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1.
Clin Exp Med ; 23(3): 759-766, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36129558

RESUMO

Juvenile idiopathic arthritis (JIA) is a common pediatric rheumatic disease. Renal manifestations have been rarely observed in JIA, although amyloidosis could be a renal complication in systemic JIA (sJIA). To investigate renal damage in JIA children and to establish the relationship with treatment. Blood urea nitrogen (BUN), creatinine, cystatin C (CysC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), urinary albumin excretion (UAE), estimated glomerular filtration rate (eGFR), and renal resistive index (RRI) were assessed in 49 JIA children (9 boys/40 girls, mean age 10.3 ± 3.8 years) and in 49 healthy controls (24 boys/25 girls, mean age 11.3 ± 3.4 years). Twenty-two JIA patients were on methotrexate (MTX) therapy (group A) and 27 on biologic drugs (group B). CysC and BUN (respectively, 0.8 ± 0.1 vs. 0.7 ± 0.1 mg/dl; 13.3 ± 2.9 vs. 11.7 ± 1.4 mg/dl) were higher (p ≤ 0.001) whereas creatinine and eGFR (respectively, 0.5 ± 0.1 vs. 0.6 ± 0.1 mg/dl; 99.2 ± 10.5 vs. 122.5 ± 19.8 ml/min/1.73 m2) were lower in JIA children as compared to controls (p < 0.001). UAE resulted higher in patients than in controls (p = 0.003). Mean RRI was higher in JIA children than controls (0.7 ± 0.04 vs. 0.6 ± 0.04; p < 0.001). Group B showed higher mean RRI than group A (0.7 ± 0.1 vs. 0.7 ± 0.04; p < 0.001). Associations were found between RRI and ESR, JADAS-27, disease state, BMI-SDS (p < 0.001), CRP (p = 0.003) and eGFR (p = 0.001). JIA children had reduced eGFR, increased UAE and higher RRI values, than controls. RRIs were higher in patients on biologic drugs than MTX group and were associated with inflammation indexes and disease state, suggesting a direct effect of the disease.


Assuntos
Artrite Juvenil , Masculino , Feminino , Criança , Humanos , Adolescente , Artrite Juvenil/complicações , Artrite Juvenil/tratamento farmacológico , Creatinina , Metotrexato/uso terapêutico , Rim , Inflamação/complicações
2.
Pediatr Pulmonol ; 54(8): 1242-1249, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31099485

RESUMO

AIM: We measured respiratory parameters in children with juvenile idiopathic arthritis (JIA) without clinical signs of respiratory involvement and assessed the influence of methotrexate (MTX) treatment and disease activity on lung function. METHODS: In 49 JIA children and 70 controls lung volumes by spirometry and body plethysmography, and lung diffusion for carbon monoxide (DLCO) with single-breath technique were evaluated. RESULTS: DLCO was significantly different between JIA children and controls (P = .01), whereas no differences were found in flow expiratory volume in 1 second (FEV 1 ), forced vital capacity (FVC), forced expiratory flow at 25% to 75% of FVC (FEF 25-75 ), peak expiratory flow, total lung capacity, and residual volume. After dividing study JIA patients according to MTX treatment, a significant difference in DLCO was found among JIA patients treated with MTX and those treated with other drugs and controls (P < .001). A significant difference in DLCO was also found among JIA patients with active disease and those with inactive disease and controls (P = .003). Analysis of covariance showed a weak independent effect of MTX therapy on DLCO after adjusting for sex and height (P = .04). Furthermore, a negative correlation of DLCO with MTX cumulative dose and MTX treatment duration (r = -.58, P = .006; r = -.68, P = .001, respectively) was found, whereas there was no correlation between DLCO and disease activity (r = -.10; P = .51). CONCLUSIONS: In JIA children MTX treatment seems to have a dose-dependent effect on lung function. For this reason in these patients, a regular assessment of lung function, especially with DLCO evaluation, is recommended.


Assuntos
Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Artrite Juvenil/fisiopatologia , Pulmão/fisiopatologia , Metotrexato/uso terapêutico , Adolescente , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Pletismografia Total , Testes de Função Respiratória
3.
Mod Rheumatol ; 28(4): 637-641, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29157059

RESUMO

OBJECTIVES: To assess whether circulating levels of 90K glycoprotein are increased in children with juvenile idiopathic arthritis (JIA) at different stages of the disease, compared to healthy controls and to evaluate potential over time changes in its concentrations following treatment with the antitumor-necrosis factor (TNF) drug etanercept. METHODS: 90K glycoprotein, C-reactive protein, erythrocyte sedimentation rate, TNF, antinuclear antibodies, rheumatoid factor and the Juvenile Arthritis Disease Activity Score were assessed in 71 children: 23 with newly diagnosed JIA, 23 with established and active JIA and 25 healthy controls. Patients, eligible for anti-TNF treatment, underwent a similar clinical/laboratory assessment after 6- and 12-month etanercept therapy. RESULTS: At baseline, significant differences were found in 90K levels between the three study groups: JIA at onset (157.7 [131.4-241.5] µg/ml), JIA on treatment (90.0 [68.8-120.2] µg/ml) and control group (58.0 [44.5-79.0] µg/ml), (p for trend <.001), with the JIA at onset group showing the highest values. In the JIA on treatment group, following one-year etanercept treatment, a significant reduction in 90K was detected already at 6 months (74.3 [56.0-104.1] µg/ml p = .001) and a further decline was observed at 12 months (49.3 [46.0-67.6] µg/ml p < .001). CONCLUSION: Our study showed that 90K glycoprotein levels are increased in JIA children compared to healthy controls, suggesting a potential pathogenetic role in the JIA. Besides, 12 months of therapy with etanercept can reduce 90K levels.


Assuntos
Antígenos de Neoplasias/sangue , Artrite Juvenil/sangue , Glicoproteínas de Membrana/sangue , Adolescente , Antirreumáticos/uso terapêutico , Artrite Juvenil/tratamento farmacológico , Biomarcadores/sangue , Estudos de Casos e Controles , Criança , Pré-Escolar , Etanercepte/uso terapêutico , Feminino , Humanos , Masculino , Fator de Necrose Tumoral alfa/sangue
4.
Ital J Pediatr ; 42(1): 81, 2016 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-27600159

RESUMO

BACKGROUND: Autoimmune sensorineural hearing loss, also known as autoimmune inner ear disease (AIED) is a rare clinical entity characterized by progressive and bilateral sensorineural hearing loss often accompanied by vestibular symptoms. Diagnosis is essential as a consistent number of patients show a positive response to steroids alone or in association with other immunosuppressive drugs. AIED is defined as primary when the disease is limited to the ear, whereas in up to a third of cases it is associated to other systemic autoimmune diseases such as Behçet disease (BD). BD is a rare multisystem vasculitis characterized by recurrent oral and genital aphtosis, uveitis, skin lesions, neurological and vascular manifestations. Clinical presentation is variable thus making the diagnosis difficult in many instances. The choice of therapy is also limited by the scarceness of high-quality therapy studies. CASE PRESENTATION: We present a 15-year-old-boy with six months of history of fever, dizziness, tinnitus and ataxia. He had a final diagnosis of AIED associated to BD and was successfully treated with the anti-tumor necrosis factor (TNF)-α adalimumab. CONCLUSIONS: This case report points out to the diagnostic and therapeutic challenges of BD especially when unusual symptoms are the prominent manifestations of the disease. It also suggests that adalimumab is a good therapeutic option in children with BD and audiovestibular symptoms.


Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/etiologia , Síndrome de Behçet/complicações , Síndrome de Behçet/diagnóstico , Síndrome de Behçet/tratamento farmacológico , Perda Auditiva Neurossensorial/diagnóstico , Perda Auditiva Neurossensorial/etiologia , Adolescente , Diagnóstico Diferencial , Humanos , Imageamento por Ressonância Magnética , Masculino
6.
Clin Exp Rheumatol ; 33(1): 109-14, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25535818

RESUMO

In most childhood rheumatic diseases, specific diagnostic markers are not yet available. Therefore, a major emphasis in medical research today is directed to the discovery of new inflammation molecules, like calprotectin. Calprotectin (MRP8/MRP14) is a complex of calcium- and zinc-binding proteins that belong to the S100 protein family. This protein is directly released by leukocytes during the interaction with inflammatory activated endothelium at the site of inflammation. Increased plasma calprotectin levels have been found in inflammatory chronic diseases such as rheumatoid arthritis (RA), juvenile idiopathic arthritis (JIA), inflammatory bowel diseases (IBD), multiple sclerosis, cystic fibrosis and systemic lupus erythematosus (SLE). In these diseases, serum calprotectin has been shown to correlate with disease activity and laboratory variables of inflammation such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). This review outlines the validity and the possible applications of calprotectin as a new inflammation marker in paediatric rheumatic diseases.


Assuntos
Complexo Antígeno L1 Leucocitário/sangue , Pediatria/métodos , Doenças Reumáticas/diagnóstico , Reumatologia/métodos , Idade de Início , Artrite Juvenil/sangue , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Doenças Autoimunes/sangue , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/epidemiologia , Biomarcadores/sangue , Criança , Humanos , Valor Preditivo dos Testes , Prognóstico , Doenças Reumáticas/sangue , Doenças Reumáticas/epidemiologia , Índice de Gravidade de Doença , Vasculite/sangue , Vasculite/diagnóstico , Vasculite/epidemiologia
7.
J Clin Immunol ; 34(7): 788-91, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25135596

RESUMO

Leukocyte adhesion deficiency type 1 (LAD-1) is an autosomal recessive disorder, caused by the absence or reduced expression of the beta-2 integrins on granulocytes, and characterized by the inability of these cells to emigrate from the bloodstream towards the sites of tissue inflammation. A twelve-year-old girl with a diagnosis of LAD-1 syndrome and recurrent skin and mucosal infections since birth, presented with a two week history of fever, abdominal pain, vomiting, weight loss and polyarthralgia. She underwent an exploratory laparotomy with the finding of inflamed terminal ileum and colon and a normal appendix. Colonoscopy and videocapsule endoscopy showed multiple ileal and colonic mucosal ulcerations, which were compatible with inflammatory bowel disease, confirmed on histological examination. Given the lack of response to conventional therapy (prednisone and mesalamine), a monoclonal anti-TNF-α antibody was started at a dosage of 5 mg/kg at weeks 0,2,4,6 and then every 8 weeks. We observed a significant improvement of all clinical and laboratory parameters after the first weeks of therapy. Five months later, we anticipated the drug's administration every 5 weeks because of a precocious recurrence of symptoms. After 30 months of treatment no relapse nor any relevant side effects have been observed, and corticosteroids were withdrawn. Interestingly, our patient presented a small subset of CD18+ T cells, similarly to previously reported LAD-1 patients with mild phenotype, inflammatory bowel disease and CD18+ somatic revertant T cells. To the best of our knowledge, this is the first LAD-1 pediatric patient with inflammatory autoimmune complications who experienced a positive response to anti-TNF-α treatment.


Assuntos
Granulócitos/fisiologia , Imunoterapia/métodos , Doenças Inflamatórias Intestinais/terapia , Cadeias beta de Integrinas/metabolismo , Síndrome da Aderência Leucocítica Deficitária/terapia , Anticorpos Monoclonais/administração & dosagem , Movimento Celular/genética , Criança , Intervalo Livre de Doença , Feminino , Humanos , Doenças Inflamatórias Intestinais/genética , Doenças Inflamatórias Intestinais/imunologia , Cadeias beta de Integrinas/genética , Síndrome da Aderência Leucocítica Deficitária/genética , Síndrome da Aderência Leucocítica Deficitária/imunologia , Fator de Necrose Tumoral alfa/imunologia
8.
Clin Exp Rheumatol ; 31(5): 788-94, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23981280

RESUMO

Pericarditis has several different causes, however, in about 70% of paediatric patients, a specific aetiology cannot be detected and the pericarditis is considered idiopathic. Recurrences may occur in up to 15-30% of cases. The pathogenesis of recurrent disease is controversial. Infectious, autoimmune and autoinflammatory pathways have been proposed as mechanisms involved in recurrences. Therapeutic strategies are not standardised, non-steroidal anti-inflammatory drugs at high dosages being the mainstay of therapy with the possible addition of low dose colchicine to prevent recurrences. Biological agents are considered a possible new therapeutic frontiers in the care of idiopathic recurrent pericarditis.


Assuntos
Anti-Inflamatórios/uso terapêutico , Pericardite/tratamento farmacológico , Adolescente , Corticosteroides/uso terapêutico , Fatores Etários , Anti-Inflamatórios não Esteroides/uso terapêutico , Produtos Biológicos/uso terapêutico , Criança , Pré-Escolar , Colchicina/uso terapêutico , Feminino , Humanos , Masculino , Pericardite/etiologia , Pericardite/imunologia , Recidiva , Fatores de Risco , Resultado do Tratamento
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