Development of Inflammatory Bowel Disease in Children With Juvenile Idiopathic Arthritis Treated With Biologics.

OBJECTIVE: The aim of our study was to describe the distinct features of inflammatory bowel disease (IBD) in juvenile idiopathic arthritis (JIA) patients and to identify risk factors for its development. METHODS: Data from the German biologics in pediatric rheumatology registry (Biologika in der Kinderrheumatologie) collected between 2001 and 2021 were analyzed retrospectively. RESULTS: In 5009 JIA patients, 28 developed confirmed IBD before the age of 18 years: 23 (82.1%) with Crohn disease (CD), 4 (14.3%) with ulcerative colitis (UC), and 1 (3.6%) with IBD-unclassified (IBD-U). The incident rate of IBD during 20 years of observation was 0.56% (0.46% for CD, 0.08% for UC, and 0.02% for IBD-U), of whom 20.3% were HLA-B27 positive, 25% had enthesitis-related arthritis, and 14.3% psoriatic arthritis. Within 90 days before IBD diagnosis, 82.1% (n = 23) received treatment with etanercept (ETA), 39.3% (n = 11) non-steroidal anti-inflammatory drugs, 17.9% (n = 5) systemic corticosteroids, 8 (28.6%) methotrexate (MTX), 14.3% (n = 4) sulfasalazine, 10.7% (n = 3) leflunomide, and 3.6% (n = 1) adalimumab and infliximab, respectively. The incidence of IBD was lower in patients treated with MTX, but higher in patients treated with ETA except if ETA was combined with MTX. Also in patients on leflunomide or sulfasalazine, the IBD incidence was higher. CONCLUSIONS: In our JIA cohort, an increased IBD incidence is observed compared to the general population, and the ratio of CD to UC is markedly higher hinting at a distinct phenotype of IBD. Pretreatment with MTX seems to be protective. Treatment with ETA does not prevent IBD development and JIA patients treated with leflunomide and sulfasalazine may be at an increased risk for IBD development.

Influence of a Novel Drill Design on Heat Generation During Conventional and Guided Implant Osteotomy.

PURPOSE: The aim of this in vitro study was to evaluate the temperature development of a novel, electropolished drill design during conventional and guided implant osteotomy in comparison to conventional drills under standardized conditions. MATERIALS AND METHODS: Single and sequential 12-mm-deep drilling protocols (guided and unguided) with a conventional (control groups) and novel drill (test groups) were performed in artificial bone blocks under external irrigation. Each drilling protocol was repeated 30 times with drill diameters of 2.2, 2.8, 3.5, and 4.2 mm. Temperature changes were recorded by an infrared camera, and the accumulated thermal energy was calculated. For group comparison, a one-way analysis of variance (ANOVA) and Tukey post hoc test were used with a level of significance set to = .05. RESULTS: The highest temperatures were measured up to 77.9°C for small-diameter drills in the control and test groups. The 3.5-mm and 4.2-mm novel drills showed significantly lower heat generation during guided and unguided osteotomy preparation for single and sequential drilling. The accumulated thermal energy during guided osteotomy preparation was significantly lower with the electropolished drills. CONCLUSION: The drill design has an important impact on heat development during osteotomy, which was most pronounced for guided osteotomy with conventional drills and for small-diameter osteotomies.

Consumption of analgesics before a marathon and the incidence of cardiovascular, gastrointestinal and renal problems: a cohort study.

OBJECTIVES: To prevent pain inhibiting their performance, many athletes ingest over-the-counter (OTC) analgesics before competing. We aimed at defining the use of analgesics and the relation between OTC analgesic use/dose and adverse events (AEs) during and after the race, a relation that has not been investigated to date. DESIGN: Prospective (non-interventional) cohort study, using an online questionnaire. SETTING: The Bonn marathon 2010. PARTICIPANTS: 3913 of 7048 participants in the Bonn marathon 2010 returned their questionnaires. PRIMARY AND SECONDARY OUTCOMES: Intensity of analgesic consumption before sports; incidence of AEs in the cohort of analgesic users as compared to non-users. RESULTS: There was no significant difference between the premature race withdrawal rate in the analgesics cohort and the cohort who did not take analgesics ('controls'). However, race withdrawal because of gastrointestinal AEs was significantly more frequent in the analgesics cohort than in the control. Conversely, withdrawal because of muscle cramps was rare, but it was significantly more frequent in controls. The analgesics cohort had an almost 5 times higher incidence of AEs (overall risk difference of 13%). This incidence increased significantly with increasing analgesic dose. Nine respondents reported temporary hospital admittance: three for temporary kidney failure (post-ibuprofen ingestion), four with bleeds (post-aspirin ingestion) and two cardiac infarctions (post-aspirin ingestion). None of the control reported hospital admittance. CONCLUSIONS: The use of analgesics before participating in endurance sports may cause many potentially serious, unwanted AEs that increase with increasing analgesic dose. Analgesic use before endurance sports appears to pose an unrecognised medical problem as yet. If verifiable in other endurance sports, it requires the attention of physicians and regulatory authorities.