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Pediatric Rheumatology Online Journal Mar 2024Biomarkers may be useful in monitoring disease activity in juvenile idiopathic arthritis (JIA). With new treatment options and treatment goals in JIA, there is an urgent...
BACKGROUND
Biomarkers may be useful in monitoring disease activity in juvenile idiopathic arthritis (JIA). With new treatment options and treatment goals in JIA, there is an urgent need for more sensitive and responsive biomarkers.
OBJECTIVE
We aimed to investigate the patterns of 92 inflammation-related biomarkers in serum and saliva in a group of Norwegian children and adolescents with JIA and controls and in active and inactive JIA. In addition, we explored whether treatment with tumor necrosis factor inhibitors (TNFi) affected the biomarker levels.
METHODS
This explorative, cross-sectional study comprised a subset of children and adolescents with non-systemic JIA and matched controls from the Norwegian juvenile idiopathic arthritis study (NorJIA Study). The JIA group included individuals with clinically active or inactive JIA. Serum and unstimulated saliva were analyzed using a multiplex assay of 92 inflammation-related biomarkers. Welch's t-test and Mann-Whitney U-test were used to analyze the differences in biomarker levels between JIA and controls and between active and inactive disease.
RESULTS
We included 42 participants with JIA and 30 controls, predominantly females, with a median age of 14 years. Of the 92 biomarkers, 87 were detected in serum, 73 in saliva, and 71 in both biofluids. A pronounced difference between serum and salivary biomarker patterns was found. Most biomarkers had higher levels in serum and lower levels in saliva in JIA versus controls, and in active versus inactive disease. In serum, TNF and S100A12 levels were notably higher in JIA and active disease. The TNF increase was less pronounced when excluding TNFi-treated individuals. In saliva, several biomarkers from the chemokine family were distinctly lower in the JIA group, and levels were even lower in active disease.
CONCLUSION
In this explorative study, the serum and salivary biomarker patterns differed markedly, suggesting that saliva may not be a suitable substitute for serum when assessing systemic inflammation in JIA. Increased TNF levels in serum may not be a reliable biomarker for inflammatory activity in TNFi-treated children and adolescents with JIA. The lower levels of chemokines in saliva in JIA compared to controls and in active compared to inactive disease, warrant further investigation.
Topics: Child; Adolescent; Female; Humans; Male; Arthritis, Juvenile; Cross-Sectional Studies; Saliva; Inflammation; Biomarkers
PubMed: 38461338
DOI: 10.1186/s12969-024-00972-6 -
Clinical Rheumatology Mar 2023This study aimed at evaluating the effect of genicular nerve block (GNB) in juvenile idiopathic arthritis (JIA) patients with persistent unilateral knee arthritis on... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This study aimed at evaluating the effect of genicular nerve block (GNB) in juvenile idiopathic arthritis (JIA) patients with persistent unilateral knee arthritis on pain, inflammatory parameters, function, and range of motion.
METHODS
A total of 104 JIA patients were diagnosed according to the International League Against Rheumatism (ILAR) criteria with persistent unilateral knee arthritis. They were allocated randomly into 2 groups: group 1 treated with GNB, while group 2 was treated with intra-articular triamcinolone (TA) only. Visual analogue scale (VAS) on pain, sonography of large joints in rheumatology (SOLAR) scoring system, and Lysholm scores were assessed at 0-, 2-, and 12-week intervals. Swelling and tenderness were clinically evaluated semi-quantitatively (0-3) at the same time intervals.
RESULTS
VAS pain, tenderness, swelling, and SOLAR grey scale (GS) and power Doppler (PD) scores were significantly reduced after 2 weeks in both groups (p < 0.05). This was greater in the GNB group regarding VAS and tenderness, while SOLAR and swelling were stronger reduced in TA group. After 12 weeks, all outcome measures showed lower values in the GNB group compared to TA, and this was significant regarding VAS pain. Moreover, Lysholm functional score was significantly increased in both groups at both intervals; and higher values were seen in the TA group compared to GNB after 2 weeks.
CONCLUSION
GNB was able to control pain and improve function and inflammation of the knee joint in JIA patients. Though steroid attained better results after 2 weeks, GNB achieved an equivalent longer-term improvement after 12 weeks.
TRIAL REGISTRATION IDENTIFYING NUMBER
NCT04687930. Key Points • Persistent knee arthritis treatment in JIA is always challenging. • GNB was approved for treatment of pain in knee osteoarthritis. • GNB in the present study succeeded to control active knee arthritis and this effect was comparable to intra-articular steroid injection.
Topics: Humans; Arthritis, Juvenile; Knee Joint; Pain; Nerve Block; Osteoarthritis, Knee; Triamcinolone; Treatment Outcome; Injections, Intra-Articular
PubMed: 36197647
DOI: 10.1007/s10067-022-06389-4 -
Pediatric Rheumatology Online Journal Aug 2021Juvenile idiopathic arthritis (JIA), is the most common pediatric rheumatologic disorder with unknown etiology. Currently, no population-based data are available...
BACKGROUND
Juvenile idiopathic arthritis (JIA), is the most common pediatric rheumatologic disorder with unknown etiology. Currently, no population-based data are available regarding the distribution of categories and frequency of uveitis in patients with JIA in Turkey. The purpose of this study was to evaluate the frequency of JIA-associated uveitis (JIAU) and distribution of JIA categories in a Turkish JIA cohort.
METHODS
This was a retrospective study of 500 randomized patients in four pediatric rheumatology clinics in Turkey.
RESULTS
Oligoarticular JIA (oJIA) was the most common JIA disease category in this study cohort (38.8%). The frequencies of the other categories were as follows: enthesitis-related arthritis (ERA), 23.2%; rheumatoid factor (RF)-negative polyarthritis, 15.6%; systemic arthritis, 12.2%; juvenile psoriatic arthritis, 5.2%; undifferentiated arthritis, 2.8%; and RF-positive polyarthritis, 2.2%. JIA-associated uveitis was observed in 6.8% of patients at a mean (Standard Deviation, SD) age of 9.1 (3.8) years over a mean JIA disease duration of 4 (1.9) years. Uveitis developed after joint disease, with a mean (SD) duration of 1.8 (1.9) years. Patients with oJIA had the highest rate of uveitis (12.9%) followed by patients with ERA (5.2%) and polyarticular RF-negative disease (3.8%). Compared with persistent oJIA, the extended oJIA category had a > 3-fold higher risk of uveitis (11.3% vs 27.7%; odds ratio, 3.38 [95% Confidence Interval, 1.09-10.4]). The most frequently administered drug after development of uveitis was tumor necrosis factor-alpha inhibitors (38.2%). Five patients (14.7%) had uveitis-related complications that required surgical intervention.
CONCLUSIONS
Turkish pediatric patients with JIA experience a lower frequency of oJIA and higher frequency of ERA than their white European counterparts; the occurrence of uveitis is also somewhat lower than expected. Geographic and ethnic factors may affect these differences and need further investigation.
Topics: Adolescent; Arthritis, Juvenile; Child; Cohort Studies; Female; HLA-B27 Antigen; Humans; Male; Patient Acuity; Patient Care Management; Prevalence; Random Allocation; Retrospective Studies; Risk Assessment; Severity of Illness Index; Tumor Necrosis Factor Inhibitors; Turkey; Uveitis
PubMed: 34425847
DOI: 10.1186/s12969-021-00613-2 -
Pediatric Rheumatology Online Journal Jul 2023Juvenile idiopathic arthritis (JIA) is a common pediatric rheumatic condition and is associated with symptoms such as joint pain that can negatively impact...
BACKGROUND
Juvenile idiopathic arthritis (JIA) is a common pediatric rheumatic condition and is associated with symptoms such as joint pain that can negatively impact health-related quality of life. To effectively manage pain in JIA, young people, their families, and health care providers (HCPs) should be supported to discuss pain management options and make a shared decision. However, pain is often under-recognized, and pain management discussions are not optimal. No studies have explored decision-making needs for pain management in JIA using a shared decision making (SDM) model. We sought to explore families' decision-making needs with respect to pain management among young people with JIA, parents/caregivers, and HCPs.
METHODS
We conducted semi-structured virtual or face-to-face individual interviews with young people with JIA 8-18 years of age, parents/caregivers and HCPs using a qualitative descriptive study design. We recruited participants online across Canada and the United States, from a hospital and from a quality improvement network. We used interview guides based on the Ottawa Decision Support Framework to assess decision-making needs. We audiotaped, transcribed verbatim and analyzed interviews using thematic analysis.
RESULTS
A total of 12 young people (n = 6 children and n = 6 adolescents), 13 parents/caregivers and 11 HCPs participated in interviews. Pediatric HCPs were comprised of rheumatologists (n = 4), physical therapists (n = 3), rheumatology nurses (n = 2) and occupational therapists (n = 2). The following themes were identified: (1) need to assess pain in an accurate manner; (2) need to address pain in pediatric rheumatology consultations; (3) need for information on pain management options, especially nonpharmacological approaches; (4) importance of effectiveness, safety and ease of use of treatments; (5) need to discuss young people/families' values and preferences for pain management options; and the (6) need for decision support. Themes were similar for young people, parents/caregivers and HCPs, although their respective importance varied.
CONCLUSIONS
Findings suggest a need for evidence-based information and communication about pain management options, which would be addressed by decision support interventions and HCP training in pain and SDM. Work is underway to develop such interventions and implement them into practice to improve pain management in JIA and in turn lead to better health outcomes.
Topics: Adolescent; Child; Humans; Arthritis, Juvenile; Pain; Pain Management; Qualitative Research; Quality of Life; Decision Making, Shared
PubMed: 37491246
DOI: 10.1186/s12969-023-00849-0 -
Clinical Rheumatology Sep 2021The aim of this study is to evaluate a possible negative action of lockdown, during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, in the...
INTRODUCTION
The aim of this study is to evaluate a possible negative action of lockdown, during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, in the follow-up of juvenile idiopathic arthritis (JIA) patients.
METHODS
We compared the number of JIA reactivations in the period March-July 2020 to the same months of 2018 and 2019.
RESULTS
A total of 10 JIA reactivations have been documented on 58 patients (17%) visited in the period March-July 2018; 10 reactivations on 61 patients (16%) in the period March-July 2019; and 19 reactivations on 39 patients (49%) in the period March-July 2020, with a statistically significant increase (p <0.001). The other 19 patients who should have been visited during the same period, contacted by phone, indicated remission. Therefore, we hypothesize that the effective number of reactivations in the period March-July 2020 would be 19/58 patients (33%) which remains significantly greater than in the previous 2 years (p < 0.05). Among the 19 JIA patients reactivated in 2020, 3 spontaneously stopped the basic treatment due to parents' choice for fear of serious complications in case of SARS-CoV-2 infection and 4 had poor compliance with underlying treatment. In addition, 14/19 reactivated JIA patients did not perform the scheduled check according to the follow-up. In fact, the mean time interval between two follow-up visits was significantly greater in 2020 (157 ± 53 days, p < 0.0001) vs 2018 (108 ± 68 days) and 2019 (107 ± 40 days).
CONCLUSIONS
We have found a significant increase in JIA reactivations in the period March-July 2020 compared to the same interval of 2018 and 2019. This increase may have been caused by poor compliance with background treatment, as documented in 7/19 JIA patients reactivated, and by a greater interval in follow-up checks. Therefore, it is necessary, in occasion of a new pandemic and lockdown, to implement greater controls using more appropriate telemedicine tools. Key Points • COVID-19 pandemic lockdown had a negative effect on the follow-up of JIA patients. • A significant increase in JIA reactivations was found during the lockdown. • Poor therapeutic compliance and follow-up checks have been proven during the lockdown. • It is necessary to improve telemedicine tools and scientific information during a pandemic and lockdown.
Topics: Arthritis, Juvenile; COVID-19; Communicable Disease Control; Humans; Pandemics; SARS-CoV-2
PubMed: 33733314
DOI: 10.1007/s10067-021-05694-8 -
Pediatric Rheumatology Online Journal Aug 2022Juvenile Idiopathic Arthritis (JIA) is a childhood-rheumatic disease with pain as a major early complaint, and in 10-17% pain remains a major symptom. Very few data...
OBJECTIVE
Juvenile Idiopathic Arthritis (JIA) is a childhood-rheumatic disease with pain as a major early complaint, and in 10-17% pain remains a major symptom. Very few data exist on sensory threshold changes at the knee in JIA, a location in which inflammation often manifests. We determined whether JIA is associated with sensory threshold changes at the knee by using Quantitative Sensory Testing (QST) and established reference values at the knee of children.
METHODS
Sixteen patients with JIA aged 9-18 years with one affected knee and a patient-reported pain by Visual Analog Scale (VAS) > 10 on a 0-100 scale, and 16 healthy controls completed the study and were included for the analysis. QST was assessed in compliance with the German Research Network on Neuropathic Pain (DFNS) standard. Disease severity was determined using Juvenile Disease Activity Score (JADAS. Perceived pain was assessed with a visual analogue scale(0-100). Feasibility of QST was tested in patients aged 6-9.
RESULTS
Under the age of 9, QST testing showed not to be feasible in 3 out of 5 JIA patients. Patients with JIA aged 9 and older reported an average VAS pain score of 54.3. QST identified a significant reduction in pressure pain threshold (PPT) and increase in cold detection threshold (CDT) compared to healthy controls. PPT is reduced in both the affected and the unaffected knee, CDT is reduced in the unaffected knee, not the affected knee.
CONCLUSION
In a Dutch cohort of Patients with JIA, QST is only feasible from 9 years and up. Also, sensory threshold changes at the knee are restricted to pressure pain and cold detection thresholds in Patients with JIA.
PERSPECTIVE
This article shows that in a Dutch population, the extensive QST protocol is only feasible in the age group from 9 years and older, and a reduced set of QST tests containing at least pressure pain thresholds and cold detection thresholds could prove to be better suited to the pediatric setting with arthritis.
Topics: Arthritis, Juvenile; Child; Feasibility Studies; Humans; Neuralgia; Pain Measurement; Pain Threshold; Sensory Thresholds
PubMed: 35945540
DOI: 10.1186/s12969-022-00715-5 -
Expert Review of Clinical Immunology Jan 2021
Topics: Arthritis, Juvenile; Humans; Machine Learning
PubMed: 33475006
DOI: 10.1080/1744666X.2020.1850268 -
Pediatric Radiology Apr 2024In recent years, imaging has become increasingly important to confirm diagnosis, monitor disease activity, and predict disease course and outcome in children with... (Review)
Review
In recent years, imaging has become increasingly important to confirm diagnosis, monitor disease activity, and predict disease course and outcome in children with juvenile idiopathic arthritis (JIA). Over the past few decades, great efforts have been made to improve the quality of diagnostic imaging and to reach a consensus on which methods and scoring systems to use. However, there are still some critical issues, and the diagnosis, course, and management of JIA are closely related to clinical assessment. This review discusses the main indications for conventional radiography (XR), musculoskeletal ultrasound (US), and magnetic resonance imaging (MRI), while trying to maintain a clinical perspective. The diagnostic-therapeutic timing at which one or the other method should be used, depending on the disease/patient phenotype, will be assessed, considering the main advantages and disadvantages of each imaging modality according to the currently available literature. Some brief clinical case scenarios on the most frequently and severely involved joints in JIA are also presented.
Topics: Child; Humans; Arthritis, Juvenile; Ultrasonography; Magnetic Resonance Imaging
PubMed: 38015293
DOI: 10.1007/s00247-023-05815-2 -
The Medical Journal of Malaysia Jul 2022Juvenile idiopathic arthritis (JIA) is the most common rheumatic condition that develops during child age and adolescence. Unbalanced production of proinflammatory...
INTRODUCTION
Juvenile idiopathic arthritis (JIA) is the most common rheumatic condition that develops during child age and adolescence. Unbalanced production of proinflammatory cytokines is suggested to participate in the etio-pathogenesis of JIA, so the objective of this study is to evaluate the role of interleukins (IL), IL-37 and IL-38, in patients with JIA.
MATERIALS AND METHODS
Sixty patients with JIA (19 males, 41 females) and 90 healthy controls (35 males, 55 females) were included in this study. Participants were assessed using the juvenile arthritis disease activity score-27 and underwent laboratory tests, including measurements for C-reactive protein, rheumatoid factor, and IL-37 and IL-38.
RESULTS
Mean ages of JIA patients and controls were 10.37±4.21 years and 11.13±3.84 years, respectively. Compared to controls, serum IL-37 levels were increased in patients with JIA (117.98±209.282ng/ml vs. 37.87±24.496ng/ml; p<0.01), whereas serum IL-38 titres were diminished in individuals with JIA (106.2±95.781ng/ml vs. 182.24±108.428 ng/ml; p<0.01).
CONCLUSION
This study provides a further layer of evidence for the role played by IL-37 in JIA and creates new questions about the potential role of IL-38 in this condition.
Topics: Adolescent; Arthritis, Juvenile; Biomarkers; C-Reactive Protein; Child; Cytokines; Female; Humans; Interleukin-1; Interleukins; Male
PubMed: 35902929
DOI: No ID Found -
Pediatric Rheumatology Online Journal Oct 2021Juvenile Idiopathic Arthritis (JIA) requires complex care that generate elevated costs, which results in a high economic impact for the family. The aim of this...
BACKGROUND
Juvenile Idiopathic Arthritis (JIA) requires complex care that generate elevated costs, which results in a high economic impact for the family. The aim of this systematic review was to collect and cluster the information currently available on healthcare costs associated with JIA after the introduction of biological therapies.
METHODS
We comprehensively searched in MEDLINE, EMBASE, Web of Science, Scopus, and Cochrane Databases for studies from January 2000 to March 2021. Reviewers working independently and in duplicate appraised the quality and included primary studies that report total, direct and/or indirect costs related to JIA for at least one year. The costs were converted to United States dollars and an inflationary adjustment was made.
RESULTS
We found 18 eligible studies including data from 6,540 patients. Total costs were reported in 10 articles, ranging from $310 USD to $44,832 USD annually. Direct costs were reported in 16 articles ($193 USD to $32,446 USD), showing a proportion of 55 to 98 % of total costs. Those costs were mostly related to medications and medical appointments. Six studies reported indirect costs ($117 USD to $12,385 USD). Four studies reported costs according to JIA category observing the highest in polyarticular JIA. Total and direct costs increased up to three times after biological therapy initiation. A high risk of reporting bias and inconsistency of the methodology used were found.
CONCLUSION
The costs of JIA are substantial, and the highest are derived from medication and medical appointments. Indirect costs of JIA are underrepresented in costs analysis.
Topics: Arthritis, Juvenile; Cost of Illness; Cost-Benefit Analysis; Health Care Costs; Humans
PubMed: 34627296
DOI: 10.1186/s12969-021-00641-y