ABSTRACT
OBJECTIVE: To develop a disease specific measure of quality of life for application in children with juvenile rheumatoid arthritis and juvenile spondyloarthritides-the Juvenile Arthritis Quality of Life Questionnaire (JAQQ). METHODS: Patients and their parents were interviewed by a trained interviewer using a questionnaire focusing on physical function, psychosocial function, and general symptoms to determine the most appropriate items to include in the JAQQ. Respondents volunteered items and scored them for frequency of occurrence and importance. Items so generated were scored by a panel of experts for potential responsiveness and categorized into dimensions. Item number was reduced using this scoring system. The product was then pretested to confirm its construct validity and responsiveness. Thereafter, it was distributed to clinical experts to establish face and content validity. RESULTS: 91 patients, mean age 10.35 years (range 1.25-18.0), mean disease duration 3.99 years, and their parents were included in the interview process. 220 items generated were ultimately reduced to 85. Pretesting this version of the instrument in a further 30 patients showed it to have construct validity and responsiveness and led to a further reduction in items to 74, distributed in 4 dimensions: gross motor function (17 items), fine motor function (16 items), psychosocial function (22 items), and general symptoms (19 items). Face and content validity were established in 20 clinicians. Scaling was by 7 point Likert scale to enhance responsiveness. English and French versions were developed. CONCLUSION: The JAQQ measures physical and psychosocial function and an array of general symptoms. Preliminary data suggest it is valid and responsive and thus might have potential in clinical trials.
Subject(s)
Arthritis, Rheumatoid/diagnosis , Health Status Indicators , Quality of Life , Spondylitis, Ankylosing/diagnosis , Surveys and Questionnaires , Adolescent , Child , Child, Preschool , Humans , Infant , Reproducibility of ResultsABSTRACT
The first case of primary antiphospholipid syndrome associated with recurrent life-threatening haemorrhages, due to the coexistence of acquired prothrombin deficiency, is described. Attention is drawn to the difficulty in diagnosing this situation, and therapeutic options are reviewed. Evidence is presented that implicates prothrombin as the protein cofactor for this lupus anticoagulant.
Subject(s)
Antiphospholipid Syndrome/complications , Hemorrhage/etiology , Hypoprothrombinemias/complications , Prothrombin/metabolism , Adolescent , Antibodies, Antinuclear/analysis , Antiphospholipid Syndrome/blood , Antiphospholipid Syndrome/immunology , Blood Coagulation , Female , Follow-Up Studies , Hemorrhage/blood , Hemorrhage/diagnosis , Humans , Hypoprothrombinemias/blood , Hypoprothrombinemias/immunology , Partial Thromboplastin Time , Prothrombin TimeABSTRACT
OBJECTIVE: This study was undertaken to investigate the recent finding of a seasonal difference in the onset of systemic-onset juvenile rheumatoid arthritis (SoJRA). We hypothesized that a seasonal onset pattern might implicate on infectious agent as a cause of SoJRA. METHODS: The date of onset was collected from the records of all patients with SoJRA from 1980 to 1992 at presentation to pediatric rheumatology clinics across Canada. The onset pattern of SoJRA was then compared with incidence data on viral infections obtained for the same period. RESULTS: Across Canada the onset of SoJRA was constant across the seasons. However, in the Prairie region there was a statistically significant seasonal pattern, with peaks in autumn and early spring. We could find no evidence that viral incidence correlated with disease incidence either throughout Canada or in the Prairie region. CONCLUSIONS: If a seasonal infectious agent causes SoJRA, then it is likely only one of several causes and may act only in certain regions. Future studies should be carried out in those areas where SoJRA does have a seasonal onset pattern.
Subject(s)
Arthritis, Juvenile/epidemiology , Seasons , Adolescent , Age of Onset , Arthritis, Juvenile/virology , Canada/epidemiology , Child , Child, Preschool , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Virus Diseases/epidemiologyABSTRACT
Clinical assessment of the sacroiliac joints is difficult. Conventional radiography and radionuclide scanning have not afforded optimal sensitivity and specificity in the diagnosis of sacroiliac involvement in spondyloarthropathies. This report describes a technique for computed tomography of the sacroiliac joints in children; the method involves coronal scanning and allows assessment of the entire surface of the joints.
Subject(s)
Sacroiliac Joint/diagnostic imaging , Tomography, X-Ray Computed , Adolescent , Arthritis/diagnostic imaging , Child , Humans , Low Back Pain/diagnostic imaging , Rheumatic Diseases/diagnostic imaging , Sacrum/diagnostic imaging , Spinal Diseases/diagnostic imaging , Tomography, X-Ray Computed/methodsABSTRACT
The cartilage of the adult sacroiliac joint contains type II collagen and a high concentration of glycosaminoglycan. Furthermore, large aggregating proteoglycans and link proteins were extracted from the sacral cartilage. In these respects the sacroiliac cartilage is similar to that in the peripheral joints. However, while the organization of the collagen in the sacral cartilage is typical of an articular cartilage, the organization of the ilial cartilage is very different, and throughout its depth it possesses narrow collagen fibrils arranged parallel to the articular surface.
