Navegando por Palavras-chave "juvenile idiopathic arthritis"
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- ItemAcesso aberto (Open Access)Avaliação de provas de fase aguda em crianças e adolescentes com artrite idiopática juvenil e sua correlação com atividade da doença(Sociedade de Pediatria de São Paulo, 2009-06-01) Nicácio, Aline Alencar Martins Fernandes [UNIFESP]; Damazio, Karine Cobucci; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Rassi, Ivan Elias; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Hospital Professor Edmundo VasconcelosOBJECTIVE:To analyze the relationship between the acute phase reactants and the disease activity of Juvenile Idiopathic Arthritis (JIA) and to evaluate the agreement between erythrocyte sedimentation rate and C-reactive protein during the acute phase of the disease. METHODS: a cohort retrospective study has been conducted based on the analysis of 30 children and adolescents who fulfilled the diagnostic criteria of JIA. All of them were in current follow-up at the pediatric rheumatology outpatient clinic and had acute phase reactants blood tests performed. RESULTS: Studied population comprised 30 patients: 21 (70%) of them were females and 19 (63.3%) presented oligoarticular subtype. The mean age at disease onset was 65.6 months; the age at diagnosis was 85.3 months and the follow-up had 57.2 months of duration. The acute phase reactants showed positive association with the disease activity. Anemia was not associated with disease activity. During the acute phase of the disease, agreement between erythrocyte sedimentation rate and C-reactive protein was greater than 80%. CONCLUSIONS: The acute phase reactants have a positive association with the activity of the disease and using both tests simultaneously increases their specificity.
- ItemSomente MetadadadosClinical significance of anticardiolipin antibodies in juvenile idiopathic arthritis(Clinical & Exper Rheumatology, 1999-05-01) Serra, Celia Regina Barrientos [UNIFESP]; Rodrigues, Silvia Helena [UNIFESP]; Silva, N. P.; Sztajnbok, F. R.; Andrade, Luiz Eduardo Coelho [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Federal do Rio de Janeiro (UFRJ)ObjectiveAnticardiolipin antibodies (aCL) have been demonstrated in a large spectrum of autoimmune diseases. However, its occurrence in childhood, in particular in juvenile idiopathic arthritis (JIA), is not well established. The present study addressed the frequency and clinical significance of aCL in a group of JIA patients.MethodsaCL (IgG and IgM isotypes), antinuclear antibodies (ANA), and rheumatoid factor (RF) were determined in 86 children with JIA (33 systemic, 31 polyarticular and 22 oligoarticular onset type). Thirty-two juvenile systemic erythematosus lupus patients (JSLE) and 52 healthy children formed the control groups. The disease activity and functional status of the JIA patients were scored to study their possible associations with the presence of aCL.ResultsSerum aCL levels above the normal range were detected in 28/86 JIA patients (32.5%), 12/32 JSLE patients (37.5%), and 3/52 healthy children (6%). Positive aCL levels were slightly or moderately elevated (usually below 30 GPL and 20 MPL). The presence of aCL was not associated with the presence of ANA or RE Associations between aCL and clinical parameters, such as disease onset, duration, activity or severity could not be established. No JIA patient had vascular thrombosis, thrombocytopenia or livedo reticularis.ConclusionaCL occurred in low titers in JIA children, in a similar frequency to that observed in JSLE. No association with JIA clinical parameters or the clinical features classically linked to the antiphospholipid antibody syndrome were observed.
- ItemSomente MetadadadosCyclosporine A in juvenile idiopathic arthritis. Results of the PRCSG/PRINTO phase IV post marketing surveillance study(Clinical & Exper Rheumatology, 2006-09-01) Ruperto, N.; Ravelli, A.; Castell, E.; Gerloni, V.; Haefner, R.; Malattia, C.; Kanakoudi-Tsakalidou, F.; Nielsen, S.; Bohnsack, J.; Gibbas, D.; Rennebohm, R.; Voygioyka, O.; Balogh, Z.; Lepore, L.; Macejkova, E.; Wulffraat, N.; Oliveira, S.; Russo, R.; Buoncompagni, A.; Hilário, Maria Odete Esteves [UNIFESP]; Alpigiani, M. G.; Passo, M.; Lovell, D. J.; Merino, R.; Martini, A.; Giannini, E. H.; PRCSG; PRINTO; Univ Genoa; Ist Gaetano Pini; Rheumakinder Klin Germisch Partenkirchen; Policlin San Matteo; Univ Thessaloniki; Rigshosp; Univ Utah; Childrens Hosp; Univ Athens; Natl Inst Rheumatism & Physiotherapy; Univ Trieste; FD Roosvelt Hosp; Wilhelmina Childrens Hosp; Universidade Federal do Rio de Janeiro (UFRJ); Hosp Pediat Prof Dr Juan P Garrahan; Universidade Federal de São Paulo (UNIFESP); IRCCS; Hosp Univ La PazObjectiveTo investigate the clinical use patterns, clinical effect and safety of cyclosporine A (CSA) in juvenile idiopathic arthritis (JIA) in the setting of routine clinical care.MethodsAn open-ended, phase IV post marketing surveillance study was conducted among members of the Pediatric Rheumatology Collaborative Study Group (PRCSG) and of the Paediatric Rheumatology International Trials Organisation (PRINTO) to identify patients with polyarticular course JIA who had received CSA during the course of their disease.ResultsA total of 329 patients, half of whom had systemic JIA, were collected in 21 countries. Data were collected during 1240 routine clinic visits. CSA was started at a mean of 5.8 years after disease onset and was given at a mean dose of 3.4 mg/kg/day. The drug was administered in combination with MTX in 61% and along with prednisone in 65% of the patients who were still receiving CSA. Among patients who were still receiving CSA therapy at the last reported visit, remission was documented in 9% of the patients, whereas in 61% of the patients the disease activity was rated as moderate or severe. The most frequent reason for discontinuation of CSA was insufficient therapeutic effect (61% of the patients); only 10% of the patients stopped CSA because of remission. In 17% of the patients, side effects of therapy was given as the primary reason for discontinuation.ConclusionThis survey suggests that CSA may have a less favourable efficacy profile than MTX and etanercept, whereas the frequency of side effects may be similar. The exact place of CSA in the treatment of JIA can only be established via controlled clinical trial.
- ItemSomente MetadadadosDevelopment of a tool for early referral of children and adolescents with signs and symptoms suggestive of chronic arthropathy to pediatric rheumatology centers(Wiley-Blackwell, 2006-06-15) Len, Claudio Arnaldo [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Puccini, Rosana Fiorini [UNIFESP]; Wechsler, Rudolf [UNIFESP]; Silva, Edina Mariko Koga da [UNIFESP]; Oliveira, Leda Magalhães de [UNIFESP]; Barbosa, Cassia Maria Passarelli Lupoli [UNIFESP]; Pedroso, Glaura César [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective. To develop an easy, time-efficient tool to identify children and adolescents with signs and symptoms suggestive of chronic arthropathies, and to evaluate its interobserver reproducibility and reliability.Methods. the instrument used standardized techniques as required for the development of health-related instruments, targeting parents of apparently healthy children and adolescents ages 1-16 years. A multidisciplinary team was involved in the design of the instrument.Results. Each health professional generated 10-15 questions addressing musculoskeletal complaints that they considered to be the most relevant. A total of 60 questions were listed. During the reduction step, each health professional scored questions from 1 to 4 according to the question's relevance. the tool comprised 12 questions and was administered to the parents of 3 groups: patients with juvenile idiopathic arthritis (JIA; n = 48), children with diffuse musculoskeletal pain (n = 39), and a healthy control group (n = 42). the JIA group achieved the highest scores, followed by the diffuse musculoskeletal pain group and the control group. Nine (18.7%) of 48 patients with JIA and 2 (5.1%) of 39 children with musculoskeletal pain had a score of 5. the interobserver reproducibility was confirmed. All 12 questions were included in the final version of the instrument. We determined that children and adolescents with a score >= 5 should be referred for a rheumatologic evaluation (cluster analysis and logistic regression).Conclusion. Our questionnaire seems to be a useful tool for the early detection of musculoskeletal problems in children that may need a referral for a rheumatologic evaluation.
- ItemSomente MetadadadosInterleukin 18 as a marker of disease activity and severity in patients with juvenile idiopathic arthritis(J Rheumatol Publ Co, 2007-04-01) Lotito, Ana Paola N.; Campa, Ana; Silva, Clovis A. A.; Kiss, Maria H. B.; Mello, Suzana B. V.; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP)Objective. To verify the importance of interleukin 18 (IL-18) in the pathogenesis of juvenile idiopathic arthritis (JIA). We measured IL-18 levels in synovial fluid (SF) and serum, and determined their correlation with measures of disease activity and severity.Methods. Fifty patients with JIA (13 systemic, 13 polyarticular, 24 oligoarticular) and 25 matched controls were analyzed. Cytokire levels (IL-1 beta, IL-1Ra, IL-6, and IL-18) were quantified in serum and SF by ELISA, and disease activity measures were evaluated immediately after knee articular puncture. Radiological assessment was made according to the Steinbrocker method. Statistical analysis was performed by Spearman's rank-order correlation and Mann-Whitney rank test.Results. All the analyzed cytokine levels (IL-1, IL-IRa, IL-6, and IL-18) were higher in patients' sera than in controls. Remarkably, in patients with JIA, IL-18 SF levels did not differ from those of serum; they were positively correlated. The levels of IL-18 (SF and serum) were positively correlated with measures of disease activity: C-reactive protein, number of active joints, and radiological score, as well as with levels of IL-1, IL-1Ra, and IL-6. Moreover, IL-18 and IL-6 levels in SF and serum were much higher in patients with systemic disease compared to the other types of disease onset. In contrast, IL-1 and IL-1Ra were not different among JIA subtypes.Conclusion. Our results strongly suggest the participation of IL-18 in the pathophysiology of JIA. The positive correlation of this cytokine with several measures of articular inflammation and disease severity suggests that IL-18 could be a better target for the treatment of arthritis.
- ItemSomente MetadadadosLow density neutrophils in patients with juvenile idiopathic arthritis(Hogrefe & Huber Publishers, 2003-01-01) Ronchezel, M. V.; Hacbarth, E. T.; Len, Claudio Arnaldo [UNIFESP]; Terreri, Maria Teresa [UNIFESP]; Andrade, LEC [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: (1) To study the correlation among conventional clinical and laboratory parameters and the relation between the number of lymphocytes and neutrophils (L/N) in cell suspensions from peripheral blood of patients with juvenile idiopathic arthritis (JIA). (2) To evaluate the L/N relation of RA patients after an 8 year follow-up period. Methods: Fifty-one JIA patients (25 female, disease course: 19 systemic, 15 polyarticular, 17 pauciarticular) were enrolled in the study. To measure the L/N relation, we used Boyum's method: The leucocyte separation was done by centrifugation of peripheral blood on Ficoll-Hypaque (FH) gradient, and the number of lymphocytes, monocytes, and neutrophils in 500 cells was determined. The following clinical and laboratory parameters were evaluated: disease activity, number of active and limited joints, functional capacity, erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). Twenty-four healthy children were used as controls. We also studied 13/51 patients from our Pediatric Rheumatology Unit who had been evaluated by the same method 8 years before. Results: We observed the lowest L/N relation in patients with active disease, especially those with polyarticular course. A statistical con-elation was also observed with the acute-phase reactants (ESR and CRP, p < 0.05). The majority of patients who had presented a low L/N relation at the first evaluation (8 years before) had a worse outcome. Conclusion: The measure of L/N relation from peripheral blood could be used as an auxiliary tool in the assessment of the activity and outcome of JIA patients, especially at disease onset.
- ItemAcesso aberto (Open Access)Prática de vacinação em crianças com doenças reumáticas(Sociedade Brasileira de Reumatologia, 2010-08-01) Silva, Clovis Artur Almeida da; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Aikawa, Nadia Emi; Carvalho, Jozélio Freire de; Pileggi, Gecilmara Cristina Salviato; Ferriani, Virginia Paes Leme [UNIFESP]; Barbosa, Cassia Maria Passarelli Lupoli [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Jesus, Adriana A; Sallum, Adriana Maluf Elias; Lotito, Ana Paola Navarrette; Liphaus, Bernadete de Lourdes; Magalhães, Claudia S; Len, Claudio Arnaldo [UNIFESP]; Okuda, Eunice Mitiko; Campos, Lucia Maria M; Carvalho, Luciana M; Ronchezel, Marcos Vinícius; Santos, Maria Carolina dos; Romanelli, Paulo Roberto Stocco; Marini, Roberto; Pereira, Rosa Maria Rodrigues; Sacchetti, Silvana Brasilia; Lotufo, Simone; Bastos, Wanda A; Universidade de São Paulo (USP); Universidade Federal de São Paulo (UNIFESP); Universidade Estadual Paulista (UNESP); Santa Casa de Misericórdia de São Paulo; Hospital Municipal Infantil Menino Jesus; Universidade Estadual de Campinas (UNICAMP)INTRODUCTION/OBJECTIVES: Evaluate clinical practice through assessment of vaccination card and recommendation of specific vaccines in pediatric patients with rheumatic diseases in use of different drugs and reveal the possible association between vaccination frequency and time of the clinical practice of pediatric rheumatologists in the state of São Paulo. MATERIAL AND METHODS: A questionnaire was sent to pediatric rheumatologists of the Departamento de Reumatologia da Sociedade de Pediatria de São Paulo. This instrument included questions about practice time on Pediatric Rheumatology, vaccination of patients with juvenile systemic lupus erythematosus (JSLE), juvenile idiopathic arthritis (JIA), juvenile dermatomyositis (JDM), and immunization according to the treatments used. RESULTS: Vaccination card was seen by 100% of the professionals at the first visit and by 36% annually. Vaccines of live agents were not recommended for patients with JSLE, JIA, and JDM in 44%, 64%, and 48%, respectively. The professionals were divided into two groups: Group A (< 15 years of practice, n = 12) and B (> 16 years, n = 13). No statistical difference was observed in the use of live agent vaccine and vaccines with inactivated agents or protein components in the two treatment groups (P > 0.05). Moreover, the groups had similar opinion regarding severity of immunosuppression in patients with JSLE, JIA, and JDM (with or without activity) and treatment used (P > 0.05). CONCLUSIONS: The frequency of immunization by pediatric rheumatologists in São Paulo is low, especially after the first visit, and not influenced by time of professional practice.
- ItemSomente MetadadadosQuality of life and impact of the disease on primary caregivers of juvenile idiopathic arthritis patients(Elsevier B.V., 2008-03-01) Bruns, Alessandra [UNIFESP]; Esteves Hilario, Maria Odete [UNIFESP]; Jennings, Fabio [UNIFESP]; Silva, Clovis Artur; Natour, Jamil [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objectives: To evaluate the quality of life and the disease burden on primary caregivers of patients with juvenile idiopathic arthritis (JIA). Methods: Seventy patients with JIA and their respective caregivers were enrolled in this study. Health, quality of life and psychological status were assessed by using the childhood health assessment questionnaire (CHAQ), the medical outcomes study 36-item short-form health survey (SF-36) and the psychiatric screening questionnaire (SRQ-20). Burden of disease on the caregivers was measured by the caregiver burden scale (CB Scale).Results: Most caregivers were women (91.4%), married (76.6%), mothers (92.2%) and their average age was 37.2 +/- 8.8 years. Low education and socioeconomic state were observed in most of the caregivers. Psychoemotional disorders measured by the SRQ-20 were detected in 34.3% of the caregivers. Pain and mental health were the items in the SF-36 questionnaire most affected in these individuals. Mean score of global burden measured by the CB Scale was 1.6 +/- 0.3 (disappointment and environment had the lowest scores). the CB Scale was significantly correlated with the SRQ-20 (r = 0.6), number of limited joints (r = 0.3), number of visits (r = 0.2), family income (r = -0.3) and mental health (r = -0.6), emotional aspects (r = -0.4), social aspects (r = -0.4), vitality (r = -0.5) and general health state of the SF-36 (r = -0.4). SRQ-20 was the most important determinant of CB Scale and of the components pain and mental health of the SF-36 questionnaire.Conclusions: Most of the disease burden on the caregivers depends upon emotional aspects rather than on the physical status of the patients. (C) 2007 Elsevier Masson SAS. All rights reserved.
- ItemAcesso aberto (Open Access)Síndrome de ativação macrofágica em pacientes com artrite idiopática juvenil(Sociedade Brasileira de Reumatologia, 2004-10-01) Prado, Rogério do [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Len, Claudio Arnaldo [UNIFESP]; Braga, Josefina Aparecida Pellegrini [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The macrophage activation syndrome (MAS) is an uncommon complication of chronic rheumatic diseases, specially systemic onset juvenile idiopathic arthritis (JIA). It can be triggered by infectious (viral or bacterial) or malignant diseases, non-steroidal anti-inflammatory or disease modified anti-rheumatic drugs, changes in the therapy and rheumatic diseases. The clinical features present at the onset are related mainly with central nervous system involvement, hepatic and renal failure and pancytopenia. We describe the clinical, evolutive features and treatment of three patients with JIA that developed MAS.
- ItemAcesso aberto (Open Access)Uveíte na artrite idiopática juvenil(Sociedade Brasileira de Pediatria, 2002-02-01) Roberto, Adriana M. [UNIFESP]; Terreri, Maria Teresa Ramos Ascensão [UNIFESP]; Len, Claudio Arnaldo [UNIFESP]; Muccioli, Cristina [UNIFESP]; Hilário, Maria Odete Esteves [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Depto. de Oftalmologia Setor da ÚveaObjective: to evaluate the frequency of chronic anterior uveitis in patients with juvenile idiopathic arthritis and its association with the presence of antinuclear antibodies. Patients and methods: we retrospectively studied 72 patients with juvenile idiopathic arthritis. All of them were submitted to slit-lamp examination of the anterior chamber at diagnosis. Both antinuclear antibodies and rheumatoid factor were determined. Patients with positive results for antinuclear antibodies were evaluated every three months and those with negative results were assessed every six months.Results: forty patients were male (55.5%) and 36 were Caucasoid (50%). The mean age at the onset of juvenile idiopathic arthritis was 6.4 years (range = 1 to 14 years) and the mean age at the beginning of the study was 10.4 years (1 to 19 years). According to the type of disease at onset, 32 were pauciarticular (44.4%) (17 boys and 15 girls), 30 were polyarticular (41.6%) (17 boys and 13 girls) and 10 were systemic (14%) (6 boys and 4 girls). We observed chronic anterior uveitis in five patients (6.5%) (mean age = 11.4 years). Among them, four (80%) had pauciarticular juvenile idiopathic arthritis at disease onset (three girls with type I juvenile idiopathic arthritis and positive antinuclear antibodies and one boy with type I juvenile idiopathic arthritis and negative antinuclear antibodies) and one girl with polyarticular juvenile idiopathic arthritis (negative antinuclear antibodies and rheumatoid factor). In this group, the mean age at the onset of juvenile idiopathic arthritis was 5.1 years and the mean age of uveitis onset was 9 years. Antinuclear antibodies were positive in 3/5 patients (60%) with uveitis. Antinuclear antibodies were positive in 12% of the patients without uveitis (n = 67). Among the patients with uveitis, three had only one flare and the other two had four flares with cataract. The frequency of antinuclear antibodies was statistically higher in the patients with uveitis (P< 0.05).Conclusion: although the incidence of uveitis in our study was lower than that reported in the literature, the frequency of uveitis was higher in females, in those with pauciarticular juvenile idiopathic arthritis and in patients with positive antinuclear antibodies.