Inflammatory Markers and Disease Activity in Juvenile Idiopathic Arthritis.

OBJECTIVE: To evaluate the post treatment changes in disease activity and inflammatory markers over time in longitudinal follow-up involving different subtypes of juvenile idiopathic arthritis (JIA) patients. METHODS: This prospective longitudinal study, carried out over a period of 2 y, included JIA patients, both old and new, with high disease activity. Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ferritin, CHAQ (Childhood Health Assessment Questionnaire) score and JADAS27 (Juvenile Arthritis Disease Activity score with 27 active joint counts) were estimated at the initial visit, 6 mo, 12 mo and 18 mo of follow-up. RESULTS: Out of 40 patients, 10 had persistent oligoarthritis, 11 had rheumatoid factor (RF) positive polyarthritis, 8 had RF negative polyarthritis and 11 had systemic JIA. Twenty-one of them were females. Serum ferritin was highly elevated in systemic JIA patients with a range of 750-7712 ng/ml at the initial visit. All three inflammatory markers with disease activity score decreased significantly over 18-mo-period in all four subtypes. At any visit, all these parameters had largest value in systemic arthritis and least in oligoarthritis variety. At 18 mo, all oligoarthritis and polyarthritis cases had low or inactive disease while none of the systemic JIA patients achieved inactive disease. Elevated ESR and serum ferritin was found in all at 18 mo. CRP normalized in some with low or moderate disease activity. CONCLUSIONS: Inflammatory markers and disease activity decreased in all subtypes of JIA with treatment without biologics. Acute phase markers often remain elevated in inactive disease state. Similarly, normal level of an inflammatory marker does not necessarily indicate absence of active disease.

Cardiovascular Autonomic Neuropathy in Systemic Lupus Erythematosus.

PURPOSE: Objective is to evaluate cardiovascular autonomic function in SLE by simple non-invasive tests. METHODS: A case control study was carried out involving 18-50 yrs old previously diagnosed SLE patients and same number of age and sex-matched controls. Parasympathetic function was assessed by heart rate (HR) response to Valsalva maneuver, deep breathing and standing. Sympathetic function was evaluated by blood pressure response to standing and sustained hand-grip test (HGT). RESULTS: There were 50 female SLE patients. They had significantly higher minimum resting HR and diastolic blood pressure (DBP). HR variation with deep breathing, expiratory inspiratory ratio, 30:15 ratio and DBP change in response to HGT were significantly lower inpatients compared to controls. Thirty patients (60%) had at least one abnormal or two borderline test results indicating autonomic impairment of which 27 had parasympathetic dysfunction and 7 had sympathetic dysfunction. CONCLUSION: Autonomic dysfunction is common in SLE with higher prevalence of parasympathetic impairment.

Spirometric Assessment in Juvenile Idiopathic Arthritis.

OBJECTIVE: To estimate the prevalence of abnormal spirometry in Juvenile idiopathic arthritis (JIA) patients and to evaluate its relation with subtype, gender, disease activity and methotrexate therapy. METHODS: A cross-sectional study was carried out involving 5-12 years old JIA patients. Forced vital capacity (FVC), Forced expiratory volume in 1 second (FEV1), FEV1/FVC ratio, Forced expiratory flow between 25-75% of vital capacity (FEF25-75%) and peak expiratory flow rate (PEFR) were measured. RESULT: Out of 33 patients, 18 were male. Six patients had oligoarthritis, 16 had polyarthritis and 11 had systemic JIA. Seventeen patients had clinically inactive disease and 16 received methotrexate. None had respiratory symptoms. Thirteen patients had decreased FVC with normal FEV1/FVC. One had decreased FEV1 and FEV1/FVC with normal FVC. Decreased FEF25-75% was found in 4 and decreased PEFR in 8 patients. JIA subtypes differed significantly with regard to prevalence of decreased FVC and FEV1. CONCLUSION: Abnormal spirometry was present in 13 patients and affected all subsets in terms of subtypes, gender, disease activity and methotrexate therapy.

Spirometric evaluation in juvenile systemic lupus erythematosus.

OBJECTIVE: Spirometric evaluation in juvenile systemic lupus erythematosus. METHODS: Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1), FEV1/FVC, forced expiratory flow between 25-75% of vital capacity (FEF25-75%) and peak expiratory flow rate (PEFR) of 21 patients with juvenile SLE (jSLE) were compared to controls. RESULTS: Reduced FVC and FEF25-75% was found in 18 and 9 patients, respectively. All had normal FEV1/FVC. None had respiratory complaint. When compared to controls, patients had significantly reduced FVC [mean (SD):1.97 (0.56) vs 2.35 (0.60), P=0.002] and FEF25-75% [2.19 (0.83) vs 2.63 (0.76), P=0.028] but similar FEV1/FVC [86.87(7.03) vs 86.72 (6.35), P=0.639]. CONCLUSION: jSLE patients had significant restrictive pattern and small airway involvement.

Spirometric evaluation in juvenile idiopathic arthritis: data from eastern India.

OBJECTIVE: To evaluate lung function in juvenile idiopathic arthritis (JIA) patients. METHODS: This was a case control study carried out at Institute of Post-Graduate Medical Education & Research, Kolkata, involving JIA patients between 5 and 12 y. They were diagnosed and classified on the basis of International League of Associations for Rheumatology (ILAR) criteria and compared with same number of age, sex, height and weight matched controls. Forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC ratio, forced expiratory flow between 25 and 75% of vital capacity (FEF25-75%) and peak expiratory flow rate (PEFR) of cases were compared to those of matched controls. RESULTS: Among 36 JIA patients initially recruited, 9 were excluded. Of the remaining 27 patients, male: female ratio was 17:10. Mean age, height and weight of JIA patients were 9.15 y, 124.67 cm and 23.78 kg respectively. Six patients had oligoarthritis, 3 had rheumatoid factor positive (RF+) polyarthritis, 10 had rheumatoid factor negative (RF-) polyarthritis and 8 had systemic JIA. Eleven patients had active disease and 15 patients required methotrexate. None had respiratory symptoms. Mean duration of the disease was 2.96 y. Mean FVC and FEV1 were significantly less in JIA patients compared to controls (p value=0.0003 and 0.0007, respectively). FEV1/FVC in both the groups was similar (p value=0.96). Mean Z scores for FVC and FEV1 were significantly higher in JIA patients (p value=0.0064 and 0.0030, respectively). CONCLUSION: Spirometry in JIA patients demonstrated statistically significant restrictive pattern of alteration in pulmonary function.