RESUMEN
OBJECTIVE: To provide evidence-based guidance for the rational and safe prescription of biological therapies in children and adolescents with juvenile idiopathic arthritis (JIAs) considering the latest available evidence and the new licensed biologics. METHODS: Rheumatologists and Pediatricians with expertise in Pediatric Rheumatology updated the recommendations endorsed by the Portuguese Society of Rheumatology and the Portuguese Society of Pediatrics based on published evidence and expert opinion. The level of agreement with final propositions was voted using an online survey. RESULTS: In total, 20 recommendations to guide the use of biological therapy in children and adolescents with JIAs are issued, comprising 4 general principles and 16 specific recommendations. A consensus was achieved regarding the eligibility and response criteria, maintenance of biological therapy, and procedures in case of non-response, for each JIA category. Specific recommendations concerning safety procedures were also updated. CONCLUSIONS: These recommendations take into account the specificities of each JIA category and are intended to continuously improve the management of JIA patients.
Asunto(s)
Artritis Juvenil/tratamiento farmacológico , Productos Biológicos/uso terapéutico , Adolescente , Niño , Árboles de Decisión , Humanos , Portugal , Guías de Práctica Clínica como Asunto , Inhibidores del Factor de Necrosis TumoralRESUMEN
Köhler disease (KD) is the osteochondrosis of the tarsal navicular bone of the young children, which is a self-limited condition. Typically the child reports pain with mechanical characteristics in the medial region of the foot, however, intermittent or continuous limping may be the only clinical manifestation, which delays the diagnosis and consequently exposes to unnecessary tests and treatments. We describe a bilateral KD whose clinical manifestation was unilateral limping with 4 months evolution. The radiologic evaluation showed flattening, sclerosis and irregular rarefaction of both navicular bones. Claudication persisted for four weeks, after which, the child remains asymptomatic.
