Knee pain as a reason for referral to a paediatric rheumatologist: A retrospective study.

AIM: Knee pain is the most frequently reported type of lower extremity pain among children and adolescents. The objective of this study was to establish the features distinguishing inflammatory knee pain from non-inflammatory knee pain and to determine the specific variables to consider in suspected juvenile idiopathic arthritis (JIA). METHODS: A retrospective chart review was performed among children with knee pain evaluated through paediatric rheumatology consultations at a single centre between 2012 and 2019. RESULTS: Among the 262 children, 32 patients (12.2%) were diagnosed with JIA, 46 patients (17.6%) presented with inflammatory knee pain (IP) of an origin different than JIA, and 57 patients (21.7%) with non-inflammatory knee pain (NIP). In 127 cases (48.5%), no musculoskeletal disorder was diagnosed (NDD). The presence of limping, joint swelling, decreased passive range of motion and decreased active range of motion of the knee joint were registered more frequently in the JIA group compared to the other three groups. Multivariate analysis showed that a family history of autoimmune diseases and pain in other joints were associated with inflammatory pain. Increased pain after physical activity, pain only in the knee joint and absence of limping were predictors of NIP. The risk factors of JIA were limping and an erythrocyte sedimentation range of ≥10 mm after an hour. In the NDD group, the risk factors included no increase in pain after physical activity, serum C-reactive protein level < 5 mg/L and normal musculoskeletal ultrasound image. CONCLUSIONS: The majority of children with knee pain referred to a paediatric rheumatologist do not have arthritis. Knee pain alone, as a chief complaint, rarely leads to a final JIA diagnosis. Further studies are necessary in order to design the appropriate diagnostic and therapeutic algorithms.

Neuropeptides SP and CGRP Diminish the Moraxella catarrhalis Outer Membrane Vesicle- (OMV-) Triggered Inflammatory Response of Human A549 Epithelial Cells and Neutrophils.

Neuropeptides such as substance P (SP) and calcitonin gene-related peptide (CGRP) play both pro- and anti-inflammatory activities and are produced during infection and inflammation. Moraxella catarrhalis is one of the leading infectious agents responsible for inflammatory exacerbation in chronic obstructive pulmonary disease (COPD). Since the airway inflammation in COPD is connected with activation of both epithelial cells and accumulated neutrophils, in this study we determined the in vitro effects of neuropeptides on the inflammatory potential of these cells in response to M. catarrhalis outer membrane vesicle (OMV) stimulant. The various OMV-mediated proinflammatory effects were demonstrated. Next, using hBD-2-pGL4[luc2] plasmid with luciferase reporter gene, SP and CGRP were shown to inhibit the IL-1ß-dependent expression of potent neutrophil chemoattractant, hBD-2 defensin, in transfected A549 epithelial cells (type II alveolar cells) upon OMV stimulation. Both neuropeptides exerted antiapoptotic activity through rescuing a significant fraction of A549 cells from OMV-induced cell death and apoptosis. Finally, CGRP caused an impairment of specific but not azurophilic granule exocytosis from neutrophils as shown by evaluation of gelatinase-associated lipocalin (NGAL) or CD66b expression and elastase release, respectively. Concluding, these findings suggest that SP and CGRP mediate the dampening of proinflammatory action triggered by M. catarrhalis OMVs towards cells engaged in lung inflammation in vitro.

Sensorimotor polyneuropathy after hexavalent vaccination.

New vaccines in infants are generally well tolerated and serious adverse events are rare. We present a patient who developed severe sensorimotor polyneuropathy 2 weeks after the first immunization with hexavalent routine vaccine (INFANRIX hexa). Through intense physiotherapy the infant made a complete recovery.

The clinical profile of Kawasaki disease of children from three Polish centers: a retrospective study.

Kawasaki disease (KD) is one of the most common vasculitides of childhood. The aim of this retrospective study is to determine the incidence of KD and to evaluate its presenting symptoms, clinical course, laboratory tests, and treatment in patients with complete KD and incomplete KD at three pediatric rheumatology centers in Poland from January 2011 to December 2012. A total of 27 Caucasian children (12 boys and 15 girls) with median age of 3 years (range 4 months-12 years) were included in this study. The incidence of complete versus incomplete KD was 17 (63 %) versus 10 (37 %) children, respectively. Patients with incomplete KD significantly less presented cervical lymphadenopathy (20 vs. 88.2 %; p = 0.00075), changes in extremities (30 vs. 76.5 %; p = 0.04), and bilateral nonpurulent conjunctivitis (60 vs. 100 %; p = 0.01). Cardiac assessments show that the majority of patients with KD have not got coronary artery aneurysms (CAA). The median time from the onset of symptoms to intravenous immunoglobulin (IVIG) infusion was 7 days for complete KD and 11 days for incomplete KD. IVIG delay in the incomplete KD had no effect on the incidence of CAA. In conclusion, there were no differences in demographic features, age of onset, and laboratory tests of patients with complete and incomplete KD. Patients with incomplete KD significantly rarely presented cervical lymphadenopathy, changes in extremities, and conjunctival injection. Electrocardiography is a sensitive test to recognize cardiac involvement in the acute phase of KD. Despite the fact that incomplete forms of presentation often delay diagnosis, in most patients treatment with IVIG can avoid complication of CAA.

Iron status and dietary iron intake of vegetarian children from Poland.

BACKGROUND/AIM: In Poland, vegetarian diets are becoming more and more popular. The aim of this study was to examine the effect of iron intake on iron status in vegetarian children. METHODS: Dietary iron intake, iron food sources, blood count, serum iron, ferritin level and total iron-binding capacity were estimated in two groups of children, namely vegetarians (n = 22) and omnivores (n = 18) of both sexes, aged from 2 to 18 years. Seven-day food records were used to assess their diet. RESULTS: Dietary iron intake in vegetarians and omnivores was low (up to 65.0 and 60.1% of the recommended dietary allowance). A significantly higher intake of vitamin C was observed in vegetarians compared with omnivores (p = 0.019). The main sources of iron in vegetarians were cereal products, followed by vegetables and mushroom products, then fruit. The prevalence of iron deficiency (ID) was higher in the vegetarian group (p = 0.023). The serum ferritin level and mean corpuscular volume in the vegetarians were also lower than in the omnivores (p = 0.01 and p = 0.014, respectively). CONCLUSIONS: Children who follow a vegetarian diet may suffer from ID in spite of having a high vitamin C intake. This indicates the need to introduce dietary education and iron status monitoring.

Relation among ghrelin, nutritional status, and immunity in children.

BACKGROUND: Ghrelin is an important mediator of energy balance and metabolism. The aim of this study was to investigate the relationship among ghrelin concentration, growth patterns, and immunological parameters in children with an impairment or inefficiency in functioning of the immune system. METHODS: Twenty patients with primary immunodeficiency diseases (PIDs), 20 patients with recurrent respiratory tract infections (RRTIs), and 20 healthy children (control group) were included. The anthropometric measurements, ghrelin plasma levels, and selected immunological parameters were measured. RESULTS: Ghrelin levels and nutritional status parameters (weight, height, and body mass index) values were negatively correlated only in the control group. Ghrelin negatively correlates with complement hemolytic activity in the PID group and with IgA serum level in the RRTI group. CONCLUSION: Our results show evidence that there is a relationship between ghrelin and nutritional status of healthy children but not in children with PID or RRTI.

Bioactive Compounds of Raspberry Oil Emulsions Induced Oxidative Stress via Stimulating the Accumulation of Reactive Oxygen Species and NO in Cancer Cells.

There are growing interests in the complex combinations of natural compounds that may advance the therapy of cancer. Such combinations already exist in foods, and a good representative is seed oils. Two raspberry oils: cold pressed (ROCOP) and one extracted by supercritical CO2 (ROSCO2) were evaluated for their chemical characteristics and oil emulsions for cell suppression potential against colon adenocarcinoma (LoVo), doxorubicin-resistant colon adenocarcinoma (LoVo/DX), breast cancer (MCF7), doxorubicin-resistant breast cancer (MCF7/DX), and lung cancer (A549) cell lines. The cytotoxicity was also assessed on normal human dermal fibroblasts (NHDFs). With increasing concentration of raspberry oil emulsions (0.5-10%), increasing inhibition of cancer cell viability and proliferation in all of the lines was observed, with different degrees of potency between cancer types and oil tested. ROSCO2 strongly induced free radical production and DNA strand damage in LoVo and MCF7 cells especially doxorubicin-resistant lines. This suggests that ROSCO2 engages and effectively targets the vulnerabilities of the cancer cell. Generally, both ROSCO2 and ROCOP could be a nontoxic support in therapy of selected human cancers.

Silicon intake and plasma level and their relationships with systemic redox and inflammatory markers in rheumatoid arthritis patients.

BACKGROUND: The nutritional significance of silicon for the human body is highlighted by a continually growing body of evidence. In conditions of excessive reactive oxygen species and upregulated immune response, silicon has been observed to provide benefits, but its role in redox and inflammatory status has not yet been examined in rheumatoid arthritis (RA). OBJECTIVES: The aim of this study was to assess the relationship of silicon intake and plasma level to systemic indices of redox status and inflammation in patients with RA. MATERIAL AND METHODS: Silicon intake and plasma levels were measured in 115 RA subjects and 129 control subjects. Serum antioxidant and oxidant levels, antioxidant enzyme activity, and albumin, uric acid, TBARS, hs-CRP, and IL-6 levels were measured and compared to the intake and plasma levels of silicon. RESULTS: Silicon intake and plasma silicon levels were higher in RA subjects than in the controls. In the RA group, a generally favorable correlation to redox and inflammatory markers was found for silicon in diet and in plasma; however, albumin level, smoking status, and gender interfered with these results. In the control subjects, a significant relationship was observed only between plasma silicon and non-enzymatic markers of redox status. CONCLUSIONS: There are suggestions of silicon's involvement in managing redox and inflammatory status in RA, though further studies are warranted.

Diet Quality and Its Relationship with Antioxidant Status in Patients with Rheumatoid Arthritis.

A direct contribution towards destructive, proliferative synovitis in rheumatoid arthritis (RA) has been attributed to reactive oxygen species action. Some nutrients are considered to be capable of improving the oxidant/antioxidant status in RA; however the impact of diet composition on the antioxidant capacity of serum has not yet been studied in this disease. The aim of the study was to assess the relationship between diet quality and antioxidant status in patients with RA and healthy controls. Nutritional assessment was performed, and antioxidant status in serum, without and with deproteinization (TAS and DSAS, resp.), was determined in 82 RA and 87 healthy subjects. The diet of the RA group was low-energy and imbalanced. TAS and DSAS were significantly lower in RA patients than in controls. Antioxidant status significantly correlated with the supply of foods and nutrients influencing antioxidant and anti-inflammatory defense in RA; however, in this group, TAS was more sensitive to diet than DSAS. In healthy subjects, the nonprotein pool of serum antioxidants was more tightly linked to diet. These outcomes indicate the need to monitor diet quality of patients with RA and the usefulness of TAS measurements in this monitoring.

The profile of polyunsaturated fatty acids in juvenile idiopathic arthritis and association with disease activity.

We investigated the association between dietary intake of n-3 and n-6 polyunsaturated fatty acids (PUFAs), serum profiles, and immune and inflammatory markers in juvenile idiopathic arthritis (JIA) in relation to onset, activity, and duration. A total of 66 JIA patients and 42 controls were included. Serum PUFA levels were assessed by gas-liquid chromatography-mass spectrometry, a dietary intake by 7-day dietary record method, and IL-6, IL-10, and IL-17A levels using ELISA. Dietary PUFA intake did not differ between the JIA group and controls. Intakes of n-6 and n-3 PUFA and serum levels were not associated. Levels of total n-6 PUFA and linoleic acid (LA) were higher in inactive JIA than in active JIA. Patients with active and short-lasting disease (less than 3 months from diagnosis) had significantly lower levels of arachidonic acid (AA) and docosahexaenoic acid (DHA) than the control. Serum α-linolenic acid (ALA) levels were significantly higher in poly-JIA than in oligo-JIA and in controls. We found significantly higher serum IL-10 levels in JIA than in controls. Serum n-6 and n-3 levels were significantly negatively correlated with active joint count, erythrocyte sedimentation rate, and C-reactive protein and positively with platelet count. Our study presents the low levels of AA and DHA in the active phase of short-lasting JIA, particularly poly-JIA, and the relationship between n-6 and n-3 PUFA and classic markers of inflammation. PUFAs may contribute to the pathogenesis of JIA and support a necessity to identify new targets suitable for successful interventional studies in JIA patients.

Hypercalciuria in a child with acral peeling skin syndrome: a case report.

We present a case of 3-year-old Caucasian boy who developed monthly cyclic attacks of skin peeling of the palms and soles over 1.5 years. The skin peeling was associated with hypercalciuria. No mutation was present in TGM5 and CSTA genes, but the typical clinical picture and the biopsy from flaccid blisters on the feet confirmed the acral peeling skin syndrome (APSS). The possible associations of rare genetic disorders and metabolic conditions in the course of APSS need to be investigated.

[Analysis of bacteriological tests of children with decreased serum immunoglobulin IgA levels]. / Analiza wyników wybrancych badan bakteriologicznych u dzieci z obnizonym stezeniem surowiczego IgA.

Results of 142 children with decreased serum immunoglobulin IgA compared with the reference values for age, and 73 reached normal age levels for serum immunoglobulin (control group), up 6 months to 14 years of age with various clinical symptoms, admitted to hospital between 1999-2000, were analysed. The patients were divided into three groups: group I--children with decreased serum immunoglobulin IgA levels (86 patients), group II--children with hypogammaglobulinaemia IgA and IgG compared with the reference values for age (56 patients), group III--children reaching normal levels of serum immunoglobulin for age (73 patients)--control group. Staphylococcus aureus was found most frequently among pathogenic strains in groups I and II in comparison to the control group. In urine, Enterococcus faecalis strains were observed more often in the first and in the second group than in the control group. All patients in our three groups showed high per cent of Candida albicans in biological material from the pharynx and faeces. We associated this with treatment of recurrent infections in children, using many antibiotics. In conclusion, our results have demonstrated that low serum IgA and IgG concentrations in children are favourable for colonisation with pathogenic microorganisms.

Serum and urinary MIP-1α and IP-10 levels in children with urinary tract infections.

OBJECTIVES: Urinary tract infection (UTI) is a common bacterial disease in infants and children, with potentially serious complications, including kidney damage. The aim of this study was to test whether serum and urinary levels of interleukin-6 (IL-6), macrophage inflammatory protein-1a (MIP-1a) and interferon-γ-inducible protein-10 (IP-10) can be used as biomarkers in children with urinary tract infections. MATERIAL AND METHODS: The study group consisted of 22 children with UTI and 20 controls. Blood and urine samples were collected in the acute phase and the convalescent phase, on the eighth day after the onset of antibiotic therapy. Serum and urine levels of MIP-1a, IP-10 and IL-6 were measured. RESULTS: In children with UTI in the acute phase, serum MIP-1a and IL-6 levels were significantly higher compared to the controls (p<0.05 and p<0.005, respectively). A correlation between the serum levels of the chemokines MIP-1a and IP-10 in the acute phase was found. CONCLUSIONS: The findings suggest that the chemokines MIP-1a or IP-10 respond to infection, but they cannot be used as biomarkers for UTI in childhood.

Impact of vegetarian diet on serum immunoglobulin levels in children.

BACKGROUND: Nutrition plays an important role in immune response. We evaluated the effect of nutrient intake on serum immunoglobulin levels in vegetarian and omnivore children. METHODS: Serum immunoglobulin levels and iron status were estimated in 22 vegetarian and 18 omnivore children. Seven-day food records were used to assess the diet. RESULTS: There were no significant differences in serum IgA, IgM, and IgG levels between groups of children. Serum immunoglobulin levels were lower in vegetarian children with iron deficiency in comparison with those without iron deficiency. In the vegetarians, IgG level correlated positively with energy, zinc, copper, and vitamin B(6) intake. In the omnivores, these correlations were stronger with IgM level. CONCLUSIONS: Despite negligible differences in serum immunoglobulin levels between vegetarian and omnivore children, the impact of several nutrient intakes on IgM and IgG levels differed between groups. Low iron status in vegetarian children can lead to decreased immunoglobulin levels.