Bibliography April 06

1. ALMEIDA SILVA CA, MAISSE SR, LEAL MM, LIPHAUS BL, CAMPOS LMMA, DE BARROS VV, ZUGAIB M: Sexuality aspects and pregnancy of adolescents with juvenile idiopathic arthritis (JIA)
   ASPECTOS DA SEXUALIDADE E GRAVIDEZ EM ADOLESCENTES COM ARTRITE IDIOPATICA JUVENIL (AIJ). Revista Brasileira de Reumatologia (Brazil ) 45:3 175-179, 2005
   Abstract: The objective of the present study is to describe the sexuality aspects, pregnancy und postpartum in three adolescents with juvenile idiopathic arthritis (JIA). From 1983 to 2004, 4,638 patients were followed at the Pediatric Rheumatology Unit of the Pediatric Department of FMUSP, of which 537 (11.5%) were diagnosed with JIA (ILAR criteria) and three of these patients became pregnant during the follow-up period. The age at their first sexual intercourse ranged from 16 to 18 years old. Patient 1 presented a twin pregnancy, with active disease throughout pregnancy, and was on 15 mg of prednisoneper day. Patients 2 and 3 were at disease remission, with no drug treatment, and had full-term pregnancies free of complications; patient 2, however, had a disease flare-up one year after the delivery. All newborns were adequate for gestational age and developed no complications during the neonatal period. Only patient 1 required prednisone, naproxen e chloroquine during breast-feeding. The increased frequency of pregnancy in adolescents is a reality in pediatric rheumatology centers, and it shows the importance of more debate concerning sexuality aspects and contraception in this population

2. BALESTRI M, CERMINARA C, BOMBARDIERI R, PEROZZI P, FRAIETTA M, GENNARO L, SERI S, CURATOLO P: Juvenile rheumatoid arthritis and myoclonic epileptic manifestations
   ARTRITE REUMATOIDE GIOVANILE E MIOCLONIE EPILETTICHE. Bollettino - Lega Italiana contro l'Epilessia (Italy ) -:129-130 51-52, 2005
   Abstract: Juvenile rheumatoid arthritis (JRA) is a heterogeneous group of diseases probably autoimmune with rare cerebral involvement. We report the case of a young girl affected by JRA who manifested frequent myoclonic epileptic events. We suggest the possibility of a correlation between myoclonic epileptic manifestations and a complex and heterogeneous condition as idiopatic juvenile rheumatoid arthritis

3. BISOTTO LS, XAVIER RM, MACHADO SH, BREDEMEIER M, BRENOL JCT: Impact of inflammatory activity and glucocorticoid use in the nutritional variables of juvenile idiopathic arthritis
   IMPACTO DA ATIVIDADE INFLAMATORIA E USO DE GLICOCORTICOIDE NAS VARIAVEIS NUTRICIONAIS DA ARTRITE IDIOPATICA JUVENIL. Revista Brasileira de Reumatologia (Brazil ) 45:5 291-300, 2005
   Abstract: Objective: To assess the nutritional status in juvenile idiopathic arthritis (JIA) and the influence of inflammatory activity and glucocorticoid use. Methods: One hundred and sixteen patients were evaluated. Disease subtype and disease activity were defined by the attending physician, and the cumulative glucocorticoid dose was recorded by chart review. The percentiles of body mass index (BMI) and triceps skinfold (TSF) and the Z-score for height were determined: low weight and low adiposity were diagnosed when BMI and TSF were below the 5th percentile. Short stature was defined by a Z-score of height for age < -2. The serum level of IGF-I was measured by radioimmunoassay. Results: The prevalences of low weight, low adiposity and short stature were 16.4%, 20.7% and 10.4%, respectively. Low IGF-1 serum level was found in 14 patients (12.1%). The factors negatively associated with the Z-score of height in multivariable regression analysis were disease duration (partial correlation coefficient, 95% confidence interval: -0.370, -0.527 to -0.188; p < 0.001), erythrocyte sedimentation rate (ESR) (-0.357, -0.516 to -0.174; p < 0.001), polyarticular or systemic subtype (-0.290, -0.459 to -0.100; p = 0.003), while there was no significant association with the cumulative dose of glucocorticoids (0.086, -0.111 to 0.277; p = 0.391). None of these variables were significantly associated with the percentiles of BMI or TSF, but patients with a systemic or polyarticular subtype tended to present lower percentiles of BMI (p = 0.051). Conclusions: Nutritional status is frequently compromised in JIA. The duration and subtype of the disease and the ESR are factors independently associated with short stature. The cumulative dose of glucocorticoids was not independently associated with short stature or other nutricional variables

4. BRUNNER HI, SHERRARD TM, KLEIN-GITELMAN MS: Cost of treatment of childhood-onset systemic lupus erythematosus. Arthritis Rheum 55:2 184-188, 2006
   Organism: Cincinnati Children's Hospital Medical Center, William Rowe Division of Rheumatology E 4010, University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA herminebrunner@cchmcorgFAU - Brunner, Hermine I
   Abstract: OBJECTIVE: To determine the direct cost of care of children with childhood-onset systemic lupus erythematosus (cSLE), and to determine the direct cost per quality-adjusted life year (QALY) with cSLE. METHODS: Administrative databases from 2 large tertiary pediatric rheumatology centers in the United States were reviewed for all patients with cSLE (n = 119) diagnosed and regularly treated in these centers between January 2001 and April 2004. Health-related quality of life estimates for patients with cSLE (n = 297) reported in the literature were used to calculate QALYs based on global health ratings of the Child Health Questionnaire (range 0-100). RESULTS: Information on 3,184 patient-months of followup was included in the analysis. During a mean +/- SD followup of 27 +/- 11.8 months, the direct cost of care for the cohort amounted to $3,965,048, excluding outpatient medications. Irrespective of patient sex, the mean +/- SD cost of cSLE per month was $1,245 +/- $2,352, or approximately $14,944 per year. Inpatient and day hospital care accounted for 28% of the cost, laboratory testing accounted for 21%, inpatient/day-patient medication costs accounted for 13%, and dialysis accounted for 11%. Visits to the rheumatology clinic only contributed 9% to the direct cost of care. When including an estimated outpatient medication cost of $1,190, the direct cost of cSLE per QALY was $30,908. CONCLUSION: Children diagnosed with cSLE were found to have a considerable direct cost of care. The treatment of cSLE appears to be far more costly than that of adult SLE and juvenile idiopathic arthritis reported in the literature

5. CHAUDHARI M, MOROLDO MB, SHEAR E, HILLARD P, THOMPSON SD, LAN D, HUANG B, BRUNNER HI, GLASS DN: Impaired reproductive fitness in mothers of children with juvenile autoimmune arthropathies. Rheumatology (Oxford) .: 2006
   Organism: Division of Rheumatology, University of Cincinnati, Cincinnati, OH, USA
   Abstract: Objective. To assess the reproductive fitness of mothers of children with juvenile idiopathic arthritis (JIA). Methods. A mail survey assessing pregnancy outcome was carried out among mothers of children with JIA (JIA mothers) treated at a tertiary paediatric rheumatology centre. The best friends of the JIA mothers served as controls. Besides family history, sociodemographics and reproductive outcomes were measured, including the number of pregnancies, pregnancy complications and gestational age at the time of delivery. Results. JIA mothers (n = 227) and controls (n = 235) had similar sociodemographics and racial backgrounds. On average, JIA mothers reported a greater number of conceptions than controls (3.5 vs 3.1; P = 0.01) but had significantly higher rates of pregnancy complications (25% vs 15%; P<0.001). Corrected for differences in the absolute number of pregnancies between groups, the chances of having a miscarriage [mean (s.d.), 0.12 (0.18) vs 0.09 (0.16); P = 0.02] or preterm delivery [0.08 (0.21) vs 0.04 (0.15); P<0.02] were significantly greater among JIA mothers than controls. Conclusions. Mothers of children with JIA have impaired reproductive fitness. This phenomenon is unlikely to be the result of difficulty with conception but rather to be due to higher rates of pregnancy loss and premature delivery

6. FACO MM, NUKUMIZU LA, DE MORAES AJP, BARROS PCB, TROSTER EJ, DA SILVA CAA: Deaths and necropsies evaluation in hospitalized patients of a Pediatric Rheumatology Unit for a period of ten years
   AVALIACA(tilde)O DOS OBITOS E NECROPSIAS EM PACIENTES INTERNADOS EM UM SERVICO DE REUMATOLOGIA PEDIATRICA POR UM PERIODO DE DEZ ANOS. Revista Brasileira de Reumatologia (Brazil ) 45:2 55-63, 2005
   Abstract: Objective: to correlate the clinical data of necropsies in hospitalized patients of a Pediatric Rheumatology Unit. Methods: this study is a historic cohort. In ten years, from January 1994 to December 2003, there were 57,159 hospitalizations with 1,907 (3%) deaths in Instituto da Crianc(cedil)a. From these hospitalizations, 548 (1%) presented rheumatic or pediatric diseases and were followed by the Pediatric Rheumatology Unit, involving 348 patients. The deaths and necropsies were analyzed and the Goldman Classification was used to detect any disagreement between the clinic diagnosis and the n ecropsy. Results: over the period of this study, 34 (10%) of patients died. The main diseases that caused deaths were: juvenile systemic erithematosus lupus (JSLE) in 18 patients (53%) and juvenile idiopathic arthritis (JIA) in 7 cases (21%). Necropsies were done in 21 patients (64% of deaths). In 18 cases of JSLE, disease activity was present in 16 cases, being associated to septicemia in 15. Differences between the clinical diagnosis and necropsy were observed in 6 cases of JSLE: 3 with fungal infection, 1 with tuberculosis, 1 with diffuse proliferative nephritis and 1 with atherosclerosis. Seven patients with JIA died: septicemia in 4 and macrophage activation syn drome in 3. In 1 case of JIA were detected only by necropsy: Hodgkin lymphoma, atherosclerosis and anterior myocardial infarction. Conclusions: the frequency of deaths was 10% and necropsy showed infection disease, atherosclerosis or malignancy not detected previously. Necropsy is important to determine events not detected or doubtful in death patients and must always be requested

7. FITCH PG, CRON RQ: Septic abscess in a child with juvenile idiopathic arthritis receiving anti-tumor necrosis factor-alpha. J Rheumatol 33:4 825-827, 2006

8. FROMMELT PC: Echocardiographic measures of diastolic function in pediatric heart disease. Curr Opin Cardiol 21:3 194-199, 2006
   Organism: Division of Pediatric Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin, USAFAU - Frommelt, Peter C
   Abstract: PURPOSE OF REVIEW: The past year has seen a continued evolution in the echocardiographic assessment of diastolic function in children. This paper reviews published studies from the past year that have helped characterize diastolic function using echocardiography in children. RECENT FINDINGS: Characterization of diastolic function using Doppler and Doppler tissue imaging in the normal infant and child was a primary focus of pediatric echocardiographic investigation. These technologies appear to hold significant promise as tools to improve understanding of diastolic function in the normal child as the heart matures. Diastolic function in children with congenital heart disease has also been better characterized using these tools, specifically in patients with atrial septal defects, tetralogy of Fallot, single ventricle physiology, and following cardiac transplantation. Finally, diastolic function in acquired heart disease or with systemic disease in the child has been evaluated using echocardiography, with recent reports describing findings in children with dilated cardiomyopathy, chronic renal disease, obesity, type I diabetes, juvenile rheumatoid arthritis, obstructive sleep apnea, and after anthracycline exposure for childhood cancer. SUMMARY: Pediatric echocardiography has clearly become the primary tool for describing and characterizing diastolic function in infants and children both with and without heart disease. It is becoming an important noninvasive diastolic monitoring tool that allows serial assessment of pathologic diastolic disease in both primary myocardial and systemic disease states

9. GARCIA-MUNITIS P, BANDEIRA M, PISTORIO A, MAGNI-MANZONI S, RUPERTO N, SCHIVO A, MARTINI A, RAVELLI A: Level of agreement between children, parents, and physicians in rating pain intensity in juvenile idiopathic arthritis. Arthritis Rheum 55:2 177-183, 2006
   Organism: Unita Operativa Pediatria II, Istituto di Ricovero e Cura a Carattere Scientifico G Gaslini, Universita di Genova, Largo G Gaslini 5, 16147 Genoa, ItalyFAU - Garcia-Munitis, Pablo
   Abstract: OBJECTIVE: To investigate the level of agreement between patients, mothers, fathers, and physicians in rating pain intensity in juvenile idiopathic arthritis (JIA), and to identify factors explaining discrepancies between raters. METHODS: Ninety-four children with JIA and their mothers and fathers were asked to rate independently the intensity of present pain and pain in the previous week on a visual analog scale. The physicians rated pain intensity after physical examination. Agreement between raters was determined using intraclass correlation coefficient and Bland and Altman method. Correlations of explanatory variables with discordance in rating pain intensity were determined by univariate and multivariate analyses. Explanatory variables included sex, age, JIA category, disease duration, results of study ratings, joint inflammation measures, and erythrocyte sedimentation rate. RESULTS: Agreement in rating present pain was moderate between children and mothers, but was poor between children and fathers and children and physicians. The agreement in rating pain in the previous week was moderate between children and mothers and children and fathers. Mother-father agreement was good. Parents and physicians agreed at a moderate level. In multiple regression analyses, only intensity of present pain was significantly associated with discordance within child-mother, child-father, and child-physician dyads. CONCLUSION: Children's ratings of pain were only in moderate agreement with those of their parents and were in poor agreement with those of the physicians, whereas the father and mothers agreed at a good level. The intensity of pain was the strongest determinant of discordance between children and other raters

10. GOGALNICEANU D, TRANDAFIR V, CHIRIAC R, GOGALNICEANU P: Temporomandibular joint ankylosis. A possible complication in juvenile psoriatic rheumatism. Rev Med Chir Soc Med Nat Iasi 109:3 652-659, 2005
    Organism: GrT Popa University of Medicine and Pharmacy Iali School of Dentistry, Department of Oral and Maxillofacial Surgery, School of MedicineFAU - Gogalniceanu, D
    Abstract: The authors present a rare case of bilateral temporomandibular joint ankylosis secondary to polyarticular juvenile psoriatic arthritis in a 24 year-old man. The patient first presented with arthritis of his right elbow joint at the age of 9, followed by involvement of the distal inter-phalangeal joints of his right foot and both sacroiliac joints. Serum rheumatoid factor was not detected. At the age of 16 he developed psoriatic lesions affecting his nails and skin. By the age of 20, clinical and radiological evidence of arthritis was detected in his tempormandibular joint (TMJ). Subsequently, the patient developed bilateral TMJ ankylosis over a period of 4 years. The patient was managed by bilateral resection of the ankylotic bone blocks, mobilization of the mandible and interposition of Dacron material between the two neoarticular surfaces. 10 months postoperatively the patient maintained an interincisal distance of 3 cm. Postoperative mechanotherapy was hindered by the limited use of the patients' hands

11. GOLDMUNTZ EA, WHITE PH: Juvenile idiopathic arthritis: a review for the pediatrician. Pediatr Rev 27:4 e24-e32, 2006
    Organism: Children's National Medical Center, Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USAFAU - Goldmuntz, Ellen A

12. GOODMAN SB, OH KJ, IMRIE S, HWANG K, SHEGOG M: Revision total hip arthroplasty in juvenile chronic arthritis%3a 17 revisions in 11 patients followed for 4%26ndash%3b12 years. Acta Orthop 77:2 242-250, 2006
    Organism: Department of Orthopaedic Surgery, Stanford University School of Medicine Stanford, tCaliforniaFAU - Goodman, Stuart B
    Abstract: Background Revision total hip arthroplasty (THA) in patients with juvenile chronic arthritis (JCA) is complicated by the young age of the patient, poor bone stock and small physical proportions. We report the complications and outcome of a prospective series of 17 revision THAs in Charnley class C JCA patients. Methods 15 acetabular components and 10 femoral components were revised. 13 cementless cups, 2 reconstruction/roof rings and cemented cups, and 4 cemented and 6 cementless femoral stems were implanted. 2 proximal femoral allografts and 1 strut allograft were used. Age at revision was 32 (21-53) years. Follow-up averaged 7 (4-12) years. Results 2 patients with cemented femoral stems developed loosening, osteolysis and fracture. Both were successfully revised to long-stem cementless implants with strut/proximal femoral allografts. 1 loose, worn cementless cup with osteolysis was revised. 1 patient with a peri-operative infection and late acetabular fracture had a loose, non-revised cementless cup. 1 case of sciatic nerve palsy occurred after revision using a reconstruction ring. 1 late infection necessitated resection arthroplasty. Harris hip scores improved from 53 (34-85) to 76 (47-96). Interpretation Revision THA in JCA has a substantial complication rate, even in experienced hands. The problem of obtaining long-term stable fixation, osteolysis, and replenishment of lost bone stock are major difficulties

13. HAUPTMANN G, MEYER A, LAMBERT B, GOETZ J, JAHN I, FINCK S, CRIBIER B, LIPSKER D: Homozygous type IC2 deficiency and immunoglobulin deficiencies in a HLA-B27 positive young girl presenting with an antinuclear antibody-positive juvenile rheumatoid arthritis. Mol Immunol 43:1-2 160, 2006

14. IESAKA K, KUBIAK EN, BONG MR, SU ET, DI CESARE PE: Orthopedic surgical management of hip and knee involvement in patients with juvenile rheumatoid arthritis. Am J Orthop 35:2 67-73, 2006
    Organism: Musculoskeletal Research Center, NYU-Hospital for Joint Diseases, New York, NY, USAFAU - Iesaka, Kazuho
    Abstract: Juvenile rheumatoid arthritis is the most common arthritic disease of childhood and a leading cause of childhood disability, affecting an estimated 300,000 US children and adolescents aged < or =16 years. Approximately 10% to 30% of patients experience functional deficits resulting from both the articular and systemic manifestations of their disease, including leg length inequality and deformity, that are often more crippling than joint destruction. Surgical intervention to treat bone and soft-tissue deformity, leg length inequality, and joint destruction is indicated when medical therapy has failed. Synovectomy, soft-tissue release, osteotomy, and epiphysiodesis are used to treat deformity and early joint destruction. Arthroplasty remains the primary therapy for joint destruction, although it is fraught with complications specific to this young patient population

15. KAUR PP, DERK CT, CHATTERJI M, DEHORATIUS RJ: Dr. Kaur, et al reply : Septic Abscess in a Child with Juvenile Idiopathic Arthritis Receiving Anti-Tumor Necrosis Factor-. J Rheumatol 33:4 826, 2006

16. KISHIMOTO T: Cytokines: From laboratory to clinic. Am J Reprod Immunol 52:Suppl. 1 7, 2004

17. KUTILEK S, BAYER M, DOLEZALOVA P, NEMCOVA D: Quantitative ultrasonometry of the calcaneus in children with juvenile idiopathic arthritis. Rheumatology (Oxford) .: 2006
    Organism: Department of Pediatrics, 1st Medical Faculty, Charles University, Prague, Czech Republic
    Abstract: Objectives. To evaluate bone quality by means of quantitative ultrasonometry (QUS) in children with juvenile idiopathic arthritis (JIA). Methods. Seventy children [37 with oligoarticular JIA, mean age (+/-s.d.) 10.54 +/- 3.42 yr; and 33 with polyarticular rheumatoid factor negative JIA, mean age (+/-s.d.) 11.33 +/- 2.88 yr] were enrolled. Quantitative ultrasonometry was measured on both heels with a Cuba Clinical portable device. Body height, weight and body mass index were recorded together with disease duration and cumulative dose of prednisone. Results. The lowest QUS parameters were observed in children with polyarticular JIA (P<0.001 and 0.01 when compared with reference data and oligoarticular JIA, respectively). In children with oligoarticular JIA, the QUS values were also significantly lower in comparison with the reference data (P<0.002). The QUS parameters were strongly influenced by body height, and to a lesser degree by body weight. In children with polyarticular JIA, there were significant inverse correlations between QUS parameters and disease duration [r=-0.57, P<0.01 for broadband ultrasound attenuation (BUA) and r=-0.67, P<0.01 for velocity of sound (VOS)]. Similarly, there were inverse correlations between QUS and cumulative dose of prednisone (r=-0.48, P<0.05 for BUA and r=-0.50, P<0.01 for VOS, respectively). Similar results were obtained when BUA and VOS were adjusted for height. Conclusions. Disease duration and cumulative dose of prednisone in children with polyarticular JIA are risk factors of stunted growth and decreased QUS values of bone quality

18. LAUNAY F, GUILLAUME J-M, GENNARI J-M, GONZALES J-F, BOLLINI G, KONE P, I: Polyarthritis and familial pulmonary fibrosis in a child. Joint Bone Spine (France ) 73:2 212-214, 2006
    Abstract: A 7-year-old girl presented with seropositive polyarthritis, autoimmune thyroiditis, and pulmonary fibrosis. Several family members had complex autoimmune disorders and pulmonary fibrosis, and the pedigree was consistent with autosomal dominant inheritance. The possible links between polyarthritis and familial pulmonary fibrosis are discussed, as well as the therapeutic challenges raised by this extraordinarily rare combination. (c) 2006 Elsevier SAS. All rights reserved

19. LIPINSKA J, SMOLEWSKA E, BROZIK H, STANCZYK J: Immunological markers in diagnosing and prognosing of JIA and RA
    MARKERY IMMUNOLOGICZNE W DIAGNOSTYCE I PROGNOZOWANIU Ml(stroke)ODZIENCZEGO IDIOPATYCZNEGO ZAPALENIA STAWOW I REUMATOIDALNEGO ZAPALENIA STAWOW. Alergia Astma Immunologia (Poland ) 10:3 117-124, 2005
    Abstract: Juvenile idiopathic arthritis (JIA), one of the connective tissue diseases of unknown etiology, causes progressive damage to the joints. It is essential to make a fast diagnosis and start immediate therapy to stop the progression of the disease. It is very difficult to diagnose the disease, especially at its early stage. The clinical symptoms are usually non-specific. In rheumatoid arthritis (RA) in adults, as well as in JIA, there are only a few serological markers with confirmed serological meaning; one of them is rheumatoid factor (IgM-RF) but, unlike in RA, in JIA it is found only in small amounts. Unfortunately, there is no correlation between IgM-RF and the severity of the clinical symptoms. IgM-RF could be also present in other disea ses. The search for a new serological marker with high sensitivity and specificity for JIA continues. Findings in RA patients indicate that antycytokeratin antibodies (AKA) and anti-CCP antibodies are very promising candidate markers. They are found in 40-90% RA patients also at early stages of the disease and have a pathognomical significance. Futrhermore, they are present in 20-25% of RF-negative cases. Anti-CCP antibodies seem to be the indicator of the activity and severity of the rheumatoid process and damages to bones and joints visible in X-ray images

20. LURATI A, PONTIKAKI I, TERUZZI B, DESIATI F, GERLONI V, GATTINARA M, CIMAZ R, FANTINI F: A comparison of response criteria to evaluate therapeutic response in patients with juvenile idiopathic arthritis treated with methotrexate and/or anti-tumor necrosis factor alpha agents. Arthritis Rheum 54:5 1602-1607, 2006
    Organism: Gaetano Pini Institute, Milan, Italy
    Abstract: OBJECTIVE: There are no validated criteria to evaluate clinical response in juvenile idiopathic arthritis (JIA). The purpose of this study was to compare 4 sets of criteria (2 from the American College of Rheumatology [ACR] and 2 from the European League Against Rheumatism [EULAR]) for clinical response evaluation in JIA patients treated with methotrexate and/or anti-tumor necrosis factor alpha drugs. METHODS: Seventy-five patients with JIA were evaluated at baseline and after 6 months of therapy with second-line drugs. Mean age at study onset was 12.8 years (range 2-32.9 years). Diagnoses were systemic JIA (n = 16), rheumatoid factor-positive JIA (n = 5), rheumatoid factor-negative JIA (n = 9), persistent oligoarticular JIA (n = 10), extended oligoarticular JIA (n = 33), and psoriatic arthritis (n = 2). Clinical response was evaluated with the ACR Pediatric 30 criteria and the ACR 20% response criteria (ACR20), and with the EULAR Disease Activity Score (DAS) and 28-joint DAS (DAS28). Patients with EULAR criteria responses of "good" or "moderate" were classified as responders. Responders and nonresponders according to the different criteria were then compared. RESULTS: For patients younger than 16 years, Cohen's kappa varied between 0.51 and 0.72, with a good-to-excellent reproducibility index for all comparisons, except for the DAS28/ACR20 comparison. The best agreement was obtained by comparing the DAS and the ACR Pediatric 30. For patients older than 16 years, the reproducibility index was good or excellent in only 2 cases, i.e., comparing the DAS and the ACR Pediatric 30 and comparing the DAS and the DAS28 (as expected). CONCLUSION: Our study shows a good agreement overall for the different criteria tested. The highest concordance was observed between the DAS and the ACR Pediatric 30, the lowest between the DAS28 and the ACR20. Our data suggest that the ACR Pediatric 30 criteria can be used also in adult patients affected by JIA, and that the original DAS can be an alternative to the ACR Pediatric 30 in both children and young adults with JIA

21. MACHADO C, RUPERTO N: Consensus in pediatric rheumatology: Part I - Criteria definition of inactive disease and remission in juvenile idiopathic arthritis/juvenile rheumatoid arthritis
    CONSENSO EM REUMATOLOGIA PEDIATRICA: PARTE I - DEFINICA(tilde) O DOS CRITERIOS DE DOENCA INATIVA E REMISSA(tilde)O EM ARTRITE IDIOPATICA JUVENIL/ARTRITE REUMATOIDE JUVENIL. Revista Brasileira de Reumatologia (Brazil ) 45:1 9-13, 2005
    Abstract: Validated and widely accepted criteria for clinical remission in JIA/JRA do not currently exist. Objective: To achieve consensus in this matter. Methods: The Delphi consensus-formation approach was used to gather the criteria in use by pediatric rheumatologists (PR) worldwide. Results from the questionnaires provided the basis for the development of a consensus conference using the nominal group technique (NGT) to reach consensus on questions not solvable by the questionnaire format. One hundred and thirty PR from 34 countries responded the Delphi questionnaires and 20 PR from 9 countries atte nded a 2-day consensus conference. Results: Consensus results were: criteria for inactive disease should include: 1) no active arthritis; 2) no fever, rash, serositis, splenomegaly, or generalised lymphadenopathy attributable to JIA/JRA; 3) no active uveitis; 4) normal ESR or CRP (if both are tested, both must be normal); 5) a physician's global assessment of disease activity rated at the best score possible and indicating no disease activity. Conclusions: According to consensus vote, 6 continuous months of inactive disease are necessary before classifying a patient as in remission on medicati on; 12 months off medication while maintaining inactive disease are necessary to classify a patient as in remission off medication. The criteria for in remission off medications should predict with 95% accuracy that a patient has a 20% probability of disease relapse within the next 5 years

22. METIVIER H, HASSON SM: Use of the faces pain scale to evaluate pain of a pediatric patient with pauciarticular juvenile rheumatoid arthritis. Physiotherapy Theory and Practice (United Kingdom ) 22:2 91-96, 2006
    Abstract: The Faces Pain Scale developed by Wong and Baker is a common assessment tool that uses cartoon-like faces to assess self-reported pain in children. The purpose of this case report is to explore the appropriateness of the Faces Pain Scale as an outcome measure for a young child with pauciarticular juvenile rheumatoid arthritis. The patient was a four-year-old boy who had undergone a synovectomy on his right knee secondary to pauciarticular JRA. Each session the patient was asked to rate his pain using the Faces Pain Scale. The patient gained full knee range of motion and his functional mobility improved compared to initial visit. His subjective pain rating remained co nstant at "no hurt" throughout three weeks of visits. His functional mobility did not match his subjective rating of pain via the Faces Pain Scale. Further research is needed to determine the relationship of pain, stiffness, and function in children with rheumatic diseases. Copyright (c) Taylor & Francis Group, LLC

23. MIRKINSON LJ, NAGLE D, JONES OY, KADOM N: Anakinra therapy in a child with systemic-onset juvenile rheumatoid arthritis after human herpesvirus 6 encephalitis. J Clin Rheumatol 12:2 83-86, 2006
    Organism: Department of Rheumatology, Children's National Medical Center, 111 Michigan Avenue NW, Washington, DC 20010, USA mirkil@holycrosshealthorgFAU - Mirkinson, Laura J
    Abstract: A 3-year-old patient with biopsy-proven herpesvirus 6 (HHV-6) encephalitis developed a clinical condition consistent with systemic-onset juvenile idiopathic rheumatoid arthritis (SoJIA) and responsive to synthetic interleukin-1 (IL-1) receptor therapy. This suggested both a temporal relationship between HHV-6 infection and the development of SoJIA and the likely involvement of IL-1 in his disease. This case adds to the current experience of IL-1 receptor antagonist therapy in SoJIA. In addition, it suggests that future prospective studies in new-onset SoJIA should include an evaluation for HHV-6 infection

24. NGUYEN TT, ZLACKA D, VAVRINCOVA P, SEDLACEK P, HROMADNIKOVA I: Detection of antibodies against 60-, 65- and 70-kDa heat shock proteins in paediatric patients with various disorders using Western blotting and ELISA. Clin Chem Lab Med 44:4 442-449, 2006
    Organism: 1 Cell Biology Laboratory, Department of Paediatrics, 2nd Medical Faculty and University Hospital Motol, Charles University in Prague, Prague, Czech RepublicFAU - Nguyen, Thi Thu Hien
    Abstract: Background: We examined antibodies against 60-, 65- and 70-kDa heat shock proteins (HSPs) in paediatric healthy individuals, patients with juvenile idiopathic arthritis (JIA) and those undergoing allogeneic stem-cell transplantation for various malignant and non-malignant diseases. Methods: Western blotting and ELISA were used to examine HSP-directed humoral immune responses. Results: Using ELISA we detected anti-Hsp60, -Hsp65 and -Hsp70 IgG antibodies in patient sera before, during and after conditioning and at all post-transplant times, as well as in JIA patients and controls. Western blotting showed positivity for anti-Hsp60 and anti-Hsp65 antibodies in all samples with a HSP concentration of 0.5 mug/lane. However, anti-Hsp70 antibodies were not detected at all when both sodium dodecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) and native PAGE were used, except for one JIA patient, for whom a positive signal was only achieved in native PAGE when Hsp70 was increased to 2 mug/lane and serum dilution decreased to 1:10. Conclusion: Western blotting is convenient for the detection of anti-Hsp60 and anti-Hsp65 antibodies, but it is not sensitive enough for the detection of anti-Hsp70 antibodies. ELISA, which is more sensitive, might be preferentially used to screen anti-Hsp60, -Hsp65 and -Hsp70 antibodies in sera of children with various disorders

25. NIGROVIC PA, WHITE PH: Care of the adult with juvenile rheumatoid arthritis. Arthritis Rheum 55:2 208-216, 2006
    Organism: Center for Adults with Pediatric Rheumatic Illness, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, One Jimmy Fund Way, Smith 356, Boston, MA 02115, USA pnigrovic@partnersorgFAU - Nigrovic, Peter A

26. NISHIMOTO N: Interleukin-6 in rheumatoid arthritis. Curr Opin Rheumatol 18:3 277-281, 2006
    Organism: Laboratory of Immune Regulation, Graduate School of Frontier Biosciences, Osaka University, Osaka, JapanFAU - Nishimoto, Norihiro
    Abstract: PURPOSE OF REVIEW: Recent progress in cytokine studies has clarified the pathological roles played by cytokines and provided key evidence that antagonizing their actions can be therapeutic. The pathogenesis of rheumatoid arthritis, an autoimmune inflammatory disease, involves inflammatory cytokines such as tumour necrosis factor-alpha, interleukin-1 and interleukin-6. Anti-tumour necrosis factor-alpha and anti-interleukin-1 therapies have been used successfully to treat rheumatoid arthritis, but they are not consistently effective. We therefore need further therapies for this refractory disease. Interleukin-6 is another target molecule for blockade in the treatment of rheumatoid arthritis. Tocilizumab is a humanized antihuman interleukin-6 receptor monoclonal antibody designed to block the actions of interleukin-6. This review addresses the pathological significance of interleukin-6 and the current status of anti-interleukin-6 therapy for rheumatoid arthritis. RECENT FINDINGS: The safety and efficacy of tocilizumab have been demonstrated in clinical trials conducted in patients with rheumatoid arthritis and other autoimmune inflammatory diseases, such as juvenile idiopathic arthritis and Crohn's disease. SUMMARY: Clinical studies have demonstrated the pathological significance of interleukin-6 and the safety and efficacy of anti-interleukin-6 therapy with tocilizumab. Blockade of interleukin-6 - the second generation of anticytokine therapy - may be a promising treatment for rheumatoid arthritis

27. PELAEZ-BALLESTAS I, ROMERO-MENDOZA M, RAMOS-LIRA L, CABALLERO R, HERNANDEZ-GARDUNO A, BURGOS-VARGAS R: Illness trajectories in Mexican children with juvenile idiopathic arthritis and their parents. Rheumatology (Oxford) .: 2006
    Organism: Rheumatology Department, Hospital General de Mexico and Universidad Nacional Autonoma de Mexico, Faculty of Medicine, Mexico
    Abstract: Background. We hypothesize that the qualitative approach of socio-cultural aspects in children with juvenile idiopathic arthritis (JIA) and their parents would improve the understanding of their illness.Objective. To explain the phenomenon of experiencing JIA within a specific cultural context.Methods. The theoretical position of this research was based on the substantive theories of suffering, explanatory models and illness experience. Its design was that of qualitative field, and its analysis followed the interpretative grounded theory methodology. Data were collected by in-depth interviews and notes; tape recordings were transcribed verbatim, read and imported into the ATLAS/ti(R) 4.2 software. Data conceptualization, categorization and interpretation were based on the constant comparison method.Results. A total of 16 adults and six children from 10 families were interviewed. 'Pilgrimage' (metaphorically referred by some of the parents) was a major code in the study that reflected the religious reference to the trajectory of pain, faith and hope. For children, pilgrimage was conformed by immediate concepts; for parents, by historical and immediate experiences influenced by JIA subtype. Pilgrimage was consistent with the model of the illness trajectory theory, which conceptually relates to the idea that the course of chronic diseases is variable and modifiable throughout time.Conclusion. The qualitative approach of JIA provides wide and deep information on the perception that children and parents have about the disease. The illness trajectory theory corresponds to pilgrimage, the theoretical model for JIA in this study

28. PONTIKAKI I, GERLONI V, GATTINARA M, LURIATI A, SALMASO A, DE MARCO G, TERUZZI B, VALCAMONICA E, FANTINI F: [Side effects of anti-TNFalpha therapy in juvenile idiopathic arthritis.]. Reumatismo 58:1 31-38, 2006
    Organism: Istituto Gaetano Pini c/o UO Reumatologia infantile, Cattedra di Reumatologia, Universita di Milano, 20122 Milano, Italia pontikaki@tiscalinetitFAU - Pontikaki, I
    Abstract: OBJECTIVES: To report adverse events registered in our population affected by JIA and treated with anti-TNFalpha blockers. METHODS: Ninety-five patients were enrolled to be treated with Etanercept, median age 14 years (range 4-34); median duration of therapy 12 months (range 1-40). 19 patients were also treated with MTX (median dose 12.5 mg/week). Fifty-six patients were enrolled to be treated with Infliximab associated with MTX (median dose of MTX 8.8mg/week), median age 23.2 years (range 7.8-34.9); median duration of therapy 20.1 months (range 1.4-60.4). All adverse events were divided in definitely, probably and possibly related to the biologic agent. RESULTS: Side effects definitely related to Infliximab were the reactions to infusions and the Anti-dsDNA positivity. Side effects definitely related to Etanercept were severe headache and thrombocytopenia. Side effects probably correlated to both the biological agents were behavioural modifications and pain amplification syndrome. Probably correlated to the treatment with Etanercept was the onset of Crohn's disease in 3 patients. Possibly correlated to the biological agents were the new onset or flare-up of Chronic Iridocyclitis and single cases of thyroideal cancer, hypoglossal nerve paralysis and a severe Cytomegalovirus pulmonary infection. No case of tuberculosis infection was registered during this study. CONCLUSIONS: Treatment with a TNFalpha antagonist seems to be associated with various adverse events. Some of them, like onset of Crohn's disease, behavioural modifications are unusual and others, like pain amplification syndrome were never described before. Children and young adults affected by JIA should be monitored very carefully so as to limit as much as possible the risk of serious side effects on anti-TNFalpha therapy

29. QUARTA L, CORRADO A, MELILLO N, CANTATORE FP: Juvenile idiopathic arthritis: an update on clinical and therapeutic approaches. Ann Ital Med Int 20:4 211-217, 2005
    Organism: Clinica Reumatologica M Carrozzo, Universiti degli Studi di FoggiaFAU - Quarta, Laura
    Abstract: Juvenile idiopathic arthritis represents a heterogeneous group of autoimmune diseases. It arises before 16 years of age and lasts more than 6 months. We can distinguish many arthritis sub-types. A serious problem in juvenile idiopathic arthritis is skeletal growth retardation, osteopenia and greater risk of developing fractures. Juvenile idiopathic arthritis diagnosis is an exclusion diagnosis. Many conditions can simulate it. First-choice drugs in juvenile idiopathic arthritis treatment are nonsteroidal anti-inflammatory drugs, analgesic and antipyretic drugs. The second-choice drugs are "slow-acting" antirheumatic drugs, like methotrexate. The use of glucocorticoids is strongly influenced by their side effects, in particular the inhibition of statural growth and the premature appearance of osteoporosis. Recent findings on the central role of tumor necrosis factor-alpha, in particular damage pathogenesis in the course of juvenile idiopathic arthritis, have permitted the development of new therapeutic strategies (infliximab, etanercept), aimed at blocking this cytokine

30. REICHERT S, MACHULLA HK, FUCHS C, JOHN V, SCHALLER HG, STEIN J: Is there a relationship between juvenile idiopathic arthritis and periodontitis? J Clin Periodontol 33:5 317-323, 2006
    Organism: University School of Dental Medicine, Department of Operative Dentistry and Periodontology, Martin-Luther University, Halle-Wittenberg, GermanyFAU - Reichert, Stefan
    Abstract: Aim: The aim was to compare the prevalence of periodontal conditions in patients with juvenile idiopathic arthritis (JIA) (n=78, age 14.4 years) with those revealed in a healthy control group (n=75, age 15.5 years). Material and Methods: In both groups, the approximal plaque index (API), the modified sulcular bleeding index (SBI), and the clinical attachment loss (CAL) were determined. Laboratory parameters for JIA activity included the capsule-reactive protein (CRP) and the immunoglobulins A, G, M. Results: JIA patients had a significantly higher API (64.6%versus 49.9%, p=0.004) and slightly higher mean percentages of sites with CAL>3.5 mm (0.58%versus 0.22%, p=0.041). There was no significant difference in the prevalence of patients and controls who had sites with CAL >3.5 mm (25.6%versus 17.3%, p=0.212). The mean CAL was slightly greater (0.2 mm; p=0.030) in patients with CRP>/=5.0 mg/l compared with patients with CRP<5.0 mg/l. Patients who took non-steroidal anti-inflammatory drugs (NSAIDs) had a significantly decreased SBI (26.2%versus 51.1%, p=0.019). Conclusion: After adjustment for microbial plaque, JIA is not a risk factor for periodontitis

31. REIFF A, LOVELL DJ, VAN ADELSBERG J, KISS MH, GOODMAN S, ZAVALER MF, CHEN PY, BOLOGNESE JA, CAVANAUGH PF, JR., REICIN AS, GIANNINI EH: Evaluation of the Comparative Efficacy and Tolerability of Rofecoxib and Naproxen in Children and Adolescents with Juvenile Rheumatoid Arthritis: A 12-Week Randomized Controlled Clinical Trial with a 52-Week Open-Label Extension. J Rheumatol .: 2006
    Abstract: OBJECTIVE: To compare the safety and efficacy of rofecoxib* to naproxen for the treatment of juvenile rheumatoid arthritis (JRA). METHODS: This was a 12-week, multicenter, randomized, double-blind, double-dummy, active comparator-controlled, non-inferiority study with a prespecified 52-week open-label active comparator-controlled extension. Children (ages 2-11 yrs) and adolescents (ages 12-17 yrs) received lower-dose (LD)-rofecoxib [0.3 mg/kg/day up to 12.5 mg/day (base study only)]; or higher-dose (HD)-rofecoxib (0.6 mg/kg/day up to 25 mg/day) or naproxen 15 mg/kg/day as oral suspensions. Adolescents received daily rofecoxib (LD) 12.5 (base study only) or (HD) 25 mg, or naproxen 15 mg/kg/day (maximum 1000 mg/day) as tablets. The primary endpoint was the time-weighted average proportion of patients meeting the American College of Rheumatology Pediatric-30 (ACR Pedi 30) response criteria. A prespecified bound for the 95% confidence interval for the ratio of the percentage of ACR Pedi 30 responders was used to assess non-inferiority of treatment response between groups. Safety was assessed throughout the study. RESULTS: A total of 310 patients ages 2-17 years (181 (3/4) age 11) were randomized to receive LD-rofecoxib (N = 109), HD-rofecoxib (N = 100), or naproxen (N = 101). The ACR Pedi 30 response rates following 12 weeks of treatment were 46.2%, 54.5%, and 55.1%, respectively. The relative rates of response compared to naproxen were 0.81 (95% CI 0.61, 1.07) and 0.98 (95% CI 0.76, 1.26) for LD- and HD-rofecoxib, respectively. Both rofecoxib doses were not inferior to naproxen. Patients (N = 227) entering the extension received HD-rofecoxib or naproxen with efficacy maintained during the extension. All treatments were generally well tolerated throughout the study. CONCLUSION: Daily treatment of JRA patients with rofecoxib up to 12.5 or 25 mg was well tolerated, providing sustained clinical effectiveness comparable to naproxen 15 mg/kg. *On September 30, 2004, Merck & Co., Inc. announced the voluntary worldwide withdrawal of rofecoxib from the market

32. ROCHA FTL, JACOB CMA, SILVA CAA, PAIM LB, CASTRO A P M, PASTORINO AC, CHIABAI J, RUTZ R, KIRSCHFINK M: Complement and mannose binding lectin in juvenile idiopathic arthritis. Mol Immunol 43:1-2 180, 2006

33. SINGH-GREWAL D, SCHNEIDER R, BAYER N, FELDMAN BM: Predictors of disease course and remission in systemic juvenile idiopathic arthritis: Significance of early clinical and laboratory features. Arthritis Rheum 54:5 1595-1601, 2006
    Organism: The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
    Abstract: OBJECTIVE: To determine whether the disease course in systemic juvenile idiopathic arthritis (JIA) can be characterized as monophasic, polycyclic, or persistent, and to determine whether early clinical and laboratory characteristics can be used to predict the disease course and time to remission. METHODS: Forty-five children with systemic JIA diagnosed between 1996 and 2000 were followed up with a standardized data collection protocol, including data on clinical and laboratory features (mean followup 4.9 years). Disease was considered inactive if the clinical and laboratory features were normal. Three definitions of remission were applied to classify disease course. Predictors of disease course were evaluated using multiple logistic regression. Predictors of time to remission were evaluated using Cox proportional hazards regression. RESULTS: When applying a definition of remission requiring inactive disease while not receiving any medications for a period of 3 months, 42.2%, 6.7%, and 51.1% of the patients were classified as having monophasic, polycyclic, and persistent disease, respectively. Fever and active arthritis at 3 months (R(2) = 0.42, area under the receiver operating characteristics curve [AUC] = 0.76) and an erythrocyte sedimentation rate (ESR) >26 mm/hour and corticosteroid use at 6 months (R(2) = 0.49, AUC = 0.92) were predictive of a nonmonophasic course. Absence of active arthritis, an ESR of <26 mm/hour, and no requirement for corticosteroid therapy at 3 and 6 months were predictors of an earlier time to remission. CONCLUSION: The disease course in systemic JIA can be characterized as monophasic, polycyclic, or persistent using a definition of remission requiring 3 months of inactive disease while not receiving any therapy. Features at 3 and 6 months are predictive of the disease course and time to remission

34. SOLIS PV, CERES L, ALONSO I, MORENO E: Sarcoidosis as an uncommon cause of articular pathology in pediatric patients
    SARCOIDOSIS COMO CAUSA INFRECUENTE DE PATOLOGIA ARTICULAR EN LA EDAD PEDIATRICA. Radiologia (Spain ) 48:1 37-40, 2006
    Abstract: We present two cases of sarcoidosis with chronic arthropathy presenting clinical and imaging findings compatible with chronic juvenile arthritis. One patient suffered from chronic nephropathy, with anomalous US pattern and sarcoid granulomas demonstrated at renal biopsy. Throughout the illness, the patient suffered from cutaneous lesions that proved to be sarcoid granulomas after biopsy. US and color-Doppler US were useful in detecting the lesions and in the follow-up of the chronic articular pathology in these children. Although sarcoidosis is uncommon, it is important to consider this disease in the diagnosis of chronic arthropathy in children. We analyze these two cases and comment on the clinical and imaging characteristics of pediatric articular sarcoidosis

35. SOUZA L, MACHADO SH, BREDEMEIER M, BRENOL JCT, XAVIER RM: Erratum: Effect of inflammatory activity and glucorticoid use on nutritional variables in patients with juvenile idiopathic arthritis (Journal of Rheumatology (2006) 33 (601-608)). Journal of Rheumatology (Canada ) 33:4 829, 2006

36. TERRONES-MUNOZ V, MELOT C, GANGJI V, STEINFELD S, APPELBOOM T: Course of juvenile rheumatoid arthritis: social life is less affected than school functioning, physical activity, and well-being during a follow-up of 1.5-13 years. Eur J Pediatr 165:6 427-428, 2006
    Organism: Hopital Erasme, Universite libre de Bruxelles, Brussels, BelgiumFAU - Terrones-Munoz, V

37. VOLTARELLI JC, STRACIERI ABPL, OLIVEIRA MCB, GODOI DF, MORAES DA, PIERONI F, MALMEGRIM KCR, COUTINHO MA, SIMO T: Hematopoietic stem cell transplantation for rheumatic diseases. Part 1: International experience
    TRANSPLANTE DE CELULAS-TRONCO HEMATOPOETICAS EM DOENCAS REUMATICAS. PARTE 1: EXPERIENCIA INTERNACIONAL. Revista Brasileira de Reumatologia (Brazil ) 45:4 229-241, 2005
    Abstract: In this review, we discuss the results of hematopoietic stem cell transplantation (HSCT) for severe and refractory rheumatic diseases performed abroad. We briefly review clinical and experimental basis for those transplants and the international results obtained in systemic lupus erythematosus (SLE) (33/50 complete remissions in the European registry with 10 relapses and 12 deaths, and 41 durable remissions in an American study with 2 deaths post-mobilisation and 4 deaths posttransplantation), adult rheumatoid arthritis (58/73 partial remissions with 85% of relapses and only one death in the European registry), juvenile idiopathic arthritis (18/34 durable remissions and 5 deaths in the European registry), systemic sclerosis (SSc) (46/50 responders in a multicentric European study with 35% of relapses and 23% of mortality, while in an US series, 4/19 patients died, 2 had progressive lung disease and all the survivors improved the skin scores and quality of life) and several other diseases, including vasculidities (9/15 complete responses in the European registry). We conclude that in the international experience, autologous HSCT induces sustained remission in most severe and refractory rheumatic diseases except for adult rheumatoid arthritis, and this finding justifies starting prospective randomized trials of HSCT compared to optimal conventional therapy

38. VOLTARELLI JC, STRACIERI ABPL, OLIVEIRA MCB, GODOI DF, MORAES DA, PIERONI F, MALMEGRIM KCR, COUTINHO MA, SIMO T, MASSUMOTO C, HAMERSCHLAK N, SCHEINBERG M, FERREIRA E, COUTINHO M, OSTRONOFF M, STURARO D, DULLEY F: Hematopoietic stem cell transplantation for rheumatic diseases. Part 2: Brazilian experience and future prospectives
    TRANSPLANTE DE CELULAS-TRONCO HEMATOPOETICAS EM DOENCAS REUMATICAS. PARTE 2: EXPERIENCIA BRASILEIRA E PERSPECTIVAS FUTURAS. Revista Brasileira de Reumatologia (Brazil ) 45:5 301-312, 2005
    Abstract: In this review, we discuss the results of hematopoietic stem cell transplantation (HSCT) for severe and refractory rheumatic diseases performed in Brazil. We analyze preliminary results obtained in Brazil with autologous HSCT in anecdotal cases (N = 3) and in the cooperative protocol initiated in 2001 (N = 18). In 8 lupus nephritis patients there were 3 sustained remissions, 3 deaths, 1 mobilisation failure and 1 short follow-up; in 7 systemic sclerosis patients there were 3 sustained remissions after transplantation and 2 after mobilisation, 1 death before mobilisation and another after the first dose of the conditioning in an overlapping syndrome of SLE and SSc, an d between 2 patients with vasculitis there was 1 sustained remission in Takayasu's arteritis and another in Behc(cedil)et's disease. One patient with juvenile idiopathic arthritis was included in the protocol very recently. The follow-up of the patients varied from 0 to 48 months with a median of 29 months. We conclude the study with a discussion of future prospectives in developed countries, where randomized trials computing transplantation with the best pharmacological therapy available have started recently, and in B razil, where several adaptations of existing protocols are required and the cost of transplantation is much lower than that of new biological therapies