Bibliography October 2007

  1. ANTHONY KKet SCHANBERG LE: Assessment and management of pain syndromes and arthritis pain in children and adolescents, Rheum.Dis.Clin.North Am., Vol. 33(3), 625-660., 2007
    Organism:Division of Medical Psychology, Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, DUMC Box 2906, Durham, NC 27710, USAFAU - Anthony, Kelly K
    Abstract:    Pediatric rheumatologists increasingly are faced with the challenge of assessing, diagnosing, and managing pain in children and adolescents. Recent research suggests that muscloskeletal pain may be the most common complaint for which children are referred to pediatric rheumatologists. Understanding the nature of chronic musculoskeletal pain in children is advantageous for general pediatric practitioners and subspecialists. This article introduces issues related to pain in children who have musculoskeletal pain syndromes and juvenile idiopathic arthritis

  2. ASKLING J, FORED CM, BRANDT L, BAECKLUND E, BERTILSSON L, FELTELIUS N, COSTER L, GEBOREK P, JACOBSSON LT, LINDBLAD S, LYSHOLM J, RANTAPAA-DAHLQVIST S, SAXNE T, VAN VOLLENHOVEN RFet KLARESKOG L: Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists, Ann.Rheum.Dis., Vol. 66(10), 1339-1344., 2007
    Organism:Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden johanaskling@kiseFAU - Askling, Johan
    Abstract:    OBJECTIVES: The degree to which treatment with tumour necrosis factor (TNF) antagonists may be associated with increased risks for serious infections is unclear. An observational cohort study was performed using prospectively collected data from the Swedish Biologics Register (ARTIS) and other national Swedish registers. METHODS: First, in the ARTIS, all 4167 rheumatoid arthritis (RA) patients starting TNF antagonist treatment between 1999 and 2003 were identified. Secondly, in the Swedish Inpatient Register, all individuals hospitalised for any reason and who also carried a diagnosis of RA, between 1964 and 2003 (n = 44 946 of whom 2692 also occurred in ARTIS), were identified. Thirdly, in the Swedish Inpatient Register, all hospitalisations listing an infection between 1999 and 2003 were identified. By cross-referencing these three data sets, RRs for hospitalisation with infection associated with TNF antagonist treatment were calculated within the cohort of 44 946 RA patients, using Cox regression taking sex, age, geography, co-morbidity and use of inpatient care into account. RESULTS: Among the 4167 patients treated with TNF antagonists, 367 hospitalisations with infections occurred during 7776 person-years. Within the cohort of 44 496 RA patients, the RR for infection associated with TNF antagonists was 1.43 (95% CI 1.18 to 1.73) during the first year of treatment, 1.15 (95% CI 0.88 to 1.51) during the second year of treatment, and 0.82 (95% CI 0.62 to 1.08) for subjects remaining on their first TNF antagonist treatment after 2 years. CONCLUSION: Treatment with TNF antagonists may be associated with a small to moderate increase in risk of hospitalisation with infection, which disappears with increasing treatment duration

  3. BABYN Pet DORIA AS: Radiologic investigation of rheumatic diseases, Rheum.Dis.Clin.North Am., Vol. 33(3), 403-440., 2007
    Organism:Department of Diagnostic Imaging, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8, Canada; Department of Medical Imaging University of Toronto, Fitzgerald Building, 150 College Street, Room 112, Toronto, Ontario M5G 1X8, CanadaFAU - Babyn, Paul
    Abstract:    This article reviews the current use of the wide variety of imaging modalities now available, presenting the imaging features of common and important causes of acute and chronic rheumatic disorders including juvenile idiopathic arthritis, spondyloarthropathies/enthesitis-related arthritis, sepsis, autoimmune diseases, vasculitis, and osteoporosis

  4. BLOOM BJ: Macrophage activation is a key component in the pathogenesis of systemic juvenile idiopathic arthritis: Comment on the article by Blessing et al, Arthritis Rheum., Vol. 56(11), 3877-3878., 2007
    Organism:Pfizer Global Research and Development, New London, CT
    Abstract:

  5. BRUNS A, HILARIO MO, JENNINGS F, SILVA CAet NATOUR J: Quality of life and impact of the disease on primary caregivers of juvenile idiopathic arthritis patients, Joint Bone Spine., Vol. ., 2007
    Organism:Universidade Federal de Sao Paulo, Division of Rheumatology, Rua Botucatu 740, Sao Paulo 04023900, Brazil
    Abstract:    OBJECTIVES: To evaluate the quality of life and the disease burden on primary caregivers of patients with juvenile idiopathic arthritis (JIA). METHODS: Seventy patients with JIA and their respective caregivers were enrolled in this study. Health, quality of life and psychological status were assessed by using the childhood health assessment questionnaire (CHAQ), the medical outcomes study 36-item short-form health survey (SF-36) and the psychiatric screening questionnaire (SRQ-20). Burden of disease on the caregivers was measured by the caregiver burden scale (CB Scale). RESULTS: Most caregivers were women (91.4%), married (76.6%), mothers (92.2%) and their average age was 37.2+/-8.8 years. Low education and socioeconomic state were observed in most of the caregivers. Psychoemotional disorders measured by the SRQ-20 were detected in 34.3% of the caregivers. Pain and mental health were the items in the SF-36 questionnaire most affected in these individuals. Mean score of global burden measured by the CB Scale was 1.6+/-0.3 (disappointment and environment had the lowest scores). The CB Scale was significantly correlated with the SRQ-20 (r=0.6), number of limited joints (r=0.3), number of visits (r=0.2), family income (r=-0.3) and mental health (r=-0.6), emotional aspects (r=-0.4), social aspects (r=-0.4), vitality (r=-0.5) and general health state of the SF-36 (r=-0.4). SRQ-20 was the most important determinant of CB Scale and of the components pain and mental health of the SF-36 questionnaire. CONCLUSIONS: Most of the disease burden on the caregivers depends upon emotional aspects rather than on the physical status of the patients

  6. CANHAO H, FONSECA JE, SANTOS MJet GOMES JA: [Protocol for clinical monitoring of juvenile idiopathic arthritis], Acta Reumatol.Port., Vol. 32(3), 277-281., 2007
    Organism:Servico de Reumatologia, Hospital de Santa Maria, Lisbon helenacanhao@netcaboptFAU - Canhao, Helena
    Abstract:    The development of new and more efficacious therapeutic agents, though expensive and potentially toxic, helped to implement objective measures to quantify the improvement and to monitor the evolution of inflammatory rheumatic diseases. The aim of our protocol (PMAIJ) is to supply rheumatologists and paediatricians with a useful tool for follow-up of juvenile arthritis patients using validated instruments for the evaluation of activity, functional capacity and response to treatment. PMAIJ has 2 pages. The first page is filled only at the initial evaluation; the second page is filled at first and in all the appointments after that. The application of this protocol would contribute to the standardization of procedures in different Paediatric Rheumatology Centres and would help to obtain useful information on the clinical evolution of JIA patients followed in Portugal

  7. CARL HD, SCHRAML A, SWOBODA Bet HOHENBERGER G: Synovectomy of the hip in patients with juvenile rheumatoid arthritis, J.Bone Joint Surg.Am., Vol. 89(9), 1986-1992., 2007
    Organism:Division of Orthopedic Rheumatology, Department of Orthopedic Surgery, Friedrich Alexander University of Erlangen-Nuremberg, Rathsberger Strasse 57, D-91054 Erlangen, Germany Hans-DieterCarl@ortho-rheumameduni-erlangendeFAU - Carl, Hans-Dieter
    Abstract:    BACKGROUND: There is a lack of data on the functional effect of open hip synovectomy in a large number of patients with juvenile rheumatoid arthritis evaluated with a validated assessment tool. METHODS: Between 1985 and 1997, sixty-seven open hip-joint synovectomies were carried out in fifty-six patients with juvenile rheumatoid arthritis. Fifty-five hips (82%) had radiographic changes that were stage III or higher according to the system of Larsen et al. Hip function was evaluated preoperatively and after a mean of fifty months with the Merle d'Aubigne hip score. RESULTS: Sixty-five (97%) of the sixty-seven hips were available for follow-up. The mean total Merle d'Aubigne hip score (and standard error of the mean) was significantly improved from 9.5 +/- 2.5 points at baseline to 16.3 +/- 1.0 points at the time of follow-up (p < 0.001). The individual scores for pain, mobility, and walking ability were significantly increased as well (all p < 0.001). Eighty-five percent of the hips were observed to have a very great or great improvement in function. A concomitant soft-tissue release was performed in seven hips, and nine hips required surgical dislocation. Surgical complications included two superficial wound hematomas that did not require intervention; osteonecrosis of the femoral head was not observed. Five hips required total hip arthroplasty during the follow-up period. Thus, the survival rate for the hips was 94% at a mean of four years following the synovectomy. CONCLUSIONS: Open hip synovectomy in patients with juvenile rheumatoid arthritis is a safe procedure that can improve hip-joint function for up to five years

  8. DE OLIVEIRA SK, DE ALMEIDA RG, FONSECA AR, RODRIGUES MC, SZTAJNBOK Fet DINIZ C: [Indications and adverse events with the use of anti-TNFalpha agents in pediatric rheumatology: experience of a single center], Acta Reumatol.Port., Vol. 32(2), 139-150., 2007
    Organism:Faculdade de Medicina da UFRJ Chefe do Servico de Reumatologia Pedictricia do IPPMGFAU - de Oliveira, Sheila Knupp Feitosa
    Abstract:    OBJECTIVE: To report the efficacy and adverse events with the use of anti-TNFalpha agents in pediatric patients with rheumatic diseases. PATIENTS AND METHODS: Retrospective, observational clinical case series of patients with rheumatic diseases refractory to the conventional treatment. Infliximab and etanercept were the the drugs used. RESULTS: Thirty patients received anti-TNFalpha therapy: Juvenile Idiopathic Arthritis (18), chronic idiopathic anterior uveitis (2), juvenile dermatomyositis (4), Blau syndrome (1), relapsing polychondritis (2), CINCA syndrome (1), and microscopic polyangiitis (1). Twenty (66,6%) patients used infliximab exclusively, 2 (6,6%) etanercept and 8 (26,6%) both drugs. The response with infliximab was good in 9 patients, partial in 12 and poor in 5. Two patients were not evaluated for the short period of treatment. The response with etanercept was good in 7, partial in 2 and poor in 1. The best benefits were observed in JIA patients with polyarticular arthritis, psoriatic arthritis and enthesitis-related arthritis. Adverse effects occurred in 15 patients (50%). Suspension of the treatment due to adverse events occurred in 7. The most frequent infusion reactions with the infliximab were cough and nausea. Infectious complications occurred in 2 patients receiving etanercept and in 7 receiving infliximab (one death due to sepsis). No patients developed tuberculosis. CONCLUSION: Infliximab and etanercept are effective in some subtypes of juvenile idiopathic arthritis and other rheumatic diseases refractory to conventional therapy. Although frequent, adverse events could be controlled most of the time

  9. DUFFY CM: Measurement of Health Status, Functional Status, and Quality of Life in Children with Juvenile Idiopathic Arthritis: Clinical Science for the Pediatrician, Rheum.Dis.Clin.North Am., Vol. 33(3), 389-402., 2007
    Organism:Division of Paediatric Rheumatology, Montreal Children's Hospital, 2300 Tupper Street, Room C503, Montreal, Quebec, H3H 1P3, Canada; McGill University Health Centre, 1650 Avenue Cedar, Montreal, Quebec, H3G 1A4, Canada; McGill University, 845 Sherbrooke St W Montreal, Quebec, H3A 2T5, Canada
    Abstract:    Several groups have undertaken research on health status, functional status, and quality of life in the pediatric rheumatic diseases, particularly juvenile idiopathic arthritis (JIA) and juvenile rheumatoid arthritis. This article highlights the principles involved in this type of measurement, discusses the measures that have been developed for JIA, and describes the outcomes determined from recent retrospective and prospective longitudinal outcome studies. These studies suggest that although there has been improvement in overall outcomes, significant numbers of individuals persist with active disease into adulthood and have significant damage, reduced functional ability, and disability

  10. ECKER-SCHLIPF B: [Juvenile rheumatoid arthritis. What is the optimal treatment?], Med.Monatsschr.Pharm., Vol. 30(9), 349-350., 2007
    Organism:

  11. FALL N, BARNES M, THORNTON S, LUYRINK L, OLSON J, ILOWITE NT, GOTTLIEB BS, GRIFFIN T, SHERRY DD, THOMPSON S, GLASS DN, COLBERT RAet GROM AA: Gene expression profiling of peripheral blood from patients with untreated new-onset systemic juvenile idiopathic arthritis reveals molecular heterogeneity that may predict macrophage activation syndrome, Arthritis Rheum., Vol. 56(11), 3793-3804., 2007
    Organism:Children's Hospital Medical Center, Cincinnati, Ohio
    Abstract:    OBJECTIVE: Systemic juvenile idiopathic arthritis (JIA) is frequently associated with the development of macrophage activation syndrome. This study was undertaken to better understand the relationship between systemic JIA and macrophage activation syndrome. METHODS: Gene expression profiles were examined in 17 patients with untreated new-onset systemic JIA, 5 of whom showed evidence of subclinical macrophage activation syndrome (of whom 2 eventually developed overt macrophage activation syndrome). Peripheral blood mononuclear cells (PBMCs) were separated on Ficoll gradients, and purified RNA was analyzed using Affymetrix GeneChip expression arrays. A fraction of the PBMCs were used for flow cytometry to define the cellular composition of the samples. RESULTS: Two hundred twenty-five differentially expressed genes (P < 0.05) that distinguished patients with systemic JIA from healthy controls (n = 30) were identified. Clustering analysis indicated that expression patterns correlated with serum ferritin levels. Three main clusters distinguished systemic JIA patients with highly elevated ferritin levels (including those with subclinical macrophage activation syndrome) from those with normal or only moderately elevated ferritin levels. The first cluster comprised genes involved in the synthesis of hemoglobins and structural proteins of erythrocytes. This transcriptional profile was consistent with immature nucleated red blood cells, likely reflective of high red blood cell turnover. Also included were transcripts indicating immature granulocytes. The second cluster was enriched for genes involved in cell cycle regulation. The third cluster was enriched for genes involved in innate immune responses, including those involved in the negative regulation of Toll-like receptor/interleukin-1 receptor-triggered inflammatory cascades and markers of the alternative pathway of macrophage differentiation. Additional differentially expressed genes of interest were those involved in the cytolytic pathway, including SH2D1A and Rab27a. CONCLUSION: These data indicate that gene expression profiling can be a useful tool for identifying early macrophage activation syndrome in patients with systemic JIA

  12. FROSCH Met ROTH J: New insights in systemic juvenile idiopathic arthritis from pathophysiology to treatment, Rheumatology (Oxford)., Vol. ., 2007
    Organism:Department of Paediatrics, University of Muenster, Germany
    Abstract:    Systemic juvenile idiopathic arthritis (SJIA) is characterized by the clinical features of remitting fever, a typical skin rash and arthritis. Many patients show frequent flares or persistent disease activity with significant morbidity and serious complications. Recent investigations in the pathophysiology of SJIA have focused on mediators of the innate immune system. Especially IL-1beta, IL-6 and IL-18 as well as phagocyte-specific S100-proteins (S100A8, S100A9 and S100A12) are correlated with disease activity and secondary complications. Beside IL-6 all these molecules are secreted by a so-called alternative pathway. A loss of control of the alternative secretory pathway seems to be involved in release of pro-inflammatory proteins leading to the inflammatory process of SJIA. These insights lead to new promising treatment approaches, like application of recombinant anti-IL-1 receptor antagonist or anti-IL-6 receptor antibodies in patients resistant to conventional anti-inflammatory treatment. First case studies show improvement and remission on therapy in a substantial portion of these patients. In this review, we summarize the current knowledge of pathophysiology and experiences in the treatment of SJIA

  13. GALLAGHER M, QUINONES K, CERVANTES-CASTANEDA RA, YILMAZ Tet FOSTER CS: Biological response modifier therapy for refractory childhood uveitis, Br.J.Ophthalmol., Vol. 91(10), 1341-1344., 2007
    Organism:Massachusetts Eye Research and Surgery Institute, 5 Cambridge Center, 8th Floor, Cambridge, MA 02142, USAFAU - Gallagher, Michael
    Abstract:    PURPOSE: To evaluate the use of biological response modifiers (BRM) in the treatment of refractory childhood uveitis. DESIGN: Retrospective non-comparative case series of pediatric patients with uveitis treated with BRM. PARTICIPANTS: 23 pediatric patients. METHODS: All children (18 years or younger) who received a BRM were assessed for visual changes, time to control inflammation, and any associated adverse side effects. Thirteen patients were treated with infliximab, five with adalimumab, and five with daclizumab. All patients had bilateral eye involvement. Diagnoses of the participants included juvenile idiopathic arthritis, keratouveitis, sarcoid panuveitis, Adamantiades-Behcets disease, and idiopathic panuveitis. MAIN OUTCOME MEASURES: Inflammation and visual acuity. RESULTS: In the infliximab group 16 of 26 eyes (62%), and 10 of 13 patients (77%) demonstrated an improvement in visual acuity. Twenty of 26 eyes (77%) demonstrated an improvement in the degree of inflammation. In the adalimumab group, four of 10 eyes (40%) demonstrated an improvement in visual acuity, with five of 10 eyes (50%) demonstrating an improvement in inflammation. Four of 10 eyes (40%) in the daclizumab group demonstrated an improvement in vision with eight of 10 eyes (80%) demonstrating an improvement in inflammation. CONCLUSION: BRM appear to be safe to use in children, and represent a useful therapeutic adjunctive drug group for treating recalcitrant childhood uveitis

  14. GHOSH P, DWIVEDI S, NAIK S, AGARWAL V, VERMA A, AGGARWAL Aet MISRA R: Antinuclear antibodies by indirect immunofluorescence : optimum screening dilution for diagnosis of systemic lupus erythematosus, Indian J.Med.Res., Vol. 126(1), 34-38., 2007
    Organism:Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, IndiaFAU - Ghosh, P
    Abstract:    BACKGROUND & OBJECTIVES: Antinuclear antibodies (ANA) are serological hallmark of systemic lupus erythematosus (SLE). Conventionally, the test is carried out on human epithelial cells (HEp2) by indirect immunofluorescence (IIF) technique. Since culturing and maintaining HEp2 cells in the laboratory are labour intensive, in-house assays have given way to kits manufactured by commercial companies. The reference screening dilutions provided by the manufacturers are based on different ethnic population than ours. Therefore, it becomes mandatory for every laboratory to have its own screening dilutions for the local population that distinguishes best between healthy and diseased state. As, there is paucity of such data, we aimed to define the optimum screening dilution that distinguishes the patient with SLE from healthy individuals. METHODS: Sera of patients fulfilling ACR criteria for diagnosis of SLE, idiopathic inflammatory polymyositis/dermatomyositis (PM/DM) and rheumatoid arthritis (RA), and age and sex matched healthy individuals were tested for ANA by IIF using a commercial kit (Euroimmun, Germany) at 5 dilutions, namely 1:40, 1:80, 1:160, 1:320 and 1:640. Receiver operator characteristics (ROC) curve were constructed to define the optimum dilution that distinguished healthy sera from the diseased ones. RESULTS: Test was performed on 213 sera from 94 healthy individuals, and 43 SLE, 37 RA and 39 DM/PM patients. In healthy individuals, ANA at dilutions 1:40, 1:80, 1:160, 1:320 and 1:640 was positive in 13.8, 4.3, 2.1, 2.1 and 0 per cent respectively, whereas in SLE it was positive in 95.3, 95.3, 65.1, 53.5 and 23.3 per cent respectively. INTERPRETATION & CONCLUSION: ROC curves analysis showed that at 1:40 dilution, sera of 95.3 per cent of SLE and 13.8 per cent of normal individuals were (ANA) positive, whereas at 1:80 dilution it was 95.3 per cent for SLE and 4.3 per cent for healthy individuals. A fluorescent intensity of > or =2 was more specific for SLE. The best discrimination between healthy individuals and the SLE patients was found at screening dilution of 1:80 and fluorescent intensity of > or =2 in our laboratory

  15. GILLIAM BE, WOLFF AEet MOORE TL: Partial C4 deficiency in juvenile idiopathic arthritis patients, J.Clin.Rheumatol., Vol. 13(5), 256-260., 2007
    Organism:Division of Rheumatology, Saint Louis University School of Medicine, 1402 South Grand Boulevard, Saint Louis, MO 63104, USAFAU - Gilliam, Brooke E
    Abstract:    OBJECTIVES: C4 is encoded by 2 distinct but closely linked loci within the major histocompatibility complex locus on human chromosome 6. C4A deficiencies have been associated with autoimmune disease and C4B with increased frequency of infection. C4 deficiencies have rarely been associated with juvenile idiopathic arthritis (JIA). Our aim was to investigate the prevalence of deficiencies in C4 allotypes in JIA patients. METHODS: We evaluated 61 patients [35 JIA patients, 15 systemic lupus erythematosus patients, 9 rheumatoid arthritis patients, and 2 mixed connective tissue disease (CTD) patients] for C4 deficiency. Genomic DNA was isolated from whole blood and subjected to polymerase chain reaction using sequence-specific primers for C4 allotypes. RESULTS: We found 5 JIA patients with C4 deficiencies. Two IgM rheumatoid factor-positive JIA polyarthritis patients had C4 deficiencies, one with complete C4A deficiency and another with partial C4A and complete C4B deficiency. Two oligoarthritis patients displayed partial C4B deficiencies, and complete C4B deficiency was revealed in 1 IgM rheumatoid factor-negative polyarthritis patient. Three patients had histories of recurrent infections and 2 demonstrated a more severe disease course. Disease controls showed 8 systemic lupus erythematosus patients had partial C4 deficiencies, whereas no deficiencies were revealed in the rheumatoid arthritis or mixed CTD patients. CONCLUSIONS: Defects in the complement system have been implicated in the pathogenesis of CTD. However, the specific role of C4 in JIA is not clear. We demonstrate partial C4 deficiencies in 5 JIA patients. Our findings suggest an association between C4 deficiency and another CTD, JIA, as well as with disease severity and recurrent infections

  16. GOLMIA A, GRINBLAT B, FINGER E, KLIEMAN C, ASSIR Fet SCHEINBERG M: The development of erythema elevatum diutinum in a patient with juvenile idiopathic arthritis under treatment with abatacept, Clin.Rheumatol., Vol. ., 2007
    Organism:Hospital Israelita Albert Einstein and Research Institute, Sao Paulo, Brazil
    Abstract:    In this case report, we present the first report of erythema elevatum diutinum after treatment of juvenile idiopathic arthritis with abatacept. Although it could also be coincidental, in our case, the appearance of vasculitis was not blocked by the simultaneous administration of a stimulation inhibitor, and alerts to the fact that as effective as a abatacept may be to control of the inflammatory articular symptoms, this might not translate into control of the disease

  17. HAINES KA: Juvenile idiopathic arthritis: therapies in the 21st century, Bull.NYU.Hosp.Jt.Dis., Vol. 65(3), 205-211., 2007
    Organism:Juvenile idiopathic arthritis (JIA) is an umbrella term for seven or more clinical patterns of arthritis of unknown cause in children. Until the mid-1980s, therapy for children, with what was then called juvenile rheumatoid arthritis in the United States and juvenile chronic arthritis (JRA) elsewhere, consisted primarily of a small repertoire of antiinflammatory drugs and corticosteroids. However, only a small percentage of children respond to NSAIDs (nonsteroidal antiinflammatory drugs) alone; almost all will respond to corticosteroids, but with the cost of unacceptable toxicities. Juvenile arthritis was often a crippling disease. The controlled trial that demonstrated methotrexate therapy was safe and effective in children was the major advance of that decade. With the burgeoning understanding of the immune system and the advent of biologic agents in the 21st century, pediatric rheumatologists now have many more therapies to offer patients, with the expectation that their disease will be controlled. This review will discuss current therapy and the approach to treatment of JIA

  18. HEILIGENHAUS A, MINGELS A, HEINZ Cet GANSER G: Methotrexate for uveitis associated with juvenile idiopathic arthritis: Value and requirement for additional anti-inflammatory medication, Eur.J.Ophthalmol., Vol. 17(5), 743-748., 2007
    Organism:Department of Ophthalmology, St Franziskus Hospital, Muenster - GermanyFAU - Heiligenhaus, A
    Abstract:    PURPOSE. To study the value of methotrexate (MTX) and the requirement for additional anti-inflammatory drugs for the treatment of severe chronic iridocyclitis associated with juvenile idiopathic arthritis (JIA). METHODS. Institutional study of 35 consecutive patients with JIA started on MTX as the single systemic immunosuppressive drug for the treatment of associated iridocyclitis. The clinical epidemiologic data, course of visual acuity (VA), development of complications, and the need for additional anti-inflammatory drugs were analyzed. RESULTS. Mean follow-up with MTX treatment was 27.6 months. Uveitic complications were present in 31 patients before MTX treatment. With MTX, quiescence of uveitis was obtained with (n=21) or without (n=4) additional topical steroids. Additional systemic immunosuppressive drugs were required in another 7 patients: cyclosporine A (n=4), azathioprine (n=1), infliximab (n=1), or etanercept (n=1). Three patients had active uveitis at the end of the follow-up period. During MTX therapy, uveitis first developed in the unaffected fellow eyes in 2 patients, and secondary glaucoma or ocular hypertension occurred in 7 patients. The VA deteriorated in 6, improved in 13, and was stable in the remaining eyes. CONCLUSIONS. The data suggest that MTX is very effective in controlling inflammation of uveitis in patients with JIA. However, additional topical steroids or systemic immunosuppressive drugs are often required

  19. HORNEFF G: Reply to the article: Initiating etanercept in a once weekly dose in children with juvenile idiopathic arthritis by Femke H.M. Prince, Lisette W.A. van Suijlekom-Smit, Rheumatol.Int., Vol. ., 2007
    Organism:Zentrum fur Allgemeine Kinderheilkunde und Neonatologie, Akademisches Lehrkrankenhaus der Universitat Bonn, Arnold-Janssen-Strasse 29, 53757, Sankt Augustin, Germany, GHorneff@asklepioscom
    Abstract:

  20. IMMONEN K, SAVOLAINEN HAet HAKALA M: Why can we no longer find juvenile idiopathic arthritis-associated amyloidosis in childhood or in adolescence in Finland?, Scand.J.Rheumatol., Vol. 36(5), 402-403., 2007
    Organism:Department of Medicine, North-Karelia Central Hospital, JoensuuFAU - Immonen, K
    Abstract:

  21. KOKKONEN J, ARVONEN M, VAHASALO Pet KARTTUNEN TJ: Intestinal immune activation in juvenile idiopathic arthritis and connective tissue disease, Scand.J.Rheumatol., Vol. 36(5), 386-389., 2007
    Organism:PaediatricsFAU - Kokkonen, J
    Abstract:    Objectives: To examine the prevalence of immune activation in gastrointestinal (GI) mucosa in children with juvenile idiopathic arthritis (JIA) or connective tissue disease (CTD). Study design: We studied 27 children (15 girls, mean age 9.8+/-4.8 years) with JIA/CTD and GI symptoms, including nine with oligoarthritis, nine with polyarthritis, two with systemic arthritis, three with enthesitis-related arthritis, and four with various CTDs. The control group consists of 54 children (31 girls, mean age 11.3+/-6.3 years) with GI symptoms but shown to have no significant GI or rheumatoid disorder. The subjects were examined by gastroduodenoscopy (22 patients, 50 controls) and colonoscopy (23 patients, 16 controls). Intraepithelial CD3(+), alpha/beta(+), and gamma/delta(+) lymphocytes were counted from duodenal and ileal biopsies. Results: Five patients with JIA/CTD (19%) had ulcerative colitis. Lymphoid nodular hyperplasia (LNH) was more common in the patients [74% (20/27)] than in the controls [16% (8/50), p = 0.001], as well in the duodenal bulb [29% (7/24) vs. 10% (5/50)], terminal ileum [74% (14/19) vs. 38% (5/13)], and the colon [50% (11/22) vs. 14% (2/14)]. In the duodenum, CD3, alpha/beta(+), and gamma/delta(+) lymphocytes counts were higher in JIA/CTD (p<0.05). In the ileum, gamma/delta(+) cell numbers had increased in JIA/CTD (p<0.05). Either LNH, increased gamma/delta(+) count, or both were more common in JIA/CTD [89% (24/27)] than in the controls [13% (7/54), p<0.0001]. Conclusions: The majority of children suffering from JIA or CTD with GI symptoms show abnormalities consistent with activation of the intestinal immune system. The aetiology of this reaction remains unknown, but similar features are seen in delayed-type food allergy

  22. KUNITOMI Tet IKEDA M: [Rheumatoid arthritis complicated with pericarditis--focused mainly on juvenile idiopathic arthritis], Nippon Rinsho., Vol. Suppl 5 Pt 2, 458-460., 2007
    Organism:Department of Pediatrics, Okayama Red Cross General HospitalFAU - Kunitomi, Taiji
    Abstract:

  23. LAPLANT MM, ADAMS BS, HAFTEL HMet CHERVIN RD: Insomnia and Quality of Life in Children Referred for Limb Pain, J.Rheumatol., Vol. ., 2007
    Organism:From the Department of Pediatric Rheumatology, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota; and Department of Pediatrics and Communicable Diseases, Sleep Disorders Center, Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
    Abstract:    OBJECTIVE: Children with limb pain have significantly diminished quality of life. Although this could result directly from the pain, we investigated the extent to which associated insomnia may contribute. METHODS: A consecutive series of pediatric rheumatology clinic patients (age 3-18 yrs) who presented for initial evaluation of limb pain were offered participation. Parents and children, as appropriate, completed the Pediatric Sleep Questionnaire and Pediatric Quality of Life Inventory (PedsQL 4.0). Validated measures of pain duration and current pain level were provided by the children. Subjects were judged to have substantial insomnia if they had at least 2 of the following symptoms: difficulty falling asleep at night, waking more than twice on average, trouble falling back to sleep, or waking in the morning feeling unrefreshed. Linear regression was used to model the total PedsQL 4.0 score on insomnia, pain duration, and pain level. RESULTS: Seventy-four subjects were recruited (47 girls, mean age 10 +/-3.9); 25 (33%) had juvenile idiopathic arthritis and 40 (54%) had insomnia. A low PedsQL 4.0 score was predicted by insomnia (p < 0.001), but not by pain duration or level (each p > 0.10). Neither pain level nor duration differed significantly between subjects with or without insomnia (each p > 0.10). CONCLUSION: Significant insomnia may affect half of the children who present to a pediatric rheumatology clinic for limb pain. Quality of life in this setting may depend more on insomnia than on current level or duration of pain

  24. LEQUERRE T, QUARTIER P, ROSELLINI D, ALAOUI F, DE BANDT M, MEJJAD O, KONE-PAUT I, MICHEL M, DERNIS E, KHELLAF M, LIMAL N, JOB-DESLANDRE C, FAUTREL B, LE L, Xet SIBILIA J: Interleukin-1 receptor antagonist (anakinra) treatment in patients with systemic-onset juvenile idiopathic arthritis or adult onset Still's disease. Preliminary experience in France, Ann.Rheum.Dis., Vol. ., 2007
    Organism:Rouen University Hospital&Inserm519, IFR23, France
    Abstract:    BACKGROUND: Anakinra treatment has been reported to be effective in some patients with Systemic-onset Juvenile Idiopathic Arthritis (SoJIA) or Adult-onset Still's Disease (AoSD). OBJECTIVES: To assess the efficacy and the safety of anakinra treatment in SoJIA and AoSD. METHODS: SoJIA and AoSD patients were treated with anakinra (1 to 2 mg/kg per day in children, 100 mg/day in adults); we analysed its effect on fever, ESR and CRP levels, numbers of swollen and tender joints, the assessment of disease activity (by physician and parent/patient) and pain (by parent/patient), and ACR pedi core set criteria for JIA activity. RESULTS: Thirty-five patients were included, 20 with SoJIA and 15 with AoSD: their mean age [range] at the onset of treatment was 12.4 [3-23] and 38.1 [22-62] years, respectively; their disease duration was 7.0 [1-16] and 7.8 [2-27] years, respectively. Active arthritis was present in all cases but one. Five of the 20 SoJIA patients achieved ACR50 response criteria at 6 months. Steroid dose had been decreased by 15% to 78% in 10 cases. Eleven of the 15 AoSD patients achieved at least a 50% improvement for all disease markers (mean follow-up: 17.5 [11- 27] months). Steroids had been stopped in 2 cases and the dose was decreased by 45% to 95% in 12 patients. Two patients stopped anakinra due to severe skin-reaction and 2 patients due to infection: one visceral leishmaniasis and one varicella. CONCLUSION: Anakinra was effective in most AoSD patients, but less than half SoJIA patients achieved a marked and sustained improvement

  25. MAGNI-MANZONI S, PISTORIO A, LABO E, VIOLA S, GARCIA-MUNITIS P, PANIGADA S, VISCONTI C, BUONCOMPAGNI A, MARTINI Aet RAVELLI A: A longitudinal analysis of physical functional disability over the course of juvenile idiopathic arthritis, Ann.Rheum.Dis., Vol. ., 2007
    Organism:IRCCS Policlinico S Matteo, Pavia, Italy
    Abstract:    OBJECTIVE: To describe the longitudinal course of physical functioning in children with juvenile idiopathic arthritis and identify predictors of long-term functional impairment. METHODS: Between January 1987 and December 2002, 227 patients had 2 or more functional ability questionnaires completed by a parent. The total number of questionnaires was 1356 and the follow-up between the first and the last questionnaire administration was 949.7 patient/years. At each questionnaire administration, patients were assigned to 1 of 3 functional disability states (1=no disability; 2=mild-to-moderate disability; 3=severe disability), based on their functional ability score. Predictor variables included sex, onset age, JIA category, age at visit, disease duration, presence of antinuclear antibodies, joint counts, acute phase reactants, and initial disability state. RESULTS: Despite patient variability in the course of physical functioning, the following 3 longitudinal patterns were observed: 1) a stable state of disability throughout the entire study period, with continued absence of disability in 27.8% of patients and persistently moderate disability in 3.5% of patients; 2) a steady improvement (22.9% of patients) or deterioration (5.7% of patients) in disability over time; 3) a fluctuating course of disability, with both deterioration and improvement (40.1% of patients). Younger age at disease onset and a greater restricted joint count were the strongest predictors of long-term functional impairment. CONCLUSION: A wide within-patient and between-patient variability in the longitudinal course of functional disability was found. Children with early disease onset and a greater number of restricted joints had the highest risk of developing long-term physical disability

  26. NEUBAUER P, WEBER AK, MILLER NHet MCCARTHY EF: Pigmented villonodular synovitis in children: a report of six cases and review of the literature, Iowa Orthop.J., Vol. 27, 90-94., 2007
    Organism:Department of Pathology and Orthopaedic Surgery, The Johns Hopkins Hospital, The Harry & Jeanette Weinberg Building, 401 N Broadway/Room 2242, Baltimore, MD 21231-2410, USAFAU - Neubauer, Philip
    Abstract:    We report six children with pigmented villonodular synovitis. They ranged in age from seven to fifteen years. In four patients, the knee was involved. One patient had involvement of the ankle, and one had diffuse involvement along a metacarpal. In five cases, the diagnosis was not suspected clinically or radiographically, and the delay in making the correct diagnosis was as long as two years. Clinical diagnosis in these five patients was usually bacterial synovitis or juvenile rheumatoid arthritis. We feel that the diagnoses of pigmented villonodular synovitis should be considered in any child with chronic joint effusion

  27. OKSI J, NIKOSKELAINEN J, HIEKKANEN H, LAUHIO A, PELTOMAA M, PITKARANTA A, NYMAN D, GRANLUND H, CARLSSON SA, SEPPALA I, VALTONEN Vet VILJANEN M: Duration of antibiotic treatment in disseminated Lyme borreliosis: a double-blind, randomized, placebo-controlled, multicenter clinical study, Eur.J.Clin.Microbiol.Infect.Dis., Vol. 26(8), 571-581., 2007
    Organism:Department of Medicine, Turku University Central Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland jarmooksi@utufiFAU - Oksi, J
    Abstract:    Despite rather strict recommendations for antibiotic treatment of disseminated Lyme borreliosis (LB), evidence-based studies on the duration of antibiotic treatment are scarce. The aim of this multicenter study was to determine whether initial treatment with intravenous ceftriaxone (CRO) for 3 weeks should be extended with a period of adjunct oral antibiotic therapy. A total of 152 consecutive patients with LB were randomized in a double-blind fashion to receive either amoxicillin (AMOX) 1 g or placebo (PBO) twice daily for 100 days. Both groups received an initial treatment of intravenous CRO 2 g daily for 3 weeks, followed by the randomized drug or PBO. The outcome was evaluated using the visual analogue scale at the follow-up visits. The final analysis included 145 patients, of whom 73 received AMOX and 72 PBO. Diagnoses of LB were categorized as either definite or possible, on the basis of symptoms, signs, and laboratory results. The diagnosis was definite in 52 of the 73 (71.2%) AMOX-treated patients and in 54 of the 72 (75%) PBO patients. Of the patients with definite diagnoses, 62 had neuroborreliosis, 45 arthritis or other musculoskeletal manifestations, and 4 other manifestations of LB. As judged by the visual analogue scale and patient records, the outcome after a 1-year follow-up period was excellent or good in 114 (78.6%) patients, controversial in 14 (9.7%) patients, and poor in 17 (11.7%) patients. In patients with definite LB, the outcome was excellent or good in 49 (92.5%) AMOX-treated patients and 47 (87.0%) PBO patients and poor in 3 (5.7%) AMOX-treated patients and 6 (11.1%) PBO patients (difference nonsignificant, p = 0.49). Twelve months after the end of intravenous antibiotic therapy, the levels of antibodies against Borrelia burgdorferi were markedly decreased in 50% of the patients with definite LB in both groups. The results indicate that oral adjunct antibiotics are not justified in the treatment of patients with disseminated LB who initially receive intravenous CRO for 3 weeks. The clinical outcome cannot be evaluated at the completion of intravenous antibiotic treatment but rather 6-12 months afterwards. In patients with chronic post-treatment symptoms, persistent positive levels of antibodies do not seem to provide any useful information for further care of the patient

  28. PASSWEG Jet TYNDALL A: Autologous stem cell transplantation in autoimmune diseases, Semin.Hematol., Vol. 44(4), 278-285., 2007
    Organism:Division of Hematology, University Hospital Geneva, Geneva, SwitzerlandFAU - Passweg, Jakob
    Abstract:    Since 1996, approximately 1,000 patients have received an autologous hematopoietic stem cell transplant (HSCT) as treatment for a severe autoimmune disease (AD). The European Group for Blood and Marrow Transplantation (EBMT)/European League Against Rheumatism (EULAR) Autoimmune Disease Working Party have registered more than 800 patients and works in close collaboration with networks in the United States where several hundred more AD patients have been similarly transplanted. The majority of ADs were multiple sclerosis (MS), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), juvenile idiopathic arthritis, and immune cytopenias. Many patients have experienced long-term disease-free remissions and immune reconstitution studies have shown in some cases that a "resetting" of autoimmunity is possible. The initially high treatment-related mortality (TRM) is reduced significantly in the later years, and the phase I/II experience is now being verified in several international prospective randomized clinical trials. In addition, the past several years have seen a growing interest in the role and potential therapeutic application of mesenchymal stem cells (MSC) in the immunomodulation of AD, as in the early experience with acute-graft-versus host disease (GvHD)

  29. PRINCE FHet SUIJLEKOM-SMIT LW: Initiating etanercept in a once weekly dose in children with juvenile idiopathic arthritis, Rheumatol.Int., Vol. ., 2007
    Organism:Department of Pediatrics/Pediatric Rheumatology, Sp 1545, Erasmus MC Sophia Children's Hospital, PO Box 2060, 3000 CB, Rotterdam, The Netherlands, fprince@erasmusmcnl
    Abstract:

  30. RIGANTE D, DE ROSA G, BERTONI B, ANSUINI V, PARDEO M, LA T, I, GASPARI Set STABILE A: Large pericardial effusion requiring pericardiocentesis as cardinal sign of macrophage activation syndrome in systemic onset-juvenile idiopathic arthritis, Rheumatol.Int., Vol. 27(8), 767-770., 2007
    Organism:Department of Pediatric Sciences, Universita Cattolica Sacro Cuore, Largo A Gemelli no 8, 00168 Rome, Italy drigante@gmailcomFAU - Rigante, Donato
    Abstract:    We report a case of large pericardial effusion which has been managed with pericardiocentesis as the main presentation feature of a dramatic clinical picture, only retrospectively framed as referred to macrophage activation syndrome in a child with juvenile idiopathic arthritis at its onset. The risk of developing this rare and severe complication should be recognized in various pathological settings of childhood, above all in children displaying systemic signs of juvenile idiopathic arthritis

  31. ROSSATO LM, ANGELO Met SILVA CA: Care delivery for the child to grow up despite the pain: the family's experience, Rev.Lat.Am.Enfermagem., Vol. 15(4), 556-562., 2007
    Organism:rossato@uspbrFAU - Rossato, Lisabelle Mariano
    Abstract:    This study aimed to understand the meaning of the experience of families having a child experiencing pain due to Juvenile Rheumatoid Arthritis and to construct a theoretical model representing this experience. Grounded Theory and Symbolic Interactionism were used as methodological framework and theoretical framework, respectively. Data were collected by semistructured interviews with 12 families. Data analysis allowed for the construction of the theoretical model Caring for the child to grow despite the pain, which describes an experience based on motivational elements: wanting to see the child without pain and wanting to see the child live a normal life, reviewing how the family lives the transition in its development cycles, retaking and integrating them in the family dynamic with the appearance of the disease and pain in the child. This theoretical model provides a framework for teaching, research and care, permitting advances in terms of theoretical nursing knowledge

  32. SIDIROPOULOS PI, GOULIELMOS G, VOLOUDAKIS GK, PETRAKI Eet BOUMPAS DT: Inflammasome and rheumatic diseases: evolving concepts, Ann.Rheum.Dis., Vol. ., 2007
    Organism:University of Crete, Greece
    Abstract:    The realization that the production of inflammatory cytokines in inflammatory rheumatic diseases may be induced by noninfectious endogenous signals has encouraged researchers to explore mechanisms of innate immunity and their contribution to the pathogenesis of these diseases. The nucleotide-binding and oligomerization domain (NOD)- like receptors (NLRs) sense pathogens, products of damaged cells or endogenous metabolites and could potentially be involved in the initiation, amplification and progression of the inflammatory response in rheumatic diseases. NLRs are involved in the regulation of innate immune responses with some of them promoting the activation of inflammatory caspases within multiprotein complexes, called inflammasomes. A typical inflammasome consists of a sensor, an NLR protein, an adaptor protein like ASC and an effector protein which is a caspase that activates pro-inflammatory cytokines like IL-1beta and IL-18. Recent data suggest a role of the inflammasome in the pathogenesis of autoinflammatory as well as inflammatory rheumatic diseases such as juvenile chronic arthritis, adult-onset Still's disease, rheumatoid arthritis and gout. Modulation of these pathways may be a potential therapeutic target for inflammatory rheumatic diseases

  33. SINGH-GREWAL D, SCHNEIDERMAN-WALKER J, WRIGHT V, BAR-OR O, BEYENE J, SELVADURAI H, CAMERON B, LAXER RM, SCHNEIDER R, SILVERMAN ED, SPIEGEL L, TSE S, LEBLANC C, WONG J, STEPHENS Set FELDMAN BM: The effects of vigorous exercise training on physical function in children with arthritis: a randomized, controlled, single-blinded trial, Arthritis Rheum., Vol. 57(7), 1202-1210., 2007
    Organism:The Hospital for Sick Children, Toronto, Ontario, CanadaFAU - Singh-Grewal, Davinder
    Abstract:    OBJECTIVE: To examine the effectiveness of high-intensity aerobic training compared with low-intensity training in terms of energy cost of locomotion, peak oxygen uptake, peak power, and self-reported physical function in children with juvenile idiopathic arthritis (JIA). METHODS: Eighty children with JIA, ages 8-16 years, were enrolled in a randomized, single-blind controlled trial. Both groups participated in a 12-week, 3-times-weekly training program consisting of high-intensity aerobics in the experimental group and qigong in the control group. Subjects underwent exercise testing measuring submaximal oxygen uptake at 3 km/hour (VO(2submax)) as the primary outcome, maximal oxygen uptake, and peak power at the beginning and end of the program. Physical function was measured using the Child Health Assessment Questionnaire (C-HAQ). RESULTS: The exercise program was well tolerated in both groups. There was no difference in VO(2submax) or any other exercise testing measures between the groups through the study period and no indication of improvement. Both groups showed significant improvements in C-HAQ with no difference between the groups. Adherence was higher in the control group than the experimental group. CONCLUSION: Our findings suggest that activity programs with or without an aerobic training component are safe and may result in an important improvement in physical function. The intensity of aerobic training did not seem to provide any additional benefits, but higher adherence in the qigong program may suggest that less intensive regimens are easier for children with JIA to comply with, and provide a degree of benefit equivalent to more intensive programs

  34. SMOLEWSKA E, STANCZYK J, BROZIK H, BIERNACKA-ZIELINSKA M, CEBULA B, ROBAK Tet SMOLEWSKI P: Distribution and clinical significance of blood dendritic cells (BDC) in children with juvenile idiopathic arthritis, Ann.Rheum.Dis., Vol. ., 2007
    Organism:Medical University of Lodz, Poland
    Abstract:    OBJECTIVES: The role of dendritic cells (DC) in the development of adult rheumatoid arthritis has been suggested. So far, this problem was poorly explored in juvenile idiopathic arthritis (JIA). In this study we analyzed distribution and maturation status of blood DC (BDC) in JIA. METHODS: Absolute BDC counts were assessed by the "single platform" method in peripheral blood (PB) of 47untreated JIA children and 32 healthy controls. Moreover, BDC were investigated in JIA synovial fluid (SF). Using the panel of monoclonal antibodies against BDC antigens (BDCA), three BDC subpopulations were determined: myeloid type 1 (mDC1; BDCA1+/HLA-DR+/CD19-), myeloid type 2 (mDC2; BDCA3+/HLA-DR+/CD14-) and plasmacytoid (pDC; BDCA2+/HLA-DR+/CD123+). RESULTS: We found the profound deficiency of all subtypes of BDC in PB of JIA children. Moreover, BDC counts in JIA SF were significantly higher than in PB from both JIA (p<0.0001) and healthy children (p<0.001). SF BDC, especially mDC1 and mDC2 subtypes, had significantly higher expression of maturation markers (CD40, CD80, CD86 or CD83 antigens) than those from PB. Moreover, lower PB BDC number at diagnosis correlated significantly with poor response to treatment. CONCLUSIONS: This is the first study giving the referential data on particular PB and SF BDC subtypes in JIA. Deficiency of BDC in PB is accompanied by SF enrichment with those cells. Probably, circulating BDC migrate to joints where undergo maturation and participate in mediation and maintaining local immune response. Interestingly, the level of PD BDC deficiency seems to influence the outcome in JIA children

  35. SPARTA G, KEMPER MJet NEUHAUS TJ: Hyperuricemia and gout following pediatric renal transplantation, Pediatr.Nephrol., Vol. 21(12), 1884-1888., 2006
    Organism:Nephrology Unit, University Children's Hospital, Steinwiesstrasse 75, 8032 Zurich, SwitzerlandFAU - Sparta, Giuseppina
    Abstract:    Hyperuricemia and gout are common complications in adult renal transplant recipients. In pediatric recipients, however, hyperuricemia seems to be rare, but data are scarce. Thirty-two children (21 males, 11 females) were investigated for a median time of 4.8 years (range: 0.4-11.2 years) following renal transplantation. The median age of this pediatric study group was 13.9 years (range: 5.7-20.3 years), and the calculated glomerular filtration rate (GFR) was 61 ml/min per 1.73 m(2) (range:12-88 ml/min per 1.73 m(2)). All patients were given calcineurin inhibitors, with 22 and ten children receiving cyclosporine A (CSA) and tacrolimus (TAC), respectively. The median plasma uric acid was 385 micromol/l (range: 62-929 micromol/l); 15 children (47%) were above the age-related normal range. Only one patient experienced gouty arthritis. There was a significant correlation between plasma uric acid concentration and both time span after transplantation and plasma creatinine, and an inverse correlation to GFR (p<0.05). No significant correlation was found between plasma uric acid and body mass index (BMI). Plasma uric acid concentrations were neither different among CSA- and TAC-treated children, nor did they correlate with drug exposure or blood trough levels of CSA or TAC. Plasma uric acid concentration was not different when compared to children with chronic renal failure (CRF) of a similar degree in native kidneys. We conclude that hyperuricemia is common among pediatric renal transplant recipients and rather a consequence of chronic renal transplant dysfunction than the use of calcineurin inhibitors. Gout, however, is rare

  36. SULLIVAN KE: Inflammation in juvenile idiopathic arthritis, Rheum.Dis.Clin.North Am., Vol. 33(3), 365-388., 2007
    Organism:University of Pennsylvania School of Medicine, Division of Allergy and Immunology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USAFAU - Sullivan, Kathleen E
    Abstract:    Inflammation evolved to aid in the clearance of microorganisms. In pediatric arthritides, the inflammation persists and causes damage to the joint. The contribution of the innate immune system to inflammation is significant and can be exploited therapeutically. Although cells of the adaptive immune system such as T cells and B cells participate in the disease process, many of the features of arthritis are directly attributable to inflammatory mediators. Recent advances in the understanding of these processes have led to dramatic improvements in treatment

  37. WEISS JEet ILOWITE NT: Juvenile idiopathic arthritis, Rheum.Dis.Clin.North Am., Vol. 33(3), 441-470., 2007
    Organism:Division of Pediatric Rheumatology, Schneider Children's Hospital, 269-01 76th Avenue, New Hyde Park, NY 11040, USAFAU - Weiss, Jennifer E
    Abstract:    Juvenile idiopathic arthritis (JIA), a term referring to a group of disorders characterized by chronic arthritis, is the most common chronic rheumatic illness in children and is a significant cause of short- and long-term disability. This article discusses the classification, differential diagnosis, and treatment of JIA

  38. YOKOTA S, MORI M, IMAGAWA T, TAKEI S, MURATA T, TOMIITA M, ITO Yet FUJIKAWA S: Proposal for juvenile idiopathic arthritis guidance on diagnosis and treatment for primary care pediatricians and nonpediatric rheumatologists (2007), Mod.Rheumatol., Vol. 17(5), 353-363., 2007
    Organism:Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, syokota@medyokohama-cuacjpFAU - Yokota, Shumpei
    Abstract:    The Pediatric Standing Committee of the Japan College of Rheumatology, in collaboration with the Pediatric Rheumatology Association of Japan, produced guidance on the diagnosis and treatment for juvenile idiopathic arthritis (JIA) for primary care pediatricians and nonpediatric rheumatologists in Japan. This guidance aims to achieve early diagnosis and treatment for JIA, which is similar to adult rheumatoid arthritis (RA), based on recent progress in rheumatology, and to resolve arthritis at an early stage and improve the prognosis of the affected inflammatory joints. It describes clinical symptoms and laboratory findings characteristic to JIA in order to make early diagnosis and treatment possible, and also serves as a triage of patients who are refractory to the treatment protocol described here and need more aggressive interventions. However, because JIA is a complicated and heterogeneous disease and the optimal treatment approach can be diverse and different patient by patient, these guidelines should be viewed as recommendations and be individualized according to the condition of the patient. Finally, we hope that this guidance will trigger exploration for further information by referring to the textbooks and literature listed at the end of these guidelines

  39. YOUM JY, WOO JH, KIM TH, BAE SCet YOO DH: Interleukin-1beta and interleukin-1 receptor antagonist gene polymorphisms in Korean patients with adult-onset Still's disease, Scand.J.Rheumatol., Vol. 36(5), 390-393., 2007
    Organism:Division of Rheumatology, Department of Medicine, College of Medicine, The Hospital for Rheumatic Disease, Hanyang University, Seoul, South KoreaFAU - Youm, J-Y
    Abstract:    Objective. Interleukin-1 (IL-1) has been implicated in the pathogenesis of several rheumatic inflammatory diseases, including adult-onset Still's disease (AOSD) and systemic-onset juvenile idiopathic arthritis (SoJIA). Several clinical trials also suggest that anakinra, a human recombinant interleukin-1 receptor antagonist (IL-1Ra), is effective in patients with AOSD and SoJIA. We have therefore investigated whether IL-1beta and IL-1Ra gene polymorphisms are associated with the development and clinical features of AOSD. Methods. Genomic DNA was isolated from 83 AOSD patients and 144 healthy controls. Genotyping of the two IL-1beta gene (IL-1B+3954 and IL-1B-511) polymorphisms was performed using polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP). Genotyping of the IL-1Ra gene (intron 2, VNTR) polymorphism was performed using PCR-based analysis. To compare genotype and allele frequencies, the chi(2)-test or Fisher's exact test was used. Haplotype frequencies and pairwise linkage disequilibrium were also estimated. A p-value <0.05 was considered significant. Results. There were no significant differences in the genotype and allele frequencies of the IL-1beta and IL-1Ra gene polymorphisms. No differences were also found in the IL-1 gene cluster haplotypes between both groups. IL-1 gene cluster polymorphisms had no effect on the clinical course and joint involvement pattern. Nevertheless, the IL-1B-511 and IL-1RN (VNTR) polymorphic sites were in linkage disequilibrium. Conclusion. These results suggest that IL-1beta and IL-1Ra gene polymorphisms are not associated with the development and clinical features of AOSD in Korean patients