anti-TPO antibodies were found in 5 of 65 patients (7.9%) and one of 89 controls (1.1%) (p = 0.08). All patients with ATA had oligoarticular type JIA (p = 0.01). Mean thyroid stimulating hormone (TSH) levels were higher in the study group than in controls (2.6 +/- 2.3 vs 1.9 +/- 1.0 mlU/l; p = 0.01); levels were above normal range (0.4-4 mlU/l) in 8 study patients (12%) and 3 controls (3.4%) (p = 0.055). Overall, ATA were found in 9 of the 150 study participants, 4 (44%) of whom had TSH levels above 4 mlU/l (p = 0.001). Conclusion. Children with JIA have a higher than normal incidence of ATA and subclinical hypothyroidism and should be routinely screened for these variables

10. HARJACEK M, OSTOJIC J, DJAKOVIC RO: Juvenile spondyloarthropathies associated with Mycoplasma pneumoniae infection. Clin Rheumatol :1-6.: 1-6, 2006
    Organism: Department of Pediatrics, Division of Pediatric Rheumatology/Immunology, Children's Hospital Zagreb, Klaiceva 16, 10 000, Zagreb, Croatia, miroslavharjacek@zghtnethr
    Abstract: BACKGROUND: Reactive arthritis (ReA) has been sporadically reported as triggered by Mycoplasma pneumoniae. This study examined the potential relationship between the acute M. pneumoniae infection and juvenile spondyloarthropathy (jSpA) in children. PATIENTS AND METHODS: Twelve patients with ReA secondary to acute M. pneumoniae were examined. M. pneumoniae-specific IgM, IgG and IgA antibodies were serologically confirmed by enzyme-linked immunosorbent assay (ELISA) tests (Savyon Diagnost., Israel). Due to the early appearance and relatively short life time of M. pneumoniae-specific IgM antibodies, their detection allowed the diagnosis of acute infection using single serum sample, confirmed by parallel serum in 7 of 12 patients. Specific IgM and IgG titers higher than 10 U/l were considered positive and those higher than 50 U/l as highly positive. Specific IgA antibodies were detected in only one patient. RESULTS: Four patients were female and eight were male. The mean age at onset was 9 years, and the mean duration of follow-up was 24.1 months (range 18-32). The mean number of involved joints was 2.8, and the knee joints were involved in 7 of 12 patients. The mean recovery time was 4.5 weeks (range 1-28) in eight reactive arthritis (ReA) cases; three patients developed enthesitis-related arthritis, and in one patient, genuine juvenile ankylosing spondylitis (jAS) was diagnosed. Two patients were HLA-B27-positive, and one patient was HLA-B7/B27-positive. Six patients had preceding respiratory symptoms, and five were treated with antibiotics. CONCLUSIONS: Our findings provide clear evidence of ReA diagnosis following an acute M. pneumoniae infection that in four patients progressed to chronic jSpA. Our results suggest that detecting M. pneumoniae-specific antibodies in serological screening of jSpA patients might be useful. It is presently unclear whether antibiotic treatment would change the disease course in those patients

11. HEILIGENHAUS A, NIEWERTH M, MINGELS A, GANSER C, THON A, PLEYER U, GREINER K, MINDEN K: Epidemiology of uveitis in juvenile idiopathic arthritis from a national paediatric rheumatologic and ophthalmologic database
    EPIDEMIOLOGISCHE DATEN ZUR UVEITIS BEI JUVENILER IDIOPATHISCHER ARTHRITIS AUS EINER BUNDESWEITEN PADIATRISCHEN UND OPHTHALMOLOGISCHEN DATENERHEBUNG (UVEITIS-MODUL DER KERNDOKUMENTATION). Klinische Monatsblatter fur Augenheilkunde (Germany ) 222:12 993-1001, 2005
    Abstract: Background: Uveitis is a frequent and potentially vision-threatening manifestation of juvenile idiopathic arthritis (JIA). There are only a few population-based studies providing data on the frequency and severity of uveitis. Methods: Documentation of patients with JIA was collected in a national database. An analysis of the paediatric rheumatologic and ophthalmologic data collected from all patients that were included in 2002 was performed. Results: Uveitis was documented in 12% of a total of 3271JIA patients: extended oligoarthritis (25%), persistent oligoarthritis (16%), seronegative polyarthritis (4%), seropositive polyarthritis (2%), psoriatic arthritis (10%), e nthesitis-related arthritis (ERA) (7%), systemic arthritis (1%), other arthritis forms (11%). Ophthalmologic data were available from 115 uveitis patients (28%). Mean age at onset of uveitis was 5.2 (SD 3.2) years. JIA patients with uveitis were significantly younger at onset of arthritis (3.8 vs. 7.0 years), and were more often girls (74 vs. 63%) or ANA-positive (86 vs. 42%) than the patients without uveitis. Uveitis complications were present in 45% at initial presentation of uveitis. After a mean duration of 5.6 years, complications were noted in 56%, and included band keratopathy (29%), posterior synechiae (27%), cataract (26%), glaucoma (8%), and macula oedema (6%). Final visual acuity was less than 20/50 in 31% and less than 20/200 in 12% of eyes. In patients with uveitis, immunosuppressive or immunomodulato ry drugs were used significantly more often than in patients without uveitis (75% vs. 43%). Conclusions: The nationwide data documents the spectrum of uveitis in patients with JIA, the complications and the therapy for uveitis. The high rate of uveitis complications at the time of diagnosis points out the need for early ophthalmologic screening and therapy, and for a close collaboration between ophthalmologist and paediatric rheumatologist. (c) Georg Thieme Verlag KG Stuttgart

12. HEILIGENHAUS A, NIEWERTH M, MINGELS A, GANSER G, THON A, PLEYER U, GREINER K, MINDEN K: [Epidemiology of uveitis in juvenile idiopathic arthritis from a national paediatric rheumatologic and ophthalmologic database]. Klin Monatsbl Augenheilkd 222:12 993-1001, 2005
    Organism: Augenabteilung am St-Franziskus-Hospital, Munster arndheiligenhaus@uveitis-zentrumdeFAU - Heiligenhaus, A
    Abstract: BACKGROUND: Uveitis is a frequent and potentially vision-threatening manifestation of juvenile idiopathic arthritis (JIA). There are only a few population-based studies providing data on the frequency and severity of uveitis. METHODS: Documentation of patients with JIA was collected in a national database. An analysis of the paediatric rheumatologic and ophthalmologic data collected from all patients that were included in 2002 was performed. RESULTS: Uveitis was documented in 12 % of a total of 3271 JIA patients: extended oligoarthritis (25 %), persistent oligoarthritis (16 %), seronegative polyarthritis (4 %), seropositive polyarthritis (2 %), psoriatic arthritis (10 %), enthesitis-related arthritis (ERA) (7 %), systemic arthritis (1 %), other arthritis forms (11 %). Ophthalmologic data were available from 115 uveitis patients (28 %). Mean age at onset of uveitis was 5.2 (SD 3.2) years. JIA patients with uveitis were significantly younger at onset of arthritis (3.8 vs. 7.0 years), and were more often girls (74 vs. 63 %) or ANA-positive (86 vs. 42 %) than the patients without uveitis. Uveitis complications were present in 45 % at initial presentation of uveitis. After a mean duration of 5.6 years, complications were noted in 56 %, and included band keratopathy (29 %), posterior synechiae (27 %), cataract (26 %), glaucoma (8 %), and macula oedema (6 %). Final visual acuity was less than 20/50 in 31 % and less than 20/200 in 12 % of eyes. In patients with uveitis, immunosuppressive or immunomodulatory drugs were used significantly more often than in patients without uveitis (75 % vs. 43 %). CONCLUSIONS: The nationwide data documents the spectrum of uveitis in patients with JIA, the complications and the therapy for uveitis. The high rate of uveitis complications at the time of diagnosis points out the need for early ophthalmologic screening and therapy, and for a close collaboration between ophthalmologist and paediatric rheumatologist

13. HINKS A, WORTHINGTON J, THOMSON W: The association of PTPN22 with rheumatoid arthritis and juvenile idiopathic arthritis. Rheumatology (Oxford) .: 2006
    Organism: Arthritis Research Campaign Epidemiology Unit, University of Manchester, Manchester M13 9PT, UK

14. INGEGNOLI F, ZENI S, GERLONI V, FANTINI F: Capillaroscopic observations in childhood rheumatic diseases and healthy controls. Clinical and Experimental Rheumatology (Italy ) 23:6 905-911, 2005
    Abstract: Objective: To describe, by using video nailfold capillaroscopy (NFC), microvascular abnormalities in children with rheumatic diseases and to evaluate the capillary changes over a follow up period. Methods: 118 children suffering from rheumatic diseases: 55 juvenile idiopathic arthritis (JIA), 7 mixed connective tissue disease (MCTD), 6 primary Raynaud's phenomenon (PRP), 34 systemic lupus erythematosus (SLE), 8 juvenile systemic sclerosis (JSSc) and 8 juvenile dermatomyositis (JDM) were included in the study. Patients with major capillaries abnormalities or scleroderma pattern were followed up for at least 12 months. 70 age- and sex-matched healthy controls (HC) were also examined. Results: In HC there was a significant correlation between age and capillary length (p = 0.001). JIA patients showed capillary number size, shape and arrangement similar to HC. Minor abnormalities were frequently observed. The percentage of major abnormalities were significantly increased compared to HC in MCTD (p = 0.008), SLE (p = 0.0002) and JDM patients (p < 0.0001). 5/8 of JSSc had a scleroderma pattern from the onset of the disease. The serial observations in connective tissue diseases also showed that the evolution of capillaroscopic pattern was not unidirectional. In fact, in some nailfolds there was an increase in capillary loss and in avascular areas, whereas sometimes it remained stable on repeated examination. Conclusion: NFC can be used as a simple, inexpensive, non-invasive method to evaluate the microvascular abnormalities in childhood rheumatic conditions, and it may be useful in early recognition and monitoring scleroderma spectrum disorders. (c) Copyright Clinical and Experimental Rheumatology 2005

15. KESTELYN PG: An eye on inflammatory eye disease. Acta Clin Belg 60:5 270-275, 2005
    Organism: Afdeling Oogheelkunde, Universitair Ziekenhuis, Gent philippekestelyn@ugentbeFAU - Kestelyn, P G
    Abstract: The purpose of this article is to outline the interaction between ophthalmologists and internists in the management of uveitis. Two issues will be addressed: 1) which strategies should the internist follow when asked to investigate a case of uveitis; and 2) in which systemic diseases should the internist order an ocular examination to rule out intraocular inflammation. The modern approach to the diagnosis of uveitis is based on the naming-meshing system popularized by Smith and Nozik. After a short history (ocular complaints, general health) an ophthalmic examination is carried out to determine the anatomic structures involved. Based on the results a uveitis is classified as anterior uveitis, intermediate uveitis, posterior uveitis, or panuveitis. Associated factors (eg, unilateral versus bilateral, acute versus chronic, granulomatous versus nongranulomatous, etc.) are also assessed. Based on this information the type of uveitis will be named (eg, acute, nongranulomatous, unilateral, anterior uveitis) and matched (meshing) to a potential list of etiologies (eg, viral iritis, HLA-B 27 associated iritis). Targeted questioning and selected medical and laboratory investigations based on the shortlist will then identify a possible cause for a particular patient's uveitis. In other words the ophthalmologist should never ask the internist to run the full battery of tests in a patient with uveitis. He rather should indicate which type of uveitis is present and what are the most likely diagnoses to be excluded. Many systemic diseases cause diffuse inflammation and are associated with uveitis. These include tuberculosis, spirochaetal diseases such as Lyme disease and syphilis, sarcoidosis, Behcet syndrome, juvenile idiopathic arthritis, and HIV infection amongst many others. Routine ophthalmic examination in patients with systemic disease may be indicated for diverse reasons: to prevent profound damage due to asymptomatic uveitis in JIA; to detect diagnostic clues in patients with febris e causa ignota; or to rule out opportunistic infections in HIV positive patients. It is clear that the information gained from routine examination in systemic disease will be greatly dependent on the prevalence of ocular involvement in a particular disease

16. KIDA-PURPUROWICZ G, KOWALSKI IM, ZABOROWSKA K, JANIKOWSKA-HOL S: Rehabilitation of juvenile idiopathic arthritis. Eurorehab (Slovakia ) 15:3-4 62-67, 2005
    Abstract: Due to the unknown aetiology the treatment of JIA is symptomatic. The process of treatment lasts many years and is multidirectional, a complex rehabilitation regime plays a major role in the treatment. JIA is a progressive disease (the deteriorating condition is followed by the rejection of one's disability), which occurs in difficult to predict attacks interspersed by periods of remission, the dysfunction concerns many sections of the organ of movement, and one of the dominating symptoms is pain. Therefore it is impossible to plan a long-term improvement. The treatment programme is established for a short term depending on the dynamics of the course and period of the disease, types of deformities of the organ of movement, efficiency and fitness, age and the attitude of the patient

17. KITSOULIS PB, STAFILAS KS, SIAMOPOULOU A, SOUCACOS PN, XENAKIS TA: Total hip arthroplasty in children with juvenile chronic arthritis: long-term results. J Pediatr Orthop 26:1 8-12, 2006
    Organism: Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Ioannina, Greece pkitsoulis@hotmailcomFAU - Kitsoulis, Panayiotis B
    Abstract: From 1984 to 2002, 20 total hip arthroplasties in children with juvenile chronic arthritis were performed in the authors' department. All patients had polyarticular disease. Average age of patients was 15.8 (range 13-24) years. Early onset of the disease occurred at an average age of 7.3 (4-10) years. In six patients the physes were open at the time of surgery. All patients had complete loss of joint space and various combinations of subchondral sclerosis, flattening of the femoral head, and anterior inclination of the neck. All patients used crutches for walking and joint function was very restricted. All patients were operated on under general anesthesia. One of them was supported additionally with laryngeal mask because of cervical spine involvement. No intra- or postoperative complications occurred. Mobilization of the patients started immediately after surgery, followed by a special rehabilitation program. Follow-up examination was based on the Merle d'Aubigne et Postel scale as modified by Charnley. Patients were followed at 6 weeks and 3 months after surgery and thereafter every 6 months with clinical and radiologic examination. Average follow-up was 9.2 (2-20) years. All patients had no pain and full functional ability. Although total hip arthroplasty is technically difficult in this age, it should be performed in specialized centers because pain relief, decreased deformity, and improved quality of life can be achieved in most patients. The only disadvantage is wear of the prosthesis

18. LEONE JE, GRAY KA, MASSIE JE, ROSSI JM: Celiac disease symptoms in a female collegiate tennis player: A case report. Journal of Athletic Training (United States ) 40:4 365-369, 2005
    Abstract: Objective: To present the case of a collegiate tennis player with celiac disease symptoms. Background: Celiac disease is a common intestinal disorder that is often confused with other conditions. It causes severe intestinal damage manifested by several uncomfortable signs and symptoms. Failure by the sports medicine staff to recognize symptoms consistent with celiac disease and treat them appropriately can have deleterious consequences for the athlete. Differential Diagnosis: Irritable bowel syndrome, Crohn disease, Addison disease, lupus erythematosus, juvenile rheumatoid arthritis, lactose i ntolerance, herpes zoster, psychogenic disorder (depression), fibromyalgia, complex regional pain syndrome, hyperthyroidism, anemia, type I diabetes. Treatment: The athlete underwent a series of blood and allergen tests to confirm or refute a diagnosis of celiac disease. When celiac disease was suspected, dietary modifications were made to eliminate all wheat-based and gluten-based products from the athlete's diet. Uniqueness: The athlete was able to fully compete in a competitive National Collegiate Athletic Association Division I tennis program while experiencing the debilitating effects associated with celiac disease. The immediacy of symptom onset was notable bec ause the athlete had no history of similar complaints. Conclusions: Celiac disease is a potentially life-threatening condition that affects more people than reported. A properly educated sports medicine staff can help to identify symptoms consistent with celiac disease early, so damage to the intestine is minimized. Prompt recognition and appropriate management allow the athlete to adjust the diet accordingly, compete at a high-caliber level, and enjoy a healthier quality of life. (c) by the National Athletic Trainers' Association, Inc

19. MARSH JS, DAIGNEAULT JP, POLZHOFER GK: Treatment of ankle instability in children and adolescents with a modified Chrisman-Snook repair: a clinical and patient-based outcome study. J Pediatr Orthop 26:1 94-99, 2006
    Organism: Department of Pediatric Orthopedic Surgery, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT, USAFAU - Marsh, James S
    Abstract: Ligamentous injuries to the lateral ankle complex, although rare in the child with open physes, increase with age and are seen with considerable frequency in late childhood and adolescence. In athletic, ligamentously lax individuals, recurrent sprains may lead to ligament attenuation and instability. When instability becomes chronic and interferes with everyday activity, reconstruction is indicated. The literature on reconstruction addresses primarily the adult population, with minimal guidance in treating the child and adolescent. The authors report their experience with 48 reconstructions performed in patients aged 8 to 17 years (mean 14.5 years) over a 12-year period. Mean follow-up was 6.5 years. All patients failed to respond to conservative treatment, including casting or bracing and physical therapy. All had disabling instability. All had a positive drawer sign clinically, and all but one had significant talar tilt on preoperative stress radiographs. A modification of the Chrisman-Snook procedure was used. Forty-four ankles in 38 patients were available for clinical and radiographic re-evaluation. One patient with generalized systemic ligamentous laxity required bilateral repair for failure of previous Evans procedures 8 years earlier; the remaining patients had primary repairs and remain asymptomatic. Each has a negative drawer sign and a reduction of talar tilt from a preoperative average of 14.5 degrees to a postoperative average of 4 degrees, based on stress radiographs. An outcomes questionnaire was administered to all patients, who subjectively rated their pain and instability at extremely low levels (1/10) and their function at a high level (8/10). All patients had their expectations met regarding the results of surgery. There was no radiographic evidence of degenerative arthritis at follow-up. The authors recommend this as an excellent means of treating children with chronic ankle instability who have failed to respond to conservative treatment. The authors have modified Chrisman's procedure by using a much smaller incision and improved graft isometry

20. MINE T, TANAKA H, ISHIDA Y, IMAMURA R, SEKI K, TAGUCHI T: Juvenile rheumatoid arthritis manifesting in only limping due to flexion contraction of the knee. Clin Rheumatol :1-3.: 1-3, 2006
    Organism: From the Department of Orthopaedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8505, Japan, tmine@poccyamaguchi-uacjp
    Abstract: Juvenile rheumatoid arthritis (JRA) is a relatively uncommon condition. The damage to the cartilaginous tissue is often irreversible and responsible for much of the morbidity. Timely diagnosis and appropriate aggressive treatment of patients improve quality of life and outcome. A reported case of JRA is presented in which limping associated with flexion contraction of the knee developed without any systemic symptoms. Magnetic resonance imaging and arthroscopic examination were helpful with early diagnosis. Aspirin was effective. There have been no recurrence to date

21. MODESTO C, PATIN T, SOTILLO-PIN T, MERINO J, GARCIA-CONSUEGRA J, MERINO R, RUA MJ, SIERRASESUMAGA L, ARNAL C: TNF-alpha promoter gene polymorphisms in Spanish children with persistent oligoarticular and systemic-onset juvenile idiopathic arthritis. Scandinavian Journal of Rheumatology (Norway ) 34:6 451-454, 2005
    Abstract: Objective: To explore the possible association/s of the first reported tumour necrosis factor (TNF-alphaTNF-) alpha promoter gene polymorphisms -308, -238, -376 and -163 (G-->A) with systemic (SoJIA) and oligoarticular subtypes of juvenile idiopathic arthritis (JIA); and to test the association between these polymorphisms and the class I/class II HLA alleles in our population. Methods: The patient group comprised 29 oligoarticular and 26 systemic Caucasian Spanish children with JIA; 68 healthy volunteers from the same ethnic group and geographical region served as controls. HLA alleles were determined using low-resolution polymerase chain reaction (PCR). TNF-alpha pr omoter gene polymorphisms were screened using PCR denaturing gradient gel electrophoresis (PCR-DGGE), followed, if positive, by restriction fragment length polymorphism (RFLP) analysis for identification. Results: No statistical association was found between the four polymorphisms studied and JIA. However, the -308 G-->A polymorphism (TNF A2) tended to be more frequent in patients with SoJIA than in the oligoarticular group. TNF A2 was strongly associated with the extended haplotype A1B8DR3 (p=0.003), and the tandem polymorphism -238/-376 in the presence of B18 and DR3. Conclusion: The TNF A2 allele was more frequent in SoJIA than in the oligoarticular group. TNF A2 can help to create a more inflammatory milieu in this JIA subtype, in combination with other polymorphisms involved in regulatory sequences of key molecules in the inflammatory response. The association of the -308 and -238/ -376 polymorphisms with specific alleles of the HLA is reconfirmed. (c) 2005 Taylor & Francis on license from Scandinavian Rheumatology Research Foundation

22. NAGAOKA S, NAKAMURA M, SENUMA A, SEKIGUCHI A: [A clinical trial of low dose methotrexate therapy in patients with rheumatoid arthritis]. Nihon Rinsho Meneki Gakkai Kaishi 28:6 389-397, 2005
    Organism: Department of Rheumatology, Yokohama Minami Kyosai HospitalFAU - Nagaoka, Shouhei
    Abstract: The efficacy and safety of MTX in active RA were evaluated based on patient medical records. The study population consisted of 460 patients with active RA who had received no prior MTX therapy and started it at our hospital between August 1998 and December 2003 (80 men and 380 women with a mean age of 59.3 years). After 24 weeks of MTX therapy, 61.3% of patients showed a 20% improvement, and 30.4% achieved a 50% improvement according to the ACR criteria. The cumulative rate of patients who continued MTX therapy for 48 weeks was 0.567. During the observation period, 260 patients (56.5%) experienced 304 adverse reactions. 52 patients (11.3%) discontinued treatment because of adverse reactions, and 10 patients (2.2%) died. The adverse reactions that occurred in at least 1% of patients were: abnormal hepatic function (31.7%), infection (6.1%), gastrointestinal symptoms (5.0%), stomatitis (3.9%), hematological abnormalities (3.5%), fracture (3.5%), malignant tumor (2.6%), interstitial pneumonia (2.0%), cerebrovascular or cardiovascular disorder (2.0%), headache (1.7%), eruption (1.3%), and alopecia (1.1%). Adverse reactions were more common in the elderly and patients with advanced stage disease. This study reaffirms the therapeutic benefit of MTX, but suggests that careful monitoring is of great importance

23. PHELAN JD, THOMPSON SD, GLASS DN: Susceptibility to JRA/JIA: complementing general autoimmune and arthritis traits. Genes Immun 7:1 1-10, 2006
    Organism: William S Rowe Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USAFAU - Phelan, J D
    Abstract: Juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA), includes the most common chronic autoimmune arthropathies of childhood. These two nomenclatures for classification include components representing the major subclasses of disease. The chromosomal regions and the genes involved in these complex genetic traits are being elucidated, with findings often specific for a particular disease subtype. With the advent of new SNP technologies, progress is being made at an ever-increasing pace. This review discusses the difficulties of deciphering the genetic components in complex disorders, while demonstrating the similarities that JRA shares with other autoimmune disorders. Particular emphasis has been placed on positive findings either for candidate genes that have been replicated independently in JRA/JIA, or findings in JRA for which consistent results have been reported in other forms of autoimmunity

24. RAJARAMAN RT, KIMURA Y, LI S, HAINES K, CHU DS: Retrospective case review of pediatric patients with uveitis treated with infliximab. Ophthalmology 113:2 308-314, 2006
    Organism: Joseph M Sanzari's Children Hospital, Hackensack University Medical Center, Hackensack, New Jersey, USAFAU - Rajaraman, Ravindran T
    Abstract: PURPOSE: To assess the response and adverse events associated with infliximab treatment for refractory, noninfectious pediatric uveitis. DESIGN: Retrospective noncomparative case series of pediatric patients with refractory uveitis treated with infliximab. PARTICIPANTS: Six patients were identified. Diagnoses of the participants included idiopathic uveitis (n = 1), juvenile rheumatoid arthritis with uveitis (n = 3), idiopathic retinal vasculitis with uveitis (n = 1), and bilateral pars planitis, with vitreitis and papillitis of the left eye (n = 1). Uveitis developed in the patients (5 female, 1 male) at a mean age of 9.0 years (+/-5.0 years; range, 0.9-14.8 years). All patients had bilateral eye involvement. These patients were refractory to or dependent on topical steroids (n = 4), oral prednisone (n = 3), or both, and were also refractory to the following therapies: methotrexate (n = 6), cyclosporine (n = 3), mycophenolate mofetil (n = 3), etanercept (n = 3), and daclizumab (n = 1). INTERVENTION: All patients initially received infliximab at doses between 5 and 10 mg/kg at 2- to 4-week intervals, and then were maintained at 4- to 8-week intervals at doses of 5 to 18 mg/kg. Mean follow-up time on treatment has been 48.1 weeks (+/-14.9 weeks; range, 32-74 weeks). MAIN OUTCOME MEASURES: Primary outcome measures included the quantitative measurement of the amount of ocular inflammation in different locations within the eye. Patients were monitored for infusion reactions as well as other potential side effects. The children's clinical status, complete blood counts, and liver function panels were monitored by pediatric rheumatologists every 6 weeks. RESULTS: All 6 patients showed reduction in their intraocular inflammation after infliximab therapy was initiated. Furthermore, control of ocular inflammation was achieved while receiving infliximab therapy. Topical and systemic corticosteroids were able to be discontinued in all patients except for 1 patient, who is currently weaning off prednisone. The only adverse reactions seen were the development of vitreous hemorrhage in 1 patient and a case of transient upper respiratory infusion reaction. No patient has had to discontinue treatment. CONCLUSIONS: Infliximab seems to be an effective agent for the treatment of refractory pediatric uveitis without apparent serious toxicity in this series of patients

25. SALAFFI F, DE ANGELIS R, GRASSI W: Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol 23:6 819-828, 2005
    Organism: Dipartimento di Patologia Molecolare e Terapie Innovative, Cattedra di Reumatologia, Universita Politecnica delle Marche, Italy fsalaff@tinitFAU - Salaffi, F
    Abstract: OBJECTIVE: The objective of the MAPPING study was to estimate the prevalence of musculoskeletal conditions in an Italian population sample. METHODS: Questionnaires were sent to a random sample of 3664 individuals aged 18 years and over, stratified for age and gender, selected from the practice lists of 16 general practices. Trained rheumatologists carried out structured visits in which subjects were asked about musculoskeletal symptoms and socio-demographic characteristics, and underwent a standardized physical examination. Cases were defined by previously validated criteria. RESULTS: A total of 2155 subjects participated in the study (response rate 58.8%). The overall prevalence of musculoskeletal conditions in the general adult population was 26.7% (95% CI 25.4-28.5), being significantly higher among women than men (p < 0.0001). Disease prevalence increased significantly with age (p < 0.0001). The most common disease group was symptomatic peripheral osteoarthritis (SPOA), with a prevalence of 8.95% (95% CI 6.81-10.7), followed by soft tissue disorders--STD (8.81%; 95% CI 7.16-10.29), low back pain--LBP (5.91%; 95% CI 4.89-6.89), and inflammatory rheumatic disease--IRD (3.06%; 95% CI 2.38-3.93). The estimated rates of disease prevalence were as follows: rheumatoid arthritis: 0.46% (95% CI 0.33-0.59); psoriatic arthritis: 0.42% (95% CI 0.31-0.61); ankylosing spondylitis: 0.37% (95% CI 0.23-0.49); polymyalgia rheumatica: 0.37% (95% CI 0.29-0.44); undifferentiated connective tissue disease: 0.14% (95% CI 0.09-0.21); crystal arthropathies, including gout 0.46% (95% CI 0.34-0.57) and chondrocalcinosis: 0.42% (95% CI 0.33-0.58); symptomatic knee osteoarthritis (OA): 5.39% (95% CI 3.41-7.99); hip-OA: 1.61% (95% CI 1.39-1.87); hand-OA: 1.95 (95% CI 1.22-2.48); fibromyalgia: 2.22% (95% CI 1.36-3.19); shoulder tendinitis/adhesive capsulitis: 3.06% (95% CI 2.11-4.09); carpal tunnel syndrome: 1.90% (95% CI 1.06-2.29), localized regional pain syndromes of the neck: 0.88% (95% CI 0.561.29), and lateral epicondylitis 0.74% (95% CI 0.47-1.33). CONCLUSIONS: The MAPPING study indicates that musculoskeletal conditions are common in the general adult population of Italy. These data are useful in planning the provision of healthcare

26. SMITH AM, SPERLING JW, O'DRISCOLL SW, COFIELD RH: Arthroscopic shoulder synovectomy in patients with rheumatoid arthritis. Arthroscopy - Journal of Arthroscopic and Related Surgery (United States ) 22:1 50-56, 2006
    Abstract: Purpose: Currently, there is little information available concerning the results of shoulder synovectomy in patients with rheumatoid arthritis. Furthermore, it remains difficult to assess the success of shoulder synovectomy because of a high association of rotator cuff tears in rheumatoid patients. We hypothesized that synovectomy in patients with a functionally intact rotator cuff would provide durable pain relief. Type of Study: Case series. Methods: Sixteen shoulders in 13 patients with rheumatoid arthritis were treated with arthroscopic shoulder synovectomy from 1988 to 2002 with a mean fo llow-up of 5.5 years. Patients with full-thickness rotator cuff tears or partial tears that required repair were excluded. Two of the 13 patients had been diagnosed with juvenile rheumatoid arthritis and 11 had adult-onset disease. The medical records of the patients were reviewed and patients were assessed clinically and by questionnaire to assess pain, satisfaction, range of motion, radiographic outcomes, and occurrence of complications. Results: There was an improvement in pain at long-term follow-up in 13 of 16 patients (P < .001). Active shoulder elevation improved from a median of 145degrees to 160degrees but was not significant (P = .14). External rotation improved significantly (P = .01) from a median of 45degrees (range, 0degrees to 90degrees) to 60degrees (range, 0degrees to 100degrees). According to the Neer rating system, there were 5 excellent, 8 satisfactory, and 3 unsatisfactory results. Seven of 8 shoulders followed-up radiographically for more than 1 year showed radiographic progression of disease. All 3 patients reporting pain that was no better or worse than before surgery had radiographic arthrosis at last follow-up with advancing periarticular erosions and reduction of glenoid articular space. Conclusions: Arthroscopic synovectomy of the shoulder in patients with rheumatoid arthritis with an intact rotator cuff offers a reliable decrease in pain with less predictable improvements in range of motion. Limitations in predicting final results based on preoperative radiographs should be discussed with patients; those with more advanced radiographic changes may not benefit from the procedure. Level of Evidence: Level IV, therapeutic study, case series, no control group. (c) 2006 by the Arthroscopy Association of North America

27. SPARSA A: Etanercept
    ETANERCEPT. Annales de Dermatologie et de Venereologie (France ) 132:11 I 861-876, 2005
    Abstract: Etanercept (Enbrel(R), Wyeth Pharmaceuticals) is a fusion protein composed of a soluble TNF alpha receptor issued from bio-technology. It is a member of TNF alpha's family with two others marked infliximab (Remicade(R), Scheringh Plough Laboratory), chimeric monoclonal antibody (25 p. 100 mouse) and adalimumab (Humira(R), Abbott France Laboratory), humanized monoclonal antibody (100 p. 100 human). In United States, etanercept is approved by Food and Drug Administration, since 1998, to treat rheumatoid arthritis showing an inadequate response to prior therapy with other disease-modifying antirheumatic drugs (DMARDS). In France, the MA (Marketing Authorization) is more recent, in 2000, etanercept to treat active rheumatoid arthritis who showed an inadequate response to others DMARDS (like methotrexate for example), with opportunity, in 2002, to administer etanercept in active, severe RA, in first line treatment without previous use of methotrexate. Others MA have been obtained in ankylosing spondylitis (2004) polyarticular-course juvenile rheumatoid arthritis (2000), and in the treatment of psoriasic arthritis (2002). Request of MA have been realised to treat cutaneous mild to severe psoriasis in adult, which failed to respond, contradication or no tolerance with systemic treatment as methotrexate, cyclosporine or phototherapy. Among the others anti-TN F therapy, only infliximab can be prescribed, in der matology, to treat psoriatic arthritis in France. Encouraging good results were the subject of cases report, but lacking clinical trial, predicting probably administration of etanercept in others indications in future. TNF alpha is a proinflammatory cytokine and plays an important role in the physiopathology of large inflammatory diseases. Logically, in future, we should increased prescription of biotherapy, particularly anti-TNF alpha. We have to mind short or mild-term adverse events, widely described in the literature, but long-term side effects remained unknown. Moreover, these biotherapic agents have a high cost and should be estimate

28. WALLEN M, GILLIES D: Intra-articular steroids and splints/rest for children with juvenile idiopathic arthritis and adults with rheumatoid arthritis. Cochrane Database Syst Rev1 CD002824, 2006
    Abstract: BACKGROUND: Resting or immobilizing a joint to enhance outcomes following intra-articular (IA) steroid injection is generally advocated. This systematic review aimed to determine the efficacy of IA steroid injections and the influence of post-injection rest. OBJECTIVES: 1. Compare IA steroid injections versus no treatment or placebo. 2. Determine the effects of rest following IA steroid injection in rheumatoid or juvenile idiopathic arthritis. SEARCH STRATEGY: The Cochrane Central Register of Controlled Trials (CENTRAL- Issue 4, 2003), Cochrane Database of Systematic Reviews (CDSR - Issue 4, 2003), Database of Abstracts of Reviews of Effectiveness (DARE - searched 8.1.04), MEDLINE (1966 to August Week 2 2004), EMBASE (1980 to August Week 2 2004) , CINAHL (1982 to December Week 2 2003), Clinical Trials site of the National Institute of Health, (USA - searched 8.1.04), OTseeker (Occupational Therapy Systematic Evaluation of Evidence - searched 8.1.04) and PEDro (Physiotherapy Evidence Database - searched 8.1.04) were searched. Journals and reference lists were hand searched. SELECTION CRITERIA: Eligible were randomised controlled trials of IA steroid injections or of rest following IA steroid injections in rheumatoid or juvenile idiopathic arthritis. DATA COLLECTION AND ANALYSIS: Potentially relevant references were evaluated and all data extracted by two independent reviewers. MAIN RESULTS: Five trials (n=346) examining IA steroid injection in the knee joint were included. It was not possible to pool data as outcome measures, timing of follow up and the methods of data reporting differed between trials. There was inconclusive conflicting evidence from two trials that walking time was reduced. There was evidence from one moderate quality trial that pain was reduced at 1-day post-injection (0-100 VAS from 28.33 to 13.46; McGill Pain Scale from 8.89 to 3.96) but not at 1 week or 7-12 weeks post-injection. There is some evidence that IA injections improved knee flexion (by 14 degrees) and reduced knee extension lag (by 20 degrees), knee circumference (median reduction = 0.3 cm) and morning stiffness (reduced from 60 mins to 7.6 mins). One trial (n=91) examined the effects of rest following injection in the knee. The rested group achieved significant improvement in pain, stiffness, knee circumference, and walking time when compared with the non-rested group (no point estimates provided). One trial evaluated rest following injection of the wrist (n=117). Relapse rate was higher in the rested group (rest relapse rate = 24/58, no-rest group = 14/59); but there were no differences between the rested and non-rested groups on pain, joint circumference, wrist function, grip strength or ROM. AUTHORS' CONCLUSIONS: There is some evidence to support the use of IA steroid injections and resting a knee following injections but that wrists should not be rested following injections. The included studies involved adult participants so any conclusions can only cautiously applied to children. Further research is required to examine the use and type of rest and the differential responses of different joints following injections

29. WATERHOUSE PJ, THOMASON JM, FITZGERALD JF, FOSTER HE, STEEN IN, WELBURY RR: The dental attitudes, knowledge and health practices of patients with Juvenile Idiopathic Arthritis. Eur J Paediatr Dent 6:4 202-208, 2005
    Organism: School of Dental Sciences, University of Newcastle upon Tyne, Newcastle upon Tyne, UK pjwaterhouse@nclacukFAU - Waterhouse, P J
    Abstract: AIM: To investigate the dental attitudes, knowledge and dental health practices of children and adults with a previous diagnosis of Juvenile Idiopathic Arthritis (JIA). STUDY DESIGN: A self-completion questionnaire. METHODS: Ninety-one children and 82 adults with JIA were age and gender matched with 152 healthy controls. For those below the age of 16 years, the parents' attitude, knowledge and dental health practices were investigated by the questionnaire. The adult subjects and controls completed an identical questionnaire assessing their own attitude, knowledge and dental health practices. RESULTS: Response rates of 84% and 75% were achieved for the subject and controls respectively. Both groups responded similarly to questions assessing perception of different medical conditions. The majority of respondents thought leukaemia was a very serious condition. Twenty-seven percent of subjects and 34% of controls felt dental decay was "slightly or not serious". Ninety percent of subjects and 93% of controls knew having sweet snacks during the day would harm teeth, but fewer were sure that eating sweet foods at mealtimes only would help reduce decay. The majority of respondents (63% and 56% respectively) did not know whether children should receive fluoride tablets but the majority of subjects in both groups had attended a dentist within the last year. STATISTICS: Descriptive analyses and chi-squared analysis were undertaken. A p-value of < or =0.01 was taken as strong evidence of a difference between groups. CONCLUSION: The perception of health and illness by both groups was appropriate. The questions investigating dental knowledge revealed understanding of the basic messages of prevention of dental disease, but finer detail appeared less well understood. Responses concerning dental health confirmed positive attitudes towards good dental health habits. The benefits of brushing with fluoride toothpaste were known, and the majority toothbrushed daily and received dental care within the previous year

30. ZYGMUNT A, BIERNACKA-ZIELINSKA M, BROZIK H, SMOLEWSKA E, STANCZYK J: Rheumatic diseases in the population of children and adolescents from the macroregion of L(stroke)odz
    CHOROBY REUMATYCZNE W POPULACJI DZIECI I Ml(stroke)ODZIEZY MAKROREGIONU l(stroke)ODZKIEGO. Pediatria Polska (Poland ) 80:11 995-1001, 2005
    Abstract: Background: The epidemiology of rheumatic diseases in children in Poland has changed considerably in the recent years. Aims: The objective of our paper was to evaluate the reasons for which children were referred to the Rheumatology Outpatient Clinic (ROC) in a tertiary clinical hospital of the Medical University of Lodz (Poland) in years 2000-2001, to establish the frequency of particular rheumatic diseases in the group of examined patients and to compare the present profile of pediatric rheumatology practice to the profile described in our service in the years 1973-1987. Methods: A retrospective chart review of 727 new patients seen at ROC from January 1 2000 to December 31 2001 was performed. Results: Musculoskeletal pain was the most co mmon complaint for which children were referred to rheumatologist, as it was present in 70% of the patients. Only 16% of these children complained of isolated pain, whereas the rest of them presented with additional symptoms as well. The second large group (17%) was constituted by patients who were referred to a rheumatologist because of serendipitously detected laboratory abnormalities indicating some rheumatological condition, mostly with elevated antistreptolysin O (ASO) titers. Reactive arthritis or reactive arthralgia were the most frequent diagnoses in ROC (33.4%), in over half of the patients they were associated with streptococcal infection. Moreover, elevated ASO titer was an isolated abnormality in 16.5% of all patients. Inflammat ory systemic connective tissue disease (ISCTD), mostly juvenile idiopathic arthritis (JIA), was diagnosed in 153% of the children, while an additional 6.6% of them are still under observation for such a condition. Acute rheumatic fever was diagnosed in only 15% of the patients. Comparing results of the present study to data from years 1973-1987 we noticed a significant decrease of the frequency of acute rheumatic fever and a significant increase in the frequency of ISCTD in children. The estimated annual incidence rate for JIA in our region is about 7/100 000 children. Conclusions: 1. The examined population was characterized by a low frequency of confirmed rheumatic fever cases, despite the high prevalence of streptococcal infection. 2. The number of children with the diagnosis of ISCTD has increased in our region