Prolactin in prepubertal children with juvenile rheumatoid arthritis. The efficacy of bromocriptine as a non-standard adjuvant therapy

The aim of the present study was to explore the possible role of prolactin [PRL] expression in immune pathogenesis of juvenile rheumatoid arthritis [JRA], and its clinical relevance in terms of disease activity and severity. Also, to investigate the efficacy and safety of bromocriptine as a non-standard adjunctive therapy in pediatric age groups. This study was performed in sixty-five subjects, of whom, thirty-five patients had JRA and thirty were healthy age and sex matched subjects. Patients were recruited from the Pediatric Allergy and Immunology Clinic, Children 's Hospital, Ain-Shams University. Patients were subjected to detailed history taking, full clinical examination, Ritchie's Articular Index [RAI] score and laboratory markers of disease activity and severity. PRL assay was perfonned twice for all patients, initially at recruitment during active phase of the disease then after bromocriptine therapy. All patients with active non-life threatening JRA received bromocriptine daily [5-15 mg/day] during treatment phase [3 to 9 months] and were followed for 6 months after drug discontinuation. The mean serum PRL concentration [ng/ml] in all patients at baseline during activity before bromocriptine therapy was significantly higher in comparison to that of the control group [9.33 +/- 2.37 versus 5.57 +/- 0.58]. The frequency of hyperprolactinemia was 65.7%. The highest serum PRL level was noticed in polyarticular RF seropositive JRA [10.32 +/- 3.27 ng/ml]. Serum PRL concentrations during activity showed positive significant correlation with [RAI] score, ESR and CRP. The serum PRL levels were significantly higher in CRP ve JRA [60%] [9.13 +/- 2.43 ng/ml] compared to CRP-ve JRA [40%] [6.52 +/- 0.99 ng/ml]. Serum PRL concentration was significantly higher in ANA seropositive patients [10.82 +/- 3.19 ng/ml] compared to ANA seronegative patients [6.45 +/- 1.02 ng/ml]. Serum PRL concentrations correlated significantly with the duration of illness [6.5 +/- 2.7 years]. There was a significant reduction of serum PRL concentrations after bromocriptine therapy [more significant reduction with longer duration of therapy] from 9.33 +/- 2.37 to 5.59 +/- 7.79 ng/ml; so that when the levels were compared after therapy to that of the control group, no significant difference was noticed. The 7M7 score had decreased significantly after therapy from 12 +/- 5 to 4 +/- 2. ESR showed significant reduction from 52 +/- 22 to 21 +/- 10 mm/hr. Also, CRP decreased significantly from 8 +/- 3 to 2 +/- lmg/dl. Moreover, CRP +ve JRA patients [21 patients; 60%] showed significant reduction after therapy to 5.7% [2 patients]. In our study, 28.6% of patients experienced nausea, 11.4% experienced headache and 2.8% experienced insomnia. The above results imply the important role ofhyperprolactinemia in the immune-pathogenesis of JRA. Hyperprolactinemia correlated significantly with clinical and laboratory indices of disease activity md severity. Therefore, PRL can be considered as a good reliable marker of disease activity, severity and disease monitoring. Bromocriptine therapy especially for longer duration had result in significant reduction of serum PRL levels and improvement of clinical and laboratory markers of disease activity with subjective and objective improvements in the clinical status of most patients with a relatively safety profile and good tolerance. Based on this limited but encouraging clinical trial, the use of bromocriptine as a non-standard adjunctive therapy in controlling JRA activity in prepubertal children is warranted yet, additional investigation is needed to verify this conclusion and extend preliminary results

Urine neopterin: a new parameter for monitoring disease activity in patients with systemic lupus erythematosus

Urine neopterin/creatinine [N/C] ratio was determined in early morning samples of 16 children with active systemic lupus erythematosus [SLE] and 10 children with inactive SLE disease, using radioimmunoassay [RIA] for measuring urine neopterin Concentration. Compared with apparently healthy 20 control children the mean urine N/C ratio was significantly increased in patients with active [P <0.001] and inactive [P <0.01] SLE. The mean urine N/C ratio was also significantly higher in children with active than in. those with inactive SLE [P <0.001]. The urine N/C ratio did not distinguish between patients with renal activity and those with other types of clinical activity and it was not influenced by different drug regimens. The correlation between urine N/C ratio and erythrocyte sedimentation rate [ESR] was a positive linear one while there was no significant correlation between urine N/C ratio and serum C4. When testing urine N/C ratio at a cut-off value of >/= 300 micro mol neopterin/mol creatinine and ESR at a cut-off value of >/= 50 mm/hr and serum C4 at a cut-off value of

Urodynamic studies in children with primary nocturnal enuresis

Twenty five children with primary nocturnal enuresis were studied by cystometry, uroflowmetry and uretheral profilometry. Ninety two percent of the studied children had abnormal cystometrograms showing hyperreflexic bladder with high resting pressure in 76%, small bladder capacity in 68% and uninhibited bladder contractions in 36% and by uroflowmetry 12% were supervoiders. These urodynamic abnormalities were more prominent with a significantly high percentage of small bladder capacity in children over 10 years of age. All studied children had a normal uretheral closure pressure by uretheral profilometry. Abnormal uroflowmetry in the form of supervoiding was very prominent in children with psychological problems. There were no significant differences in the cystometric and uroflowmetric findings of enuretic children with and without a family history of enuresis although uninhibited bladder contractions were more common in children with a positive family history indicating a defect in the central rather than the peripheral control of mictruition. It is concluded that children with primary nocturnal enuresis exhibit significant cystometric abnormalities that may reflect a delayed maturation of the controlling central and peripheral nervous system and which may benefit from proper anticholinergic theapy. Supervoiding might indicate the presence of psychologic problem that necessitates psychotherapy