Percepção e enfrentamento da dor em crianças e adolescentes com fibromialgia juvenil e artrite idiopática juvenil poliarticular / Pain perception and pain coping mechanisms in children and adolescents with juvenile fibromyalgia and polyarticular juvenile idiopathic arthritis

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.

Prevalence of juvenile idiopathic arthritis in schoolchildren from the city of São Paulo, the largest city in Latin America

Abstract Background: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease that affects children and adolescents. Its prevalence varies greatly from one study to another according to the population and methodology. Some tools may be helpful in screening for suspected cases. The aim of this study is determine the prevalence of JIA in children and adolescent students in the city of São Paulo, Brazil. Methods: This cross-sectional study was conducted from March 2016 to November 2017. It was based on a populational study envolving school children and adolescents from São Paulo, the largest city of Brazil. We randomly selected students under 16 years old from private schools with more than 1000 students who were evaluated through a specific questionnaire for screening suspected cases of chronic arthropathy (Early Diagnosis of Chronic Arthritis - 12 items - EDA-12) and subsequent anamnesis and rheumatologic physical examination for diagnostic confirmation. Results: We contacted all 79 schools in the universe, of which 12(15, 18%) agreed to participate in the study. A total of 21,119 questionnaires were handed out to the parents. We obtained a response of 5,710 (27%). In 108 cases the EDA-12 score was considered positive (≥ 5). We examined all these 108 suspicious" children. In 10 cases, the rheumatologic evaluation confirmed the diagnosis of arthritis, since the subjects presented a history and physical examination compatible with JIA. The prevalence of JIA in children and adolescents was 0.196% (95% CI = 0.1040.371%). Conclusion: In this first Brazilian population study to evaluate the prevalence of JIA, we observed that the disease is relatively prevalent in our country (196 / 100.000 children), which is similar to that observed in other studies involving children from urban centers.

Prevalence and factors of functional disability in patients with juvenile idiopathic arthritis

The aim of this study was to identify the prevalence of functional disability and the possible factors that may be associated with functional disability in children and adolescents with juvenile idiopathic arthritis (JIA) in Sharkia Governorate. Methods: This cross sectional study was carried out in Rheumatology and Rehabilitation department, Faculty of Medicine, Zagazig University Hospitals. Forty-eight consecutive patients of JIA aged from 7 to 17 years underwent assessment of socio-economic and demographic characteristics, functional ability using the childhood health assessment questionnaire (CHAQ), disease activity using the Juvenile Arthritis Disease Activity Score based on 27 joints (JADAS-27), psychological symptoms using the Children's Depression Inventory (CDI) score. Results: Multivariate modeling was applied to determine the factors that associated with functional disability. A total of 80 % of the patients (39 of 48) had functional disability. In multiple regression analyses, high CDIscores (OR 20.78, 95 % CI 1.64 to 262.91, P =.019),JADAS-27 (OR 17.49% CI 2.16 to 141.62, P =.007), low socioeconomic status (OR 10.43, 95 % CI 1.24 to 87.57, P =.031) were strong predictors of functional disability in JIA patients.Conclusion: Our study on patients with JIA provides evidence suggesting that a total of 80 % of the patients had functional disability, that is associated with higher CDI scores, higher JADAS -27 and a low socioeconomic status

Medication adherence in patients with juvenile idiopathic arthritis / Adesão ao tratamento farmacológico em pacientes com artrite idiopática juvenil por meio de questionários

ABSTRACT Objective: The aim of this study was to investigate pharmacological treatment adherence of patients with juvenile idiopathic arthritis, attended in an outpatient pharmacy at a tertiary hospital in northeastern Brazil. Methods: The analysis of adherence was performed along with caregivers, through a structured questionnaire based on Morisky, Green and Levine, which enabled the categorization of adherence in “highest”, “moderate” or “low” grades, and through evaluating medication dispensing registers, which classified the act of getting medications at the pharmacy as “regular” or “irregular”. Drug Related Problems (DRP) were identified through the narrative of caregivers and classified according to the Second Granada Consensus. Then, a pharmaceutical orientation chart with information about the therapeutic regimen was applied, in order to function as a guide for issues that influenced adherence. Results: A total of 43 patients was included, with a mean age of 11.12 years, and 65.1% (n = 28) were female. Applying the questionnaire, it was found “highest” adherence in 46.5% (n = 20) patients, “moderate” adherence in 48.8% (n = 21), and “low” adherence in 4.7% (n = 2). Through an analysis of the medication dispensing registers, a lower level of adherence was observed: only 25.6% (n = 11) of the participants received “regularly” the medications. Twenty-six DRP was identified, and 84.6% (n = 22) were classified as real. There were no significant associations between socio-demographic variables and adherence, although some caregivers have reported difficulty in accessing the medicines and in understanding the treatment. Conclusion: Our findings showed problems in the adherence process related to inattention, forgetfulness and irregularity in getting medicines, reinforcing the need for the development of strategies to facilitate a better understanding of treatment and to ensure adherence.

RESUMO Objetivo: Investigar a adesão ao tratamento farmacológico de pacientes com artrite idiopática juvenil, atendidos na farmácia ambulatorial de hospital terciário do Nordeste do Brasil. Métodos: A análise da adesão foi feita junto aos cuidadores, por meio de questionário estruturado com base no teste de Morisky, Green e Levine, que viabilizou a categorização da adesão em “máxima”, “moderada” ou “baixa”, e da avaliação dos registros de dispensação dos medicamentos, que classificou a retirada de medicamentos na farmácia como “regular” ou “irregular”. Os problemas relacionados com medicamentos (PRM) foram identificados por meio da narrativa dos cuidadores e classificados conforme o Segundo Consenso de Granada. Em seguida, aplicou-se uma tabela de orientação farmacêutica, que contém informações sobre o esquema terapêutico, de forma a esclarecer questões que influenciavam a adesão. Resultados: Participaram 43 pacientes, com média de 11,12 anos, 65,1%, (n = 28) do sexo feminino. Por meio do questionário, verificou-se adesão “máxima” em 46,5% (n = 20) dos pacientes, “moderada” em 48,8% (n = 21) e “baixa” em 4,7% (n = 2). Pelo registro de dispensação, observou-se um nível de adesão menor: apenas 25,6% (n = 11) dos participantes receberam os medicamentos “regularmente”. Identificaram-se 26 PRM, 84,6% (n = 22) classificados como “reais”. Não foram observadas associações significativas entre as variáveis sociodemográficas e a adesão, embora alguns cuidadores tenham relatado dificuldade de acesso ao medicamento e de compreensão do tratamento. Conclusão: Nossos achados demonstraram falhas no processo de adesão, relacionadas ao descuido, esquecimento e à irregularidade para receber os medicamentos, o que reforça a necessidade de estratégias para facilitar a compreensão do tratamento e garantir a adesão

Substance use and sexual function in juvenile idiopathic arthritis / Uso de substâncias e função sexual na artrite idiopática juvenil

ABSTRACT Objective: To evaluate alcohol/tobacco/illicit drug use and sexual function in adolescent juvenile idiopathic arthritis (JIA) and healthy controls. Methods: 174 adolescents with pediatric rheumatic diseases were selected. A cross-sectional study with 54 JIA patients and 35 controls included demographic/anthropometric data and puberty markers assessments, physician-conducted CRAFFT (car/relax/alone/forget/friends/trouble) screen tool for substance abuse/dependence high risk and a questionnaire that evaluated sexual function, bullying and alcohol/tobacco/illicit drug use. Clinical/laboratorial data and treatment were also assessed in JIA. Results: The median current age was similar between JIA patients and controls [15(10–19) vs. 15(12–18) years, p = 0.506]. Frequencies of alcohol/tobacco/illicit drug use were high and similar in both JIA and controls (43% vs. 46%, p = 0.829). However, age at alcohol onset was significantly higher in those with JIA [15(11–18) vs. 14(7–18) years, p = 0.032], particularly in polyarticular onset (p = 0.040). High risk for substance abuse/dependence (CRAFFT score ≥ 2) was found in both groups (13% vs. 15%, p = 1.000), likewise bullying (p = 0.088). Further analysis of JIA patients regarding alcohol/tobacco/illicit drug use showed that the median current age [17(14–19) vs. 13(10–19)years, p < 0.001] and education years [11(6–13) vs. 7(3–12)years, p < 0.001] were significant higher in those that used substances. Sexual activity was significantly higher in the former group (48% vs. 7%, p < 0.001). A positive correlation was evidenced between CRAFFT score and current age in JIA patients (p = 0.032, r = +0.296). Conclusion: A high risk for substance abuse/dependence was observed in both JIA and controls. JIA substance users were more likely to have sexual intercourse. Therefore, routine screening is suggested in all visits of JIA adolescents.

RESUMO Objetivo: Avaliar o uso de álcool/tabaco/drogas ilícitas e a função sexual em adolescentes com artrite idiopática juvenil (AIJ) e controles saudáveis. Métodos: Selecionaram-se 174 adolescentes com doenças reumatológicas pediátricas. Fez-se um estudo transversal com 54 pacientes com AIJ e 35 controles. Foram feitas avaliações de dados demográficos/antropométricos e marcadores da puberdade; a escala de triagem CRAFFT (carro/relaxar/sozinho/esquecer/amigos/problemas) foi aplicada por um médico para determinar o alto risco de uso abusivo/dependência de substâncias. Um questionário avaliou a função sexual, a ocorrência de bullying e o uso de álcool/tabaco/drogas ilícitas. Também foram avaliados dados clínicos/laboratoriais e de tratamento da AIJ. Resultados: A média da idade atual foi semelhante entre pacientes com AIJ e controles [15 (10 a 19) vs. 15 (12 a 18) anos, p = 0,506]. As frequências de uso de álcool/tabaco/drogas ilícitas foram elevadas e semelhantes entre pacientes com AIJ e controles (43% vs. 46%, p = 0,829). No entanto, a idade em que começou a usar álcool foi significantemente maior naqueles com AIJ [15 (11 a 18) vs. 14 (7 a 18 anos), p = 0,032], em particular na doença de início poliarticular (p = 0,040). Encontrou-se um alto risco de uso abusivo/dependência de substâncias (pontuação no CRAFFT ≥ 2) em ambos os grupos (13% vs. 15%, p = 1,000), do mesmo modo que o bullying (p = 0,088). Uma análise mais aprofundada dos pacientes com AIJ em relação ao uso de álcool/tabaco/drogas ilícitas mostrou que a média da idade atual [17 (14 a 19) vs. 13 (10 a 19) anos, p < 0,001] e os anos de escolaridade [11 (6 a 13) vs. 7 (3 a 12) anos, p < 0,001] foram significativamente maiores naqueles que usaram substâncias. A atividade sexual foi significantemente maior no primeiro grupo (48% vs. 7%, p < 0,001). Foi evidenciada correlação positiva entre a pontuação na escala CRAFFT e a idade atual dos pacientes com AIJ (p = 0,032, r = + 0,296). Conclusão: Observou-se um alto risco de uso abusivo/dependência de substâncias em pacientes com AIJ e controles. Os usuários de substâncias que têm AIJ são mais propensos a ter relações sexuais. Portanto, sugere-se a triagem de rotina em todas as consultas de adolescentes com AIJ.

Características clínicas de niños y niñas con artritis idiopática juvenil del Instituto Teletón Santiago-Chile, año 2012-2013 / Clinical characteristics of children with juvenile idiopatic arthritis at Instituto Teletón Santiago-Chile, 2012-2013

Introducción: La artritis idiopática juvenil (AIJ) es un grupo heterogéneo de trastornos inflamatorios que se expresan con inflamación, dolor e impotencia funcional en una o más articulaciones en niños menores de 16 años. Las características clínicas y epidemiológicas planteadas por la literatura nacional e internacional son diversas. Objetivos: Describir las características clínicas de los pacientes con diagnóstico de AIJ, subtipos de clasificación, articulación más afectada, relación con género y edad promedio de incorporación al Instituto Teletón Santiago. Pacientes y Método: Estudio descriptivo, transversal. Se identificaron 217 pacientes en cubo OLAP con diagnóstico de AIJ, de éstos se revisaron 174 fichas clínicas (80,1 por ciento) de pacientes activos, con edades entre 7 y 18 años, que fueron atendidos en el Instituto Teletón Santiago durante los años 2012-2013. Los datos se procesaron mediante SPSS versión 17.0. Se calcularon medidas de resumen y la relación entre variables se estableció mediante test de asociación, con p < 0,05. Resultados: Según subtipo de artritis, las mayores frecuencias correspondieron a oligoarticular (31 por ciento) y poliarticular (22,4 por ciento). Las articulaciones más afectadas fueron rodilla (70 por ciento), tobillo (57,6 por ciento) y muñeca (45,9 por ciento). Un 70,1 por ciento del total de pacientes correspondieron al género femenino. Se verifica asociación al género femenino estadísticamente significativa (p = 0,002) en los subtipos poliarticular (razón femenino/masculino = 5,50), oligoarticular (razón femenino/masculino= 3,15) y sistémica (razón femenino/masculino = 1,83). La edad de incorporación al Instituto se registró en promedio a los 9,22 +/- 3,96 años. Conclusión: Las características clínicas generales, tuvieron similitud a lo descrito en literatura, sin embargo, sería conveniente realizar estudios posteriores a nivel nacional.

Introduction: Juvenile idiopathic arthritis (JIA) is a heterogeneous group of inflammatory disorders, which manifest themselves with swelling, pain and loss of function in one or more joints, in children under 16 years of age. Clinical and epidemiological characteristics raised by the national and international literature are varied. Objectives: To describe the general clinical characteristics of patients diagnosed with JIA, regarding subtype classifications, most affected joint, gender and average age of admission at Instituto Teletón Santiago. Patients and Method: A descriptive cross-sectional study with 217 patients diagnosed with JIA identified through OLAP Cubes, was performed. Medical records for 174 (80.1 percent) active patients were reviewed, whose ages ranged from 7 to 18 years of age, and who were treated at the Instituto Teletón Santiago, between the years 2012- 2013. Data was processed using SPSS version 17.0. Summary measures and the association between variables were calculated using c2 Test of Association, with p < 0.05. Results: According to subtype of arthritis, olygoarticular obtained the higher frequencies (31 percent) and polyarticular (22.4 percent). The most commonly affected joints were, knee (70 percent), ankle (57.6 percent) and wrist (45.9 percent). A 70.1 percent of all patients, were female. Association to the female gender was statistically significant (p = 0.002) for the polyarticular subtypes (reason female/male = 5.50), oligoarticular (reason female/male = 3.15 ) and systemic (right female/male = 1.83). The age for admission to the Institute, was recorded at an average of 9.22 +/- 3.96 years. Conclusion: The general clinical characteristics of the population, were similar to those described in literature, however further studies would be useful at the national level.

La artritis idiopática juvenil y su relevancia dentro de las enfermedades reumatológicas de la infancia / Juvenile idiopathic arthritis and its relevance in rheumatological diseases of children

El dolor y la inflamación que afecta a las articulaciones o tejidos periarticulares son motivo frecuente de consulta a nivel pediátrico. Dentro de los diagnósticos diferenciales se encuentran las enfermedades reumatológicas. En los últimos años ha cambiado el pronóstico y visión que se tenía de estas enfermedades gracias a los nuevos conocimientos sobre la patogenia y a la incorporación de nuevas terapias con agentes biológicos, basados en anticuerpos monoclonales y que se ha traducido en un cambio en los tratamientos convencionales de estas enfermedades. La Artritis Reumatoidea Juvenil, actualmente denominada Artritis Idiopática Juvenil (AIJ), constituye la enfermedad más frecuente dentro del espectro de estos cuadros autoinmunes. El objetivo de esta presentación es dar a conocer las diversas formas de AIJ y los principales hallazgos clínicos y de laboratorio que pueden orientar al clínico acerca de estas enfermedades y así iniciar un tratamiento oportuno que asegure un buen pronóstico de la enfermedad.

Musculoskeletal pain, joint pain and arthritis are a common complaint in pediatric practice. Among the differential diagnosis for these conditions are rheumatic diseases. Treatment and outcome of these conditions has greatly improved in recent years due to advances in the knowledge of the underlying mechanisms and the development of new therapies with biologic agents, based on monoclonal antibodies. These new therapies have changed the outcome and vision of these diseases. Among the different rheumatologic diseases described in children, Juvenile Rheumatoid Arthritis, now called Juvenile Idiopathic Arthritis (JIA), is the most common disease within the spectrum of autoimmune conditions. The aim of this presentation is to show the different forms of JIA and the main clinical and laboratory findings that can guide the clinician to an early diagnosis and initiate a timely treatment that can guarantee a better prognosis.

Renal cell carcinoma and systemic onset juvenile idiopathic arthritis.

Renal cell carcinoma (RCC) accounts for majority of malignancies arising out of the kidney. Paraneoplastic rheumatologic manifestations; myositis, vasculitis, and arthritis have been described in a few cases with RCC. Systemic onset juvenile idiopathic arthritis (JIA) is characterized by intermittent fever, arthritis, reticulo-endothelial cell hyperplasia and absence of rheumatoid factor and antinuclear antibodies. Herein, we report a 16-year-old boy with systemic onset JIA for 5 years who developed RCC and his systemic and articular symptoms paralleled the course of RCC. The common pathophysiologic influence of the cytokine Interleukin-6 possibly played a role in the exacerbation of symptoms of systemic onset JIA during the relapse of the RCC. The case is presented to highlight the rare co-occurrence of these two diseases and their influence on each other.

Decreased high-density lipoprotein cholesterol levels in polyarticular juvenile idiopathic arthritis

OBJECTIVES: To investigate the prevalence of dyslipoproteinemia in a homogeneous cohort of polyarticular juvenile idiopathic arthritis patients. METHODS: Based on the National Cholesterol Education Program, fasting lipoprotein levels and risk levels for coronary artery disease were determined in 28 patients with polyarticular juvenile idiopathic arthritis. The exclusion criteria included diabetes, thyroid dysfunction, smoking, proteinuria, lipid-lowering drugs, and hormone/diuretic therapy. Disease activity, disease duration, and therapy with corticosteroids and/or chloroquine were defined at the time of lipid measurements. RESULTS: Dyslipoproteinemia was identified in 20 of the 28 (71 percent) patients with polyarticular juvenile idiopathic arthritis. The primary lipoprotein risk factor was decreased high-density lipoprotein cholesterol (57 percent), followed by elevated levels of low-density lipoprotein cholesterol (18 percent), triglycerides (14 percent), and total cholesterol (7 percent). The male patients had decreased high-density lipoprotein cholesterol levels than the female patients (p<0.05). The incidence of decreased high-density lipoprotein cholesterol levels did not seem to be affected by disease activity or therapy because the incidence was similar in patients with active or inactive disease, with or without corticosteroid use and with or without chloroquine use. In addition, the frequency of decreased high-density lipoprotein cholesterol levels was similar in patients with short (≤5 years) vs. long (>5 years) disease duration. CONCLUSIONS: Dyslipoproteinemia is highly prevalent in patients with polyarticular juvenile idiopathic arthritis and is primarily related to decreased high-density lipoprotein cholesterol levels; therefore, early intervention is essential.

Artrite idiopática juvenil em um serviço de reumatologia: Belo Horizonte, Minas Gerais / Juvenile idiopathic arthritis in a department of rheumatology:Belo Horizonte, Minas Gerais

O termo artrite idiopática juvenil (AIJ) descreve um grupo clinicamente heterogêneo de artrites com mais de seis semanas de duração, de causa desconhecida e início até os 16 anos de idade. Objetivo: descrever o perfil clínico de um grupo de pacientes com diagnóstico de AIJ. Métodos: os prontuários de 72 indivíduos foram revistos com o objetivo de classificá-los conforme critérios propostos pelo ILAR. Os dados obtidos foram comparados com a literatura. Resultados: eram 37 crianças (51,4%) do sexo masculino e 35 do sexo feminino, com mediana de idade de 164,5 meses; 23 (31,9%) estavam classificados como sistêmicos, 25 (34,7%) como oligoarticulares, três (4,2%) poliarticulares fator reumatoide positivo, 13 (18,1%) poliarticulares fator reumatoide negativo, três (4,2%) com artrite psoriásica, quatro (5,6%) com artrite associada à entesite e um (1,4%) com doença indiferenciada. O fator reumatoide foi positivo em 10 (13,9%) e o FAN em 14 (19,4%). Uveíte crônica foi encontrada em quatro (5,6%) crianças, todas do sexo feminino (p=0,05), com doença iniciada antes dos quatro anos de idade (p=0,03) e com FAN positivo (p < 0,001). Conclusão: sabe-se que há diferenças na prevalência e na distribuição dos subtipos de AIJ dependendo da origem da população. Os dados analisados neste estudo, o primeiro do gênero em nosso país, indicaram importantes diferenças entre os diversos grupos geográficos/étnicos acometidos pela AIJ, sugerindo a influência de fatores genéticos, associados ou não a fatores ambientais, que deverão ser estudados e confirmados posteriormente, na expressão da AIJ.

The term Juvenile Idiopathic Arthritis (JIA) describes an arthritis clinically heterogeneous group of over six week?s duration, unknown causes and beginning up to 16 years old. Objective: to describe the clinic profile of a patients? group with JIA diagnosis. Methods: the records of 72 individuals were reviewed with the aim of classifying them according to the ILAR proposed criteria. The collected data were compared with the literature. Results: there was 37 male children (51,4%) and 35 female, with the mean age of 164,5 months; 23 (31,9%) were classified as systemic, 25 (34,7%) as oligoarticular, three (4,2%) as polyarticular positive rheumatoid factor, 13 (18,1%) polyarticular negative rheumatoid factor, three (4,2%) psoriatic arthritis, four (5,6%) with arthritis associated to enthesitis and one (1,4%) with indifferenced disease. The rheumatoid factor was positive in 10 (13,9%) and the FAN in 14 (19,4%). Chronic uveitis was found in four (5,6%) children, all female (p=0,05), with the disease started before four years old (p=0,03) and with positive FAN (p < 0,001). Conclusion: it is known that there are differences in the prevalence and distribution of the JIA subtypes depending on the population origins. The data analyzed in this study, the first of the kind in our country, indicate relevant differences between the several geographic / ethnical groups affected by the JIA, suggesting the influence of docugenetic factors, whether associated or not to environmental factors, which must be further studied and confirmed.

Clinico-serological profile of juvenile idiopathic arthritis.

We report clinico-serological profile of 210 children with Juvenile idiopathic arthritis (JIA), diagnosed as per ILAR classification criteria. Polyarticular, oligoarticular, and systemic onset disease was observed in 72, 69, and 40 children, respectively. The knee joint was the most frequently involved joint. Antinuclear factor and Rheumatoid factor were positive in 10 and 8, 6 and 20, and 7 and 7 percent children with polyarticular, oligoarticular, and systemic disease, respectively.

Guía de tratamiento de la artritis idiopática juvenil / Treatment guide of juvenile idiopathic arthritis

Las artritis inflamatorias del niño constituyen un grupo heterogéneo de enfermedades de presentaciones clínicasdiversas y distintas bases genéticas. Esto ha hecho necesario desarrollar protocolos para el mejor manejo de estos cuadros. En este artículo el Grupo Pediátrico de la Sociedad Chilena de Reumatología ha propuesto una Guía clínica de tratamiento de la Artritis Idiopática Juvenil según los actualesCriterios de Clasificación de ILAR (International League of Associatons for Rheumatology), Edmonton 2001.

Inflammatory arthritis in children is a heterogeneous disease group with several clinical signs and different genetic background. This has brought about the need to develop clinical trials to improve disease management. In this article, the Pediatric Group of the Chilean Rheumatology Society has proposed a Clinical Guide for the medical treatment of Juvenile Idiopathic Arthritis, based on the latest Classification Criteria of the International League of Associations for Rheumatology, ILAR, Edmonton 2001.

Uveitis and anti nuclear antibody positivity in children with juvenile idiopathic arthritis.

This study was conducted to determine the frequency of antinuclear antibodies (ANA) positivity and uveitis in our newly diagnosed juvenile idiopathic arthritis (JIA) patients classified according to International League Against Rheumatology (ILAR) classification criteria. Ninety-two girls and 106 boys, totally 198 children were enrolled in the study. of them 36 (18.2 percent) were found to be ANA positive. Chronic anterior uveitis was detected in 20 (10.1 percent) patients. ANA positivity was determined in 4 of the systemic JIA patients, in whom no uveitis had been detected. Twenty-five of 37 patients with oligoarticular JIA were ANA positive, in 10 of them uveitis was also diagnosed. ANA were positive in 3 of 34 patients with RF positive polyarticulat JIA, only one patient had positive ANA, and another one had uveitis. Nine patients were extended JIA and in none of them, ANA positivity or uveitis were present. Of 43 patients classified as enthesitis related arthritis (ERA), uveitis was diagnosed in 6 and there was no evidence of ANA positivity, but one had uveitis. We conclude that the incidence of ANA positivity and uveitis is low in Turkish children with JIA.

A follow-up study of juvenile rheumatoid arthritis into adulthood.

AIM OF THE STUDY: To study the clinical profile of various subtypes of juvenile rheumatoid arthritis (JRA) in adulthood and analyse the outcome of the disease in terms of functional status, educational achievement, growth abnormalities, radiological progression and activity of the disease. METHODS: From a group of 150 JRA cases, 26 adult patients were included in the study. All of them were under follow up since the onset of disease in childhood. Clinical data at the onset were obtained from old medical documents. Detailed clinical and laboratory assessment of all cases were done. RESULTS: There were 10 oligoarticular, 13 polyarticular and three systemic onset cases. Mean age of onset of disease was 11.7 +/- 3.39 years (range 2-15). Mean duration of follow up was 11.4 +/- 4.46 years range (6-22). Twenty-one patients had active disease. Ninety percent of oligoarthritis group were in class 1 status whereas none of the systemic onset JRA cases were in class I. Micrognathia, short stiff neck and short stature were noticed among polyarticular and systemic onset JRA. Seventy percent of oligoarthritis group developed inflammatory low back ache. Bony ankylosis of tarsal and carpal bones were seen in eight cases. CONCLUSION: In our study there is a male predominance in JRA. Pauciarticular (oligoarthritis) JRA occurring in older boys had the best functional outcome. Growth abnormalities and radiological changes were more common in polyarticular and systemic onset JRA.

Principales enfermedades reumáticas en México: aspectos epidemiológicos e impacto socioeconómico / Principal rheumatic diseases in Mexico: epidemiological aspects and socioeconomic impact

Objetivo. Conocer las características epidemiológicas y demográfias de aquellos pacientes que acuden a la práctica privada e institucional de la reumatología en la república mexicana. Método. Se efectuó una revisión bibliográfica formal, principalmente de revistas médicas mexicanas, de las que las tres cuartas partes fueron publicaciones aparecidas en la RevistaMexicana de Reumatología. Resultados. Los resultados pueden considerarse como una muy importante contribución al conocimiento de algunos hechos acerca de los enfermos que acuden a la consulta reumatológica privada e institucional en diversas muestras de población de México país. Conclusiones. Entre las enfermedades reumáticas más comunes en México, hay cierto predominio del sexo femenino y es también evidente la tendencia a la cronicidad; se informan y comentan algunos otros aspectos sobresalientes.

Artritis reumatoidea juvenil: diagnóstico difícil con consecuencias impredecibles / Juvenile rheumatoid arthritis: a difficult diagnosis with unpredictable consequences

La Artritis Reumatoidea Juvenil (AJR) es una enfermedad crónica que reviste gran interés en la infancia. En primer lugar para el niño, porque al tratarse de un organismo en crecimiento, puede derivar en graves alteraciones funcionales; en segundo lugar para el pediatra, porque requiere una gran experiencia clínica llegar al diagnóstico. Material y Método: Estudio descriptivo, retrospectivo, sobre una población de 16 niños, con diagnóstico de ARJ internados entre los años 1992 y 1998 en el Hospital del Niño Jesús de San Miguel de Tucumán. Las fuentes fueron las historias clínicas respectivas. Las variables seleccionadas fueron: 1) Condición de vivienda. 2) Condición de escolaridad paterna. 3) Características de edad y sexo. 4) Subtipos de ARJ. 5) Estado nutricional. 6) Síntomas iniciales, compromiso articular y extraarticular. 7) Características de laboratorio. 8) Complicaciones, secuelas y evolución grave, relacionadas con antecedentes previos. 9) Número y duración de las internaciones. Resultados: 1. Necesidades básicas insatisfechas: 9 de 16 niños. 2. Jefes de familia sin escolaridad básica: 3 de 16 hombres. 3. Relación varón/mujer: fue 7/9 en general; 5/4, 1/4 y 1/1 en las ARJ poliarticular, sistémica y oligoarticular respectivamente. Edad: Media 8,6; mediana 7, en general. Promedio 7,8; 6; y 11,5 para la poliarticular, sistémica y oligoarticular respectivamente. 4. Subtipos de ARJ: poliarticular 9/16; sistémica 5/16; oligoarticular 2/16. 5. Estado nutricional: Desnutridos 10/16 (7/16 de 2§ grado; 3/16 de 1§ grado); 1/16 eutrófico; 1/16 obeso; 4/16 sin registro de peso. 6. Síntomas de inicio: 3/16 niños con síndrome febril prolongado, con una media de 4 meses de evolución, siempre ARJ sistémica. 1/16 anemia (poliarticular). 11/16 poliartralgias y 4/11 asociadas a un síndrome febril. 1/16 cefalea y "nucalgia" (oligoarticular). Compromiso articular: 3/16 rodilla, 8/16 tobillo, 6/16 manos, 6/16 pies, 5/16 cadera. Muñeca 5/16. Hombro 4/16. Columna cervical 3/16. Codo 1/16. Témporomaxilar 1/16. Manifestaciones extraarticulares: siempre en la ARJ Sistémica (n=16). 3/5 SFP. 4/5 Rush, 2/5 hepatoesplenomegalia, 1/5 esplenomegalia, adenomegalia 3/5. 7. Laboratorio: leucocitocis con neutrofilia 5/9 poliarticular; 5/5 sistémica. Anemia (n=8) 4 sistémicas, 4 poliarticulares. Reactantes de fase aguda, eritrosedimentación > 60 mm franco predominio poliarticular, > 100 mm franco predominio sistémica...

Manifestacoes extra-articulares iniciais em 80 criancas com artrite reumatoide juvenil forma sistemica / Extra-articular manifestations in 80 children with juvenile rheumatoid arthritis

A forma sistemica da artrite reumatoide juvenil (ARJ) e caracterizada por manifestacoes extra-articulares iniciais com multiplas formas de apresentacao, ressaltando-se a febre alta com duracao prolongada. Objetivos: descrever as manifestacoes extra-articulares da forma sistemica da ARJ. Casuistica e metodos: foram avaliados retrospectivamente 80 pacientes com ARJ forma sistemica admitidos na Unidade de Reumatologia Pediatrica do Instituto da Crianca do HC-FMUSP no periodo de outubro de 1974 a dezembro de 1996. Resultados: a idade do inicio dos sintomas variou de 10 meses a 13,4 anos (media de 4,3 anos). As manifestacoes extra-articulares ocorreram em 100 por cento dos pacientes, ressaltando: febre (100 por cento), sendo 21 por cento com diagnostico inicial de febre de origem indeterminada...

Enfermedades reumáticas y del tejido conectivo en niños de Santiago, Chile / Rheumatic and connective tissue diseases in children at Santiago, Chile

Se describen los resultados de una encuesta sobre enfermedades reumatológicas infantiles en pacientes de 15 años o menos de edad de los consultorios públicos y privados de reumatología pediátrica del área metropolitana de Santiago, cuyo diagnóstico hubiese quedado definido en el curso del año 1991. La población cubierta por dichos servicios fue estimada en 1.571.171 menores de 15 años. Durante 1991 hubo 2.807 consultas de reumatología infantil, de las cuales 478 (17 por ciento) correspondieron a nuevas consultas, entre las cuales se comprobaron 135 casos nuevos de enfermedades del tejido conectivo (incidencia estimada de 8.6 casos por 100.000). La artritis reumatoidea fue la afección más frecuente entre ellas (incidencia estimada 5,6 casos por 100.000)

Epidemiología de la artritis reumatoide en el Hospital de La Fuerza Aérea del Perú. Mayo 1976-Junio 1992 / Epidemiological aspects of rheumatoid arthritis at the rheumatology service of Hospital Central Fuerza Aerea del Peru (HCFAP) 976-1992

El objetivo de este estudio fue conocer algunos aspectos epidemiológicos de la artritis reumatoide (clásica) en el Servicio de Reumatología del Hospital Central de la Fuerza Aérea del Perú (HCFAP) entre los años 1976 y 1992. El estudio fue descriptivo, longitudinal y retrospectivo. Se estudió 206 casos, de pacientes con el diagnóstico de artritis reumatoidea clásica. La demora en el diagnóstico fue definida como el periódo de tiempo comprendido entre el inicio de los síntomas y el momento del diagnóstico. Se encontró 169 mujeres (82,03 por ciento) y 37 hombres (17,97 por ciento). La edad promedio fue 65ñ14,43 años (mediañDE) en los varones y 61ñ14,44 años en las mujeres. El grupo etáreo más comprometido fue el de 46-55 años (23,30 por ciento) y el menos comprometido el de 16-25 años. Al momento del ingreso al servicio, el 48,75 por ciento de los casos presentaba grado funcional II. El factor reumatoide (FR) fue positivo en el 70 por ciento de los pacientes (p<0,001). La mayor frecuencia de casos nuevos se registró en el año 1988 (11,65 por ciento) y la menor en el año 1978 (2,42 por ciento). El 52,38 por ciento evolucionó a la incapacidad en un intervalo de 0-5 años. Con relación a la ocupación, se observó que la mayor frecuencia correspondió a las amas de casa (71,21 por ciento). Se concluye que los resultados encontrados concuerdan con los datos referidos en la literatura nacional y extranjera, siendo posible que el mayor número de casos observados en 1988 esté relacionado a la modificación de los criterios diagnósticos de la Asociación Americana de Reumatología (ARA) en 1987.