Diferenciación de sinovitis transitoria y artritis séptica de cadera con criterios clínicos y ecográficos / Differentiation between transient synovitis and septic arthritis of the hip with clinical and ultrasound criteria

Introducción: La ecografía no distingue entre los diferentes tipos de sinovitis. El objetivo de este trabajo fue valorar su contribución junto a algunos datos clínicos en el diagnóstico de la artritis séptica (AS) y la sinovitis transitoria (ST) de cadera. Método: Estudio prospectivo de pacientes con ST o AS de cadera unilateral realizado entre diciembre 2006 y julio 2009. Las variables incluyeron manifestaciones clínicas y medidas ecográficas. Las ecografías fueron realizadas con un método estandarizado. Resultados: La muestra estaba compuesta por 26 niños, 22 diagnosticados de ST y 4 de AS. Se encontró diferencia en la historia de fiebre (p=0,002). La edad no era diferente, aunque la media y la mediana en ST fue 6 años, frente a media de 4,3 y mediana de 2,3 en AS. Tampoco fueron diferentes las medidas ecográficas. El valor predictivo positivo del criterio «mayor de 4 años y ausencia de fiebre» para el diagnóstico de sinovitis transitoria fue 100%, mientras que «menor de 4 años e historia de fiebre» para el diagnóstico de artritis séptica era del 75%, siempre que la radiología hubiese excluido procesos ortopédicos y la ecografía mostrara derrame. Conclusiones: Pese a las limitaciones del estudio (tamaño de la muestra y baja prevalencia) la combinación de edad e historia de fiebre parece útil para diferenciar la sinovitis transitoria de la artritis séptica. La contribución de la ecografía fue confirmar la presencia de derrame articular (AU)

Introduction: Ultrasound does not distinguish between different types of synovitis. The aim of this study was to evaluate its contribution, together with several clinical data, in the diagnosis of septic arthritis (SA) and transient synovitis (TS) of the hip. Methods: Prospective study of patients diagnosed with unilateral SA or TS of the hip carried out between December 2006 and July 2009. A set of clinical variables and ultrasound measurements were analysed. The ultrasound examinations were performed using a standardised procedure. Results: The sample included 26 children, 22 diagnosed with TS and 4 with SA. A difference was found in the history of fever (P=0.002). On the other hand, no differences were detected in the age of the children, although mean and median in the TS group were 6 years vs a mean of 4.3 with a median of 2.3 years in the SA group. There were no differences in the ultrasound measurements either. The positive predictive value of the criterion “older than 4 years of age and no history of fever” for the diagnosis of transient synovitis was 100%, while “younger than 4 years and history of fever” for the diagnosis of septic arthritis was 75%, once radiology had excluded orthopaedic processes and ultrasound showed an effusion. Conclusions: In spite of the study limitations (sample size and low prevalence) the combination of age and history of fever appears to be useful in distinguishing transient synovitis from septic arthritis. The contribution of ultrasound was to confirm the presence of joint effusion (AU)

[Differentiation between transient synovitis and septic arthritis of the hip with clinical and ultrasound criteria]. / Diferenciación de sinovitis transitoria y artritis séptica de cadera con criterios clínicos y ecográficos.

INTRODUCTION: Ultrasound does not distinguish between different types of synovitis. The aim of this study was to evaluate its contribution, together with several clinical data, in the diagnosis of septic arthritis (SA) and transient synovitis (TS) of the hip. METHODS: Prospective study of patients diagnosed with unilateral SA or TS of the hip carried out between December 2006 and July 2009. A set of clinical variables and ultrasound measurements were analysed. The ultrasound examinations were performed using a standardised procedure. RESULTS: The sample included 26 children, 22 diagnosed with TS and 4 with SA. A difference was found in the history of fever (P=0.002). On the other hand, no differences were detected in the age of the children, although mean and median in the TS group were 6 years vs a mean of 4.3 with a median of 2.3 years in the SA group. There were no differences in the ultrasound measurements either. The positive predictive value of the criterion "older than 4 years of age and no history of fever" for the diagnosis of transient synovitis was 100%, while "younger than 4 years and history of fever" for the diagnosis of septic arthritis was 75%, once radiology had excluded orthopaedic processes and ultrasound showed an effusion. CONCLUSIONS: In spite of the study limitations (sample size and low prevalence) the combination of age and history of fever appears to be useful in distinguishing transient synovitis from septic arthritis. The contribution of ultrasound was to confirm the presence of joint effusion.

Tarsitis as an initial manifestation of juvenile spondyloarthropathy.

OBJECTIVE: The aim of this study was to determine the frequency of tarsitis as one of the first symptoms of juvenile spondyloarthropathy (JSpA) and to analyze whether patients with tarsitis at onset differ from those without it. METHODS: A retrospective chart review was performed, from January 1996 to September 2007, at a paediatric rheumatology unit of a tertiary university hospital. RESULTS: Tarsitis was detected in one-third of the children diagnosed with JSpA. They had fever and received antibiotics due to a suspected infection more frequently than those without tarsitis. Inflammatory low back pain was extremely unusual among these patients. CONCLUSION: There were some differences between children diagnosed with JSpA initially affected with tarsitis and those without it. Patients with tarsitis as one of the first symptoms were often misdiagnosed as soft tissue infections.

Juvenile localized scleroderma: clinical and epidemiological features in 750 children. An international study.

OBJECTIVE: Juvenile localized scleroderma (JLS) includes a number of conditions often grouped together. With the long-term goal of developing uniform classification criteria, we studied the epidemiological, clinical and immunological features of children with JLS followed by paediatric rheumatology and dermatology centres. METHODS: A large, multicentre, multinational study was conducted by collecting information on the demographics, family history, triggering environmental factors, clinical and laboratory features, and treatment of patients with JLS. RESULTS: Seven hundred and fifty patients with JLS from 70 centres were enrolled into the study. The disease duration at diagnosis was 18 months. Linear scleroderma (LS) was the most frequent subtype (65%), followed by plaque morphea (PM) (26%), generalized morphea (GM) (7%) and deep morphea (DM) (2%). As many as 15% of patients had a mixed subtype. Ninety-one patients (12%) had a positive family history for rheumatic or autoimmune diseases; 100 (13.3%) reported environmental events as possible trigger. ANA was positive in 42.3% of the patients, with a higher prevalence in the LS-DM subtype than in the PM-GM subtype. Scl70 was detected in the sera of 3% of the patients, anticentromere antibody in 2%, anti-double-stranded DNA in 4%, anti-cardiolipin antibody in 13% and rheumatoid factor in 16%. Methotrexate was the drug most frequently used, especially during the last 5 yr. CONCLUSION: This study represents the largest collection of patients with JLS ever reported. The insidious onset of the disease, the delay in diagnosis, the recognition of mixed subtype and the better definition of the other subtypes should influence our efforts in educating trainees and practitioners and help in developing a comprehensive classification system for this syndrome.

[Spondylodiscitis in the autonomus community of Madrid (Spain)]. / Espondilodiscitis en la Comunidad de Madrid.

INTRODUCTION: Spondylodiscitis is a relatively uncommon entity in infancy and childhood, with typical, although non-specific symptoms. The aim of this study was to describe the clinical features at presentation and follow-up in patients diagnosed with spondylodiscitis in hospitals in the Autonomous Community of Madrid. PATIENTS AND METHODS: All cases of spondylodiscitis diagnosed in children in the hospitals of La Paz, Niño Jesús, Gregorio Marañón, Severo Ochoa, Doce de Octubre and Getafe in Madrid were reviewed. Their clinical features, diagnostic tests, treatment and follow-up were analyzed. RESULTS: Twenty children with a mean age of 37 months were studied. The level of disc involvement was L5-S1 in six patients, L2-L3 in five, L3-L4 in four, C6-C7 in two, and D12-L1 in one. The mean time before diagnosis was 20 +/- 16 days. The most frequent symptoms were gait disturbances, limping, or inability to remain seated. Eleven patients had low grade fever (< 38.5 degrees C). Other less specific symptoms were irritability, constipation and abdominal pain. All patients presented moderate leukocytosis without neutrophilia. The mean erythrocyte sedimentation rate was 60 +/- 26. The most frequently used diagnostic tests were conventional spine radiographs, technetium-99m bone scan and magnetic resonance imaging. All patients received antibiotics; three received oral antibiotics only and the remaining patients received intravenous and oral antibiotics. The most frequently prescribed antibiotics were cefuroxime, cloxacillin and amoxicillin-clavulanate. The duration of treatment ranged between 3 and 8 weeks. All patients had a favorable outcome, although in eight, radiological sequelae were observed. CONCLUSIONS: Spondylodiscitis is not exceptional in childhood and awareness of this entity among pediatricians should be increased.

Espondilodiscitis en la Comunidad de Madrid / Spondylodiscitis in the autonomous community of Madrid (Spain)

Introducción: La espondilodiscitis es una entidad relativamente infrecuente en la infancia, que cursa con una sintomatología típica, aunque poco específica. El objetivo de este trabajo es describir las características clínicas y evolutivas de los pacientes con este diagnóstico en los hospitales de la Comunidad de Madrid. Pacientes y métodos: Se revisaron los casos de espondilodiscitis diagnosticados en los últimos 5 años en los hospitales La Paz, Niño Jesús, Gregorio Marañón, Severo Ochoa, Doce de Octubre y Getafe. Se recogieron las características clínicas, las pruebas diagnósticas, el tratamiento y la evolución. Resultados: Se estudiaron 20 niños con una edad media de 37 meses. El nivel lesión al fue L5-S1 en 6 casos, L-2-L3 en cinco,L3-L4 en 4 casos, C5-C6 y C6-C7 en dos y D12-L1 en uno. El tiempo hasta el diagnóstico fue de 20 +/- 16 días. La sintomatología más frecuente fue la alteración de la marcha, cojerao rechazo de la sedestación. Presentaron fiebre no muy elevada (< 38,5 °C) 11 pacientes. Otros síntomas más inespecíficos fueron irritabilidad, estreñimiento y dolor abdominal. Todos los pacientes presentaron leucocitosis moderada sin neutrofilia. La velocidad de sedimentación globular estuvo elevada (60 +/- 26).Las técnicas diagnósticas más empleadas fueron la radiografía convencional, la gammagrafía y la resonancia magnética. Todos recibieron antibióticos, tres de ellos orales y el resto oral e intravenosos. Los antibióticos más empleados fueron cefuroxima, cloxacilina y amoxicilina-ácido clavulánico. La duración del tratamiento osciló entre3 y 8 semanas. Todos los pacientes evolucionaron de manera favorable, aunque en 8 casos se encontraron secuelas radiológicas. Conclusiones: La espondilodiscitis no es una entidad excepcional en niños y creemos que precisa mayor atención por parte delos pediatras

Introduction: Spondylodiscitis is a relatively uncommon entity in infancy and childhood, with typical, although non-specificsymptoms. The aim of this study was to describe the clinical features at presentation and follow-up in patients diagnosed with spondylodiscitis in hospitals in the Autonomous Community of Madrid. Patients and methods: All cases of spondylodiscitis diagnosed in children in the hospitals of La Paz, Niño Jesús, Gregorio Marañón, Severo Ochoa, Doce de Octubre and Getafe in Madrid were reviewed. Their clinical features, diagnostic tests, treatment and follow-up were analyzed. Results: Twenty children with a mean age of 37 months were studied. The level of disc involvement was L5-S1 in six patients,L2-L3 in five, L3-L4 in four, C6-C7 in two, and D12-L1in one. The mean time before diagnosis was 20 +/- 16 days. The most frequent symptoms were gait disturbances, limping, or inability to remain seated. Eleven patients had low grade fever (< 38.5 °C). Other less specific symptoms were irritability, constipation and abdominal pain. All patients presented moderate leukocytosis without neutrophilia. The mean erythrocyte sedimentation rate was60 +/- 26.The most frequently used diagnostic tests were conventional spine radiographs, technetium-99m bone scan and magnetic resonance imaging. All patients received antibiotics; three received oral antibiotics only and the remaining patients received intravenous and oral antibiotics. The most frequently prescribed antibiotics were cefuroxime, cloxacillin and amoxicillin-clavulanate. The duration of treatment ranged between 3 and 8 weeks. All patients had a favorable outcome, although in eight, radiological sequelae were observed. Conclusions: Spondylodiscitis is not exceptional in childhood and awareness of this entity among pediatricians should be increased

TNF-alpha promoter gene polymorphisms in Spanish children with persistent oligoarticular and systemic-onset juvenile idiopathic arthritis.

OBJECTIVE: To explore the possible association/s of the first reported tumour necrosis factor (TNF-alphaTNF-) alpha promoter gene polymorphisms -308, -238, -376 and -163 (G-->A) with systemic (SoJIA) and oligoarticular subtypes of juvenile idiopathic arthritis (JIA); and to test the association between these polymorphisms and the class I/class II HLA alleles in our population. METHODS: The patient group comprised 29 oligoarticular and 26 systemic Caucasian Spanish children with JIA; 68 healthy volunteers from the same ethnic group and geographical region served as controls. HLA alleles were determined using low-resolution polymerase chain reaction (PCR). TNF-alpha promoter gene polymorphisms were screened using PCR denaturing gradient gel electrophoresis (PCR-DGGE), followed, if positive, by restriction fragment length polymorphism (RFLP) analysis for identification. RESULTS: No statistical association was found between the four polymorphisms studied and JIA. However, the -308 G-->A polymorphism (TNF A2) tended to be more frequent in patients with SoJIA than in the oligoarticular group. TNF A2 was strongly associated with the extended haplotype A1B8DR3 (p = 0.003), and the tandem polymorphism -238/-376 in the presence of B18 and DR3. CONCLUSION: The TNF A2 allele was more frequent in SoJIA than in the oligoarticular group. TNF A2 can help to create a more inflammatory milieu in this JIA subtype, in combination with other polymorphisms involved in regulatory sequences of key molecules in the inflammatory response. The association of the -308 and -238/-376 polymorphisms with specific alleles of the HLA is reconfirmed.

Lymphoproliferative disorders in paediatric rheumatic diseases. A report of two cases.

Lymphoproliferative disorders (LPD) are reported with a much lower frequency in children with rheumatic diseases than in their adult counterparts. We describe 2 patients who developed a lymphoma during the course of the disease. The first is a 16-year-old girl diagnosed with systemic juvenile idiopathic arthritis 6 years before who developed a mucosa-associated lymphoid tissue (MALT) lymphoma. The second report involves a boy diagnosed with systemic lupus erythematosus at 9 years of age who developed a Hodgkin's lymphoma 9 years after the disease onset. In spite of the low frequency of LPD in children with rheumatic diseases, these processes do occur.

Fabry's disease: long-term study of a family.

Fabry's disease is the second most prevalent lysosomal storage disorder after Gaucher's disease. It occurs as the result of a deficit in the alpha-galactosidase A enzyme. The gene coding for it is located on the long arm of the X chromosome (Xq22.1). This deficit causes the gradual accumulation of a glycosphingolipid. The main substance accumulated is globotriaosylceramide (Gb3). This accumulation leads to pain and angiokeratomas, and to cardiac, cerebral, and vascular involvement as the disease progresses. The treatment of Fabry's disease has so far only been symptomatic; however, new advances have now made it possible to prescribe alpha-galactosidase replacement therapy, which not only improves symptoms, but also enhances these patients' quality of life and lowers mortality. In this paper we review the status of Fabry's disease and we report the follow-up of a family with Fabry's disease, with some members receiving replacement therapy with alpha-galactosidase A and demonstrating good progress.

[Involvement of betamimetics in increased survival during fetal surgery in sheep]. / Implicación de los betamiméticos en el aumento de la supervivencia tras procedimientos quirúrgicos en el feto del cordero común.

INTRODUCTION: Fetal surgery is a therapeutic reality. Available only in a few centres worldwide. Experimental animal models are needed to continue research in this field. The target problem being the control of preterm labour. OBJECTIVES: To find a tocolytic drug regimen in order to reduce fetal loss. MATERIAL AND METHODS: Pregnant sheep were divided randomly in two groups. At a gestation age of seventy days sheep were operated in order to create a myelomeningocel model in the fetus. Follow-up with weekly amniocentesis guided by ultrasound scan. Group A (n = 6) were treated pre and post-op with indomethacine and with magnesium sulphate during surgery and in the following 24 hours. Group B (n = 8) were treated with diclofenac pre-op, and post-op with ritodrine until the end of pregnancy. RESULTS: Group A we find a survival rate 50% (n = 3) being 87% (n = 7) in group B. Fetal weight being higher in group A. We find an increase heart rate and a weight loss in both the fetus and mother in group B. Urea and creatinine amniotic fluid levels were increase in group B. CONCLUSIONS: The use of ritodrine as a tocolytic agent reduces fetal loss significantly. Ritodrine increases fetal and mother cardiac output causing weight loss.

Implicación de los betamiméticos en el aumento de la supervivencia tras procedimientos quirúrgicos en el feto del cordero común / Involvement ofbetamimetics as increase of survival during fetal surgery in sheep

La cirugía fetal es actualmente una realidad terapéutica en algunos centros a nivel mundial. La investigación en este campo obliga a utilizar modelos animales experimentales. El problema principal de estos modelos es el control del trabajo de parto prematuro. Objetivos: Encontrar un régimen tocolítico que minimice las pérdidas fetales tras procedimientos quirúrgicos en el feto de oveja común. Material y métodos: Partiendo de dos grupos de ovejas gestantes elegidas mediante método aleatorio simple, a los 70 días de gestación son intervenidas, realizándose un mielomeningocele quirúrgico en el feto. Durante el postoperatorio se monitorizó los valores bioquímicos de urea y creatinina en líquido amniótico, mediante la realización de una amniocentesis semanal guiada con control ecográfico. El grupo A (n =6) fue tratado preoperatoriamente con indometacina y postoperatoriamente con sulfato de magnésico, que se mantenía durante 24 horas. En el grupo B (n = 8) se utilizó diclofenaco preoperatorio asociado a ritodrina postoperatoria, mantenida hasta la finalización de la gestación. Resultados. En el grupo A encontramos una supervivencia del 50% (n= 3), siendo en el grupo B del 87% (n = 7). El peso comparado de los fetos en ambos grupos fue menor en los tratados con ritodrina, así como también fue menor la ganancia ponderal de las madres de dicho grupo. Encontramos un incremento en la frecuencia cardíaca materna y fetal en el grupo B. Los valores de urea y creatinina en líquido amniótico fueron mayores en el grupo B, aunque no de forma significativa. Conclusión: El uso de ritodrina como agente tocolítico reduce las pérdidas fetales de forma significativa en el modelo de cirugía fetal basado en la oveja común. La ritodrina aumenta el gasto cardíaco materno y fetal ocasionando pérdidas de peso (AU)

[Clinical characteristics of children with chronic pain in a pediatric pain unit: oncologic pain versus non-oncologic pain]. / Análisis de las características clínicas de los pacientes con dolor crónico tratados por la unidad de dolor infantil: dolor oncológico frente a no oncológico.

BACKGROUND: Despite undoubted scientific advances in the field of chronic pain in children, there is no evidence of clinical application of this knowledge. OBJECTIVE: To describe the experience of a pediatric pain unit (PPU) specifically dedicated to the treatment of chronic pain in children. MATERIAL AND METHODS: We performed an analytic, observational, retrospective, cohort study of the clinical features of the first 42 patients treated for chronic pain in the PPU during a two-year period. The patients were assigned to two groups: an oncologic group and a non-oncologic group. ANOVA was used to analyze quantitative variables and the Chi-square test was used to analyze qualitative variables. RESULTS: No significant differences were found between the two groups in the demographic variables studied (age and sex). Concerning the type of treatment used, no significant differences were found in effectiveness or compliance. However, treatment duration was significantly longer in the non-oncologic group than in the oncologic group (74.2 days vs 37.5 days, p(0.008). The duration of non-oncologic chronic pain before attending the PPU (mean: 557 days) influenced the effectiveness (r 5 0.781; p 5 0.0001) and duration of treatment (r 5 0.61; p 5 0.0051). However, the duration of previous chronic oncologic pain was significantly shorter (mean: 34 days) and showed no influence on treatment effectiveness or duration. CONCLUSIONS: The pediatric population presents chronic pain syndromes that can be appropriately treated in a PPU with conventional, easy to manage analgesics. We recommend the establishment of pediatric pain units similar to those for adults, using a multidisciplinary approach to mitigate children's suffering.

Análisis de las características clínicas de los pacientes con dolor crónico tratados por la unidad de dolor infantil: dolor oncológico frente a no oncológico / Clinical characteristics of children with chronic pain in a pediatric pain unit: oncologic pain versus non-oncologic pain

Antecedentes: A pesar de que en los últimos años se asiste a un innegable avance en los conocimientos científicos sobre el dolor crónico en el niño, estos avances no se han trasladado al campo asistencial. Objetivo: Describir la experiencia de una unidad de dolor infantil (UDI) dedicada específicamente al control del dolor crónico en el niño. Material y métodos: Se realizó un estudio analítico, observacional, retrospectivo y tipo cohortes de las características clínicas de los 42 primeros pacientes tratados de dolor crónico en una UDI durante un período de 2 años. Se dividió a los pacientes en 2 grupos según padeciesen dolor crónico oncológico o dolor crónico no oncológico, y se realizó un estudio de análisis de la varianza (ANOVA) para variables cuantitativas y chi cuadrado ( 2 ) para variables cualitativas. Resultados: No se apreciaron diferencias significativas entre los 2 grupos en las variables demográficas de edad y sexo estudiadas. En cuanto al tipo de tratamientos empleados, la efectividad y el grado de cumplimiento de éstos tampoco se observaron diferencias significativas; sólo se apreciaron en la duración del tratamiento, que fue mayor en el grupo de dolor crónico no oncológico (74,2 días frente a 37,5 días; p < 0,008).La duración del dolor crónico no oncológico antes de acudir a la UDI (media, 557 días) influyó en la efectividad del tratamiento (r 0,781; p 0,0001) y en la duración del mismo (r 0,61; p 0,0051). Sin embargo, la duración del dolor crónico oncológico (media, 34 días) fue significativamente menor (p < 0,0067) y no influyó ni en la efectividad ni en la duración del tratamiento. Conclusiones: La población pediátrica también presenta síndromes dolorosos crónicos que se pueden tratar correctamente en una UDI con fármacos analgésicos convencionales que son de fácil manejo. Se recomienda el desarrollo de unidades de tratamiento del dolor infantil específicas con un esquema asimilable al de las unidades de dolor crónico del adulto y con un abordaje multidisciplinario para contribuir a mitigar el sufrimiento en los niños (AU)

The European Spanish version of the Childhood Health Assessment Questionnaire (CHAQ) and the Child Health Questionnaire (CHQ).

We report herein the results of the cross-cultural adaptation and validation of 2 health related quality of life instruments into the European Spanish language. The Childhood Health Assessment Questionnaire (CHAQ) is a disease specific health instrument that measures functional ability in daily living activities in children with Juvenile Idiopathic Arthritis (JIA). The Child Health Questionnaire (CHQ) is a generic health instrument designed to capture the physical and psychosocial well-being of children independently from an underlying disease. The Spanish CHQ was fully validated with 3 forward and 3 backward translations, while the Spanish CHAQ, already published, was revalidated. A total of 149 subjects were enrolled: 80 patients with JIA (28% systemic arthritis, 34% polyarthritis, 17% extended oligoarthritis, and 21% persistent oligoarthritis) and 69 healthy children. The CHAQ appropriately distinguished healthy subjects from JIA patients, with those classified in the systemic arthritis, polyarthritis and extended oligoarthritis categories having a higher degree of disability and pain, as well as a lower overall well-being than their healthy peers. The CHQ was also able to discriminate healthy subjects from JIA patients, with those allocated in the systemic arthritis, polyarthritis and extended oligoarthritis categories having a lower physical and psychosocial well-being than their healthy counterparts. In conclusion, the European Spanish version of the CHAQ-CHQ is a reliable and valid tool for the functional, physical and psychosocial assessment of children with JIA.

Systemic onset juvenile chronic arthritis, polyarticular pattern and hip involvement as markers for a bad prognosis.

OBJECTIVE: To explore all the common clinical and biological variables that are characteristic of Systemic onset Juvenile Chronic Arthritis (SoJCA) in order to determine which of them are suitable as predictors of a bad articular outcome (persistence of inflammatory symptoms and/or established limitation of the range of motion (ROM). MATERIAL AND METHODS: Clinical charts for 124 SoJCA patients were retrospectively reviewed. From them, 91 were finally included in the study because they had all of the clinical and biological data at disease onset properly recorded. All have been followed for at least 3 years since the beginning of the disease. Data collected at onset, and after 3 and 6 months of the disease included: 1) systemic symptoms; 2) joint involvement, using both the usual articular count and the value of an articular index (Helsinki Index = HI) which intentionally excludes those joints that are not uniformly recorded in clinical charts; and 3) biological data. HI was used to separate the patients into two groups. When applied 3 years after the disease onset, HI > or = 10 represented a bad articular outcome while HI < 10 meant a good prognosis. SPSS for Windows 6.1 was used for both the univariate and multivariate analyses. RESULTS: From the multivariate logistic regression analysis, two different "clusters" of clinical data were found to be the best predictors of a bad articular outcome. A bad prognosis was linked at onset with the presence of generalized lymphadenopathies, age < 8 years and an HI > 6; at six months a bad outcome was linked with the presence of a polyarticular pattern plus hip involvement. CONCLUSION: Clinical parameters at the beginning of the disease were shown to be extremely useful in predicting the articular outcome of SoJCA. Therefore, they could constitute a good instrument to help clinicians tailor the best therapy for their patients.

Tumores de la superficie epitelial-estroma: epidemiología, etiopatogenia, prognóstico, clínica, diagnóstico / Epithelial-stroma ovarian neoplasms: epidemiology, pathogenesis, symtoms, diagnosis, prognosis

El cáncer de ovario es el Tumor más frecuente del aparato genital femenino y la cuarta causa más frecuente de muerte por cáncer en la mujer sólo superado por el cáncer de pulmón, mama y colon. Sigue siendo desconocida la causa precisa de su origen, aunque se han identificado una serie de factores endocrinos, reproductivos, virales, dietiticos, ambientales y hereditarios que pueden influir en su aparición (AU)

Evaluation of ILAR classification criteria for juvenile idiopathic arthritis in Spanish children.

OBJECTIVE: To evaluate the proposed International League of Associations for Rheumatology (ILAR) classification criteria for juvenile idiopathic arthritis in a cohort of Spanish children. METHODS: One hundred twenty-five patients with chronic arthritis were categorized according to one of the traditional classifications and the proposed ILAR classification system after at least 6 months of disease. The traditional classifications included the European League Against Rheumatism (EULAR) criteria for pauciarticular, polyarticular rheumatoid factor (RF) negative, and systemic juvenile chronic arthritis (JCA), as well as for RF+ polyarthritis; the Vancouver criteria for juvenile psoriatic arthritis (JPsA); and the European Spondylarthropathy Study Group (ESSG) preliminary criteria for juvenile spondyloarthropathy (JSpA). RESULTS: The ILAR criteria classified 106/125 patients (84.8%). All patients with systemic and polyarticular JCA, RF+ polyarthritis, and definite juvenile psoriatic arthritis were reclassified in the corresponding ILAR category. In contrast, only 80% of pauciarticular JCA and 47% of JSpA patients could be allocated to the ILAR oligoarthritis (47/59 patients, 35 persistent and 12 extended) and enthesitis related arthritis (ErA. 8/17 patients) categories. Two children with probable PsA were reclassified in the RF- polyarthritis category. Nineteen patients (15.2%) were allocated to the ILAR "other arthritis" group, 13/19 because they did not fulfill criteria for any of the other categories (12 due to family history of psoriasis and one because of family history of HLA-B27 associated disease). The remaining 6 patients met criteria for 2 categories, RF- polyarthritis and either ErA (n = 5) or PsA (n = 1). No differences other than family history of psoriasis were found in any of the variables studied between pauciarticular JCA patients classified in the oligoarthritis (n = 47) and those in the "other arthritis" (n = 11) ILAR categories. CONCLUSION: The proposed ILAR criteria allocated 84.8% of the patients classified by traditional criteria. Family history of psoriasis (n = 12) and polyarticular onset of disease in patients with ErA (n = 5) were responsible for most of the exclusions from other ILAR categories.

Gastroenteritis por Campylobacter jejuni y edema agudo hemorrágico del lactante / Campylobacter jejuni gastroenteritis and acute hemorrhagic edema of childhood

El edema agudo hemorrágico (EAH) del lactante es una vasculitis leucocitoclástica que afecta a niños entre los 4 y 24 meses de edad y consiste en la presencia de púrpura equimótica en escarapela y edema en extremidades o en la cara; no afectándose las vísceras. Se produce la resolución espontánea y completa en una o tres semanas. Ha sido considerada una variante del Síndrome de Schonlein Henoch pero de curso benigno. El EAH se ha relacionado con diferentes procesos infecciosos (tuberculosis pulmonar, infección por adenovirus, etc.). Nosotros presentamos un caso asociado a infección por Campylobacter jejuni (AU)