Juvenile Idiopathic Arthritis Children Research Articles

Endothelial factors and blood homocysteine level in adolescents with rheumatic diseases

It is known that the dysfunction of the endothelium has crucial role in many pathological conditions and underlines adverse cardiovascular events. The aim of our study was to determine biologically active substances in the blood that affect endothelial function and homocysteine level in adolescents with rheumatic diseases. Materials and methods. We examined 68 patients with rheumatic diseases, among them 25 patients with systemic lupus erythematosus (SLE) and 43 patients with juvenile idiopathic arthritis (JIA). Obtained results were compared with similar indicators of peers from the control group. All patients received basic therapy for 12 or more months at the time of examination. Biologically active substances (Homocysteine (Hcy), vascular endothelial growth factor (VEGF), high-sensitivity C-reactive protein (hs-CRP)) were studied by enzyme-linked immunosorbent assay, brain natriuretic peptide (NT-proBNP) by competitive immunoassay, and angiotensin-converting enzyme (ACE) by turbidimetric FAPGG kinetics method. Results. Patients with rheumatic diseases had a significantly higher level of BNP (p < 0.01). These changes were most significant in patients with SLE. The level of Hcy did not differ from the similar indicator of the control group, but in patients with SLE it was significantly higher (p < 0.01) than in patients with JIA. Conclusions. In patients with rheumatic diseases, biologically active substances level affecting the endothelium function depends on the disease. Biologically active substances affecting the function of the endothelium were within normal values. Thus, in children with SLE compared with JIA children, an increase in Hcy and NT-proBNP, and a decrease in ACE and hs-CRP protein were found. In children with JIA, normal levels of Hcy and ACE are accompanied by an increase in NT-proBNP and hs-CRP. In adolescents aged 10–18 years with SLE and JIA, multidirectional changes in biologically active substances and homocysteine, affecting the endothelial function of blood vessels were found.

Level and correlates of physical activity among children and adolescents with juvenile idiopathic arthritis compared to controls: results from a German nationwide prospective observational cohort study

BackgroundPhysical active lifestyles are essential throughout growth and maturation and may offer potential preventive and therapeutic benefit in patients with juvenile idiopathic arthritis (JIA). Insufficient physical activity (PA), in contrast, can lead to aggravation of disease-related symptoms. This study aimed to i) examine PA levels in children and adolescents with JIA compared to general population controls and ii) investigate correlates of pronounced physical inactivity in order to identify risk groups for sedentary behaviour.MethodsData from children and adolescents with JIA and population controls aged 3 to 17 years documented in the National Pediatric Rheumatologic Database (NPRD) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were used. Self-reported PA was collected from parents/guardians of children up to 11 years of age or adolescents 12 years of age and older. To compare PA-related data, age- and sex-specific pairwise analyses were conducted considering NPRD/KiGGS participants' data from 2017. Correlates of physical inactivity among patients were identified using a linear regression model.ResultsData of 6,297 matched-pairs (mean age 11.2 ± 4.2 years, female 67%, patients’ disease duration 4.5 ± 3.7 years, persistent oligoarthritis 43%) were available for evaluation. Almost 36% of patients aged 3–17 years (vs. 20% of controls) achieved the WHO recommended amount of PA, while PA steadily decreased with age (18% of patients aged ≥ 12 years) and varied between JIA categories. Female adolescents and patients with enthesitis-related arthritis were least likely to achieve the minimum recommended level of PA. Physical inactivity was associated with female sex, higher age at disease onset, longer disease duration, more functional disability (C-HAQ) and higher disease activity (cJADAS-10).ConclusionsDepending on JIA category, children and adolescents with JIA were similarly or even more likely to achieve the WHO recommended minimum level of PA compared to general population controls. However, since a large proportion of young JIA patients appear to be insufficiently physically active, engagement in targeted efforts to promote PA is urgently needed.

Machine learning diagnosis of active Juvenile Idiopathic Arthritis on blood pool [ 99M Tc] Tc-MDP scintigraphy images.

Neural network has widely been applied for medical classifications and disease diagnosis. This study employs deep learning to best discriminate Juvenile Idiopathic Arthritis (JIA), a pediatric chronic joint inflammatory disease, from healthy joints by exploring blood pool images of 2phase [ 99m Tc] Tc-MDP bone scintigraphy. Self-deigned multi-input Convolutional Neural Network (CNN) in addition to three available pre-trained models including VGG16, ResNet50 and Xception are applied on 1304 blood pool images of 326 healthy and known JIA children and adolescents (aged 1-16). The self-designed model ROC analysis shows diagnostic efficiency with Area Under the Curve (AUC) 0.82 and 0.86 for knee and ankle joints, respectively. Among the three pertained models, VGG16 ROC analysis reveals AUC 0.76 and 0.81 for knee and ankle images, respectively. The self-designed model shows best performance on blood pool scintigraph diagnosis of patients with JIA. VGG16 was the most efficient model rather to other pre-trained networks. This study can pave the way of artificial intelligence (AI) application in nuclear medicine for the diagnosis of pediatric inflammatory disease.

Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain

Background: Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. Objective: To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. Methods: Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). Results: Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). Conclusion: JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.

Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain.

Background: Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. Objective: To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. Methods: Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). Results: Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). Conclusion: JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.

Bone mineral density in egyptian children with juvenile idiopathic arthritis: possible correlation to serum RANKL / osteoprotegerin (OPG) ratio and OPG gene polymorphisms

BackgroundChildren with juvenile idiopathic arthritis (JIA) are at higher risk of decreased bone mineral density (BMD) compared with healthy children due to genetic, disease and medication-related causes. This study aims to investigate the possible effects of osteoprotegerin (OPG) gene polymorphisms and serum levels of osteoprotegerin (OPG) and receptor activator of nuclear factor κB-ligand (RANKL) and RANKL/OPG ratio on BMD in children with JIA.MethodsOPG gene rs2073617, rs3134069, serum RANKL, OPG and RANKL/OPG ratio were evaluated in 60 JIA children and 100 matched healthy controls. BMD was evaluated by lumbar dual energy X-ray absorptiometry (DEXA) according to which patients were classified in 2 groups (DEXA z-score above and below − 2). Composite disease activity was measured using the Juvenile Arthritis Disease Activity Score (JADAS) 27-joints. Articular damage was scored using the juvenile arthritis damage index (JADI).ResultsPatients aged 12.05 ± 3.2 years, included 38 females and 31% had BMD z-score below-2. Systemic-onset JIA was the most frequent phenotype (38%). Genotypes and alleles frequencies of the 2 studied polymorphisms did not differ between patients and controls (p > 0.05 for all) while serum RANKL and RANKL/OPG ratio were significantly higher in patients compared to controls (p = < 0.001 and 0.03 respectively). Patients with BMD < -2 had significantly greater frequencies of rs2073617 TT genotype and T allele (p < 0.001), higher serum RANKL, RANKL/OPG ratio (p = 0.01, 0.002), female predominance (p = 0.02), higher articular and extra-articular damage index (p = 0.008,0.009) and more frequent steroid usage (p = 0.02) compared to patients with BMD z-score >-2. Multivariate analysis showed rs2073617 TT genotype, RANKL/OPG ratio, long disease duration (above 36 months) and use of steroid to be associated with decreased BMD (p = 0.03,0.04,0.01,0.01 respectively) in JIA children.ConclusionsEgyptian children with JIA have decreased BMD. rs2073617 TT genotype and T allele, RANKL/OPG ratio are possible determinants of reduced BMD in JIA. Our results underline the importance of frequent monitoring of BMD in JIA children and trying to control disease activity to preserve long term bone health.

Ankle and Foot: Focus on Inflammatory Disease.

The ankle and foot have numerous bones and complex joints that can be affected by several types of inflammatory arthritis with different patterns and various radiologic signs, depending on the phase of the disease. Involvement of these joints is most frequently seen in peripheral spondyloarthritis and rheumatoid arthritis in adults and juvenile idiopathic arthritis in children. Although radiographs are a mainstay in the diagnostic process, ultrasonography and especially magnetic resonance imaging allow early diagnosis and are crucial diagnostic tools. Some diseases have typical features based on target populations (e.g., adults versus children, men versus women), but others may have overlapping imaging characteristics. We highlight key diagnostic features and describe appropriate investigations to guide clinicians toward the correct diagnosis and provide support during disease monitoring.

The role of ultrasonography in assessing remission in juvenile idiopathic arthritis: a systematic review.

Musculoskeletal ultrasound (MSUS) is an important measurement tool in pediatric rheumatology as it detects subclinical disease activity and enables clinicians to treat patients during "the window of opportunity". However, the role of MSUS in assessing remission in JIA patients is not well-defined. This systematic review aimed to provide the most up-to-date published literature regarding the added value of MSUS in JIA patients in remission. This systematic review followed the preferred reporting items for systematic reviews guidelines. Original articles from PubMed and Scopus, published until February 7th 2022, and tackling the role of MSUS in JIA patients in remission were included. Eight studies met the inclusion criteria. They were published between 2011 and 2019 and included 356 children with JIA. Remission criteria were unanimous and relied on the Wallace criteria. Subclinical synovitis and Power Doppler signal (PD) were found in up to 84% and 33% of patients in remission, respectively. In most of the studies, predictors of future flares were abnormal MSUS findings at baseline particularly the presence of PD signal and patients without medication. Conclusion: Published data indicate that JIA children in remission may have abnormal MSUS findings including PD signal. The application of a specific scoring system for the pediatric joint may be helpful in homogenizing outcomes in future trials. Further studies on this matter are needed to ascertain the specific implication for each subset for a better holistic approach. What is Known: • In these recent years, significant progress has been made on building the evidence base for MSUS in pediatric rheumatology, particularly in juvenile idiopathic arthritis (JIA). • In the frame of the OMERACT ultrasound pediatric subtask force, standardized musculoskeletal US examination for the pediatric population was established. What is New: • Published data indicate that JIA children in remission may have abnormal MSUS findings including PD signal. The role of MSUS in assessing remission in JIA is still not well-defined. • The application of a specific scoring system for the pediatric joint may be helpful in homogenizing outcomes and comparing results.

Molecular-Genetic Mechanisms of the Development of Juvenile Idiopathic Arthritis in Children

The article presents clinical and genetic features and prognostic criteria for juvenile idiopathic arthritis. The clinical features of the disease, the results of laboratory analysis are important when choosing an effective method of treatment. Depending on the severity of the disease, the characteristics of the clinical course and the results of the functional laboratory analysis, drug and surgical treatment of joints is recommended

Different types of juvenile idiopathic arthritis in children presenting in a tertiary care hospital.

Objective: To determine the frequency of different types of juvenile idiopathic arthritis (JIA) in children presenting in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Children Hospital Complex &amp; Institute of Child Health Multan. Period: January 2021 to July 2021. Material &amp; Methods: Children of both genders with diagnosis of JIA aged 6-12 years and having duration of illness more than six weeks. Age, gender and duration of JIA were noted. Stratification of confounder variables e.g., age, gender and duration of JIA was done. Post-stratification Chi-square test was applied to determine the effect of the variables on frequency of different forms of arthritis. P-value &lt;0.05 was taken as significant. Results: In a total of 121 children, mean age was 8.84±1.83 years. 72 (59.5%) were boys. Mean duration of symptoms was 7.93±4.61 months. Oligoarticular JIA was most common type diagnosed in 40 (33.1%) children followed by polyarticular JIA in 37 (30.6%). Oligoarticular and polyarticular JIA were significantly more common in boys (67.5% and 67.6%) compared to girls (32.5% and 32.4%) respectively (p&lt;0.001). Conclusion: Oligoarticular JIA sub-type is the most common subtype of JIA. Identification of these different subtypes is beneficial for diagnosis and long-term treatment of such children.

Vaccination coverage in children with juvenile idiopathic arthritis, inflammatory bowel diseases, and healthy peers: Cross-sectional electronic survey data.

Patients with immune-mediated diseases, such as juvenile idiopathic arthritis (JIA) and inflammatory bowel disease (IBD) are at increased risk of developing infections, due to disease-related immune dysfunction and applying of immunosuppressive drugs. To evaluate vaccine coverage in patients with IBD and JIA, and compare it with healthy children. In the cross-sectional study we included the data from a questionnaire survey of 190 Legal representatives of children with JIA (n = 81), IBD (n = 51), and healthy children (HC, n = 58). An electronic online questionnaire was created for the survey. There were female predominance in JIA patients and younger onset age. Parents of JIA had higher education levels. Employment level and family status were similar in the three studied groups. Patients with JIA and IBD had lower vaccine coverage, without parental rejection of vaccinations in IBD, compare to JIA and healthy controls. The main reason for incomplete vaccination was medical conditions in IBD and JIA. IBD patients had a lower rate of normal vaccine-associated reactions compared to JIA and HC. The encouraging role of physicians for vaccinations was the lowest in JIA patients. IBD patients had more possibilities to check antibodies before immune-suppressive therapy and had more supplementary vaccinations compared to JIA and HC. JIA and IBD patients had lower vaccine coverage compared to HC. Physicians' encouragement of vaccination and the impossibility of discus about future vaccinations and their outcomes seemed the main factors for patients with immune-mediated diseases, influencing vaccine coverage. Further investigations are required to understand the reasons for incomplete vaccinations and improve vaccine coverage in both groups, especially in rheumatic disease patients. The approaches that stimulate vaccination in healthy children are not always optimal in children with immune-mediated diseases. It is necessary to provide personalized vaccine-encouraging strategies for parents of chronically ill children with the following validation of these technics.

Reliability and measurement error of anterior maximum voluntary bite force in children with juvenile idiopathic arthritis and healthy children.

In children with juvenile idiopathic arthritis (JIA) the temporomandibular joint (TMJ) can be involved. As a consequence, the oral function can be impaired due to joint and/or muscle involvement of the masticatory system with a negative influence on the maximum bite force. The aim of this cross-sectional study was to establish the reliability of AMVBF in children with JIA and healthy children. Children with JIA and healthy children conducted three attempts of AMVBF. The reliability of AMVBF measurement was determined by the intra-class correlation coefficient (ICC) by age, standard error of measurement (SEM), smallest detectable change (SDC), and limits of agreement (LoA). A total of 298 children with JIA and 168 healthy children were examined. The AMVBF measurements showed an good to excellent reliability in children with JIA based on the ICCs corrected for age (0.782-0.979). In healthy children, the reliability was moderate to excellent (0.546-0.999). The SDC in our study indicated that values above 11.4N might be a clinical relevant change over time in children with JIA. The LoA showed a wide spread of variability in both children with JIA (-72.6-44.4N) and healthy children (-79.9-72.8N). The Bland-Altman plots indicated that the differences between the test and retest increased in value proportionally to the biteforce value.

Juvenile idiopathic arthritis in children and adolescents with atopic dermatitis: A Finnish nationwide registry study

Juvenile idiopathic arthritis in children and adolescents with atopic dermatitis: A Finnish nationwide registry study

COMPARISON OF EPIDEMIOLOGICAL AND CLINICAL PARAMETERS IN PATIENTS WITH SEVERE COVID 19 TREATED WITH AND WITHOUT TOCILIZUMAB

&nbsp;Cytokine storm is an uncontrolled immune response in the immunopathogenic mechanism of COVID 19, similar to that of severe influenza. Inflammatory cytokines including: TNF-α, IL-6, IL-8, IL-12, are released in large amounts during of disease progression, causing potential Acute Respiratory Distress Syndrome (ARDS), Hemophagocytic Lymphohistiocytosis (HLH) and Multi-Organ Dysfunction (MOFS). Tocilizumab is an immunosuppressive drug that is used in the treatment of Rheumatoid Arthritis and Systemic Juvenile Idiopathic Arthritis in children. As a human monoclonal antibody targeting Interleukin 6 receptors (IL-6R), it interrupts its action in the cytokine storm and thereby reduces vascular permeability and increased passage of fluid and blood elements into the alveoli that would lead to severe respiratory distress (ARDS). To evaluate the effect of Tocilizumab treatment in patients with severe form of COVID-19. This retrospective study included 213 patients with a severe form of COVID-19 divided into 2 groups: Group 1 of 131 male and female patients who received Cytokine storm is an uncontrolled immune response in the immunopathogenic mechanism of COVID 19, similar to that of severe influenza. Inflammatory cytokines including: TNF-α, IL-6, IL-8, IL-12, are released in large amounts during of disease progression, causing potential Acute Respiratory Distress Syndrome (ARDS), Hemophagocytic Lymphohistiocytosis (HLH) and Multi-Organ Dysfunction (MOFS). Tocilizumab is an immunosuppressive drug that is used in the treatment of Rheumatoid Arthritis and Systemic Juvenile Idiopathic Arthritis in children. As a human monoclonal antibody targeting Interleukin 6 receptors (IL-6R), it interrupts its action in the cytokine storm and thereby reduces vascular permeability and increased passage of fluid and blood elements into the alveoli that would lead to severe respiratory distress (ARDS). To evaluate the effect of Tocilizumab treatment in patients with severe form of COVID-19. This retrospective study included 213 patients with a severe form of COVID-19 divided into 2 groups: Group 1 of 131 male and female patients who received Tocilizumab and Group 2 of 82 male and female patients who did not receive tocilizumab. Patients who received tocilizumab had a significantly shorter stay in the intensive care unit compared to patients who did not received tocilizumab (p=0.021). A significantly lower mortality was registered in patients who were treated with Tocilizumab . This retrospective case control study showed that treatment with Tocilizumab as a human monoclonal antibody in patients with severe form of COVID-19 can lead to shorter hospital stay and reduced mortality compared to patients who did not receive Tocilizumab. Keywords: Cytokine storm, Tocilizumab, COVID 19, Interleukin 6, ARDS.

Haptoglobin in Juvenile Idiopathic Arthritis

BackgroundHaptoglobin (Hp), a liver derived acute phase inflammatory protein (APP), has scarcely been studied in juvenile idiopathic arthritis (JIA). Hp can occur in blood as two isoforms (Hp1 and Hp2) in precursor and mature forms. Routine clinical chemistry immunoturbidimetry does not discern these forms. It is unknown how different forms relate to disease activity in JIA. Our aims were to determine allele frequency and plasma concentrations of different Hp forms at higher versus lower JIA disease activity and compare to other APPs.MethodsPlasma from JIA (n = 77) and healthy (n = 42) children were analyzed for apparent Hp allelic frequency and densitometric concentrations of alpha forms by Western blot (WB). Polymerase chain reaction (PCR) (buffy coat) was performed in a subset to estimate conformity with genetics. At higher versus lower juvenile arthritis disease activity score (JADAS27) (which includes erythrocyte sedimentation rate (ESR)), total mature Hp concentration from WB was compared and correlated against immunoturbidimetry and total protein, albumin, serum amyloid A (SAA) and C-reactive protein (CRP).ResultsAt 300-fold dilution needed to study mature forms in Western blot, precursors were undetectable. Hp2 contributed most signal in most samples. Hp allele frequency was similar in JIA and controls. Both mature forms, taken separately or by sum, declined following treatment, but remained above concentrations of healthy controls, even in a remission subset that achieved JADAS27 < 1. Densitometry correlated with immunoturbidimetry. Hp concentrations correlated with JADAS27, albumin (negatively), CRP and SAA with immunoturbidimetric method correlating strongest to JADAS27 (Spearman R ~ 0.6, p < 0.0001).ConclusionHp allele frequency in JIA is similar to the general population, indicating that children with JIA should have the same possibility as in healthy children to produce preHp2 (zonulin), thought to increase intestinal permeability. Circulating Hp concentrations largely parallel other APPs and ESR; none of these measures correlate very strongly to JADAS27 score but Hp can be measured from capillary sampling which is impossible with ESR.

Analytical Method Development and Validation for Simultaneous Estimation of Naproxen and Esomeprazole in Pharmaceutical Dosage Forms

Introduction: An accurate, specific and precise reverse phase UV spectrophotometric method was developed for the simultaneous estimation of Naproxen and Esomeprazole in tablet dosage form. Naproxen and Esomeprazole tablets were used to relieve the spondylitis, osteoarthritis and rheumatoid arthritis in adults’ juvenile idiopathic arthritis in children.&#x0D; Methods: Simple and accurate UV spectroscopic method was developed using Naproxen and Esomeprazole tablet and results were tabulated.&#x0D; Results and Discussion: The optimum conditions were established for the analysis of the drug. The maximum wavelength of Naproxen (λmax) was found to be 231nm and for Esomeprazole was 301nm respectively. The linearity of the method developed was in the range 10-50 μg/ml for Naproxen and 30-70 μg/ml for Esomeprazole. Calibration curves for Naproxen and Esomeprazole showed a linear relationship among the absorbance and concentration. The line equation observed for Naproxen is Y= 0.0374X + 0.0805 with r2 of 0.9936 and for Esomeprazole drug was 0.0377 X+0.0576 with R2 of 0.9962 . Validation parameters were performed as per ICH guidelines for all validation parameters like linearity, accuracy, precision, LOD and LOQ. The results of LOD and LOQ were found to be within the range.&#x0D; Conclusion: The proposed method for Naproxen and Esomeprazole was simple, yet sensitive and precise for repeated analysis of Naproxen and esomeprazole in bulk and tablet formulations.

31 Oligoarticular juvenile idiopathic arthritis in a Tunisian pediatric population

Abstract Background Juvenile idiopathic arthritis (JIA) is an acquired autoinflammatory disease characterised by arthritis of unknown origin with onset before age of 16 years. JIA comprises a group of heterogeneous diseases further divided into various categories based on shared clinical presentation, laboratory markers, and disease prognosis. Oligoarticular JIA is the most common group of JIA. The region of Africa constitutes a diverse group of ethnicities, socioeconomic conditions, and climates which influence the prevalence of oligoarticular JIA. Objective The aim of our study was to assess the incidence of oligoarticular JIA in children and to describe the clinical and evolutionary characteristics of a series of children presenting with oligoarticular JIA. Results We retrospectively evaluated 192 consecutive pediatric patients with JIA in the emergency and outpatient paediatric department at the children's hospital in Tunisia between January 2005 and December 2021. A total of 95 cases (49,4%) with oligoarticular JIA were included in the final analysis. The incidence of oligoarticular JIA was 4,11 cases per year. The median age of the onset of symptoms was 56 months (range 6–156) and the ratio of males to females was 0,24. we noticed the presence of a family history of autoinflammatory or autoimmune disease in 15.7% of cases. Children were referred to a paediatrician specializing in rheumatic diseases of the child within a maximum of 3 years. These children were referred by an orthopaedist in 31.4% of cases. 82.9% of children were eutrophic at the time of diagnosis while 11.4% were found to having a failure to thrive. We noted that the knees were the most frequently affected joint (48,6%). Oligoarticular JIA with positive autoantibodies represented 64.3% of our patients. The evolution was marked by the occurrence of uveitis in 17.1% of cases. Of the 95 children followed for oligoarticular JIA, 21.4% had an extensive form and 7.1% are currently at the stage of joint deformation. Conclusion The prevalence of JIA in Africa was observed to be towards the lower range of the global estimate. We observed that the most prevalent subtype in our country was oligoarticular arthritis. The incidence of uveitis and anti-nuclear antibody (ANA) positivity were found to be higher as compared with the incidence from other regions.

Antibiotic exposures and the development of pediatric autoimmune diseases: a register-based case–control study

BackgroundAntibiotics have been associated with several individual autoimmune diseases (ADs). This study aims to discover whether pre-diagnostic antibiotics are associated with the onset of ADs in general.MethodsFrom a cohort of 11,407 children, 242 developed ADs (type 1 diabetes, autoimmune thyroiditis, juvenile idiopathic arthritis (JIA), or inflammatory bowel diseases) by a median age of 16 years. Antibiotic purchases from birth until the date of diagnosis (or respective date in the matched controls n = 708) were traced from national registers.ResultsTotal number of antibiotic purchases was not related to the onset of ADs when studied as a group. Of specific diagnoses, JIA was associated with the total number of antibiotics throughout the childhood and with broad-spectrum antibiotics before the age of 3 years. Intriguingly, recent and frequent antibiotic use (within 2 years before diagnosis and ≥3 purchases) was associated with the onset of ADs (OR 1.72, 95% CI 1.08–2.74). Regardless of frequent use in childhood (40% of all antibiotics), penicillin group antibiotics were not related to any ADs.ConclusionsUse of antibiotics was relatively safe regarding the overall development of ADs. However, broad-spectrum antibiotics should be used considerately as they may associate with an increased likelihood of JIA.ImpactIncreasing numbers of antibiotic purchases before the age of 3 years or throughout childhood were not associated with the development of pediatric autoimmune diseases.Broad-spectrum antibiotics were related to the development of autoimmune diseases, especially juvenile idiopathic arthritis in children, while penicillin group antibiotics were not.The use of broad-spectrum antibiotics in children should be cautious as they may carry along a risk for autoimmune disease development.

Association of juvenile idiopathic arthritis with maternal infection: a case control study

ObjectiveMaternal infection has been posited as a risk factor for childhood autoimmune disease such as type I diabetes. Given that similar studies in JIA are scant, our objective was to evaluate the association between Juvenile Idiopathic Arthritis (JIA) and maternal infection.MethodsThis case–control study used an existing database that included 1290 JIA cases and 6072 controls matched on birth year. Maternal infection information was obtained from Washington State birth records. JIA diagnosis and categories were confirmed through chart review. Logistic regression was used to calculate adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs).ResultsJIA was not associated with maternal infection (OR = 1.02, 95%CI: 0.8–1.3). There was no association between JIA and maternal infection for persistent oligoarticular, RF negative polyarticular, or enthesitis-related JIA. There was suggestive evidence of an increased association of maternal infection with JIA in females in sex-stratified analysis.ConclusionsWe did not observe an increased risk of JIA in children exposed to maternal infection. Suggestive evidence of differential sex-specific results warrants further study.

Can ultrasound help to overcome uncertainty in clinical joint assessment in juvenile idiopathic arthritis?

Assessment of active synovitis is crucial for the management of juvenile idiopathic arthritis (JIA). We aimed to investigate the correlation of musculoskeletal ultrasound (MSUS) and clinical examination results and relate them to arthritis relapse rate. JIA patients with questionable presence of active arthritis (Q-joints) and controls (JIA and healthy children) were recruited. MSUS of Q-joints, active joints and their inactive counterparts was performed at study entry. Standard disease activity parameters were prospectively recorded. Of 481 joints of 138 JIA patients, 99 joints (20.6%) of 58 patients had one or more Q-joints with 54/99 (54.5%) having MSUS features of active disease. Clinically inactive joints had lower proportion of MSUS synovitis (78/253, 30.8%) while MSUS activity was present in 114/129 (88.4%) of clinically active joints and in 2/105 (1.9%) joints of 36 healthy controls. Within the 15-month follow-up 23/99 (22%) Q-joints and 31/253 (12%) clinically inactive joints relapsed. Joints with subclinical synovitis relapsed more frequently than MSUS inactive ones (p<0.001). The relapse rate was higher in MSUS-active Q-joints (19/23, 82%) than in clinically inactive ones (16/31, 52%) with MSUS synovial hypertrophy as the main relapse predictor in multivariate analysis. Ankle and knee joints relapsed most frequently. Acknowledgement of joints with questionable synovitis may contribute to the assessment of disease activity in JIA. Presence of MSUS synovitis carries a clinically meaningful risk of disease recurrence in these joints. In clinical practice, our findings encourage timely MSUS assessment of the joints in question, especially in patients without any other features of active disease.