Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 642
Filtrar
1.
Georgian Med News ; (294): 88-91, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687956

RESUMO

Plenty of studies demonstrated an association between a Vitamin D deficiency and several autoimmune disorders, such as diabetes mellitus, systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA) in adult patients. This study was aimed to assess probable association between the 25-hydroxyvitamin D [25(OH)D] level and juvenile idiopathic arthritis (JIA) features and the possible relationship between serum vitamin D level and disease activity. 69 patients with JIA were examined and 15 healthy children were chosen as the control group. The mean age of patients was 10 years 8 months ±4 years 6 months (45 female, 24 male). 25 patients with oligoarthicular subtype of disease, 34 with poliarthicular sybtype and 10 patient with undifferentiated arthritis . The total duration of the disease was 4 years 1 month ± 1 year 1 month. Patients got methotrexate therapy (15mg/m2). Any of the patients were not treated by corticosteroids. The serum level of vitamin D was measured through blood test by chemiluminescence method. The relationship between the level of vitamin D and disease activity was analyzed based on juvenile arthritis disease activity score (JADAS27). The average level of vitamin D in serum was 22,69±7,8 ng/ml at the control group the vitamin D status was 28,67±5,06 ng/ml. In spite of the fact that a decrease in vitamin D status was observed in both groups, however in the group of healthy children it was significantly higher (p>0.05). Using the regression method, a significant relationship was established between the number of active joints and the age of patients, duration of disease, the level of vitamin D in serum, the number of injured joints, and disease activity (accordant to JADAS27 score) (number of active joints = - 1,144 + 0,005 x age of patients - 0,007x duration of disease + 0,292 x the number of injured joints + 0,033 x level of vitamin D + 0,077 x the number of points accordant to JADAS27). The monitoring of vitamin D level is advisable to carry out during observing the children with JIA. It can be useful for timely correction of vitamin D deficiency and preventions both skeleton and non-skeleton complications. That may improve the quality of life of patients and their families.


Assuntos
Artrite Juvenil , Deficiência de Vitamina D/sangue , Adulto , Artrite Juvenil/sangue , Artrite Juvenil/complicações , Artrite Juvenil/epidemiologia , Artrite Reumatoide , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Qualidade de Vida , Ucrânia/epidemiologia , Vitamina D/sangue , Deficiência de Vitamina D/complicações , Deficiência de Vitamina D/epidemiologia
2.
Arthritis Rheumatol ; 71(11): 1943-1954, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31379071

RESUMO

OBJECTIVE: Systemic juvenile idiopathic arthritis (JIA) is associated with a recently recognized, albeit poorly defined and characterized, lung disease (LD). The objective of this study was to describe the clinical characteristics, risk factors, and histopathologic and immunologic features of this novel inflammatory LD associated with systemic JIA (designated SJIA-LD). METHODS: Clinical data collected since 2010 were abstracted from the medical records of patients with systemic JIA from the Cincinnati Children's Hospital Medical Center. Epidemiologic, cellular, biochemical, genomic, and transcriptional profiling analyses were performed. RESULTS: Eighteen patients with SJIA-LD were identified. Radiographic findings included diffuse ground-glass opacities, subpleural reticulation, interlobular septal thickening, and lymphadenopathy. Pathologic findings included patchy, but extensive, lymphoplasmacytic infiltrates and mixed features of pulmonary alveolar proteinosis (PAP) and endogenous lipoid pneumonia. Compared to systemic JIA patients without LD, those with SJIA-LD were younger at the diagnosis of systemic JIA (odds ratio [OR] 6.5, P = 0.007), more often had prior episodes of macrophage activation syndrome (MAS) (OR 14.5, P < 0.001), had a greater frequency of adverse reactions to biologic therapy (OR 13.6, P < 0.001), and had higher serum levels of interleukin-18 (IL-18) (median 27,612 pg/ml versus 5,413 pg/ml; P = 0.047). Patients with SJIA-LD lacked genetic, serologic, or functional evidence of granulocyte-macrophage colony-stimulating factor pathway dysfunction, a feature that is typical of familial or autoimmune PAP. Moreover, bronchoalveolar lavage (BAL) fluid from patients with SJIA-LD rarely demonstrated proteinaceous material and had less lipid-laden macrophages than that seen in patients with primary PAP (mean 10.5% in patients with SJIA-LD versus 66.1% in patients with primary PAP; P < 0.001). BAL fluid from patients with SJIA-LD contained elevated levels of IL-18 and the interferon-γ-induced chemokines CXCL9 and CXCL10. Transcriptional profiling of the lung tissue from patients with SJIA-LD identified up-regulated type II interferon and T cell activation networks. This signature was also present in SJIA-LD human lung tissue sections that lacked substantial histopathologic findings, suggesting that this activation signature may precede and drive the lung pathology in SJIA-LD. CONCLUSION: Pulmonary disease is increasingly detected in children with systemic JIA, particularly in association with MAS. This entity has distinct clinical and immunologic features and represents an uncharacterized inflammatory LD.


Assuntos
Artrite Juvenil/epidemiologia , Proteinose Alveolar Pulmonar/epidemiologia , Distribuição por Idade , Artrite Juvenil/diagnóstico por imagem , Artrite Juvenil/imunologia , Artrite Juvenil/patologia , Líquido da Lavagem Broncoalveolar , Quimiocina CXCL10/metabolismo , Quimiocina CXCL9/metabolismo , Criança , Pré-Escolar , Feminino , Fator Estimulador de Colônias de Granulócitos e Macrófagos/imunologia , Humanos , Lactente , Interferon gama/metabolismo , Interleucina-18/imunologia , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pneumopatias/diagnóstico por imagem , Pneumopatias/epidemiologia , Pneumopatias/imunologia , Pneumopatias/patologia , Síndrome de Ativação Macrofágica/epidemiologia , Síndrome de Ativação Macrofágica/imunologia , Masculino , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Proteinose Alveolar Pulmonar/imunologia , Proteinose Alveolar Pulmonar/patologia , Linfócitos T/metabolismo , Tomografia Computadorizada por Raios X , Transcriptoma , Regulação para Cima
3.
BMC Health Serv Res ; 19(1): 572, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412858

RESUMO

BACKGROUND: The study evaluates Performance Measures (PMs) for Juvenile Idiopathic Arthritis (JIA): The percentage of patients with new onset JIA with at least one visit to a pediatric rheumatologist in the first year of diagnosis (PM1); and the percentage of patients with JIA under rheumatology care seen in follow-up at least once per year (PM2). METHODS: Validated JIA case ascertainment algorithms were used to identify cases from provincial health administrative databases in Manitoba, Canada in patients < 16 years between 01/04/2005 and 31/03/2015. PM1: Using a 3-year washout period, the percentage of incident JIA patients with ≥1 visit to a pediatric rheumatologist in the first year was calculated. For each fiscal year, the proportion of patients expected to be seen in follow-up who had a visit were calculated (PM2). The proportion of patients with gaps in care of > 12 and > 14 months between consecutive visits were also calculated. RESULTS: One hundred ninety-four incident JIA cases were diagnosed between 01/04/2008 and 03/31/2015. The median age at diagnosis was 9.1 years and 71% were female. PM1: Across the years, 51-81% of JIA cases saw a pediatric rheumatologist within 1 year. PM2: Between 58 and 78% of patients were seen in yearly follow-up. Gaps > 12, and > 14, months were observed once during follow-up in 52, and 34%, of cases, and ≥ twice in 11, and 5%, respectively. CONCLUSIONS: Suboptimal access to pediatric rheumatologist care was observed which could lead to diagnostic and treatment delays and lack of consistent follow-up, potentially negatively impacting patient outcomes.


Assuntos
Artrite Juvenil/terapia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Algoritmos , Artrite Juvenil/epidemiologia , Criança , Feminino , Seguimentos , Humanos , Masculino , Manitoba/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Reumatologia
4.
Pediatr Rheumatol Online J ; 17(1): 58, 2019 Aug 23.
Artigo em Inglês | MEDLINE | ID: mdl-31443722

RESUMO

BACKGROUND: Juvenile idiopathic arthritis (JIA) has been categorized into seven different categories according to the International League of Associations for Rheumatology (ILAR) criteria. Enthesitis-related arthritis (ERA) was found to represent the largest category in a Taiwanese cohort study. The aim in this study was to compare the clinical characteristics, treatments, and outcomes of ERA in a single tertiary center in Taiwan, as compared to those of other categories of JIA. Furthermore, we determined patients' characteristics and risk factors that can help assess the outcomes in ERA. METHODS: A retrospective chart review of all patients with JIA referred to a pediatric rheumatology clinic in the National Taiwan University Hospital between 1993 and 2018 were identified according to ILAR criteria. Outcomes were assessed based on the Wallace criteria to categorize patients into active and non-active, including inactive, remission on medication, and remission off medication, groups. A subset of samples was further tested by DNA sequencing to identify HLA-B27 subtypes. RESULTS: One-hundred and eighty-three patients were included in the study, with a mean of 8 years' follow-up. ERA was the single largest category of JIA (39.9%); psoriasis and undifferentiated JIA were both the least common type (0.5%). ERA was male predominant (86%), had a late age of onset (11.0 ± 3.2 years), and the majority of ERA patients was HLA-B27-positive (97%). Of 25 HLA-B27-positive ERA patients checked by HLA-B27 sequencing, 23 were B*27:04 and 2 were B*27:05. ERA patients were significantly less likely to achieve non-active status compared to patients with persistent oligoarthritis (P = 0.036). In terms of treatment response to TNF-α inhibitors in methotrexate-refractory ERA, 26 patients remained active and only 11 patients (30%) achieved a non-active status. Sacroiliitis was a risk factor contributing to poorer treatment response in ERA (P = 0.006). CONCLUSION: ERA represented the most common category of JIA in Taiwan. Those ERA patients with sacroiliitis were likely to have persistent active disease and may require a more aggressive treatment strategy to improve their outcomes.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/epidemiologia , Adolescente , Artrite Juvenil/diagnóstico , Artrite Juvenil/tratamento farmacológico , Criança , Feminino , Seguimentos , Antígeno HLA-B27/metabolismo , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Sacroileíte/epidemiologia , Sacroileíte/etiologia , Taiwan/epidemiologia , Centros de Atenção Terciária , Resultado do Tratamento
5.
Pediatr Rheumatol Online J ; 17(1): 51, 2019 07 26.
Artigo em Inglês | MEDLINE | ID: mdl-31349785

RESUMO

BACKGROUND: To describe the demographic, clinical, and treatment characteristics of youth diagnosed with juvenile primary fibromyalgia syndrome (JPFS) who are seen in pediatric rheumatology clinics. METHODS: Information on demographics, symptoms, functioning, and treatments recommended and tried were obtained on patients with JPFS as part of a multi-site patient registry (the Childhood Arthritis and Rheumatology Research Alliance Legacy Registry). Data were summarized using descriptive statistics. In a subset of patients completing registry follow-up visits, changes in symptoms, pain, and functioning were evaluated using growth modeling. RESULTS: Of the 201 patients with JPFS enrolled in the registry, most were Caucasian/White (85%), non-Hispanic (83%), and female (84%). Ages ranged from 9 to 20 years (M = 15.4 + 2.2). The most common symptoms reported were widespread musculoskeletal pain (91%), fatigue (84%), disordered sleep (82%), and headaches (68%). Pain intensity was rated as moderate to severe (M = 6.3 + 2.4/10). Scores on measures of functioning indicated mild to moderate impairment, with males observed to report significantly greater impairments. For the 37% of the initial cohort having follow-up data available, indicators of function and well-being were found to either worsen over time or remain relatively unchanged. CONCLUSIONS: The symptoms of JPFS remained persistent and disabling for many patients treated by pediatric rheumatologists. Further study appears warranted to elucidate gender differences in the impact of JPFS symptoms. Work also is needed to identify accessible and effective outpatient treatment options for JPFS that can be routinely recommended or implemented by pediatric rheumatology providers.


Assuntos
Fibromialgia/epidemiologia , Adolescente , Anti-Inflamatórios não Esteroides/uso terapêutico , Antidepressivos/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Juvenil/epidemiologia , Artrite Juvenil/terapia , Criança , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Fadiga/etiologia , Feminino , Fibromialgia/terapia , Transtornos da Cefaleia/etiologia , Humanos , Masculino , Dor Musculoesquelética/epidemiologia , Dor Musculoesquelética/etiologia , Modalidades de Fisioterapia , Qualidade de Vida , Sistema de Registros , Estudos Retrospectivos , Transtornos do Sono-Vigília/etiologia , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
6.
Arab J Gastroenterol ; 20(2): 95-98, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31182344

RESUMO

BACKGROUND AND STUDY AIMS: Juvenile idiopathic arthritis (JIA) is characterized by autoimmune aetiology. A gene locus 4q27 related to rheumatoid arthritis, psoriatic arthritis, and coeliac disease is associated with susceptibility to JIA. There are reports indicating several patients with JIA had been diagnosed with CD. We aimed to assess the frequency of coeliac disease (CD) in patients with juvenile idiopathic arthritis (JIA). PATIENTS AND METHODS: This prospective study was carried out from October 2015 to August 2016 and included 96 patients with JIA. All patients were evaluated in terms of clinical and laboratory findings of CD. Levels of total IgA and tissue transglutaminase antibody (tTG) IgA were measured in all patients. Those with increased level of tTG IgA were further tested for anti-endomysium IgA antibodies (EMA). Gastroduodenoscopy were planned for a definite diagnosis of CD in patients with positive EMA. RESULTS: Of the 96 patients in our study, 34 (35.4%) had oligoarticular form of JIA, 29 (30.2%) had polyarticular form, 12 (12.5%) had ERA form, 11 (11.5%) had systemic form, and 10 (10.4%) had psoriatic form. Sixteen of our patients (16.6%) were not using any drugs during the study. Neither EMA IgA antibodies were analysed nor gastro-duodenoscopy was performed because no patients were positive for tTG IgA. There was no difference in terms of tTG levels between the patients using NSAIDs or other drugs. CONCLUSION: We did not find CD in children with JIA. Long term studies with more JIA patients are needed to provide more precise interpretation.


Assuntos
Artrite Juvenil/epidemiologia , Doença Celíaca/diagnóstico , Doença Celíaca/epidemiologia , Adolescente , Artrite Juvenil/sangue , Artrite Juvenil/tratamento farmacológico , Doença Celíaca/sangue , Criança , Comorbidade , Feminino , Proteínas de Ligação ao GTP/imunologia , Humanos , Imunoglobulina A/sangue , Incidência , Masculino , Estudos Prospectivos , Transglutaminases/imunologia , Turquia/epidemiologia
7.
Drug Discov Ther ; 13(2): 96-100, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31080209

RESUMO

Oligoarticular arthritis (inflammation of upto 4 joints) has a wide range of infectious and non-infectious etiologies. The aim of our study was to identify the features which could help in the differentiation of infectious from non-infectious arthritis. The study was prospective and observational, and included 100 patients with oligoarticular inflammatory arthritis. The final diagnosis was made using standard diagnostic criteria and the patients were categorized into infectious and non-infectious groups. Among the 100 patients who were recruited, the following final diagnosis were made: peripheral spondyloarthritis (n = 37), axial spondyloarthritis (n = 11), tuberculosis (n = 19), brucellosis (n = 6), septic arthritis (n = 6), gouty arthritis (n = 5), early rheumatoid arthritis (n = 5), non-tubercular mycobacteria (n = 2), SLE (n = 2), post-chikungunya arthritis (n = 2), acute lymphocytic leukaemia (n = 1), pachydermoperiostosis (n = 1), sarcoidosis (n = 1) and juvenile idiopathoic arthritis (n = 1). The patients were categorized into two groups: infectious (33) and non-infectious (60). The presence of monoarthritis, clinically-significant weight loss, hepatomegaly, splenomegaly and erosive arthritis were significantly more common in the infectious group as compared to the non-infectious group.


Assuntos
Artrite Infecciosa/epidemiologia , Artrite/classificação , Doenças não Transmissíveis/epidemiologia , Adolescente , Adulto , Artrite/diagnóstico , Artrite Gotosa/diagnóstico , Artrite Gotosa/epidemiologia , Artrite Infecciosa/diagnóstico , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/epidemiologia , Brucelose/diagnóstico , Brucelose/epidemiologia , Feminino , Humanos , Índia , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Sarcoidose/epidemiologia , Espondilartrite/diagnóstico , Espondilartrite/epidemiologia , Centros de Atenção Terciária , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Adulto Jovem
8.
Clin Rheumatol ; 38(8): 2227-2231, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062254

RESUMO

To determine the influence of breastfeeding duration in the clinical activity of low-income juvenile idiopathic arthritis (JIA). Ninety-one JIA patients followed in Fortaleza-CE, Brazil, were cross-sectionally evaluated from May 2015 to April 2016. Breastfeeding duration was obtained by interviewing mothers. Mean age was 14.6 ± 5.2 years with 10.31 ± 3.7 years of disease duration. Polyarticular category predominated, with 39 (42.8%) patients, followed by 23 (25.3%) oligoarticular and 17 (18.7%) enthesitis-related. Forty-seven (61.8%) were receiving methotrexate isolated or combined to leflunomide, which was used by 12 (15.4%); 30 (32.9%) were on biologic DMARD with 16 (53.3%) etanercept, 8 (26.7%) adalimumab, 3 (10%) tocilizumab, and 1 (3.3%) each on infliximab, abatacept, and canakinumab. Mean(SD) CHAQ and JADAS27 were 0.37 ± 0.36 and 5.03 ± 6.1, respectively and 22 (24%) had permanent joint deformities. No family declared monthly income over US$900.00 and 32 (37.2%) earned less than US$300.00. Eighty-three (91%) were ever breastfed; over two-thirds were breastfed for more than 3 months. Those breastfed for more than 6 months had less joint deformities and a tendency to lower JADAS27 and CHAQ scores using minimally adjusted general linear or logistic models, as appropriate. Parental smoking or literacy and family income did not differ regarding breastfeeding time. This is a low-income JIA cohort with the highest breastfeeding prevalence ever reported. Breastfeeding over 6 months was associated with less disease activity.Key Point• Long-term breastfeeding benefits juvenile idiopathic arthritis.


Assuntos
Artrite Juvenil/prevenção & controle , Aleitamento Materno , Abatacepte/administração & dosagem , Adalimumab/administração & dosagem , Adolescente , Anticorpos Monoclonais Humanizados/administração & dosagem , Antirreumáticos/administração & dosagem , Artrite Juvenil/epidemiologia , Produtos Biológicos/administração & dosagem , Brasil/epidemiologia , Criança , Estudos Transversais , Etanercepte/administração & dosagem , Feminino , Humanos , Infliximab/administração & dosagem , Leflunomida/administração & dosagem , Masculino , Metotrexato/administração & dosagem , Mães , Pobreza , Adulto Jovem
9.
Arthritis Care Res (Hoboken) ; 71(6): 717-734, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31021516

RESUMO

OBJECTIVE: To develop treatment recommendations for children with juvenile idiopathic arthritis manifesting as non-systemic polyarthritis, sacroiliitis, or enthesitis. METHODS: The Patient/Population, Intervention, Comparison, and Outcomes (PICO) questions were developed and refined by members of the guideline development teams. A systematic review was conducted to compile evidence for the benefits and harms associated with treatments for these conditions. GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to rate the quality of evidence. A group consensus process was conducted among the Voting Panel to generate the final recommendations and grade their strength. A Parent and Patient Panel used a similar consensus approach to provide patient/caregiver preferences for key questions. RESULTS: Thirty-nine recommendations were developed (8 strong and 31 conditional). The quality of supporting evidence was very low or low for 90% of the recommendations. Recommendations are provided for the use of nonsteroidal antiinflammatory drugs, disease-modifying antirheumatic drugs, biologics, and intraarticular and oral glucocorticoids. Recommendations for the use of physical and occupational therapy are also provided. Specific recommendations for polyarthritis address general medication use, initial and subsequent treatment, and adjunctive therapies. Good disease control, with therapeutic escalation to achieve low disease activity, was recommended. The sacroiliitis and enthesitis recommendations primarily address initial therapy and adjunctive therapies. CONCLUSION: This guideline provides direction for clinicians, caregivers, and patients making treatment decisions. Clinicians, caregivers, and patients should use a shared decision-making process that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/terapia , Entesopatia/terapia , Terapia Ocupacional , Modalidades de Fisioterapia , Reumatologia/normas , Sacroileíte/terapia , Anti-Inflamatórios não Esteroides/uso terapêutico , Antirreumáticos/efeitos adversos , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Produtos Biológicos/uso terapêutico , Consenso , Entesopatia/diagnóstico , Entesopatia/epidemiologia , Glucocorticoides/uso terapêutico , Humanos , Fatores de Risco , Sacroileíte/diagnóstico , Sacroileíte/epidemiologia , Resultado do Tratamento
10.
Arthritis Care Res (Hoboken) ; 71(6): 703-716, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31021540

RESUMO

OBJECTIVE: To develop recommendations for the screening, monitoring, and treatment of uveitis in children with juvenile idiopathic arthritis (JIA). METHODS: Pediatric rheumatologists, ophthalmologists with expertise in uveitis, patient representatives, and methodologists generated key clinical questions to be addressed by this guideline. This was followed by a systematic literature review and rating of the available evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology. A group consensus process was used to compose the final recommendations and grade their strength as conditional or strong. RESULTS: Due to a lack of literature with good quality of evidence, recommendations were formulated on the basis of available evidence and a consensus expert opinion. Regular ophthalmic screening of children with JIA is recommended because of the risk of uveitis, and the frequency of screening should be based on individual risk factors. Regular ophthalmic monitoring of children with uveitis is recommended, and intervals should be based on ocular examination findings and treatment regimen. Ophthalmic monitoring recommendations were strong primarily because of concerns of vision-threatening complications of uveitis with infrequent monitoring. Topical glucocorticoids should be used as initial treatment to achieve control of inflammation. Methotrexate and the monoclonal antibody tumor necrosis factor inhibitors adalimumab and infliximab are recommended when systemic treatment is needed for the management of uveitis. The timely addition of nonbiologic and biologic drugs is recommended to maintain uveitis control in children who are at continued risk of vision loss. CONCLUSION: This guideline provides direction for clinicians and patients/parents making decisions on the screening, monitoring, and management of children with JIA and uveitis, using GRADE methodology and informed by a consensus process with input from rheumatology and ophthalmology experts, current literature, and patient/parent preferences and values.


Assuntos
Artrite Juvenil/diagnóstico , Artrite Juvenil/tratamento farmacológico , Produtos Biológicos/uso terapêutico , Glucocorticoides/uso terapêutico , Imunossupressores/uso terapêutico , Oftalmologia/normas , Reumatologia/normas , Uveíte/diagnóstico , Uveíte/tratamento farmacológico , Artrite Juvenil/epidemiologia , Produtos Biológicos/efeitos adversos , Consenso , Glucocorticoides/efeitos adversos , Humanos , Imunossupressores/efeitos adversos , Valor Preditivo dos Testes , Fatores de Risco , Resultado do Tratamento , Uveíte/epidemiologia
11.
J Fam Pract ; 68(2): E8-E13, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30870545
12.
Int J Rheum Dis ; 22(7): 1289-1296, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30884197

RESUMO

AIM: The aim of the study was to assess the distribution of human leukocyte antigen (HLA)-B*27 subtypes and its correlation with disease phenotypes in children with enthesitis-related arthritis variant of juvenile idiopathic arthritis (JIA-ERA). METHOD: One hundred and sixty patients (132 males, 28 females) satisfying the International League Against Rheumatism (ILAR) classification criteria for JIA-ERA were assessed and relevant demographic, clinical and radiographic data were documented. HLA-B*27 typing was done for all the patients and B*27 positive samples were subjected to high-resolution gene sequencing. The effect of duration of illness, HLA-B*27, its subtypes, and gender on the clinical phenotype were analyzed. RESULTS: The mean age of disease onset was 12.69 ± 2.4 years with a male:female ratio of 4.7:1.0. HLA-B*27 was positive in 109/160 patients and HLA-B*27:04 was detected in 63% followed by B*27:05 (30%). Duration of illness was greater in patients with skeletal deformity, hip arthritis, sacroiliitis, cervical spine involvement and acute anterior uveitis (AAU) (P < 0.05). HLA-B*27 positivity was associated with a prolonged course of disease, higher incidence of AAU (14.7% vs 2%, P = 0.015), family history of spondyloarthritis (21.1% vs 5.9%; P = 0.015) and higher erythrocyte sedimentation rate as compared to HLA-B*27 negative patients (P < 0.01). The HLA-B*27:04 and *27:05 positive patients had similar clinical phenotypes. CONCLUSION: Presence of HLA-B*27 and long duration of illness results in skeletal deformity, hip arthritis, sacroiliitis, cervical spine involvement and AAU. HLA-B*27:04 followed by B*27:05 are the most common HLA-B*27 subtypes in our study population and both have a similar clinical phenotype.


Assuntos
Artrite Juvenil/genética , Antígeno HLA-B27/genética , Adolescente , Fatores Etários , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Artrite Juvenil/imunologia , Criança , Pré-Escolar , Estudos Transversais , Progressão da Doença , Feminino , Predisposição Genética para Doença , Antígeno HLA-B27/imunologia , Humanos , Índia/epidemiologia , Masculino , Fenótipo , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
13.
Int J Rheum Dis ; 22(7): 1283-1288, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30816022

RESUMO

OBJECTIVE: To clarify the development of juvenile idiopathic arthritis (JIA) to adult-onset autoimmune diseases in a population-based study in Taiwan. METHODS: We analyzed data of 107 433 children born between 1990 and 1997 from the National Taiwan Health Insurance Database. There were 262 JIA patients and 107 171 individuals without JIA who were selected and followed up until December 2013 to investigate their outcomes of adult-onset autoimmune diseases after reaching 16 years of age. The adjusted hazard ratios (aHRs) including 95% confidence intervals (95% CI) of adult-onset autoimmune diseases were calculated using the Cox proportional regression model among different age groups. RESULTS: The incidence rate for patients with a history of JIA was 83.56 per 105 person-months for rheumatoid arthritis (RA), 16.61 for systemic lupus erythematosus (SLE), 58.39 for ankylosing spondylitis (AS), and 33.26 for psoriatic diseases. The aHRs were 29.60 for any autoimmune disease, 129.52 for RA, 10.01 for SLE, 49.62 for AS, and 8.20 for psoriatic diseases. Compared with non-JIA individuals, the aHRs of adult-onset autoimmune diseases were 34.87 (95% CI: 4.85-250.62) at the onset age of 3-5 years, 12.01 (95% CI: 2.99-48.26) at the age of 6-10 years, and 45.80 (95% CI: 29.69-70.64) at the age of 11-15 years. CONCLUSION: Children with JIA were at an increased risk of developing RA, AS, psoriatic disease, and SLE in adulthood.


Assuntos
Artrite Juvenil/epidemiologia , Artrite Reumatoide/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Psoríase/epidemiologia , Espondilite Anquilosante/epidemiologia , Adolescente , Idade de Início , Artrite Juvenil/diagnóstico , Artrite Juvenil/imunologia , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/imunologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lúpus Eritematoso Sistêmico/diagnóstico , Lúpus Eritematoso Sistêmico/imunologia , Masculino , Psoríase/diagnóstico , Psoríase/imunologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/imunologia , Taiwan , Fatores de Tempo
14.
Scand J Rheumatol ; 48(4): 300-307, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30836033

RESUMO

Objectives: Healthcare service needs have changed with the use of effective treatment strategies. Using data from the modern era, we aimed to explore and compare health service-related direct costs in juvenile idiopathic arthritis (JIA), psoriatic arthritis (PsA), rheumatoid arthritis (RA), and axial spondyloarthritis (AxSpA). Methods: We linked a longitudinal, population-based clinical data set from Finland's largest non-university hospital's rheumatology clinic with an administrative database on health service-related direct costs in 2014. We compared all-cause costs and costs of comorbidities between adult patients with JIA, PsA, RA, and AxSpA (including ankylosing spondylitis). We also characterized patients with high healthcare resource utilization. Results: Cost distributions were similar between rheumatic diseases (p = 0.88). In adulthood, patients with JIA displayed a similar economic burden to much older patients with other inflammatory rheumatic diseases. A minority were high utilizers: among 119 patients with JIA, 15% utilized as much as the remaining 85%. For PsA (213 patients), RA (1086), and AxSpA (277), the high-utilization proportion was 10%. Both low and high utilizers showed rather low disease activity, but in high utilizers, the patient-reported outcomes were slightly worse, with the most distinct differences in pain levels. Of health service-related direct costs, index rheumatic diseases comprised only one-third (43.6% in JIA) and the majority were comorbidity costs. Conclusions: Patients with JIA, PsA, RA, and AxSpA share similar patterns of healthcare resource utilization, with substantial comorbidity costs and a minority being high utilizers. Innovations in meeting these patients' needs are warranted.


Assuntos
Artrite Juvenil , Artrite Psoriásica , Artrite Reumatoide , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Espondilartrite , Adulto , Artrite Juvenil/economia , Artrite Juvenil/epidemiologia , Artrite Psoriásica/economia , Artrite Psoriásica/epidemiologia , Artrite Reumatoide/economia , Artrite Reumatoide/epidemiologia , Custos e Análise de Custo/métodos , Custos e Análise de Custo/estatística & dados numéricos , Feminino , Finlândia/epidemiologia , Alocação de Recursos para a Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Espondilartrite/economia , Espondilartrite/epidemiologia
15.
PLoS Med ; 16(2): e1002750, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30807586

RESUMO

BACKGROUND: Joint inflammation is the common feature underlying juvenile idiopathic arthritis (JIA). Clinicians recognize patterns of joint involvement currently not part of the International League of Associations for Rheumatology (ILAR) classification. Using unsupervised machine learning, we sought to uncover data-driven joint patterns that predict clinical phenotype and disease trajectories. METHODS AND FINDINGS: We analyzed prospectively collected clinical data, including joint involvement using a standard 71-joint homunculus, for 640 discovery patients with newly diagnosed JIA enrolled in a Canada-wide study who were followed serially for five years, treatment-naïve except for nonsteroidal anti-inflammatory drugs (NSAIDs) and diagnosed within one year of symptom onset. Twenty-one patients had systemic arthritis, 300 oligoarthritis, 125 rheumatoid factor (RF)-negative polyarthritis, 16 RF-positive polyarthritis, 37 psoriatic arthritis, 78 enthesitis-related arthritis (ERA), and 63 undifferentiated arthritis. At diagnosis, we observed global hierarchical groups of co-involved joints. To characterize these patterns, we developed sparse multilayer non-negative matrix factorization (NMF). Model selection by internal bi-cross-validation identified seven joint patterns at presentation, to which all 640 discovery patients were assigned: pelvic girdle (57 patients), fingers (25), wrists (114), toes (48), ankles (106), knees (283), and indistinct (7). Patterns were distinct from clinical subtypes (P < 0.001 by χ2 test) and reproducible through external data set validation on a 119-patient, prospectively collected independent validation cohort (reconstruction accuracy Q2 = 0.55 for patterns; 0.35 for groups). Some patients matched multiple patterns. To determine whether their disease outcomes differed, we further subdivided the 640 discovery patients into three subgroups by degree of localization-the percentage of their active joints aligning with their assigned pattern: localized (≥90%; 359 patients), partially localized (60%-90%; 124), or extended (<60%; 157). Localized patients more often maintained their baseline patterns (P < 0.05 for five groups by permutation test) than nonlocalized patients (P < 0.05 for three groups by permutation test) over a five-year follow-up period. We modelled time to zero joints in the discovery cohort using a multivariate Cox proportional hazards model considering joint pattern, degree of localization, and ILAR subtype. Despite receiving more intense treatment, 50% of nonlocalized patients had zero joints at one year compared to six months for localized patients. Overall, localized patients required less time to reach zero joints (partial: P = 0.0018 versus localized by log-rank test; extended: P = 0.0057). Potential limitations include the requirement for patients to be treatment naïve (except NSAIDs), which may skew the patient cohorts towards milder disease, and the validation cohort size precluded multivariate analyses of disease trajectories. CONCLUSIONS: Multilayer NMF identified patterns of joint involvement that predicted disease trajectory in children with arthritis. Our hierarchical unsupervised approach identified a new clinical feature, degree of localization, which predicted outcomes in both cohorts. Detailed assessment of every joint is already part of every musculoskeletal exam for children with arthritis. Our study supports both the continued collection of detailed joint involvement and the inclusion of patterns and degrees of localization to stratify patients and inform treatment decisions. This will advance pediatric rheumatology from counting joints to realizing the potential of using data available from uncovering patterns of joint involvement.


Assuntos
Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Progressão da Doença , Articulações/patologia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos
16.
Turk J Med Sci ; 49(1): 58-65, 2019 02 11.
Artigo em Inglês | MEDLINE | ID: mdl-30761857

RESUMO

Background/aim: The aims of this study were to primarily investigate fatigue and sleep and to secondarily examine possible relationships between disease activity, pain, and functional ability in children and adolescents with juvenile idiopathic arthritis (JIA). Materials and methods: Ninety-six patients were enrolled in the study. Disease activity, functional ability, fatigue symptoms, fatigue severity, and sleep quality were assessed with the Juvenile Arthritis Disease Activity Score (JADAS), Childhood Health Assessment Questionnaire (CHAQ), Pediatric Quality of Life Inventory-Multidimensional Fatigue Scale (PedsQL-F), visual analog scale (VAS), and Pittsburgh Sleep Quality Index (PSQI), respectively. Results: Fatigue severity was moderate to high in 75% of patients with JIA and sleep quality was poor in 40% of them. VAS-fatigue was correlated with VAS-pain, VAS-wellbeing, PSQI, and sleep duration (P < 0.001). Significant relationships were found between the PedsQL-F and all other parameters except JADAS (P < 0.05). VAS-fatigue, CHAQ, and PSQI were identified as significant predictors of PedsQL-F (P < 0.05). Sleep quality, pain, and sleep duration were also significant predictors of fatigue severity (P < 0.05). Conclusion: This study suggests that fatigue and sleep problems are common problems in JIA. If underlying factors of fatigue and sleep are understood, strategies for improving sleep/fatigue paradox may develop in JIA.


Assuntos
Artrite Juvenil/complicações , Fadiga/etiologia , Sono/fisiologia , Adolescente , Artralgia , Artrite Juvenil/epidemiologia , Criança , Estudos Transversais , Fadiga/epidemiologia , Feminino , Humanos , Masculino , Medição da Dor
17.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(1): 11-19, Jan.-Mar. 2019. tab, graf
Artigo em Português | LILACS | ID: biblio-985125

RESUMO

RESUMO Objetivo: Mensurar e comparar a dor musculoesquelética em pacientes com fibromialgia juvenil (FMJ) e em pacientes com artrite idiopática juvenil poliarticular (AIJ); e avaliar e comparar a percepção e o enfrentamento da dor. Métodos: Foram avaliados, em estudo transversal, 150 crianças e adolescentes (e seus respectivos pais), divididos em três grupos: FMJ, AIJ e controles saudáveis. A mensuração e o enfrentamento da dor foram realizados por meio de instrumentos específicos. Para a avaliação da percepção da dor, desenvolveram-se três vinhetas com simulação de situações que pudessem gerar dor: aplicação de injeção, queda de bicicleta e isolamento social. Os pais e os pacientes responderam individualmente quanto à percepção da dor em cada situação. Resultados: As maiores notas de dor, os menores escores de enfrentamento da dor, as maiores notas para a percepção da dor nas vinhetas e os piores índices de qualidade de vida relacionada à saúde foram observados nos pacientes com FMJ, quando comparados aos pacientes com AIJ e aos controles. O mesmo padrão foi observado com os respectivos pais. Conclusões: Pacientes com AIJ e FMJ se comportam diferentemente em relação à percepção da dor e ao desenvolvimento de técnicas para o enfrentamento da dor. A dor deve ser avaliada sob diferentes perspectivas para um planejamento mais individualizado e efetivo do tratamento desses pacientes.


ABSTRACT Objective: To measure and compare musculoskeletal pain in patients with juvenile fibromyalgia (JFM) and polyarticular juvenile idiopathic arthritis (JIA), and to evaluate and compare pain perception and pain coping mechanisms in these patients. Methods: In this cross sectional study, we evaluated 150 children and adolescents, and their respective parents, from 3 different groups: JFM, polyarticular JIA, and healthy controls. Pain intensity and pain coping mechanisms were measured using specific questionnaires. Pain perception was evaluated according to three illustrations simulating situations that might cause pain: a shot, a bicycle fall, and social isolation. The patients' parents also filled out the questionnaires and provided a pain score that matched their child's perception of pain for each illustration. Results: The highest pain scores, the lowest pain coping strategy scores, the highest pain perception scores for all three illustrations, and the worse health related to quality of life indicators were observed in the JFM group, when compared to the JIA and control groups. The same pattern was observed with their parents. Conclusions: Patients with JIA and JFM behave differently in relation to pain perception and the development pain coping mechanisms. Pain should be evaluated from different perspectives for an individualized and efficient treatment of patients.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Qualidade de Vida , Adaptação Psicológica/fisiologia , Dor/diagnóstico , Dor/etiologia , Dor/psicologia , Artrite Juvenil/fisiopatologia , Artrite Juvenil/psicologia , Artrite Juvenil/epidemiologia , Medição da Dor/métodos , Medição da Dor/psicologia , Brasil/epidemiologia , Fibromialgia/fisiopatologia , Fibromialgia/psicologia , Fibromialgia/epidemiologia , Estudos Transversais , Avaliação da Deficiência , Disparidades nos Níveis de Saúde , Percepção da Dor
18.
Rev Paul Pediatr ; 37(1): 11-19, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-29898009

RESUMO

OBJECTIVE: To measure and compare musculoskeletal pain in patients with juvenile fibromyalgia (JFM) and polyarticular juvenile idiopathic arthritis (JIA), and to evaluate and compare pain perception and pain coping mechanisms in these patients. METHODS: In this cross sectional study, we evaluated 150 children and adolescents, and their respective parents, from 3 different groups: JFM, polyarticular JIA, and healthy controls. Pain intensity and pain coping mechanisms were measured using specific questionnaires. Pain perception was evaluated according to three illustrations simulating situations that might cause pain: a shot, a bicycle fall, and social isolation. The patients' parents also filled out the questionnaires and provided a pain score that matched their child's perception of pain for each illustration. RESULTS: The highest pain scores, the lowest pain coping strategy scores, the highest pain perception scores for all three illustrations, and the worse health related to quality of life indicators were observed in the JFM group, when compared to the JIA and control groups. The same pattern was observed with their parents. CONCLUSIONS: Patients with JIA and JFM behave differently in relation to pain perception and the development pain coping mechanisms. Pain should be evaluated from different perspectives for an individualized and efficient treatment of patients.


Assuntos
Adaptação Psicológica/fisiologia , Artrite Juvenil , Fibromialgia , Dor , Qualidade de Vida , Adolescente , Artrite Juvenil/epidemiologia , Artrite Juvenil/fisiopatologia , Artrite Juvenil/psicologia , Brasil/epidemiologia , Criança , Estudos Transversais , Avaliação da Deficiência , Feminino , Fibromialgia/epidemiologia , Fibromialgia/fisiopatologia , Fibromialgia/psicologia , Disparidades nos Níveis de Saúde , Humanos , Masculino , Dor/diagnóstico , Dor/etiologia , Dor/psicologia , Medição da Dor/métodos , Medição da Dor/psicologia , Percepção da Dor
19.
Arthritis Care Res (Hoboken) ; 71(7): 961-969, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30055093

RESUMO

OBJECTIVE: To study self-reported pain early in the disease course of juvenile idiopathic arthritis (JIA) as a predictor of long-term disease outcomes. METHODS: Consecutive cases of JIA with disease onset from 1997 to 2000 from defined geographical areas of Norway, Sweden, Finland, and Denmark were prospectively enrolled in this population-based cohort study. Self-reported, disease-related pain was measured on a 10-cm visual analog scale (VAS pain). Inclusion criteria were a baseline visit with a pain score 6 months after disease onset, followed by an 8-year study visit. Remission was defined according to Wallace et al (2004) preliminary criteria. Functional disability was measured by the Childhood Health Assessment Questionnaire and the Child Health Questionnaire Parent Form if the child was age <18 years and by the Health Assessment Questionnaire if age ≥18 years. Damage was scored using the Juvenile Arthritis Damage Index. RESULTS: The final study cohort consisted of 243 participants, and 120 participants (49%) had oligoarticular onset. At baseline, 76% reported a VAS pain score >0 compared to 57% reporting at 8 years. Half of those who reported baseline pain also reported pain at 8 years but at a lower intensity. Compared to no pain, higher pain intensity at baseline predicted more pain at 8 years, more functional disability, more damage, and less remission without medication. Baseline pain predicted more use of disease-modifying antirheumatic drugs/biologics during the disease course. Participants with oligoarticular JIA reporting pain at baseline were more likely to develop extended oligoarticular JIA or other JIA categories with an unfavorable prognosis. CONCLUSION: Early self-reported, disease-related pain among children and adolescents with JIA is common and seems to predict persistent pain and unfavorable long-term disease outcomes.


Assuntos
Artralgia/diagnóstico , Artrite Juvenil/diagnóstico , Avaliação da Deficiência , Medição da Dor , Autorrelato , Adolescente , Antirreumáticos/uso terapêutico , Artralgia/tratamento farmacológico , Artralgia/epidemiologia , Artrite Juvenil/tratamento farmacológico , Artrite Juvenil/epidemiologia , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Indução de Remissão , Países Escandinavos e Nórdicos/epidemiologia , Índice de Gravidade de Doença , Fatores de Tempo , Resultado do Tratamento
20.
Arthritis Care Res (Hoboken) ; 71(3): 413-418, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-29799673

RESUMO

OBJECTIVE: To estimate the incidence and prevalence of juvenile idiopathic arthritis (JIA) in children ages <16 years in the province of Manitoba, Canada, and to determine changes in estimates between 2000 and 2012. METHODS: JIA cases were ascertained from the administrative health data of Manitoba, using a validated case-finding algorithm. Annual incidence and prevalence rates were estimated using a generalized linear model with generalized estimating equations (GEEs), adjusting for sociodemographic characteristics. Changes in estimates were tested using piecewise regression models. RESULTS: A total of 455 cases of JIA prevalence met the inclusion criteria. Sex- and age-adjusted incidence estimates were 14.01 (95% confidence interval [95% CI] 13.52, 14.53) in 2000/2001 and 9.18 (95% CI 8.56, 9.85) in 2010/2011. Prevalence estimates were 65.33 (95% CI 63.87, 66.83) in 2000/2001 and 59.61 (95% CI 58.17, 61.08) in 2010/2011. A linear piecewise model provided the best fit to the data. There was a significant decrease in prevalence over the study period (-0.18 [95% CI -0.35, -0.02]; P = 0.0292) but no statistically significant change in incidence (-0.46 [95% CI -0.94, 0.01]; P = 0.0571). Sex-stratified models revealed a decrease for males in both prevalence (estimate -0.54 [95% CI -0.84, -10.25]; P = 0.0003) and incidence (estimate -1.02 [95% CI -2.02, -0.04]; P = 0.0439); there were no changes for females. CONCLUSION: Few population-based longitudinal epidemiologic studies of JIA have been conducted. Our findings suggested a decrease in overall JIA prevalence, and in incidence and prevalence in men. Further research to validate these findings in other cohorts and to explore factors that contribute to this change will benefit future health care planning for JIA.


Assuntos
Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Vigilância da População , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Estudos Longitudinais , Masculino , Manitoba/epidemiologia , Vigilância da População/métodos , Prevalência
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA