ABSTRACT
OBJECTIVE: The aim of this study was to determine the frequency of tarsitis as one of the first symptoms of juvenile spondyloarthropathy (JSpA) and to analyze whether patients with tarsitis at onset differ from those without it. METHODS: A retrospective chart review was performed, from January 1996 to September 2007, at a paediatric rheumatology unit of a tertiary university hospital. RESULTS: Tarsitis was detected in one-third of the children diagnosed with JSpA. They had fever and received antibiotics due to a suspected infection more frequently than those without tarsitis. Inflammatory low back pain was extremely unusual among these patients. CONCLUSION: There were some differences between children diagnosed with JSpA initially affected with tarsitis and those without it. Patients with tarsitis as one of the first symptoms were often misdiagnosed as soft tissue infections.
Subject(s)
Inflammation/diagnosis , Spondylarthropathies/diagnosis , Tarsal Joints/pathology , Adolescent , Child , Child, Preschool , Diagnosis, Differential , Female , Humans , Inflammation/diagnostic imaging , Male , Radionuclide Imaging , Retrospective Studies , Spondylarthropathies/diagnostic imaging , Tarsal Joints/diagnostic imaging , TechnetiumABSTRACT
Objetivos: Los objetivos de este estudio son evaluar la efectividad del etanercept en el tratamiento de la artritis idiopática juvenil (AIJ) a los 6 meses de tratamiento; valorar la contribución de diferentes variables clínico demográficas en la respuesta, y valorar la seguridad y la tolerancia del fármaco a los 12 meses de tratamiento. Pacientes y métodos: Estudio retrospectivo de pacientes con AIJ que iniciaron tratamiento con etanercept entre enero de 2000 y junio de 2007. Se recogieron variables clínico demográficas y variables analíticas antes de iniciar el tratamiento y después de 3 y 6 meses. La mejoría se evaluó mediante el índice ACRped (criterio de mejoría pediátrico del ACR [American College of Rheumatology `Colegio Americano de Reumatología]). Resultados: Se estudiaron 71 pacientes. A los 6 meses del tratamiento el 77,5% de los pacientes alcanzó el ACRped30, el 70,4% de los pacientes alcanzó el ACRped50 y el 54,9% de los pacientes alcanzó el ACRped70. La mejoría según el ACRped 30 fue del 100% en pacientes con artritis y entesitis, del 91,7% en pacientes con oligoartritis y del 66,7% en pacientes con poliartritis. Aunque 19 de los niños con AIJ sistémica (63%) alcanzaron una mejoría ACRped30, la fiebre no se controló en ninguno de los 12 pacientes que la presentaban y todos (menos 3 pacientes) precisaron aumento de corticoides sistémicos o infiltraciones articulares con esteroides. El etanercept se suspendió en 12 pacientes, en 6 durante el primer semestre y en 6 durante el segundo semestre. En 7 pacientes el tratamiento se interrumpió por ineficacia o recaída. El 80,3% de los pacientes continuaba el tratamiento a los 12 meses. Conclusiones: El etanercept es un tratamiento efectivo y bien tolerado en niños con AIJ, aunque es de escasa utilidad en pacientes con formas sistémicas (AU)
Objectives: 1) To assess the efficacy of etanercept in the treatment of children with juvenile idiopathic arthritis (JIA) after 6 months of therapy, 2) to analyse the contribution of several variables in the clinical response, and 3) to evaluate the safety and tolerability of the drug after 12 months of treatment. Patients and methods: Retrospective chart review of JIA patients started on etanercept from January 2000 to June 2007. The same clinical and laboratory variables were considered at the beginning of therapy and 3 and 6 months afterwards. Clinical improvement was defined according to the American College of Rheumatology pediatric criteria for improvement (ACRped). Results: Seventy one patients were studied. The ACRpedi30 response was achieved by 77.5% of the children, the ACRped50 by 70.4% and the ACRped70 by 54.9%. All children (100%) with enthesitis related arthritis, 91.7% of those with oligoarthritis and 66.7% with polyarthritis responded according to ACRped30. An ACRped30 response was achieved by 63% of children with systemic JIA (n=19), although fever was not controlled in any of the 12 children who presented it, and all but three required an increase in the steroid dose (oral and/or intra-articular). Etanercept was discontinued in 12 patients, 6 during the first six months and six between 7 and 12 months of therapy. In 7 of them because of inefficacy or flare-up. At the 12 month follow-up 80.3% of the patients continued taking etanercept. Conclusion: Etanercept is effective for the treatment of JIA and is well tolerated by children. Its clinical usefulness is very much reduced in children with systemic JIA (AU)
Subject(s)
Humans , Male , Female , Child , Antibodies, Monoclonal/pharmacology , Antibodies, Monoclonal/therapeutic use , Tumor Necrosis Factor-alpha/antagonists & inhibitors , Tumor Necrosis Factor-alpha/pharmacokinetics , Arthritis, Juvenile/pathology , Arthritis, Juvenile/therapy , Retrospective Studies , Drug Hypersensitivity/complications , Rheumatology/standardsABSTRACT
OBJECTIVES: 1) To assess the efficacy of etanercept in the treatment of children with juvenile idiopathic arthritis (JIA) after 6 months of therapy, 2) to analyse the contribution of several variables in the clinical response, and 3) to evaluate the safety and tolerability of the drug after 12 months of treatment. PATIENTS AND METHODS: Retrospective chart review of JIA patients started on etanercept from January 2000 to June 2007. The same clinical and laboratory variables were considered at the beginning of therapy and 3 and 6 months afterwards. Clinical improvement was defined according to the American College of Rheumatology pediatric criteria for improvement (ACRped). RESULTS: Seventy one patients were studied. The ACRpedi30 response was achieved by 77.5% of the children, the ACRped50 by 70.4% and the ACRped70 by 54.9%. All children (100%) with enthesitis related arthritis, 91.7% of those with oligoarthritis and 66.7% with polyarthritis responded according to ACRped30. An ACRped30 response was achieved by 63% of children with systemic JIA (n=19), although fever was not controlled in any of the 12 children who presented it, and all but three required an increase in the steroid dose (oral and/or intra-articular). Etanercept was discontinued in 12 patients, 6 during the first six months and six between 7 and 12 months of therapy. In 7 of them because of inefficacy or flare-up. At the 12 month follow-up 80.3% of the patients continued taking etanercept. CONCLUSION: Etanercept is effective for the treatment of JIA and is well tolerated by children. Its clinical usefulness is very much reduced in children with systemic JIA.
Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Juvenile/drug therapy , Immunoglobulin G/therapeutic use , Receptors, Tumor Necrosis Factor/therapeutic use , Child , Child, Preschool , Etanercept , Female , Humans , Male , Retrospective StudiesABSTRACT
INTRODUCTION: The relationship between thyroid dysfunction and autoimmune diseases has mainly been described in adults. The aim of this study was to analyse the prevalence and characteristics of thyroid abnormalities in children with rheumatic diseases. PATIENTS AND METHOD: One hundred and forty-five patients (109 girls and 36 boys) from a rheumatology paediatric unit were studied for two years. The diagnoses were: juvenile idiopathic arthritis (JIA) (n=115), lupus (n=17), juvenile dermatomyositis (n=5), scleroderma (n=4), and one case each of the following: mixed connective mixed disease, CINCA syndrome (chronic infantile neurological, cutaneous and articular), TRAPS (tumour necrosis factor receptor-associated periodic syndrome), and familial mediterranean fever. T4 and TSH levels were carried out, and if these showed abnormalities, antithyroid antibodies (ATA) were determined. RESULTS: Six girls aged between 2 and 17 years old had thyroid abnormalities. Three had JIA and three had lupus. Five were diagnosed with autoimmune hypothyroidism, with high ATA levels, and there was one case of hyperthyroidism. All of the patients with thyroid dysfunction had positive antinuclear antibodies (ANA), compared to 34.5% of the rest of the patients (p=0.003). CONCLUSIONS: The prevalence of thyroid abnormalities in children with rheumatic disease was 4.14% to 7.9% in JIA patients with positive ANA, and up to 17.6% with lupus. The majority of patients were asymptomatic. Thyroid hormones should be determined when rheumatic disease is diagnosed and periodically afterwards.
Subject(s)
Rheumatic Diseases/complications , Thyroid Diseases/complications , Thyroid Diseases/epidemiology , Adolescent , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Male , Prevalence , Thyroid Diseases/diagnosisABSTRACT
Introducción: la asociación de trastornos tiroideos y enfermedades autoinmunitarias ha sido descrita en adultos y, en menos ocasiones, en niños. El objetivo de este trabajo es analizar la prevalencia y las características de las alteraciones tiroideas en niños con enfermedades reumáticas. Pacientes y método: se estudió a 145 pacientes (109 mujeres y 36 varones) atendidos en una unidad de reumatología pediátrica durante 2 años. Los diagnósticos fueron: artritis idiopática juvenil (AIJ) (n=115), lupus (n=17), dermatomiositis juvenil (n=5), esclerodermia (n=4) y 1 caso de cada uno de los siguientes: enfermedad mixta del tejido conectivo, síndrome CINCA (chronic infantile neurologic cutaneous and articular), TRAPS (tumor necrosis factor receptor-associated periodic syndrome) y fiebre mediterránea familiar. En todos se determinaron las concentraciones de T4 y TSH, y si estaban alterados, se determinaban los anticuerpos antitiroideos (ATA). Resultados: 6 niñas tuvieron alteración tiroidea, con edades de 2 a 17 años; 3 tenían AIJ y 3, lupus; 5 fueron diagnosticadas de hipotiroidismo autoinmunitario, con ATA elevados, y 1 caso, de hipertiroidismo. El 100% de los pacientes con alteración tiroidea tenían anticuerpos antinucleares (ANA) positivos, frente al 37,4% de los restantes (p=0,003). Conclusiones: La prevalencia de alteraciones tiroideas en niños con enfermedad reumática fue del 4,14%, y aumentó al 7,9% en AIJ con ANA positivos y al 17,6% en lupus. La mayoría estaban asintomáticos. La determinación de hormonas tiroideas debería realizarse al diagnóstico de enfermedad reumática y de forma periódica después (AU)
Introduction: The relationship between thyroid dysfunction and autoimmune diseases has mainly been described in adults. The aim of this study was to analyse the prevalence and characteristics of thyroid abnormalities in children with rheumatic diseases. Patients and method: One hundred and forty-five patients (109 girls and 36 boys) from a rheumatology paediatric unit were studied for two years. The diagnoses were: juvenile idiopathic arthritis (JIA) (n=115), lupus (n=17), juvenile dermatomyositis (n=5), scleroderma (n=4), and one case each of the following: mixed connective mixed disease, CINCA syndrome (chronic infantile neurological, cutaneous and articular), TRAPS (tumour necrosis factor receptor-associated periodic syndrome), and familial mediterranean fever. T4 and TSH levels were carried out, and if these showed abnormalities, antithyroid antibodies (ATA) were determined. Results: Six girls aged between 2 and 17 years old had thyroid abnormalities. Three had JIA and three had lupus. Five were diagnosed with autoimmune hypothyroidism, with high ATA levels, and there was one case of hyperthyroidism. All of the patients with thyroid dysfunction had positive antinuclear antibodies (ANA), compared to 34.5% of the rest of the patients (p=0.003). Conclusions: The prevalence of thyroid abnormalities in children with rheumatic disease was 4.14% to 7.9% in JIA patients with positive ANA, and up to 17.6% with lupus. The majority of patients were asymptomatic. Thyroid hormones should be determined when rheumatic disease is diagnosed and periodically afterwards (AU)
