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1.
Pediatr Rheumatol Online J ; 17(1): 81, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31842923

RESUMEN

BACKGROUND: The oral microbiota has been implicated in the pathogenesis of rheumatoid arthritis through activation of mucosal immunity. This study tested for associations between oral health, microbial communities and juvenile idiopathic arthritis (JIA). METHODS: A cross-sectional exploratory study of subjects aged 10-18 years with oligoarticular, extended oligoarticular and polyarticular JIA was conducted. Control groups included pediatric dental clinic patients and healthy volunteers. The primary aim was to test for an association between dental health indices and JIA; the secondary aim was to characterize the microbial profile of supragingival plaque using 16S rRNA gene sequencing. RESULTS: The study included 85 patients with JIA, 62 dental patients and 11 healthy child controls. JIA patients overall had significantly more gingival inflammation compared to dental patients, as evidenced by bleeding on probing of the gingiva, the most specific sign of active inflammation (p = 0.02). Overall, however, there was a trend towards better dental hygiene in the JIA patients compared to dental patients, based on indices for plaque, decay, and periodontitis. In the JIA patients, plaque microbiota analysis revealed bacteria belonging to genera Haemophilus or Kingella elevated, and Corynebacterium underrepresented. In poly JIA, bacteria belonging to the genus Porphyromonas was overrepresented and Prevotella was underrepresented. CONCLUSION: Increased gingival inflammation in JIA was independent of general oral health, and thus cannot be attributed to poor dental hygiene secondary to disability. The variation of microbial profile in JIA patients could indicate a possible link between gingivitis and synovial inflammation.


Asunto(s)
Artritis Juvenil/etiología , Placa Dental/complicaciones , Microbiota , Salud Bucal , Adolescente , Artritis Juvenil/microbiología , Estudios de Casos y Controles , Niño , Estudios Transversales , Placa Dental/microbiología , Femenino , Humanos , Masculino , Microbiota/genética , Boca/microbiología , Periodontitis/complicaciones , Periodontitis/microbiología , ARN Ribosómico 16S/genética
4.
J Autoimmun ; 98: 1-12, 2019 03.
Artículo en Inglés | MEDLINE | ID: mdl-30638708

RESUMEN

Microbial diversity plays a key role in the maintenance of intestinal homeostasis and in the development of the immune system in the gut mucosa. Maybe one of the most important function of our gut microbiota is the immune system education, in particular the discrimination of friends from foes that occurs during childhood. In addition to bacterial antigens, several metabolites of microbial origin have a crucial role in training of the immune system, such as Short Chain Fatty Acids (SCFAs). There are many evidences on the role of the gut microbiota in rheumatic diseases, in particular modifications of microbiota composition causing dysbiosis that, in turn, can induce gut permeability, and thus immunological imbalance and trigger inflammation. In particular, immune cells can reach extra-intestinal sites, such as joints and trigger local inflammation. Childhood is a crucial period of life for development and evolution of the gut microbiota, especially for the acquisition of fundamental functions such as immunotolerance of commensal microorganisms. For this reason, gut dysbiosis is gaining interest as a potential pathogenetic factor for Juvenile Idiopathic Arthritis (JIA). Here we summarized the studies conducted on JIA patients in which a pro-arthritogenic microbial profiles has been observed; this, together with a depletion of microbial biodiversity, clearly distinguish patients' from healthy subjects' microbiota. Further studies are however needed to better clarify the role of microbiota in JIA pathogenesis.


Asunto(s)
Artritis Juvenil/microbiología , Disbiosis/inmunología , Microbioma Gastrointestinal/inmunología , Niño , Homeostasis , Humanos , Sistema Inmunológico , Inflamación , Enfermedades Inflamatorias del Intestino , Simbiosis
5.
Best Pract Res Clin Rheumatol ; 33(6): 101496, 2019 12.
Artículo en Inglés | MEDLINE | ID: mdl-32171669

RESUMEN

In recent decades, because of advances in technology there has been an explosion of knowledge on how microbiome affects human health. In most chronic immune-inflammatory diseases, alterations in gut microbiome has been shown. The successful use of faecal microbial transplants for the treatment of clostridium difficile associated diarrhoea has also paved the way for novel therapies. Gut microbiome is affected by early life events like the mode of delivery, breast feeding, the use of antibiotics, etc. and that may have an indirect effect on the developing immune system as well as on the predisposition to juvenile idiopathic arthritis (JIA). Multiple studies have found altered gut microbiome in JIA though no single organism or microbial community has been found to be associated with JIA. In JIA, attempts to modify gut microbiome by using probiotics, exclusive enteral nutrition and other modalities have had variable success. The current review discusses the current data available on gut microbiome in different categories of JIA and how this knowledge can translate into new therapies.


Asunto(s)
Artritis Juvenil , Microbioma Gastrointestinal , Microbiota , Artritis Juvenil/microbiología , Nutrición Enteral , Humanos
6.
Arthritis Rheumatol ; 71(6): 1000-1010, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30592383

RESUMEN

OBJECTIVE: To assess the composition of gut microbiota in Italian and Dutch patients with juvenile idiopathic arthritis (JIA) at baseline, with inactive disease, and with persistent activity compared to healthy controls. METHODS: In a multicenter, prospective, observational cohort study, fecal samples were collected at baseline from 78 Italian and 21 Dutch treatment-naive JIA patients with <6 months of disease duration and compared to 107 geographically matched samples from healthy children. Forty-four follow-up samples from patients with inactive disease and 25 follow-up samples from patients with persistent activity were analyzed. Gut microbiota composition was determined by 16S ribosomal RNA-based metagenomics. Alpha- and ß-diversity were computed, and log ratios of relative abundance were compared between patients and healthy controls using random forest models and logistic regression. RESULTS: Baseline samples from Italian patients showed reduced richness compared to healthy controls (P < 0.001). Random forest models distinguished between Italian patient baseline samples and healthy controls and suggested differences between Dutch patient samples and healthy controls (areas under the curve >0.99 and 0.71, respectively). The operational taxonomic units (OTUs) of Erysipelotrichaceae (increased in patients), Allobaculum (decreased in patients), and Faecalibacterium prausnitzii (increased in patients) showed different relative abundance in Italian patient baseline samples compared to controls after controlling for multiple comparisons. Some OTUs differed between Dutch patient samples and healthy controls, but no evidence remained after controlling for multiple comparisons. No differences were found in paired analysis between Italian patient baseline and inactive disease samples. CONCLUSION: Our findings show evidence for dysbiosis in JIA patients. Only patient/control status, age, and geographic origin appear to be drivers of the microbiota profiles, regardless of disease activity stage, inflammation, and markers of autoimmunity.


Asunto(s)
Artritis Juvenil/microbiología , Disbiosis/epidemiología , Microbioma Gastrointestinal/genética , Artritis Juvenil/epidemiología , Estudios de Casos y Controles , Niño , Preescolar , Estudios de Cohortes , Comorbilidad , Faecalibacterium prausnitzii , Femenino , Firmicutes , Humanos , Italia/epidemiología , Modelos Logísticos , Estudios Longitudinales , Masculino , Metagenómica , Países Bajos/epidemiología , ARN Ribosómico 16S , Índice de Severidad de la Enfermedad
7.
J Infect Chemother ; 24(7): 531-537, 2018 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-29606414

RESUMEN

Reactive arthritis after Group A streptococcal infection (poststreptococcal reactive arthritis: PSRA) that does not meet the Jones criteria for acute rheumatic fever (ARF) has been reported as a new entity for over a decade. In Japan there are few reports of PSRA. We encountered four children with arthritis accompanied with Group A streptococcal infection in our department. We investigated our cases and the recent Japanese literature. Japanese cases of PSRA are frequently accompanied with uveitis and erythema nodosum, and tonsillectomy resolved their symptoms in some cases. There were overlap cases between ARF, juvenile idiopathic arthritis, and PSRA.


Asunto(s)
Artritis Juvenil/diagnóstico por imagen , Artritis Reactiva/diagnóstico por imagen , Artritis Reactiva/microbiología , Infecciones Estreptocócicas/complicaciones , Adolescente , Antibacterianos/uso terapéutico , Artritis Juvenil/microbiología , Artritis Reactiva/tratamiento farmacológico , Biomarcadores/sangre , Niño , Preescolar , Quimioterapia Combinada , Eritema Nudoso , Femenino , Humanos , Japón , Masculino , Fiebre Reumática/diagnóstico por imagen , Fiebre Reumática/microbiología , Infecciones Estreptocócicas/tratamiento farmacológico , Tonsilectomía , Uveítis
8.
Arthritis Res Ther ; 20(1): 14, 2018 01 30.
Artículo en Inglés | MEDLINE | ID: mdl-29382366

RESUMEN

BACKGROUND: Prior studies have demonstrated abnormalities in the composition of the gastrointestinal microbiota in pediatric and adult patients with spondyloarthritis (SpA). In particular, diminished fecal abundance of Faecalibacterium prausnitzii and abnormalities in both directions in the abundance of the Bacteroides genus have been identified. METHODS: We obtained fecal specimens from 30 children with treatment-naïve enthesitis-related arthritis (ERA) and 19 healthy controls, as well as specimens from 11 adult patients with longstanding SpA and 10 adult healthy controls. All of the samples underwent sequencing of the 16S ribosomal DNA. A subset of the pediatric fecal samples was subjected to shotgun metagenomics sequencing. RESULTS: ERA patients had decreased abundance of the anti-inflammatory F. prausnitzii A2-165 strain (41 ± 28% versus 54 ± 20% of all sequences matching F. prausnitzii, p = 0.084) and an increased abundance of the control F. prausnitzii L2/6 strain (28 ± 28% versus 15 ± 15%, p = 0.038). Similar trends were observed in adults with longstanding SpA (n = 11) and controls (n = 10). In contrast, the fecal abundance of Bacteroides fragilis was increased in ERA subjects (2.0 ± 4.0% versus 0.45 ± 0.7% of all sequences, p = 0.045), yet was diminished in adult subjects (0.2 ± % versus 1.0 ± % of all sequences, p = 0.106). Shotgun metagenomics sequencing of the fecal DNA in the pediatric subjects revealed diminished coverage of the butanoate pathway (abundance normalized to controls of 1 ± 0.48 versus 0.72 ± 0.33 in ERA, p = 0.037). CONCLUSIONS: The anti-inflammatory F. prausnitzii A2-165 strain appears to be depleted in both pediatric and adult SpA. In contrast, B. fragilis may be depleted in adult disease yet abundant in pediatric SpA, suggesting developmental effects on the immune system.


Asunto(s)
Artritis Juvenil/microbiología , Heces/microbiología , Microbioma Gastrointestinal/fisiología , Espondiloartritis/microbiología , Adolescente , Adulto , Factores de Edad , Bacterias/clasificación , Bacterias/genética , Niño , ADN Bacteriano/química , ADN Bacteriano/genética , Femenino , Microbioma Gastrointestinal/genética , Humanos , Masculino , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN , Especificidad de la Especie
9.
J Dent Child (Chic) ; 84(2): 72-79, 2017 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-28814366

RESUMEN

PURPOSE: The purpose of this study was to evaluate the periodontal status and the presence and concentration of Porphyromonas gingivalis (P. gingivalis) and immunoglobulin G (IgG) subclass against P. gingivalis in juvenile idiopathic arthritis (JIA) and its association with rheumatic clinical activity parameters. METHODS: Rheumatologic conditions and periodontal status were clinically assessed in 51 patients with JIA. P. gingivalis, IgG1 and IgG2, high-sensitivity C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor (RF), anti-citrullinated protein antibodies (ACPAs), and human leukocyte antigen B27 were also evaluated. RESULTS: Periodontitis was observed in 21.5 percent of the patients, 23.5 percent of whom were positive for P. gingivalis, which was associated with enthesitis-related arthritis (P<0.035). IgG1 against P gingivalis was associated with RF autoantibodies (P=0.05), and all patients positive for ACPAs had higher anti-P gingivalis IgG1 levels. A significant correlation was found between the presence of limited joint mobility and the plaque index in polyarticular JIA (r=0.55, P=0.028). CONCLUSIONS: An association between IgG and rheumatic disease activity markers in JIA was evident. It is important to investigate the familiar periodontal status and clinical course in JIA, especially in enthesitis-related arthritis.


Asunto(s)
Artritis Juvenil/complicaciones , Infecciones por Bacteroidaceae/complicaciones , Infecciones por Bacteroidaceae/inmunología , Inmunoglobulina G/sangre , Periodontitis/complicaciones , Periodontitis/microbiología , Porphyromonas gingivalis/inmunología , Adolescente , Artritis Juvenil/inmunología , Artritis Juvenil/microbiología , Femenino , Humanos , Masculino , Periodontitis/inmunología , Índice de Severidad de la Enfermedad
10.
Arch Dis Child ; 102(4): 316-322, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-27655660

RESUMEN

AIM: Childhood arthritis arises from several causes. The aim of this observational study is to compare the clinical and biological features and short-term outcome of different types of arthritis because they have different treatment and prognoses. METHODS: Children <16 years of age hospitalised in a French tertiary care centre for a first episode of arthritis lasting for less than 6 weeks who underwent joint aspiration were retrospectively included. We performed non-parametrical tests to compare groups (septic arthritis (SA), juvenile idiopathic arthritis (JIA) and arthritis with no definitive diagnosis). The time before apyrexia or C reactive protein (CRP) <10 mg/L was analysed using the Kaplan-Meier method. RESULTS: We studied 125 children with a sex ratio (M/F) of 1.1 and a median age of 2.2 years (range 0.3 to 14.6). SA was associated with a lower age at onset (1.5 years, IQR 1.2-3.0 vs 3.6 years, IQR 2.2-5.6), shorter duration of symptoms before diagnosis (2 days, IQR 1-4 vs 7 days, IQR 1-19) and higher synovial white blood cell count (147 cells ×103/mm3, IQR 71-227, vs 51 cells ×103/mm3, IQR 12-113), than JIA. Apyrexia occurred later in children with JIA (40% after 2 days, 95% CI 17% to 75%) than children with SA (82%, 95% CI 68% to 92%), as did CRP<10 mg/L (18% at 7 days, 95% CI 6.3% to 29.6% vs 82.1%, 95% CI 76.1% to 89.7%, p=0.01). CONCLUSIONS: There were no sufficiently reliable predictors for differentiating between SA and JIA at onset. The outcomes were different; JIA should be considered in cases of poor disease evolution after antibiotic treatment and joint aspiration.


Asunto(s)
Artritis Infecciosa/diagnóstico , Artritis Juvenil/diagnóstico , Adolescente , Edad de Inicio , Antibacterianos/uso terapéutico , Artritis Infecciosa/tratamiento farmacológico , Artritis Infecciosa/microbiología , Artritis Juvenil/tratamiento farmacológico , Artritis Juvenil/microbiología , Biopsia con Aguja , Proteína C-Reactiva/metabolismo , Niño , Preescolar , Diagnóstico Diferencial , Femenino , Hospitalización , Humanos , Lactante , Masculino , Estudios Retrospectivos , Líquido Sinovial/química
11.
Clin Exp Immunol ; 187(3): 480-489, 2017 03.
Artículo en Inglés | MEDLINE | ID: mdl-27861762

RESUMEN

In Asia, enthesitis-related arthritis (ERA) is the most frequent category of juvenile idiopathic arthritis. ERA has a strong association with human leucocyte antigen (HLA)-B27 and subclinical gut inflammation. In an HLA-B27 transgenic rat model, the presence of Bacteroides bacteria in the gut appears to cause spondyloarthropathy (SpA). Thus, we studied gut microbiota in children with ERA. Stool specimens from 33 patients with ERA and 14 age-matched healthy controls were studied; none had any gastrointestinal symptom, or had received a drug known to affect gut motility or microbiota in the preceding 6 weeks. From each specimen, a cDNA library for the V3 region of bacterial 16S rRNA was subjected to high-throughput, massively parallel sequencing. Relationship of the specimens was studied using principal co-ordinate analysis (PCoA), and abundances of various bacterial taxa and alpha diversity were compared between groups. In eight patients, a repeat faecal specimen was studied after 12 weeks of probiotic therapy. The 55 specimens yielded a median (range) of 397 315 (102 093-1 502 380) high-quality reads each. In PCoA, gut microbiota from ERA showed a wider dispersion than those from controls. In patients, families Bacteroidaceae and Enterobacteriaceae were more abundant and Prevotellaceae were less abundant than in controls. Also, genera Bacteroides, Entercoccus and Klebsiella were over-represented and genus Prevotella was under-represented in ERA patients. Probiotic therapy led to a non-significant increase in Prevotellaceae. Patients with ERA have a dysbiosis in the gut, with increased abundance of Bacteroides and reduction of Prevotella. Probiotic supplementation in a subset of patients did not reverse these changes significantly.


Asunto(s)
Artritis Juvenil/tratamiento farmacológico , Artritis Juvenil/microbiología , Microbioma Gastrointestinal/efectos de los fármacos , Probióticos/administración & dosificación , Adolescente , Adulto , Bacterias/efectos de los fármacos , Estudios de Casos y Controles , Niño , Preescolar , Países en Desarrollo , Disbiosis/tratamiento farmacológico , Disbiosis/microbiología , Heces/microbiología , Femenino , Antígeno HLA-B27/metabolismo , Secuenciación de Nucleótidos de Alto Rendimiento/métodos , Humanos , Masculino , Microbiota/efectos de los fármacos , Adulto Joven
12.
Pediatr Rheumatol Online J ; 14(1): 55, 2016 Sep 20.
Artículo en Inglés | MEDLINE | ID: mdl-27650128

RESUMEN

Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood. The pathogenesis of JIA is thought to be the result of a combination of host genetic and environmental triggers. However, the precise factors that determine one's susceptibility to JIA remain to be unravelled. The microbiome has received increasing attention as a potential contributing factor to the development of a wide array of immune-mediated diseases, including inflammatory bowel disease, type 1 diabetes and rheumatoid arthritis. Also in JIA, there is accumulating evidence that the composition of the microbiome is different from healthy individuals. A growing body of evidence indeed suggests that, among others, the microbiome may influence the development of the immune system, the integrity of the intestinal mucosal barrier, and the differentiation of T cell subsets. In turn, this might lead to dysregulation of the immune system, thereby possibly playing a role in the development of JIA. The potential to manipulate the microbiome, for example by faecal microbial transplantation, might then offer perspectives for future therapeutic interventions. Before we can think of such interventions, we need to first obtain a deeper understanding of the cause and effect relationship between JIA and the microbiome. In this review, we discuss the existing evidence for the involvement of the microbiome in JIA pathogenesis and explore the potential mechanisms through which the microbiome may influence the development of autoimmunity in general and JIA specifically.


Asunto(s)
Artritis Juvenil , Autoinmunidad , Microbiota/inmunología , Artritis Juvenil/inmunología , Artritis Juvenil/microbiología , Humanos
13.
Clin Exp Rheumatol ; 34(5): 941-945, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27383427

RESUMEN

OBJECTIVES: There is extensive evidence for an influence of gut microbiota on the immune system, which has consequences for inflammatory diseases. Exclusive enteral nutrition (EEN), which may change the gut microbiota, is an effective anti-inflammatory treatment for Crohn's disease in children. We wanted to explore the immediate anti-inflammatory effect of EEN in children with juvenile idiopathic arthritis (JIA). METHODS: Thirteen patients with JIA (7-17 years of age), in a disease flare-up, were included in the study. Six children dropped out within 1.5-2.0 weeks of treatment, and seven patients continued, constituting the study cohort. EEN was given for three to eight weeks, with clinical and laboratory status assessed before and after treatment periods. In addition to conventional laboratory tests, 92 inflammatory proteins were analysed with a multiplex system (Proseek Multiplex Inflammation I, Olink Bioscience). RESULTS: EEN had a significant anti-inflammatory effect on active joints (p=0.031), JADAS27 (p=0.016) and morning stiffness (p=0.031). In the multiplex analysis of inflammatory proteins, MMP-1 (matrix metalloproteinase), involved in the degradation of collagens in chondrocytes, decreased significantly (p=0.047), as did MCP-4 (p=0.031) and 4E-BP1 (p=0.031). CONCLUSIONS: Exclusive enteral nutrition for three to eight weeks had anti-inflammatory effect in all children with JIA that continued with EEN for more than two weeks. The study is only exploratory but the result supports an immunologically important role for the intestinal canal in these patients.


Asunto(s)
Artritis Juvenil/terapia , Nutrición Enteral , Adolescente , Artritis Juvenil/sangre , Artritis Juvenil/inmunología , Artritis Juvenil/microbiología , Biomarcadores/sangre , Niño , Femenino , Microbioma Gastrointestinal , Tracto Gastrointestinal/inmunología , Tracto Gastrointestinal/microbiología , Humanos , Mediadores de Inflamación/sangre , Masculino , Estudios Prospectivos , Análisis por Matrices de Proteínas , Factores de Tiempo , Resultado del Tratamiento
14.
Pediatr Rheumatol Online J ; 14(1): 44, 2016 Jul 22.
Artículo en Inglés | MEDLINE | ID: mdl-27448997

RESUMEN

BACKGROUND: Juvenile idiopathic arthritis is the most common form of chronic arthritis in children. There is mounting evidence that the microbiota may influence the disease. MAIN BODY: Recent observations in several systemic inflammatory diseases including JIA have indicated that abnormalities in the contents of the microbiota may be factors in disease pathogenesis, while other studies in turn have shown that environmental factors impacting the composition of the microbiota, such as delivery mode and early exposure to antibiotics, affect the risk of chronic inflammatory diseases including JIA. Microbial alterations may predispose to JIA through a variety of mechanisms, including impaired immunologic development, alterations in the balances of pro- versus anti-inflammatory bacteria, and low-grade mucosal inflammation. Additional confirmatory studies of microbiota aberrations and their risk factors are needed, as well as additional mechanistic studies linking these alterations to the disease itself. CONCLUSIONS: The microbiota may influence the risk of JIA and other systemic inflammatory conditions through a variety of mechanisms. Additional research is required to improve our understanding of the links between the microbiota and arthritis, and the treatment implications thereof.


Asunto(s)
Artritis Juvenil/microbiología , Disbiosis/microbiología , Microbioma Gastrointestinal/fisiología , Interacciones Huésped-Patógeno/fisiología , Artritis Juvenil/epidemiología , Artritis Juvenil/fisiopatología , Disbiosis/epidemiología , Disbiosis/fisiopatología , Humanos , Factores de Riesgo
15.
Curr Opin Rheumatol ; 28(5): 537-43, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27286235

RESUMEN

PURPOSE OF REVIEW: There has been increasing interest in the contents and function of the microbiota, as it relates to pediatric inflammatory diseases. Here, we discuss the factors underlying the development of the microbiota, its role in juvenile idiopathic arthritis (JIA) and prospects for therapeutic interventions in the microbiota. RECENT FINDINGS: The human microbiota undergoes a succession of changes, until it reaches a mature form. A variety of early-life exposures, including mode of delivery and form of feeding, can affect the contents of the microbiota and possibly impact upon long-term risk of developing autoimmune diseases. The microbiota is altered in children with JIA, including elevated Bacteroides genus in JIA as a whole and decreased Faecalibacterium prausnitzii in pediatric spondyloarthritis. Although there are limited data so far indicating that microbiota-based therapies can result in therapeutic improvement of arthritis, most of the data are on adults and thus may not be applicable to children. SUMMARY: Perturbations of the microbiota during childhood may result in the development of a microbiota associated with increased risk of pediatric rheumatic illness. Whether the microbiota can be targeted is a focus of ongoing research.


Asunto(s)
Artritis Juvenil/inmunología , Microbioma Gastrointestinal/inmunología , Espondiloartropatías/inmunología , Adolescente , Artritis Juvenil/microbiología , Artritis Juvenil/terapia , Bacteroides , Niño , Dietoterapia , Faecalibacterium prausnitzii , Humanos , Probióticos/uso terapéutico , Enfermedades Reumáticas/inmunología , Enfermedades Reumáticas/microbiología , Enfermedades Reumáticas/terapia , Factores de Riesgo , Espondiloartropatías/microbiología , Espondiloartropatías/terapia
16.
Clin Exp Immunol ; 185(3): 301-8, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27238895

RESUMEN

Gut microflora and dysbiosis as an environmental factor has been linked to the pathogenesis of enthesitis-related arthritis (JIA-ERA); thus, we performed a proof-of-concept study of probiotics to modulate the gut-flora and study the effects on immune and clinical parameters of children having JIA-ERA. Forty-six children with active JIA-ERA were randomized to placebo or probiotic therapy along with non-steroidal anti-inflammatory drugs (NSAIDs) for 12 weeks. Patients were assessed using a six-point composite disease activity index (mJSpADA) based on morning stiffness, joint count, enthesitis count, sacroiliitis/inflammatory back pain, uveitis and erythrocyte sedimentation rate/C-reactive protein (ESR/CRP). Frequencies of T helper type 1 (Th1), Th2, Th17 and regulatory T cells in blood were measured using flow cytometry. Serum cytokines interferon (IFN)-γ, interleukin (IL)-4, IL-17, IL-10, tumour necrosis factor (TNF)-α and IL-6 were measured by cytokine bead array using flow cytometer. The average age of 46 children (44 boys) was 15 ± 2.5 years and duration of disease was 3.5 ± 3 years. There was no significant difference in improvement in mJSpADA between the two groups (P = 0·16). Serum IL-6 levels showed a decrease (P < 0·05) in the probiotic-group. Th2 cell frequency (P < 0·05) and serum IL-10 levels (P < 0·01) showed an increase in the placebo group, but again the probiotic use did not show a significant change in immune parameters when compared to the placebo. Adverse effects among the probiotic and placebo groups were diarrhea (36 versus 45%), abdominal pain (9 versus 20%), minor infections (4·5 versus 20%) and flatulence (23 versus 15%), respectively. Thus, we can conclude that probiotic therapy in JIA-ERA children is well tolerated, but failed to show any significant immune or clinical effects over NSAID therapy.


Asunto(s)
Artritis Juvenil/inmunología , Artritis Juvenil/terapia , Citocinas/sangre , Probióticos/uso terapéutico , Adolescente , Antiinflamatorios no Esteroideos/uso terapéutico , Artritis Juvenil/microbiología , Proteína C-Reactiva/análisis , Diarrea/etiología , Flatulencia/etiología , Humanos , Interleucina-17/sangre , Interleucina-6/sangre , Masculino , Evaluación de Resultado en la Atención de Salud , Probióticos/efectos adversos , Linfocitos T Reguladores/inmunología , Células Th17/química , Células Th2/inmunología
18.
Artículo en Ruso | MEDLINE | ID: mdl-30695388

RESUMEN

AIM: To study the state of gut microsymbiocenosis in children with reactive arthritis (RA), with the assessment of biofilm formation (BFF) of microsymbionts and the ability to change cytokine levels (their anticyokine activity) in vitro. MATERIALS AND METHODS: The investigation of gut microsymbiocenosis by means of bacteriological method was conducted in 34 children with RA and 25 relatively healthy 3 - 16 year- old children. Microorganisms were identified with the help of MALDI-TOF mass-spectrometry, anticytokine activity (ACA) of microsymbionts - according to Bukharin O.V et al. (2011), biofilm formation - according to O'Toole G.A., Kolter R. (1998). RESULTS: On the ground of species composition differences of gut microbiota discrimination model was created which allowed to separate the group of children with RA from healthy individuals. Microsymbiocenosis of patients with RA was characterized by increasing number of opportunistic microorganisms (OM) (enterobacteria, clostridia, bacteroides, and Candida), BFF and ACA level. CONCLUSION: The obtained data greatly contribute.to the deciphering of spondylo- arthritis and disclose the role of microbial factor under given pathology. Hypercolonisation of human gut with OM, having pronounced ability to BFF and regulating cytokine level, promotes strengthening of arthritogenic potential and serves as additional marker of arthritis development risk in children.


Asunto(s)
Artritis Juvenil/microbiología , Bacterias , Candida , Microbioma Gastrointestinal , Adolescente , Bacterias/clasificación , Bacterias/crecimiento & desarrollo , Bacterias/aislamiento & purificación , Candida/clasificación , Candida/crecimiento & desarrollo , Candida/aislamiento & purificación , Niño , Preescolar , Femenino , Humanos , Masculino
19.
Int J Oral Maxillofac Surg ; 45(3): 318-22, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26554824

RESUMEN

Temporomandibular joint (TMJ) involvement in juvenile idiopathic arthritis (JIA) occurs in up to 80% of affected children. The purpose of this study was to investigate the presence of bacterial DNA in synovial fluid, and to compare this with clinical and immunological findings in children with JIA, adults with persistent JIA, and adults with rheumatoid arthritis, in order to detect whether bacteria contribute to inflammation in TMJ arthritis. Synovial fluid and skin swab samples were collected from 30 patients (54 TMJs). Bacterial detection was performed using 16S rRNA pyrosequencing. Bacterial DNA was detected in 31 TMJs (57%) in 19 patients (63%). A positive statistically significant correlation was registered between bacterial DNA detected in TMJ synovial fluid and the following factors: total protein concentration in synovial fluid, interleukin 1ß, tumour necrosis factor alpha, adrenocorticotropic hormone, and adiponectin, as well as the duration of the general medical disease. Fourteen different bacterial species were detected in synovial fluid. Bacterial DNA in TMJ synovial fluid without contamination was detected in more than 50% of the patients. Studies are needed to evaluate the consequences of this bacterial DNA in synovial fluid with regard to TMJ arthritis.


Asunto(s)
Artritis Juvenil/microbiología , Artritis Reumatoide/microbiología , Líquido Sinovial/microbiología , Articulación Temporomandibular/microbiología , Adolescente , Adulto , Anciano de 80 o más Años , Artritis Juvenil/inmunología , Artritis Reumatoide/inmunología , Niño , ADN Bacteriano/análisis , Femenino , Humanos , Inflamación , Masculino , Reacción en Cadena de la Polimerasa , Líquido Sinovial/inmunología
20.
J Infect Chemother ; 21(8): 610-2, 2015 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-25960155

RESUMEN

BACKGROUND: Acute rheumatic fever (ARF) is an illness caused by group A streptococcus (GAS) infection, and remains the leading cause of acquired heart disease in worldwide. Distinguishing between ARF and septic arthritis may be difficult. This report describes a case of suppurative arthritis overlapping with ARF. CASE PRESENTATION: A 4-year-old, previously healthy boy presented with fever and left leg pain. The level of anti-streptolysin O (ASO) was elevated. His throat swab cultures grew GAS, but none were detected in his synovial fluid. Magnetic resonance imaging revealed suspected arthritis and osteomyelitis. The patient was treated for septic arthritis, but was subsequently diagnosed with ARF, after the development of carditis. CONCLUSION: The clinical and laboratory features of ARF and suppurative arthritis demonstrate substantial overlap. Patients with an elevated ASO should undergo a careful cardiac examination for carditis associated with ARF by an echocardiogram.


Asunto(s)
Artritis Infecciosa/diagnóstico , Artritis Juvenil/diagnóstico , Osteomielitis/diagnóstico , Fiebre Reumática/diagnóstico , Fiebre Reumática/tratamiento farmacológico , Infecciones Estreptocócicas/complicaciones , Streptococcus pyogenes/aislamiento & purificación , Enfermedad Aguda , Artritis Infecciosa/microbiología , Artritis Juvenil/microbiología , Preescolar , Diagnóstico Diferencial , Humanos , Masculino , Miocarditis/microbiología , Osteomielitis/microbiología , Fiebre Reumática/microbiología , Infecciones Estreptocócicas/tratamiento farmacológico
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