Chronic Arthritis In Children Research Articles

РАЗВИТИЕ ХРОНИЧЕСКОГО МУЛЬТИОЧАГОВОГО НЕБАКТЕРИАЛЬНОГО ОСТЕОМИЕЛИТА У ПАЦИЕНТА С ИСХОДНО ДИАГНОСТИРОВАННЫМ СИСТЕМНЫМ ЮВЕНИЛЬНЫМ АРТРИТОМ: КЛИНИЧЕСКОЕ НАБЛЮДЕНИЕ

Systemic juvenile arthritis (sJA) is a special variant of chronic arthritis in children belonging to the spectrum of polygenic autoinflammatory diseases whose main features are persistent febrile fever, skin rashes, other systemic manifestations (serositis, lymphadenopathy, hepatosplenomegaly) as well as the presence of joint damage with the frequent development of destructive polyarthritis and osteonecrosis, high laboratory indicators of systemic inflammation either at the disease onset or delayed. The list of differentiated conditions includes many diseases such as infections, cancer, primary immunodeficiencies, monogenic autoinflammatory diseases etc. Authors represent a clinical case of a patient with sJA manifestations who was diagnosed with chronic multifocal nonbacterial osteomyelitis (CMNO), that demonstrates the great difficulties in diagnosis and the variability of the course of rheumatic diseases in childhood, which in its turn causes a delay in the timely prescription of effective therapy. Thus, patients with manifestations of a systemic inflammatory process, joint changes, especially those with an atypical course of the disease, pain in the bones and joints of a nocturnal nature, as well as an insufficient response to the therapy even long-term, are in need of conducting of a differential diagnostic search with the inclusion of CMNO, the ‘whole body’ mode magnetic-resonance tomography prescribed by a rheumatologist practitioner.

E29 Juvenile Idiopathic Arthritis (JIA) in Algeria, from diagnosis to management

Abstract Introduction Juvenile idiopathic arthritis (JIA) is the most common chronic arthritis in children in the world. Objectives to describe a series of 120 children with juvenile idiopathic arthritis (JIA), diagnosed and recruited in the pediatric departments of 5 cities; Sétif and the cities surrounding: Bordj BouArreridj, M'sila, Béjaïa, Batna, between January 1st 2012 to December 31st, 2018 (seven years). The aim is to study the epidemiological, clinical, therapeutic, evolutionary, and the quality of life at presentation, 3rd, 6th and 12th month of follow-up of patients with JIA with evaluation of the incidence and prevalence rate. Materials and methods Our longitudinal, multicentre, and ambispective study (retrospective between 2012–2015, prospective between 2016–2018), allowed us to collect 120 newly diagnosed cases of JIA who fulfilled International League of Association for Rheumatology (ILAR) criteria. Patients were followed up for a duration of 12 months. Results 120 children were studied; females were predominant (54,2%). The average age at diagnosis was 7,46 ± 3,77 years with age at disease onset of ∼6,69 ± 3,65 years and a relatively diagnostic delay of 9,34 ± 13,05 months. Oligoarticular JIA was the most frequent (35,8%), persistent oligoarticular (32,5%) and extensive oligoarticular (3,3%).This is followed by polyarticular JIA (30,8%), Rheumatoid factor (RF) (25,8%) and with RF (5%), and systemic JIA (21,7%), 4.2% psoriatic arthritis (JPsA) and 2.5% enthesitis related arthritis (ERA) with 5% of uncategorized forms. Uveitis was present in 5.8% of cases. The initial inflammatory balance is disturbed with a erythrocyte sedimentation rate (ESR) of 56,32 ± 35,54 mm at the first h, and an average C-reactive protein (CRP) of 42,84 ± 53,76 mg/l, anaemia was seen in more than two thirds of the children (67,5%), thrombocytosis 35,8% and hyperleukocytosis in almost a quarter of children (22,5%). Antinuclear Antibodies (ANA) were present in a quarter of cases (25,8%), RF in 5%, and anti-cyclic citrullinated peptides (anti-CCP) in 3,3% of cases and Human Leucocyte Antigen B27 (HLA B27) was positive in 4.2% of children. An initial activity in non-systemic forms according to the Juvenile Arthritis Disease Activity Score (JADAS10) was moderate in more than a quarter of children, and a strong initial activity according to the American College of Rheumatology (ACR) in more than half of the systemic forms. A moderate initial average functional incapacity assessed by the Childhood Health Assessment Questionnaire (CHAQ) at 1,73 ± 0,52, a moderately altered initial average quality of life Juvenile Arthritis Quality of Life Questionnaire (JAQQ) at 4,07 ± 1,12 and a pain-physician Visual Analogue Scale (VAS) initial mean at 4,98 ± 1,74. The mean annual incidence rate in Sétif during the prospective study was 3,88/100 000 children under 16 and those of the Eastern region including Sétif and the surrounding wilayas (BBA, M'sila, Béjaïa, and Batna) is 2 per 100 000 children under 16. The rate of prevalence of JIA in Sétif is 11,25/100 000 children under 16, and in the East region of the study was 5,80/100 000 children under the age of 16. Medications used were non-steroidal anti-inflammatory drugs (NSAIDs) in (83.3%) followed by disease-modifying antirheumatic drugs (DMARDs) in 65%. Methotrexate in (63,3%), glucocorticoids in (49,2%), and aspirin used in 16,7%, intra-articular corticosteroid injections (IACs) in (15.8%), biotherapy in (19,1%). 27,5% had functional rehabilitation. Evolution at one year is marked by 44.5% disease inactivity with treatment and 31,1% remission. Conclusion JIA is the most common chronic rheumatic disease in children. Nevertheless, it is considered a rare but not exceptional pathology. It is one of the main causes of short-, medium- and long-term disability. Ethics Associate Professor of pediatrics, department of medicine University Setif-Algeria (pediatric center –Setif-Algeria)

History of Classification for Chronic Arthritis in Children

History of Classification for Chronic Arthritis in Children

Pattern, frequency and management outcome of juvenile idiopathic arthritis, Sudan.

Juvenile idiopathic arthritis (JIA) is the most prevalent chronic arthritis in children and is a leading cause of disability. The clinical profile of JIA shows wide range of variation .This study aimed to describe demographic, clinical and laboratory characteristics, treatment regimen and outcome of JIA patients in Sudanese children. Cross sectional hospital based study was conducted at Rheumatology Clinic, Ahmed Gasim Hospital, Khartoum, Sudan, covering 81 patients from October 2019 to March 2020. Data were extracted from the patient records, and then re-entered into a predesigned data collection form. Data were analyzed using SPSS version 24. P value of 0.05 or less was considered statistically significant. A total of 81 JIA patients were included in the study (54 females, 27 males) with female: male ratio 2:1 among all subtypes. Of the study population 58% were above 10 years of age. Polyarticular JIA was the predominant subtype (63%) followed by systemic onset JIA (22.2%), then oligoarticular (12.3%) and lastly spondiloarthropathies (2.5%). Clinically, morning stiffness was the most common presenting symptom (98.8%) and knee joint (82.7%) was the most frequently affected. Rheumatoid factor and anti-nuclear antibody were positive among 30.9% and 46.9% of the study participant, respectively. Remission rate was 39.5% and it is affected by RF and treatment regimen, being RF positive associated with lower remission rate while use of combined two drug therapy was associated with higher remission rate. A population based study rather than a single center study will provide more information about JIA characteristics in Sudan.

Outcome of children with oligoarticular juvenile idiopathic arthritis compared to polyarthritis on methotrexate- data of the German BIKER registry

BackgroundOligoarticular juvenile idiopathic arthritis (oligoJIA) is the most commonly diagnosed category of chronic arthritis in children. Nevertheless, there are no evidence- based guidelines for its treatment, in particular for the use of methotrexate (MTX). The primary objective of this analysis is to evaluate the outcomes in patients with persistent oligoJIA compared to those with extended oligoJIA and rheumatoid factor (RF) negative polyarthritis treated with methotrexate.MethodsPatients with persistent or extended oligoJIA or RF negative PA recorded in the Biologics in Pediatric Rheumatology Registry (BiKeR), receiving methotrexate for the first time were included in the analyses. Efficacy was determined using the Juvenile Arthritis Disease Activity Score 10 (JADAS 10). Safety assessment included the documentation of adverse and serious adverse events.ResultsFrom 2005 through 2011, 1056 patients were included: 370 patients with persistent oligoJIA, 221 patients with extended oligoJIA and 467 patients with RF negative PA. Therapeutic efficacy was observed following the start of methotrexate.Over a period of 24 months JADAS-minimal disease activity (JADAS ≤2) was reached in 44% of patients with persistent oligoJIA, 38% with extended oligoJIA, 46% with RF negative PA, JADAS-remission defined as JADAS ≤1 was reached in 33% of patients with persistent oligoJIA, 29% with extended oligoJIA and 35% (RF negative PA). Patients with extended oligoJIA achieved JADAS remission significantly later and received additional biologic disease-modifying drugs significantly more often than patients with persistent oligoJIA or RF negative PA (p < 0.001). Tolerability was comparable. New onset uveitis occurred in 0.3 to 2.2 per 100 patient years.ConclusionsPatients with persistent oligoJIA taking methotrexate are at least as likely to enter remission as patients with extended oligo JIA or polyarticular JIA. Patients with extended oligoJIA achieved JADAS remission significantly later. Within 2 years, almost half of the patients with persistent oligoJIA achieved JADAS-minimal disease activity.

Overview of Juvenile Idiopathic Arthritis

Joint pain is a common symptom in children and adolescents. While there are many causes of joint pain in children, most of these are acute or not related to underlying joint inflammation. Chronic arthritis, however, can be one of the reasons behind the joint pain. The most common causes of chronic arthritis in children are categorized under juvenile idiopathic arthritis (JIA). The purpose of this review is to highlight the most important clinical features, work-up, and medical management of the different subtypes of JIA.

The necessity, efficacy and safety of biologics in juvenile idiopathic arthritis.

OBJECTIVE:Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children. Biologics have changed the faith of children with rheumatic diseases. The main objective of this study was to demonstrate the rate of usage, efficacy and safety of biologics in JIA subtypes.METHODS:This retrospective observational cohort study was conducted between May 2010 and September 2017. All children with the diagnosis of JIA and children under a biological agent treatment were recorded into the local registry system. Age, gender, JIA subtype, medications used, the clinical status of the patient, tuberculosis screening results, and side effects observed under biologics were retrieved from the registry.RESULTS:There were 405 patients with the diagnosis of JIA in the cohort. Biologics were used in 123 (30.3%) JIA patients. Subtype frequencies of JIA patients were as follows: persistent oligoarticular JIA (33.6%), enthesitis-related arthritis (29.2%), systemic JIA (13%), rheumatoid factor (RF)-negative polyarticular JIA (13%), extended oligoarticular JIA (4.2%), RF-positive polyarticular JIA (3.4%), psoriatic arthritis (1.8%) and unclassified arthritis (1.8%). The rate of biologic use was high in extended oligoarticular JIA (64.7% of the cases), RF-positive polyarticular JIA (57.1%), psoriatic arthritis (57.1%), RF-negative polyarticular JIA (41.5%), and in systemic JIA (39.6%). Enthesitis-related arthritis (27.1%), persistent oligoarticular JIA (17.6%) and unclassified arthritis (16.6%) patients were the cases that needed a biologic agent in the last order. At the last control, 78.9% of the cases were in remission, while 21.1% of them were active despite biologic treatment. Isoniazid prophylaxis was used in 30.8% of the patients. None of the patients developed active tuberculosis infection under prophylaxis. Adverse events were observed in 18.6% of patients under biologics as recurrent uncomplicated upper respiratory tract infections being the most common.CONCLUSION:Biologics are safe and effective treatment options in children with JIA. Most of the JIA patients with polyarticular involvement require biologics earlier in the disease course. The risk of tuberculosis infection seems not to be increased after appropriate screening and prophylaxis.

Issue Highlights-May 2018 (94B3).

Issue Highlights-May 2018 (94B3).

Low synovial double negative T and γδ T cells predict longer free-disease survival in oligoarticular JIA.

Oligoarticular juvenile idiopathic arthritis (oJIA) is the most frequent form of chronic arthritis in children; the clinical course is extremely variable. In this study we have characterized by flow cytometry synovial B and T cells subsets in patients with oJIA in order to identify any parameters that could predict a more aggressive course of disease. B and T cells from synovial fluid (SF) of 39 patients with oJIA were characterized by flow cytometry. In 22 patients SF was analysed at the onset of the disease (GroupA), in 17 SF was analysed at articular relapse (Group B). All patients in Group A were followed up for at least for 2 years after SF analysis: 13 patients relapsed during the follow-up period. Comparison of SF from Group A and Group B demonstrated an activated phenotype in relapsed patients, with higher Switched Memory B cells (58.53 vs 36.07% of CD19+, P-value 0.004) and lower Naïve B cells (8.53 vs 25.9 of CD19+, P-value 0.002) in Group B. Furthermore, patients from Group A who did not relapse showed lower percentages of synovial DNT (2.38 vs 1.50% of CD3 + TCRalpha/beta+, P-value 0.025) and γδ T cells (19.1 vs 15.0% of CD3+ cells, P-value 0.004) at the onset, if compared with other Group A patients. In oJIA relapse SF present an activated B phenotype. Patients at disease onset with DNTs <1.8% and/or γδ T cells <16% of CD3+ in synovial fluid have longer free-disease survival. © 2017 International Clinical Cytometry Society.

Juvenile Idiopathic Arthritis Onset in a Neonate: A Rare Case Report

Background: A common type of chronic arthritis in children and adolescents is juvenile idiopathic arthritis (JIA).According to the International League of Associations for Rheumatology (ILAR) classification, JIA diagnostic criteria include age under 16 years and disease duration of six-weeks. Based on the number of involved joints in the first sixmonths of disease onset, JIA is categorized into oligoarticular or polyarticular subtypes. Age is a characteristic factor in the diagnosis of disease subsets; it is worth mentioning that cases younger than six months of age are seldom found in any of the subtypes. Case report: In this report, we present a rare case of JIA in an infant, presenting at 20 days of age. Effusion of the right hip joint was one of the primary manifestations of the disease. During hospitalization, she went through sepsis workup and a four-week antibiotic therapy for management of lower limb pseudoparalysis. In spite of antibiotic therapy, she developed effusion of a second joint. According to the course and duration of symptoms and ILAR classification forJIA, oligoarticular JIA was diagnosed and treated.Conclusion: In this case, infectious diseases, such as tuberculosis and brucellosis, and malignancies were ruled out as a cause of inflammation through bone marrow aspiration, culture, and tests; ultrasound and magnetic resonance imaging showed no lytic and sclerotic lesions or a fracture. Our experience showed a rare case of JIA and suggested that JIA must be considered in children with joint inflammation at any age

THE ROLE OF RADIOLOGIC IMAGING IN EARLY DIAGNOSTICS OF SACROILITIS IN CHILDREN WITH ARTHRITIS SYNDROME

The term juvenile spondyloarthritis (JSpA) refers to spondyloarthritis that starts during childhood. Juvenile spondyloarthropathy (JSpA) represents an important subgroup of chronic arthritis in children that needs to be recognized and appropriately managed. Early diagnosis of spondyloarthritis (SpA) is becoming more important as new medical treatment options have become available to treat inflammation and delay progression of the disease. Increasingly, magnetic resonance imaging (MRI) of the sacroiliac joints is obtained for early detection of inflammatory changes, as it shows active inflammatory and structural lesions of sacroiliitis long before radiographic changes become evident. MRI of the sacroiliac joints in children is a useful tool for suspected juvenile spondyloarthritis (JSpA), even though it is not yet included in the current pediatric classification systems. Actually, the adult Assessment of Spondyloarthritis International Society (ASAS) definition for sacroiliitis needs some adaptations for children. The aim of study was early evaluation of sacroiliitis in differential diagnosis in children with juvenile chronic arthritis. Hossible pediatric-specific definition for active sacroiliitis on MRI is presented in this article. In most cases gadolinium-enhanced MRI images may help to confirm the presence of different features of sacroiliitis in children.

Subtype frequencies, demographic features, and remission rates in juvenile idiopathic arthritis - 265 cases from a Turkish center.

Juvenile idiopathic arthritis (JIA) is the most common cause of chronic arthritis in children. It is a group of heterogeneous disorders that have chronic arthritis as a common feature. It has a worldwide distribution and many studies have shown that subtype frequencies in JIA seem to be showing geographical distribution. The aim of this study was to define subtype frequencies, demographic features, and the rates of macrophage activation syndrome, uveitis and remission in Turkish JIA patients. The files of all JIA patients (378 cases) that were being followed in Pediatric Rheumatology Clinic of our institution, between May 2010 and February 2016 were reviewed. Two hundred and sixty-five patients were included into the study. Gender, JIA subtype, age at diagnosis, age at the initial symptoms, JIA medications, uveitis presence, JIA status at the time of enrollment were recorded from the files. There were 87 enthesitis related arthritis, 87 oligoarthritis (81 persistent, 6 extended), 36 rheumatoid factor (RF) negative polyarthritis, 35 systemic arthritis, 10 RF-positive polyarthritis, 5 psoriatic arthritis and 5 undifferentiated arthritis cases. Mean age at diagnosis was 9.9 ± 4.9 years and male/female ratio was 1.05. Uveitis was found in 4.5% of the cases. Biologics were used in 26% of the patients. At the time of enrollment, 69% of the patients were under remission while 31% of them were active. Systemic arthritis and persistent oligoarthritis cases were the groups that most commonly achieved remission, while patients with polyarticular involvement, namely RF positive polyarthritis, RF negative polyarthritis and extended oligoarthritis patients were the groups with high number of active patients. In conclusion, JIA is a heterogeneous group of disorder, and differences in subtype frequencies from country to country make it even more heterogeneous disease. Patients with polyarticular involvement may need early and aggressive treatment to control the disease activity.

Association of PTPN22 Gene Polymorphisms with Susceptibility to Juvenile Idiopathic Arthritis in Iranian Population

ABSTRACTJuvenile idiopathic arthritis (JIA), the most common cause of chronic arthritis in children, is a complex immune-mediated disease with considerable long-term morbidity and mortality. According to previous studies, PTPN22 gene has been associated with JIA in several populations. In the present study, we attempted to determine the association of PTPN22 single nucleotide polymorphisms (SNPs) with susceptibility to JIA in Iranian population. Using the Real-time PCR allelic discrimination method, samples consisting of 55 unrelated patients and 93 healthy controls were genotyped. Using Fisher exact test or Chi-square test, genotypic and allelic frequencies were estimated. The results of our study indicated a significantly decreased association of rs1310182 (OR = 0.59, 95% CI = 0.36 −0.97, p = 0.037) with JIA. This association may indicate a protective role for rs1310182 SNP against JIA. More research would be needed to elucidate the mechanistic role of this association.

Environmental Risk Factors and Early-Life Exposures in Juvenile Idiopathic Arthritis: A Case-Control Study.

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of disorders characterized by chronic arthritis in children with unknown etiology. Although research evaluating environmental or early-life exposures in JIA is scarce, there are data to suggest that infections, smoking exposure, and lack of breastfeeding play a role. This case-control study investigated the association of selected environmental and early-life risk factors with the development of JIA. JIA cases were identified at a major pediatric rheumatology outpatient clinic. Each case was asked to identify up to 3 healthy playmates of similar age and same sex to serve as controls. Parents/caregivers of cases and controls completed a questionnaire on selected environmental and early-life exposures. Conditional logistic regression adjusted for age and socioeconomic status was used to determine the odds ratio (OR) for developing JIA with 95% confidence intervals (95% CIs) for the playmate-matched design. Included in the study were 225 JIA cases and 138 controls. Compared to playmate-matched controls, preterm delivery (OR 1.8 [95% CI 1.2-2.7]) was associated with JIA. There was no association between JIA and household smoking or maternal prenatal smoking, breastfeeding, hospitalization with infection in the first year of life, daycare attendance before 6 years of age, household pets, or residential area prior to the onset of JIA. There was no association between the previously reported risk factors of smoking, early-life infection, or breastfeeding and development of JIA in this study. The association of preterm delivery with JIA needs to be further studied.

Gut microbiota-host interactions and juvenile idiopathic arthritis.

BackgroundJuvenile idiopathic arthritis is the most common form of chronic arthritis in children. There is mounting evidence that the microbiota may influence the disease.Main bodyRecent observations in several systemic inflammatory diseases including JIA have indicated that abnormalities in the contents of the microbiota may be factors in disease pathogenesis, while other studies in turn have shown that environmental factors impacting the composition of the microbiota, such as delivery mode and early exposure to antibiotics, affect the risk of chronic inflammatory diseases including JIA. Microbial alterations may predispose to JIA through a variety of mechanisms, including impaired immunologic development, alterations in the balances of pro- versus anti-inflammatory bacteria, and low-grade mucosal inflammation. Additional confirmatory studies of microbiota aberrations and their risk factors are needed, as well as additional mechanistic studies linking these alterations to the disease itself.ConclusionsThe microbiota may influence the risk of JIA and other systemic inflammatory conditions through a variety of mechanisms. Additional research is required to improve our understanding of the links between the microbiota and arthritis, and the treatment implications thereof.

The Pattern of Juvenile Idiopathic Arthritis in a Single Tertiary Center in Saudi Arabia.

Introduction. Juvenile Idiopathic Arthritis (JIA) is the most common chronic arthritis in children. Our aim is to describe demographic, clinical, and laboratory characteristics and treatment of JIA patients followed up in Pediatric Rheumatology clinic in a tertiary center in Saudi Arabia. Methods. Medical records of all patients who are followed up between January 2007 and January 2015 were retrospectively reviewed. Data were collected about demographic, clinical, and laboratory features and treatment. Results. Total patients were 82, males were 31 (37.8%), and mean age of JIA onset was 7.1 ± 3.6 yr. Mean follow-up duration was 2.67±1.6 yr. Systemic onset JIA (SoJIA) was the commonest (36.5%), followed by polyarticular in 29.2% and oligoarticular in 28%. Large and small joints are involved in 76 (92%) and 30 (36.6%), respectively. Main extra-articular feature was fever in 34 (41.4%). Uveitis was diagnosed in 7 (8.5%) and in 5 (21.7%) of oligoarticular JIA. Anemia was found in 49 (59.7%), high ESR in 45 (54.8%), and leukocytosis and thrombocytosis in 33 (40.2%). Positive ANA was found in 30 (36.5%) mainly in oligoarticular subtype as 12 (52%) patients (out of 23) had this positive test. 9 patients (10.9%) required NSAIDs only, 6 patients (7.3%) required NSAIDs and intra-articular steroids only, and 19 (23%) required NSAIDs, methotrexate, steroids, and biologics. Conclusion. SoJIA is the most common JIA subtype in our study. A population based rather than a single center study will give more details about JIA characteristics in Saudi Arabia

Juvenile idiopathic arthritis–an update on its diagnosis and management.

Juvenile idiopathic arthritis (JIA) is the most common form of chronic arthritis in children and the most common cause of musculoskeletal disability in children. Early diagnosis may be challenging, but it is essential to ensure good outcomes. This review proposes an approach to the investigation and diagnosis of JIA. It also gives a summary of the latest available evidence-based treatment for this disease.

Identification of rare genetic variants in Juvenile Idiopathic Arthritis using whole exome sequencing

Juvenile Idiopathic Arthritis (JIA) is the most common form of chronic arthritis in children. JIA is characterized by onset of disease before the age of 16, with arthritis lasting >6 weeks, and with an unknown cause. Among JIA, seven sub-groups based on clinical and biological features have been individualized namely: systemic arthritis (sJIA) with autoinflammatory conditions, persistent and extended oligoarthritis (per-oJIA and ext-oJIA, respectively), rheumatoid factor-positive polyarthritis (RFpos-pJIA), enthesitis-related arthritis (ERA), psoriatic arthritis (PsA), and undifferentiated arthritis. Physiopathology of JIA is complex and JIA is considered to be a multifactorial disease due to the combination of genetic and environmental factors. Searching for genetic factors in JIA during the last decade, the introduction of genome-wide association studies (GWAS) and whole-exome sequencing have discovered several new loci associated with JIA susceptibility and have identified the disease-associated gene monogenic form of sJIA, respectively. However, despite these novel knowledge, our understanding of JIA pathogenesis still remains poorly elusive and accumulating evidence supports genetic variability as playing a key role in JIA development.

Overview Of Connective Tissue Diseases And Juvenile Idiopathic Arthritis In Children

Paediatric connective tissue diseases (PCTD) and juvenile idiopathic arthritis (JIA) have been investigated and reported extensively among Western children compared with low frequency of reports among African children. This may be due to reduced awareness among African general practitioners ; paucity of Paediatric rheumatologists in most Africa countries; little or no laboratory back up; and the belief that CTD and arthritis are not diseases of children. This article aims at discussing the general approach to CTDs and chronic arthritis in children; as well as increase awareness among doctors in Africa

ANA positivity in juvenile idiopathic arthritis: make a difference in a Colombian children population?

Juvenile idiopathic arthritis is the most common cause of chronic arthritis in children. JIA is a heterogeneous disease that has been classified by the International League of Associations for Rheumatology (ILAR) on seven different subtypes according to the most relevant clinical and serological features. Previous studies have demonstrated an association between the presence of antinuclear antibodies (ANA) and features like: early-onset oligoarticular disease, female predominance, asymmetric arthritis and higher frequency of uveitis. There are limited data on the characteristics clinical and analytical into different subtypes of JIA in Colombian children and their relationship with type of onset and clinical course.